CRISIS INTERVENTION IN DISASTERS: TRAINING FOR WORKERS
AN INTRODUCTION
COURSE TEST
PART 1: Multiple Choice
1. A Critical Incident is defined as
a. The reactions that occur during or immediately after the actual incident or stressor.b. An on-scene opportunity for workers involved in a stressful incident to vent their feelings, and institute coping strategies which can reduce stress while they are still working in the assignment setting.
c. Any situation faced by emergency responders or survivors that causes them to experience unusually strong emotional reactions which have the potential to interfere with their ability to function, either on the scene or later.
d. A crisis situation that involves people in crisis who need medical attention due to injuries incurred.
ANSWER: ______
2. Debriefing can be defined as
a. Focusing on providing immediate emotional support at times when a person's own resources appear to have failed to adequately cope with a problem.b. An organized approach to supporting disaster workers who have been involved in emergency operations under conditions of extreme stress in order to assist in mitigating long-term emotional trauma. Usually done at the end of an assignment as part of exiting procedure to assist the worker in putting closure on the experience.
c. An on-scene opportunity for workers involved in a stressful incident to vent their feelings, and institute coping strategies which can reduce stress while they are still working in the assignment setting.
d. A chance for all involved to assess the job they have done and delineate the strengths and weaknesses of their approach with recommendations for improvement in performance.
ANSWER: ______
3. In the aftermath of a disaster and loss of loved ones, friends, property, pets, etc. what stages of grieving do most people go through and, generally, in what order?
a. Bargaining, Anger, Denial, Depression, Acceptanceb. Denial, Anger, Bargaining, Depression, Return to Equilibrium
c. Denial, Anger, Bargaining, Depression, Acceptance
d. Denial, Depression, Equilbrium, Acceptance, Rebuilding
ANSWER: ______
4. Individuals and communities usually go through a number of stages due to disaster. What are the stages of disaster?
a. Heroic, Honeymoon, Disillusionment, Reconstructionb. Heroic, Honeymoon, Disillusionment, Return to Equilibrium
c. Impact, Honeymoon, Reconstruction, Return to Equilibrium
d. Impact, Honeymoon, Disillusionment, Reconstruction
ANSWER: ______
5. During the Heroic Stage,
a. There is a strong sense of having shared a catastrophe experience and lived through it.b. Lasts from 1 week to 3 to 6 months after the disaster.
c. Victims clear out debris and wreckage.
d. People use energy to save their own and others' lives and property.
ANSWER: ______
6. Which of the following is/are symptoms of psychological trauma that could result from exposure to a disaster or critical incident?
a. exaggerated startle response or hyper-vigilanceb. difficulty with memory
c. phobia about weather conditions
d. all of the above
ANSWER: ______
7. What is BASIC-ID?
a. Simple Freudian explanation of disaster personalities.b. An acronym for studying the basic responses of the Id to disasters.
c. An acronym useful for assessing multi-modal behavior in stressful situations.
d. An approach to behavior that is relatively simple and basic.
ANSWER: ______
8. Which of the following somatic reactions in victims may be associated with disasters and critical incidents?
a. sleep disturbancesb. trouble breathing or "getting breath"
c. fatigue or generalized weakness
d. all of the above
ANSWER: ______
9. Three levels of anxiety in pre-school children following a disaster were discussed. They are
a. Contagious Anxiety; Intense Anxiety; Profound Anxietyb. Contagious Anxiety; Subjective Anxiety; Profound Anxiety
c.Contagious Anxiety; True or Objective Anxiety; Profound Anxiety
d. Relative Anxiety; Stranger Anxiety; Phobic Anxiety
ANSWER: ______
10. Children may react to a disaster with which following behaviors?
a. regressive behaviors such as bedwetting, thumbsucking, clingingb. not wanting to attend school or athletic or social events
c. increased playfulness with new friends
d. both a and b
ANSWER: ______
11. What is one of the most common problems for children following a disaster?
a. difficulties getting along with school friendsb. sleep disturbances
c. problems with obedience
d. finding out what really happened
ANSWER: ______
12. Some possible school activities for children to help them adjust following a disaster might include:
a. field trips to disaster sites; use of puppets to re-enact disasters; coloring books about the disasterb. mandatory counseling sessions; teacher talks; religious explanation of why the disaster happened
c. school rap groups; school newsletters; chat rooms on the internet
d. both a and c
ANSWER: ______
13. Magical thinking is more prevalent in children than in adults. Very young children may believe that wishing for, or thinking about something can make it happen. For example, children may believe that fighting with a sibling can cause a parent's death and that ceasing to fight will prevent the other parent from dying. How do you handle this?
a. Give them reassurance that the parent's death was not their fault, that it was caused by an accident or illness.b. Let them know that the dead parent wants them to stop fighting.
c. Encourage the children to fight it out in order to get the anger out of their system while making sure they do not hurt each other.
d. Tell the child that he/she will have to see a counselor if they continue fighting.
ANSWER: ______
14. What children will require more intensive attention in a disaster situation?
a. Unruly ones who have a history of acting out to gain attention.b. Exceptional children who have developmental disabilities or physical limitations and those who have been injured or became ill due to the disaster.
c. Those who are not being supervised properly by their parents and/or teachers.
d. Younger children who have not been socialized enough to be able to understand the seriousness of their situation.
ANSWER: ______
15. Studies have shown that the difficulties experienced by adolescents after a disaster are boredom and loneliness resulting from isolation from peers due to disturbance of their activities and rehousing of their families.
a. Falseb. True
ANSWER: ______
16. What are some of the feelings and behavior symptoms experienced by many older adults following a disaster?
a. depression, withdrawal, apathy, agitation, anger, irritability, suspicion, confusion, disorientation, memory loss, increased somatic complaintsb. clinging behaviors, increased anger, spousal abuse, attention-seeking, lack of understanding
c. depression, withdrawal, clinging, increased abuse, attention seeking, long-term memory loss
d. Suspicion, confrontive behaviors, increased abuse, decreased somatic complaints, depression, anxiety
ANSWER: ______
17. What are some other groups to consider when working with disaster victims?
a. Socioeconomic classes, political groups, religious groupsb. Socioeconomic classes, cultural and racial differences, institutionalized persons, people in emotional crises, people requiring medical care, relief workers and first responders, cultural and ethnic minorities
c. cultural groups, political groups, first responders, medically indigent, peers
d. First responders, cultural and ethnic minorities, institutionalized persons, politicians, religious groups, labor unions, sports teams
ANSWER: ______
18. What are some of the cognitive signs of Acute Stress?
a. Mental slowness, inability to make decisions, loss of objectivity in evaluating own functioning, loss of ability to conceptualize thoughts and prioritize tasksb. Mental slowness, inability to make decisions, decreased computational skills, hyperactivity, excessive fatigue, headaches
c. Mental slowness, irritability, headaches, chest pain, anxiety, decreased memory and attention span
d. Mental slowness, confusion, inability to express self verbally or in writing, isolation
ANSWER: ______
19. A disaster worker is exhibiting excessive fatigue, irritability, anxiety, impatience and similar behaviors. This worker is likely showing beginning symptoms of
a. fatigueb. burn-out
c. over-extension
d. disaster worker syndrome
ANSWER: ______
20. When is the ideal time for a debriefing?
a. 12 weeks after the traumatic eventb. a few weeks following the traumatic event
c. 24-72 hours following the traumatic event
d. within 24 hours of the traumatic event
ANSWER: ______
21. What is the objective of a debriefing?
a. a rational way of dealing with stress reactionsb. to help individuals understand their emotional reactions and behaviors
c. to encourage the return to dynamic equilibrium
d. both b and c
ANSWER: ______
PART 2: ScenarioTo complete this section, respond to each question below and return your comments with the test above. Please number each item as you answer it. Refer to the Scenario at the end of the course material in order to help you complete this portion of the test.
1. What actions do you initially take?2. Develop a disaster plan of action for physicians, nurses, and mental health teams.
3. How are you going to deal with the families and friends who begin arriving looking for their loved ones?
4. More manpower is needed so that each family member can have, if at all possible, at least one mental health professional to meet and stay with them throughout the ordeal, or at least until each family is settled for the night. What actions do you take to accomplish this?
5. Those families whose child - in one case children - is/are dead have to go through the painful process of answering questions, making funeral arrangements, and, in some instances, viewing the body and gathering their child's personal belongings. How do you help families get through this process?
6. You listen to families talk of their dead children over and over again. They keep repeating comments such as "I just saw her this morning?" "We were saving our money to go skiing together." :"She was so good; she went to church every week." :He was going to be a lawyer." "I'll never see her again." How do you respond? How do you deal with this for yourself? How do you help your fellow workers deal with this?
7. In the midst of their shock and distress, the families have to answer questions for the coroner's office and make preliminary funeral arrangements. How do you help the families answer questions and guide them through various activities?
8. Families ask "Did he suffer?" "Is her face smashed?" It is important to answer these questions when they arise. Some parents may not be ready to deal with issues such as funeral arrangements and viewing the body. How do you intervene to assist the family with this?
9. One family refuses to see their daughter's body. One mental health professional then tells the family that she is worried that they would later wonder if their child was really dead. The family agrees that this could happen. What do you as a mental health professional do next?
10. You assess the grief reactions of the families for potential complications. In some families there may be a single family member who shows little emotion. The danger for such a person is a delayed or repressed grief reaction which might later express itself through psychosomatic disease or depression. What do you do to help stimulate discussion by these families in order to encourage an accompanying emotional response?
11. You are concerned about those people who do not express grief directly, but spend time and energy helping others. A possibility is that these people are doing for others what they want done for themselves, and by focusing on others, they are not experiencing their own grief. What are some of the dangers in this reaction? How do you handle this with them?
12. Another reaction which concerns you is an extreme and profound expression of guilt. "I killed her - if I hadn't been gone, she would be alive! She wouldn't have been in the choir if I hadn't left. I killed her - it's all my fault." How would you intervene to deal with this?
13. Follow-up is provided for those families who appear to be at high risk in terms of having difficulty beginning grief work. How do you accomplish this?
14. Because of the tragic nature of the accident and the intensity of emotion involved, the staff at the disaster center has to deal with their own reactions as well. These reactions parallel those of the families, although they may be less intense. At times, staff had tears streaming down their faces as they comforted family members. Staff began comforting one another with a hand on a shoulder or an embrace. Most talk of feeling numb and describe feeling like a sponge that soaked up the pain and grief of others until a saturation was reached. How do you debrief the staff and help them deal with their feelings?
15. For the next couple of days, several staff members experience dreams and vivid visual images of the day's experiences. The staff are aware of feelings of inadequacy and helplessness. They find themselves thinking of their own children and loved ones. No one remains untouched. What follow-up do you provide for staff? How do you deal with your own personal reactions and feelings?
16. What do you do to respond to ongoing concerns over the ensuing months and even years following this tragedy? What about anniversaries?
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