Acute disaster intervention

Critical Incident interventionDr Ayedh TalhaA.B.PsychOverview Disaster victims and those who love them are vulnerable to considerable emotional turmoilAll people experience traumatic events in their lives

Arwa story

Arwa story

Arwa story

Arwa story

Arwa story

Stages of bereavement and griefDenialAngerBargainingDepressionAcceptance

DenialShocked disbelief This stage lasts up to 2 weeksEpisodes of deep sighing, lack of strength and appetite, choking, and breathlessness may occur.She may deny the death.She may feel numb and cut off from the world.

This cant be happening to me.

AngerAwareness develops Loss of vitality, physical symptoms of stress, Emotional symptoms include outbursts of weeping; hallucinations; searching; pining; guilt; idealization; loneliness; and anger at doctors, other family members, the deceased, or God.

Why is this happening? Who is to blame?

BargainingBargaining Individual attempts to strike a deal, or bargain, with God to undo what occurred.Make this not happen, and in return I will ____.

DepressionDepression may occur about 6 months after the trauma.Loss of interest in her own life and the lives of others occurs.Her life may seem to be without purpose.Existing personality problems may worsen.Social isolation is possible

Im too sad to do anything.

ResolutionAcceptancenow believes she can cope.Resolution may take 1-2 years.She can begin to enjoy life without feeling disloyal to the deceased.

Im at peace with what happened.

Emotional response to disasterImpact phase: During the first few days, individuals often feel stunned. In the first week, disbelief, numbness, fear, and possibly confusion to the point of disorganization occur

Emotional response to disasterCrisis phase: individuals can experience a number of feelings. may alternate between denial and intrusive symptoms with hyperarousal.Persons may experience somatic symptoms (eg, fatigue, dizziness, headaches, nausea) as well as anger, irritability, apathy, and social withdrawal. Individuals may be angry with caregivers who fail to solve problems

Emotional response to disasterResolution phase:Grief, guilt, and depression are often prominent during the first year as individuals continue to cope with their losses.

Emotional response to disasterReconstruction phase: During this phase, reappraisal, assignment of meaning, and the integration of the event into a new self-concept occur.

Effect on Community

Potential outcomes of traumatic eventsEmotional reactions Shock, daze, grief, anxiety, guilt, anger, numbness, helplessness, shame, emptiness, decreased ability to feel pleasure/interest/love; children may regress

Potential outcomes of traumatic eventsCognitive reactions poor concentration, unwanted memories of the disaster, self-blame, confusion, disorientation, indecisiveness, worry

Potential outcomes of traumatic eventsPhysical reactions Difficulty sleeping, exaggerated startle response, tension, fatigue, irritability, aches and pains, tachycardia, nausea, change in appetite, change in libido

Potential outcomes of traumatic eventsInterpersonal reactions Distrust, conflict, withdrawal, work problems, school problems, irritability, decreased intimacy, domineering demeanor, feeling rejected or abandoned; children may become clingy or oppositional

Signs the client needs help

Task-oriented activities are not being performed.Task-oriented activity is not goal-directed, organized, or effective.The survivor is overwhelmed by emotion most of the time.Emotions cannot be modulated when necessary.The survivor inappropriately blames himself or herself, and the self-blame generalizes to the entire self.The survivor is isolated and avoids the company of others.Thoughts or plans of suicide or homicide.

Basic Principles of Intervention After Emotional TraumaReduce stress by all possible means.Avoid increasing stressShare the experienceIdentify persons at high riskHave faith in the normal healing processes.Promote support networksReduce stressEnsure that survivors have a safe environment.Promote contact with loved ones and other sources of support Support self-esteem. People reaction to the trauma is a normal reaction to an abnormal situation, not a sign of weakness Help the person to focus on immediate needs, like rest, food, shelter, etc.Help individuals to reframe any destructive cognitions, .Seek more help from professionals.Avoid increasing stressAvoid prompting discussion of issues that cannot be resolved.Avoid abreaction in groups and the resulting contagion effect.Respect defenses, and do not force reality on persons who cannot handle it yet.Debriefing may be harmful.

Share the experienceShare the experience with persons who want to talk about it. avoid pressuring those who do not want to talk about it.Identify high riskIdentify persons at high risk: Screen for physical causes of psychiatric problems (eg, dehydration, head trauma, infection, metabolic abnormality, toxins)Risk factors Persons who lost a loved oneIndividuals who experienced an injuryPersons who witnessed horrendous imagesPersons who had dissociation at the time of the eventThose who experience serious depressive symptoms within a week and lasting for a month or moreIndividuals with numbness, depersonalization, sense of reliving the trauma, and motor restlessness after the eventRisk factors Those with preexisting psychiatric problemsPersons with prior traumaLoss of home or communityExtended exposure to dangerToxic exposureIndividuals with a lack of social supports or whose social supports were also traumatized and are unable to be adequately emotionally available

Be there Be available, and do not allow a grieving person to become isolated.Take action (eg, call, send a card, give hugs, help with practical matters).Be available after others get back to their own lives.Be a good listener, but do not give advice.Do not be afraid to talk about the loss.Talk about the person who died by name.

Be thereDo not minimize the loss; avoid clichs and easy answers.Be patient with the bereaved; there are no shortcuts.Encourage the bereaved to care for themselves.Remember significant days and memories.Do not try to distract the bereaved from grief through forced cheerfulness

Tips to the victimGet supportTurn to friends and family members Draw comfort from your faith Join a support group Talk to a therapist or counselor do not grieve aloneTips to the victimTake care of yourselfFace your feelingsExpress your feelings in a tangible or creative wayLook after your physical healthDont let anyone tell you how to feel, and dont tell yourself how to feel eitherPlan ahead for grief triggers.Myths and Facts About GriefMYTH: The pain will go away faster if you ignore it. Fact: Trying to ignore your pain or keep it from surfacing will only make it worse in the long run. For real healing it is necessary to face your grief and actively deal with it.

Myths and Facts About GriefMYTH: Its important to be be strong in the face of loss. Fact: Feeling sad, frightened, or lonely is a normal reaction to loss. Crying doesnt mean you are weak. You dont need to protect your family or friends by putting on a brave front. Showing your true feelings can help them and you.

Myths and Facts About GriefMYTH: If you dont cry, it means you arent sorry about the loss. Fact: Crying is a normal response to sadness, but its not the only one. Those who dont cry may feel the pain just as deeply as others. They may simply have other ways of showing it.Myths and Facts About GriefMYTH: Grief should last about a year. Fact: There is no right or wrong time frame for grieving. How long it takes can differ from person to personCare of Rescue WorkersRescue workers may develop the same symptoms as victims. As many as 1 in 3 rescue workers develop PTSD.

Care of Rescue WorkersEncourage staying in touch with family and friends.Be sure that rescue workers get rest, food, exercise, and relaxation.Encourage understanding of survival guilt.Explain how chaos and confusion inevitably leads to upset between individuals and groups that are participating in the rescue effort. Develop a buddy system, and encourage support of coworkers.

Care of Rescue WorkersEncourage workers to defuse after troubling incidents and following each shift.After the rescue operation, workers should take a few days to decompress and attend a debriefing.Do not overwhelm children with talk of experiences as a rescue worker; ask about their activities.

Debriefing Debriefings are usually the second level of intervention for those directly affected by the incident and often the first for those not directly involved.A debriefing is normally done within 72 hours of the incident gives the individual or group the opportunity to talk about their experiencehow it has affected themidentify individuals at riskbrainstorm coping mechanismsDebriefing inform the individual or group about services available The final step is to follow up with them the day after the debriefing to ensure that they are safe and coping well or to refer the individual for professional counselling.interviews are meant to allow individuals to directly confront the event and share their feelings with the counselor and to help structure their memories of the eventit may harm individuals by increasing their arousal and overwhelming their defenses

Reduce harmProvide trained individuals to perform the intervention.Avoid ventilating feelings at high levels; this can lead to contagion and flooding, rather than calming and helping cope with feelings. Do not pressure individuals to talk about things they do not want to; respect their defenses, including denial.Critical tasks to cover include the following: education : normal reaction to a very disturbing situation.

Reduce harmDiscuss ways of improving coping skills, including getting adequate rest, recreation, food, and fluids.Avoid excessive exposure to media coverage of the traumatic incident.Discuss common cognitive distortions, such as survivor guilt and fears that the world is totally unsafe.Explain the signs and symptoms indicating that someone should get professional help.

Stages Classically, critical incident stress debriefing has 7 stages, including (1) introduction (purpose of the session), (2) describing the traumatic event, (3) appraisal of the event, (4) exploring the emotional reactions during and after the event, (5) discussion of the normal nature of symptoms after traumatic events, (6) outlining ways of dealing with further consequences of the event, and (7) discussion of the session and practical conclusions.Correct thinking errorsMalignant SchemataConstructive SchemataLife has no meaning.Right now it is hard to make sense of what happened.I can't go on.What happened is very painful. It is hard but will get easier in time.I behaved terribly.I was frightened and unsure what to do and made some bad choices.The world is unsafe.Disasters are rare. Many things can be done to protect my safety.I'm losing my mind.Feeling confused and overwhelmed after a traumatic experience is common.It was my fault it happened.What was done to me was a crime.When to seek professional helpMarked depression marked hyperarousalextreme numbnessinability to control emotions even when important to do sopersistent problems in work or schoolsignificant problems in self-care Dissociative symptoms (eg, depersonalization, derealization, fugue, amnesia)Intrusive reexperiencing - Terrifying memories, persistent nightmares, flashbacksWhen to seek professional helpSubstance abuseAggressionIn children, aggression, risk taking, sexual acting out