Disasters bring together emergency service workers from diverse backgrounds. Some arrive immediately with clear responsibility and priority assignments. Others arrive with different levels of previous experience and skills and different assigned post-disaster jobs. All emergency workers attempt to be helpful and proceed to rescue the wounded, gather the dead, and use triage methods to determine the priority of intervention. They work long hours with little thought to food or sleep. This group of workers represents a challenge for planning and operationalizing a program of post-disaster intervention.
Each type of post-disaster worker works within different organizations that interrelate within the common goal of disaster assistance. After individuals are recruited to a site to help, there is little opportunity to identify or work out a good fit between worker and assignment. This situation generally produces role conflict, ambiguity, and discomfort. Workers generally have multiple functions. They often attend to diverse, and at times, conflicting, needs of survivors.
The mental health worker should focus on the emotional impact of these stressors on disaster workers, as well as their reactions, behavior, and feelings, as a guide for selecting the best methods of helping them do their jobs. These reactions can range from good coping and growth to pathological and chronic sequelae that leave a dysfunctional individual and persist for months after the worker has returned to his/ her home and previous job.
"Burn-out" is the term used to describe the many aspects of the occupational stress experienced by disaster workers. Most disaster workers are not taught to look for, identify, and address their own physical and emotional needs. They often do not acknowledge that their needs are normal in these very abnormal situations. They often fail to understand that, unless they meet their needs continually, they will not be able to function in a supportive, consistent, and sensitive manner.
The following factors have been identified as barriers to the use of preventive methods to diminish burn-out:
• High professional standards and high self-expectations;
• Reluctance or discomfort in discussing feelings for fear of showing weakness and doubt about performance;
• Denial or suppression of feelings during difficult situations in order to function;
• Discomfort in acknowledging and discussing feelings as soon as they emerge;
• Fear that acknowledging the need for help will reflect negatively on job performance evaluation and opportunities for promotion;
• Difficulties in judging one's own reactions and performance when overwhelmed and distressed;
• Shame over the contrast between one's personal situation and that of survivors.
Various approaches are available to disaster planners and program directors to prevent burn-out and assist disaster workers. These methods help workers acquire techniques and skills for coping with stress. The need for exercise, diet, relaxation, and recreation is now recognized in employment conditions.
"Debriefing" focuses on the cognitive and emotional reactions of workers who are trying to cope with novel internal sensations that accumulate from their painful experiences. These debriefing interventions are done in small groups, with specific objectives and confidentiality boundaries.
The structure of the debriefing includes the following sequence of processes:
• Description of the workers' activities in interacting with survivors;
• Identification and recognition of paradoxical and unusual emotional reactions of workers;
• Recognition of ambivalent feelings in some situations;
• Linkage of feelings to disturbance of sleep and appetite, impulse control, and irritability.
The mental health "leader" summarizes the discussion, answers questions, and reinforces the message that the emergency workers' responses are normal reactions to abnormal situations. A critical incident session is generally conducted with individuals who have participated in extremely traumatic situations and are experiencing signs of psychophysiological stress. The session is confidential and nonjudgmental.
Conditions Present in Occupational Stress
• Time pressures
• Work overload
• Minimal positive reinforcement
• High probability of conflict
• Prolonged expenditure of energy and attention to survivors
• Coincidental incidents of crisis involving several survivors at the same time
• Personal crisis in the life of the post-disaster worker
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