Disaster Mental Health

Overview

CDC Capabilities Videos and Files( 3.1 MB): 1, 3, 4, 6

On February 28, 2003, the President issued Homeland Security Presidential Directive 5 (HSPD–5), “Management of Domestic Incidents,” which directed the Secretary of Homeland Security to develop and administer a National Incident Management System (NIMS). This system provides a consistent nationwide template to enable Federal, State, tribal, and local governments, nongovernmental organizations (NGOs), and the private sector to work together to prevent, protect against, respond to, recover from, and mitigate the effects of incidents, regardless of cause, size, location, or complexity. This consistency provides the foundation for utilization of NIMS for all incidents, ranging from daily occurrences to incidents requiring a coordinated Federal response.

HSPD–5 requires all Federal departments and agencies to adopt NIMS and to use it in their individual incident management programs and activities, as well as in support of all actions taken to assist State, tribal, and local governments. The directive requires Federal departments and agencies to make adoption of NIMS by State, tribal, and local organizations a condition for Federal preparedness assistance (through grants, contracts, and other activities). NIMS recognizes the role that NGOs and the private sector have in preparedness and activities to prevent, protect against, respond to, recover from, and mitigate the effects of incidents.

http://www.fema.gov/emergency/nims/ImplementationGuidanceStakeholders.shtm

http://www.fema.gov/emergency/nims/AboutNIMS.shtm

http://www.fema.gov/pdf/emergency/nims/NIMS_core.pdf

The National Institute for Occupational Safety and Health (NIOSH)
http://www.cdc.gov/niosh/

Return to Top

Pre-disaster Planning

CDC Capabilities Videos and Files( 3.1 MB): 1, 3, 5, 6, 7, 11

Videos; Families; Businesses: Local, State and Tribal Government;

Return to top

Risk Communication

PHPR: 1.1, 1.3, 1.4, 1.5, 1.6, 2.1, 2.2, 2.3, 2.4, 2.5; CDC Capabilities Videos and Files( 3.1 MB): 1, 3, 4, 5, 6, 7, 8, 9, 11, 15

Section Content

Return to top

Mental Health Workers

PHPR: 4.3; CDC Capabilities Videos and Files( 3.1 MB): 1, 2

Section Content

Return to Top

Disaster Workers (Non-Mental Health Providers)

PHPR: 1.1, 1.2, 1.3, 1.4, 2.1,2.2,2.3,.3.1, 3.3, 4.1, 4,2., 4.3; CDC Capabilities Videos and Files( 3.1 MB): 1, 2, 5, 14, 15

Section Content

Return to top

The Community

CDC Capabilities Videos and Files( 3.1 MB): 1, 2, 15

Section Content

Return to top

Caregivers of the Mentally Ill

CDC Capabilities Videos and Files( 3.1 MB): 1

Section Content

Return to Top

The Elderly

CDC Capabilities Videos and Files( 3.1 MB): 1

Section Content

Return to top

The Military and Their Families

CDC Capabilities Videos and Files( 3.1 MB): 1

Section Content

Return to Top

For Families

CDC Capabilities Videos and Files( 3.1 MB): 1

Section Content

Return to Top

Videos

CDC Capabilities Videos and Files( 3.1 MB): 1

Videos; Families; Businesses: Local, State and Tribal Government;

Return to top

Team Members

CDC Capabilities Videos and Files( 3.1 MB): 3, 6, 15

Section Content

Return to top

Training

CDC Capabilities Videos and Files( 3.1 MB): 3, 6, 15

SAMHSA: Webinar Series: Building Awareness of Disaster Behavioral Health;

Return to Top

Publications

CDC Capabilities Videos and Files( 3.1 MB): 1, 2, 3, 4, 6, 7, 13

Section Content

Return to top

Post Traumatic

CDC Capabilities Videos and Files( 3.1 MB): 1, 2

Coping with Traumatic Events

http://www.nimh.nih.gov/health/topics/coping-with-traumatic-events/index.shtml

 

NIMS Implementation and Compliance Guidance for Stakeholders

• Overview
• Federal Departments and Agencies
  http://www.fema.gov/pdf/emergency/nims/FY2010_FederalNIMSImplementationObjectivesMetrics.pdf

States and Territories
http://www.fema.gov/pdf/emergency/nims/AllGovernors_2009_NIMS_ImplementationLetterIMSI.pdf

• Tribal Nations
• Local Governments and Jurisdictions
• Nongovernmental and Private Sector

Link for all three of the above
http://www.fema.gov/pdf/emergency/nims/FY2009_NIMS_Implementation_Chart.pdf

 

Traumatic Incident Stress
http://www.cdc.gov/niosh/topics/traumaticincident/

• Symptoms of Stress
• On-Site Monitoring
• Post-Incident Health
• NIOSH Publications
• Additional Resources

Recommendations to Monitor and Maintain Health On-Site

Responders need to take care of their own health to maintain the constant vigilance they need for their own safety. Responders must be able to stay focused on the job in the dynamic, changing emergency environment. Often responders do not recognize the need to take care of themselves and to monitor their own emotional and physical health. This is especially true if recovery efforts stretch into several weeks. The following guidelines contain simple methods for workers and their team leaders to help themselves and their team members. These guidelines should be read while at the site and again after workers return home.

Control the organization and pace of the rescue and recovery efforts

• Pace yourself. Rescue and recovery efforts at the site may continue for days or weeks.
• Watch out for each other. Coworkers may be intently focused on a particular task and may not notice a hazard nearby or behind.
• Be conscious of those around you. Responders who are exhausted, stressed, or even temporarily distracted may place themselves and others at risk.
• Take frequent rest breaks. Rescue and recovery operations take place in extremely dangerous work environments. Mental fatigue, particularly over long shifts, can greatly increase emergency workers' risk of injury.

Maintain adequate nutrition and rest

• Eat and sleep regularly. Maintain as normal a schedule as possible and adhere to the team schedule and rotation.
• Drink plenty of fluids such as water and juices.
• Try to eat a variety of foods and increase your intake of complex carbohydrates (for example, breads and muffins made with whole grains, granola bars).
• Whenever possible, take breaks away from the work area. Eat and drink in the cleanest area available.

Monitor mental/emotional health

• Recognize and accept what you cannot change—the chain of command, organizational structure, waiting, equipment failures, etc.
• Talk to people when YOU feel like it. You decide when you want to discuss your experience. Talking about an event may be reliving it. Choose your own comfort level.
• If your employer provided you with formal mental health support, use it!
• Give yourself permission to feel rotten: You are in a difficult situation.
• Recurring thoughts, dreams, or flashbacks are normal—do not try to fight them. They will decrease over time.
• Communicate with your loved ones at home as frequently as possible.

Recommendations to Maintain Health Following the Incident

Over time, workers' impressions and understanding of their experience will change. This process is different for everyone. No matter what the event or an individual's reaction to it, workers can follow some basic steps to help themselves adjust to the experience:

• Reach out—people really do care.
• Reconnect with family, spiritual, and community supports.
• Consider keeping a journal.
• Do not make any big life decisions.
• Make as many daily decisions as possible to give yourself a feeling of control over your life.
• Spend time with others or alone doing the things you enjoy to refresh and recharge yourself.
• Be aware that you may feel particularly fearful for your family. This is normal and will pass in time.
• Remember that "getting back to normal" takes time. Gradually work back into your routine. Let others carry more weight for a while at home and at work.
• Be aware that recovery is not a straight path but a matter of two steps forward and one back. You will make progress.
• Appreciate a sense of humor in yourself and others. It is okay to laugh again.
• Your family will experience the disaster along with you. You need to support each other. This is a time for patience, understanding, and communication.
• Avoid overuse of drugs or alcohol. You do not need to complicate your situation with a substance abuse problem.
• Get plenty of rest and normal exercise. Eat well-balanced, regular meals.

Return to top

Signs and Symptoms

CDC Capabilities Videos and Files( 3.1 MB): 1, 2, 11

Symptoms of Stress

Workers may experience physical, cognitive, emotional, or behavioral symptoms of stress. Some people experience these reactions immediately at the scene, while for others symptoms may occur weeks or months later.

Physical symptoms

Workers experiencing any of the following symptoms should seek IMMEDIATE medical attention:

• Chest pain
• Difficulty breathing
• Severe pain
• Symptoms of shock (shallow breathing, rapid or weak pulse, nausea, shivering, pale and moist skin, mental confusion, and dilated pupils)

Workers may also experience the following physical symptoms. If these symptoms occur over time or become severe, workers should seek medical attention. Additional physical symptoms include:

• Fatigue
• Nausea/vomiting
• Dizziness
• Profuse sweating
• Thirst
• Headaches
• Visual difficulties
• Clenching of jaw
• Nonspecific aches and pains

Cognitive symptoms

If these symptoms occur on the scene workers may not be able to stay clearly focused to maintain their own safety or to rescue injured victims. Workers may experience momentary cognitive symptoms; however, if symptoms are chronic or interfere with daily activities, workers should seek medical attention. These symptoms include:

• Confusion
• Disorientation
• Heightened or lowered alertness
• Poor concentration
• Poor problem solving
• Difficulty identifying familiar objects or people
• Memory problems
• Nightmares

Emotional symptoms

Strong emotions are ordinary reactions to a traumatic or extraordinary situation. Workers should seek mental health support from a disaster mental health professional if symptoms or distress continue for several weeks or if they interfere with daily activities. Emotional symptoms include:

• Anxiety
• Guilt
• Denial
• Grief
• Fear
• Irritability
• Loss of emotional control
• Depression
• Sense of failure
• Feeling overwhelmed
• Blaming others or self
• Severe panic (rare)

Behavioral symptoms

As a result of a traumatic incident, workers may notice the following behavioral changes in themselves or coworkers:

• Intense anger
• Withdrawal
• Emotional outburst
• Temporary loss or increase of appetite
• Excessive alcohol consumption
• Inability to rest, pacing
• Change in sexual functioning

Return to Top

Critical Incident

CDC Capabilities Videos and Files( 3.1 MB): 2, 3, 4, 5, 6, 7, 8, 9,11

Emergency Preparedness and Response:
Resilience Resources for Emergency Response

Federal and federalized employees involved in emergency response may be physically and emotionally impacted by this experience. Employees involved in response efforts should be encouraged to care for their own health by maintaining normal sleeping habits, trying to exercise, eating well-balanced meals, drinking plenty of non-caffeinated, non-alcoholic beverages, taking rest breaks when possible, and talking about their feelings as needed.

Emergency response can be both rewarding and stressful, and it is important to recognize that some emotional reactions are to be expected. Support can be provided by family, friends, and consider utilizing community or faith-based organizations. Employers (agencies and contractors) should also make information available to employees about resources for addressing emotional and physical health issues that may arise before, during, and after emergency response efforts. Educational materials and counseling are important options, and employers should encourage the use of these resources to help support their employees.
http://www.osha.gov/SLTC/emergencypreparedness/resilience_resources/index.html

Return to Top

Therapists

Section Content

Return to Top