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      Emergency Medical Services , 88 , 90— Dyregrov, A. Dallas, Texas. Ellison, K. Police officer as burned out Samaritan. Everly, G. Stress mess solution: The causes and cures of stress on the job. Bowie, MD: Robert J. Eysenck, M.Trait anxiety and stress. Reason Eds. Figley, C. Working on a theory of what it takes to survive. APA Monitor , 9. Forstenyer, A. Stress, the psychological scarring of air crash rescue personnel. Firehouse , pp. Frederick, C. Aircraft accidents: Emergency mental health problems. Department of Health and Human Services. Freeman, K. Gist, R. Psychosocial aspects of disaster. Glass, A. Psychological aspects of disaster. Graham, N. Done in, fed up, burned out: Too much attrition in EMS.Hall, R. The professional burnout syndrome. Psychiatric Opinion , 16 4 , 12—13,  Hartsough, D. Mitigating the emotional consequences of disaster work: A guide for training and debriefing. Unpublished manuscript, Purdue University. Stress and Mental Health Interventions in three major disasters. Myers Eds. Hemenway, P. Burnout update. E2, E4. Henderson, S. Coping behavior after shipwreck.British Journal of Psychiatry , , 15— Holsti, O. Crisis, stress and decision making. International Social Science journal , 23 , 53— Holt, F. The dispatcher and stress. Howarth, I. Helping people cope with the long-term effects of stress. Ilinitch, R. Caretakers as victims: The Big Thompson flood,  Janis, J.Stress and frustration. New York: Harcourt Brace Jovanovich. Jaremko, M. Contribution of an educational phase of stress inoculation of speech anxiety. Johnston, D. Crisis intervention. Kahn, R. Job burnout prevention and remedies.Public Welfare , 36 2 ,  Keena, B. Emergency Management ,  Kliman, A. Unnecessary risk-taking, failure to use personal protective equipment, refusal to follow orders or leave the disaster scene, endangerment of team members, increased use or misuse of prescription drugs or alcohol.Irritability, anger and hostility, blaming, reduced ability to support teammates, conflicts with peers or family, withdrawal, isolation Some disaster-specific warning signs include high adrenaline, physical euphoria, numbness—the endorphin effect a reduction in feeling disguises distress. Coupled with fatigue, cognition can change and create an inability to recognize poor judgment. Anger is a common defense against recognizing these problems.Research has suggested that about half of the people who work in the traumatic stress field have a history of exposure to traumatic events. For some of these individuals, this can be a risk factor, particularly when events that responders have to deal with are similar to their own experiences. It may be harder for responders in the field to process or be resilient because they are often without their usual supports like family and friends, pets, homes, and other supports.Some responders may have health vulnerabilities. For example, someone may be diabetic, or have joint or muscle problems, or may be prone to allergies. Still others may have a mental disorder. None of these things makes a person unable to be an efficient disaster worker, but they do mean that workers must be aware of their health needs and respect what they need to do to stay healthy, especially in the field.If responders are unaware of the need to monitor their physical, emotional, and spiritual needs, they may begin to experience difficulties in their work and personal lives. Irritability with co-workers and family members, difficulty performing routine tasks as well as more serious issues such as increased alcohol and substance use, including prescription medication misuse, are common concerns in the disaster responder community.Understanding that these are the shared experiences of many disaster responders can help reduce the stigma and avoidance of talking about and seeking help to address the stress of disaster response work. Responders can increase the awareness of their work stress by routinely participating in stress debriefing events or stress management exercises.Formal groups that include the opportunity to talk about and learn about the physiology of stress and the opportunity to explore what management techniques work personally for each group member are effective ways to cope with stress.Scheduling these activities into the work day or the work week and weekend is essential. For those with busy schedules, it is important to actually mark the days and times during each day and week that will be allotted for stress management techniques.Since we are likely to pay attention to our physical responses, it might help to remember the anagram HALT to help recognize that you need to stop whenever you are:. H ungry A ngry L onely T ired. Know that when these physical reactions are occurring, your body is telling you that it is time to stop and provide whatever type of self-care you require.Pay attention to the messaging. Sometimes when we are full steam ahead in our work, we disregard when our body is trying to alert us to concerns. Know this and tell yourself that you will stop, listen, and respond.This wallet card is a way for disaster response program staff to keep track of their own behavioral health needs. An effective way to reduce stress is to vary the caseload or outreach to the most severely traumatized versus the nontrauma survivors. In the field during a disaster, staff may be providing outreach to hard hit communities and everyone they come in contact with may have suffered extensive losses.This can be difficult for the staff day in and day out. Whenever possible, staff should vary their exposure with survivors so they are not always with those most highly affected.This might mean changing the geographic areas they cover every day or every other day to vary the intensity of the exposure. If that is not possible, then use the buddy system. Even switching roles between buddies so that the same responder is not always the one doing the introductions and taking the lead can be somewhat of a relief. Additionally, when responders are exposed to very distressed survivors, survivors who have suffered the loss of a loved one or other heavy personal losses or those who have very difficult experiences for whatever reason, responders should have more and immediate access to supervision.Supervisors can listen and support responders, help problem solve and make decisions about rotation as well as keeping a worker in the field or not. Supervisors can also mandate rotation and use of benefit time especially when responders will not take needed breaks or remove themselves from difficult assignments. When I began working in disaster and emergency management, there was a funny anecdote suggesting the job was 98 per cent paperwork and two per cent adrenalin.Looking around at my office environment, I failed to see much adrenalin. To make sense of this, I researched some major disasters and discovered that when they strike, emergency managers transition to working in emergency co-ordination centres.These nerve centres often look like something out of the movies, with people staring intently at their computers while large screens everywhere display critical information. For months, the work was non-stop and around the clock.Soon, I noticed the initial state of exhilaration was replaced by a state of exhaustion. I observed that during a disaster, all of these factors are present in droves. In a disaster, critical decisions must be made with incomplete or contradictory information. Lack of control and uncertainty emerge when navigating policies, guidelines and laws.Mental confusion, slowness of thought, inability to make judgments and decisions, loss of ability to conceptualize alternatives or to prioritize tasks, loss of objectivity in evaluating own functioning, etc. Depression, irritability, anxiety, hyperexcitability, excessive rage reactions, loss of control, etc. Physical exhaustion, loss of energy, gastrointestinal distress, appetite disturbances, hypochondria, sleep disorders, tremors, etc. Hyperactivity, excessive fatigue, impulsiveness, inability to express oneself verbally or in writing, etc.Disasters bring together emergency service workers from diverse backgrounds. Some arrive immediately with clear responsibility and government-mandated priority assignments. Others arrive with different levels of previous experience and skills and different assigned post-disaster jobs.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. Programs geared toward the different teams that work with survivors for long periods of time should be put in place to monitor and prevent stress reactions. The importance of contemporary approaches to identify, understand, and assist post-disaster workers suffering from stress reactions has been documented.Jeffrey Mitchell and colleagues have produced training materials outlining the history of critical incident stress and common reactions and symptoms experienced by emergency workers see Reading List.Workers are also under severe stress - especially those who are both survivors and rescue workers - due to time pressures and job commitments. Each type of post-disaster worker works within different organizations that interrelate within the common goal of disaster assistance. Multiple individuals are recruited to a site to help, with 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.Multiple variables interact at a given historical moment in the life of the worker, which accounts for such widely divergent outcomes. The phenomenon of burn-out has many sources, but an obvious major one is that most disaster workers are not taught or assisted during the relief operation to look for, identify, and address their own physical and emotional needs.They do not acknowledge that their needs are normal in these very abnormal situations and that, unless they meet their needs continuously, they will not be able to function in a supportive, consistent, and sensitive manner to help survivors.Various approaches are available to disaster trainers, planners, and program directors to prevent burn-out and assist workers as they function in disasters.These methods help workers acquire techniques and skills for coping with stress. The importance of exercise, diet, relaxation, and recreation is now recognized in employment conditions and should be emphasized in ongoing training activities for workers. Mental health crisis counselors who are employed to assist survivors are also now available to assist other workers in debriefing meetings and critical incident stress debriefing sessions.Debriefing focuses on the cognitive and emotional reactions of workers who are trying to cope with novel internal sensations that accumulate from their work experiences. Debriefing interventions are done in small groups, with specific objectives and confidentiality boundaries. The structure of the debriefing includes the following sequence of processes:. This approach also provides an opportunity to support and reinforce coping efforts.A critical incident session is generally conducted with individuals who have participated in extremely traumatic situations and are experiencing signs of psychophysiological stress that they are finding it difficult to cope with and overcome. A very important condition of such sessions is that they should be completely confidential and nonjudgmental. An incident occurs: it is sudden, random, and stressful. It affects not only the survivor, but the workers as well. The incident can shatter their sense of safety and well-being and temporarily destroy their ability to function normally.The CISD should be offered within the first few days following the incident. The participants will be encouraged to share their feelings and reactions so that they can be helped to understand what has happened, put it into context, and learn the normal reactions expected in the specific situation. At these meetings, guidance, advice, and information can be exchanged. If needed, these meetings can be followed by a formal, planned CISD or debriefing meeting.A state of mild, moderate, or severe exhaustion, irritability, and fatigue which markedly decrease an individual's effectiveness. Process through which the worker tolerates or decreases the negative effects of an experience or masters a threatening situation. Assistance at every level to the individual in the aftermath of disaster - person-to-person exchange. Learn to recognize the stresses inherent in high-risk work and develop preventive strategies for mitigating those stresses.Learn to recognize and assess signs and symptoms of stress when they occur and develop approaches and goals for managing such stress coping and use of support systems. Become aware that prevention and treatment strategies can potentially decrease or eliminate negative effects of stress and its consequences:.Support system and resources available to workers for dealing with crisis situations - debriefing, counseling, education - are preventive methods for avoiding burn-out.High professional standards and high self-expectations among workers influence appraisal of a situation. Reluctance or discomfort in discussing feelings, especially those that might connote weakness and reflect doubt about one's performance self-appraisal.  

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