DISASTER RESPONSES

Ns. BASMANELLY, M.Kep., Sp.Kep.J

 KARAKTERISTIK DISASTER
Barton : Quarantelli suggested eight aspects
that were important in
a. Scope Of Impact understanding the stress of disaster:
b. Speed Of Onset
c. Duration Of Impact, And Social a. preparation of the involved
population
Preparedness. b. social centrality of the affected
population
c. length of involvement of the
Berren and associates proposed affected population in the crisis
a five-factor typology which: d. rapidity of involvement by the
population in crisis
a. Examines disasters in terms of e. predictability of involvement in a
crisis
type of disaster agent f. unfamiliarity of the crisis
b. Duration of disaster g. depth of involvement of the
c. Degree of personal impact population in the disaster
d. Potential for recurrence h. recurrency of involvement.
e. Control over future impact
 IMPACT CHARACTERISTICS THAT WILL AFFECT THE
LEVEL OF TRAUMA POTENTIAL ( BOLIN )
a. terror and horror e. sociocultural changes such as activities of
involved in experiencing daily living, control over events, social
or witnessing the event support
b. duration of impact; f. networks in the postdisaster environment
unexpectedness of the g. symbolism of events (the meaning of the
event (i.e., those events event to an individual, particularly the
without warning having differentiation between acts of God
the maximum and human-caused technological or
psychological impact) terrorism events)
c. threat, as determined h. interactive and cumulative effects of
by preimpact these and other pre- and postdisaster
interpretation of risk issues upon victims and helpers, who vary
d. impact ratio, or greatly in personality types, predisaster
proportion of the emotional state, and ability to manage
community directly stress
affected or suffering loss
 STRESS-PRODUCING FACTORS AFFECTING
DISASTER WORKERS ( Myers )
1. Factors related to the individual worker (health, preexisting
stresses, previous traumatic experiences, coping skills, prior
disaster experience, self-expectations, and perception and
interpretation of the event)
2. Interpersonal factors (strength of social support system,
preexisting stresses in relationships, expectations and needs of
others, and status of family members in disaster)
3. Community factors (size of the community, previous degree of
social solidarity, prior disaster experience, amount of social
disruption due to the disaster)
4. Factors related to the disaster (warning, contrast of scene,
type of disaster, nature of the destructive agent, degree of
uncertainty, time of occurrence, duration of the disaster or
continued threat, scope of the disaster, and location of the
disaster)
Stressors predicting psychological impact for
disaster workers include the intensity and
duration of interactions with families of
deceased victims, identification with the victims,
and role conflict (Bartone, Ursano, Wright, &
Ingraham, 1989; Hodgkinson & Shepherd, 1994).
THE COMMON RESPONSES OF CHILDREN AND
ADOLESCENTS FALL INTO THE FOLLOWING
CATEGORIES:

1. Change in behavior
2. Fear and anxiety: relate to injury, death,
separation, and loss.
3. Reexperiencing the disaster
4. Confusion
5. Regression
6. School problems
7. Sleep problems
8. Physical complaints.
Behavioral Physical
Loss of appetite
Resumption of bed-wetting, Stomachaches
thumb-sucking Nausea
Clinginess Sleep problems, nightmares, refusing
Separation anxiety to sleep alone
Fears of the dark, animals, or Speech difficulties
weather Tics
Avoidance of sleeping alone Loss of bladder or bowel control
Increased crying
Regression Emotional and cognitive
Incontinence Fears
Dependency Anxiety and insecurity
Helplessness and passivity Powerlessness
Hyperactivity Irritability
Lack of verbalization ngry outbursts, temper tantrums
Withdrawal Sadness
Aggressive behavior Confusion
Difficulty identifying feelings
 INTERVENTIONS

Give verbal assurance, support, rest, and physical comfort

Provide frequent attention
Arrange for consistent caretaking
Provide comforting bedtime routines
Avoid unnecessary separations
Allow time-limited regression
Permit child to sleep in parents room temporarily
Encourage expression regarding losses (i.e., deaths, pets, toys)
Give names to feelings
Offer repeated clarifications when child is confused
Provide explanations of death, if necessary
Monitor media exposure to disaster trauma
Encourage expression through play activities
 CHILDHOOD (611)
Behavioral
Decline in school performance
School avoidance
Aggressive behavior at home or
school
Disobedience
Hyperactive or silly behavior
Whining, clinging, acting like a
younger child
Fighting with siblings or friends
Increased competition with younger
siblings for parents attention
Decline in previously responsible
behavior (chores, etc.)
Inability to enjoy previously
pleasurable activities
Withdrawal
Traumatic play and retelling
Physical
Change in appetite
Headaches
Stomachaches, nausea
Sleep disturbances, nightmares
Hearing or visual problems
Emotional and cognitive
Trouble concentrating, distractibility
Irrational fears
ear of darkness
Irritability
Depression
Angry outbursts
Obsessive preoccupation with disaste/ safety
Responsibility and guilt for the trauma
Monitoring parents anxieties
Separation anxiety
Excessive concern for others
 INTERVENTIONS
Give additional attention
and consideration
Patience and tolerance
Relax expectations of
performance at home and at
school temporarily
Set gentle but firm limits for
acting out behavior
Provide structured but
undemanding home chores
and rehabilitation activities
Encourage verbal and play
expression of thoughts and
feelings
Listen with understanding to the childs
repeated retelling of disaster event
Provide realistic, age-appropriate
information about what happened
and will happen next
Identify and discuss triggers and
reminders that bring up memories
and feelings
Involve the child in preparation of
family emergency kit, home drills
Rehearse safety measures for future
disasters
Develop school disaster program for
peer support, expressive activities,
education on disasters, preparedness
planning, identifying at-risk children
 PRE-ADOLESCENCE AND
ADOLESCENCE (1218)
Behavioral Physical
Decline in academic performance Appetite changes
Rebellion at home or school Headaches
Resistance to authority Gastrointestinal problems
Decline in previous responsible behavior Skin eruptions
Agitation or decrease in energy level, Complaints of vague aches and pains
apathy Sleep problems
Aggressive behavior Menstrual irregularity
Antisocial behavior
Social withdrawal
Substance abuse
Emotional and cognitive
Loss of interest in peer social activities,
Life-threatening acting out (suicide, hobbies, recreation
reckless driving, unsafe sex)
Sadness or depression
Premature adult behaviors and attitudes
(too old, too soon) Feelings of inadequacy and helplessness
Lack of involvement in community Shame and guilt
recovery activities Self-consciousness, preoccupation with self
Confusion
 INTERVENTIONS

Give additional attention and consideration

Relax expectations of performance at home and school
(temporarily)
Encourage discussion of disaster experiences with peers and
significant adults
Avoid insistence on discussion of feelings with parents
Encourage physical activities
Rehearse family safety measures for future disasters
Support resumption of social activities, athletics, clubs, and so on
Urge participation in community rehabilitation and reclamation
work
Address suicidal ideation and reckless behavior
Develop school programs for peer support and debriefing,
preparedness planning, volunteer community recovery, identifying
at-risk teens
 ADULTS
Behavioral:
Crying
Anger and aggression
Hyperactivity and restlessness
Robot-like behavior
Increased level of activity in response to
disaster-related demands
Decreased efficiency and effectiveness of
activities
Decline in job or academic performance
Absences from work
Increased irritability, conflict, and
estrangement within family
Domestic violence
Hypervigilance for danger
Excessive disaster planning and preparedness
activities
Isolation and withdrawal
Change in eating patterns
Substance abuse
Avoidance of reminders of the disaster
Trigger and anniversary reactions
Physical
Fatigue, exhaustion
Sleep problems (insomnia,
nightmares, early wakening)
Arousal and increased startle
response
Appetite changes, weight gain or
loss
Headache, bodyaches and pains
Muscle tension
Gastrointestinal distress
Impaired immune response
Increase in allergies
Worsening of chronic health
conditions
Increase in blood pressure
Change in libido
Menstrual irregularities
Emotional and cognitive:
Shock, disbelief, numbness
Need for information
Intrusive thoughts, memories,
or flashbacks
Sadness and depression
Grief about loss of loved ones,
home, health, lifestyle,
community
Lost sense of control over life
Irritability, anger
Mood swings
Frustration with relief efforts
Anxiety
Fear, worries, insecurity
Concern about the future:
Despair, hopelessness, helplessness
Changes in religious faith (strengthening
or weakening of beliefs)
Decreased self-esteem
Loss of pleasure from regular activities
Suicidal ideation
Guilt, self-doubt, self-blame
Memory problems
Disorientation and confusion
Dissociation (e.g., perceptual experience
seems dreamlike,
spacey, or on automatic pilot)
Depersonalization, derealization
Decline in cognitive abilities (problem
solving, setting priorities,decision making)
Impaired concentration and attention
Time distortion
 INTERVENTIONS
Provide supportive listening and opportunity to talk in detail about disaster
experience
Give opportunities for grieving over losses
Assist with prioritizing and problem solving
Offer information on disaster stress, coping, childrens reactions, and impact of
disaster on the family
Facilitate communication among family members
Encourage use of social supports
Urge practical steps to resume ordinary day-to-day routines
Facilitate resumption of normal family, community, school, and work roles
Assist survivors in taking practical steps to resolve pressing immediate problems
caused by the disaster
Teach relaxation techniques
Address physical health problems or exacerbation of prior conditions
Assess and refer when indicated
Provide information on referral resources
Self-help and coping suggestions
Disaster mental health worker should refer:
Significant disturbance of memory
Disorientation to person or place
Inability to perform necessary
everyday functions
Inability to care for ones personal
needs
Loss of simple decision-making skills
Inability to recognize familiar people
Preoccupation with a single thought
Repetition of ritualistic acts
Extreme hyperactivity or immobility
(inability to be aroused to action)
Abuse (rather than misuse) of
alcohol or drugs
Talk that overflowsshows
extreme pressure in speech
Excessively flat emotional expression
Serious withdrawal
Suicidal or homicidal talk or actions
Reckless behavior that may be life-
threatening (driving under the influence
of drugs or alcohol, unsafe sex, etc.)
Psychotic symptoms
Frequent and disturbing occurrence of
flashbacks, excessive nightmares, and
excessive crying
Persistent inappropriate emotion such
as laughter or uncontrolled anger
Serious regression
Inappropriate anger or abuse of others
Episodes of dissociation
Inappropriate reaction to triggering
events
COMPARISON OF DISASTER MENTAL HEALTH AND
TRADITIONAL MENTAL HEALTH SERVICES
Disaster mental health Traditional mental
services health services
Goals Prevention of disasterrelated Assessment, treatment planning,
stress reactions and restoration to and treatment, leading to
predisaster level of functioning reduction in or management of
symptoms and long-term
change in the person
Target Normal persons affected Persons identified as having a
Population by disaster diagnosed mental disorder
Objectives Support, education, and Identification of illness that can
development of resources be treated, managed, or cured
Methods CODE-C (consultation, outreach, Psychotherapy, medication, case
debriefing, education, and crisis management
intervention and brief crisis
counseling)
Settings Community-based, where Office-, clinic-, or hospitalbased
people live, work, congregate,
or seek assistance
 COMPARISON OF CRISIS COUNSELING
AND PSYCHOTHERAPY
Crisis counseling Traditional
psychotherapy
a. Active a. Passive
b. Restoration and b. Explorative
enhancement of coping and c. In-depth historical
problem-solving approach
c. Strategic history d. Insight oriented
d. Educational e. Psychological
e. Problems of daily living understanding
f. Prevention f. Intensive treatment or
case management or
both
 DISASTER MENTAL HEALTH SERVICES FOR
DISASTER RECOVERY
THE GOALS OF CRISIS COUNSELING INCLUDE
THE FOLLOWING:

Helping the person deal with the current situational crisis

Protecting the person from additional stress or harm
Instilling a sense of hope
Assisting the person in organizing and mobilizing resources, both
internal and external
Helping people return to at least their precrisis level of
functioning: to restore and enhance coping abilities; to restore and
enhance problem-solving capabilities; and to restore and enhance
use of social support
Doing everything possible to promote growth as an outcome
Preventing negative or destructive outcomes
THE GOALS OF CRISIS COUNSELING ARE NOT
THE FOLLOWING:
Psychological testing
Personality reconstruction
Reconstruction of defense mechanisms
Development of insight
Working-through of unconscious conflicts
Working-through of historical issues or prior
trauma
Family therapy
Treatment of mental disorders
Long-term psychotherapy
CRISIS COUNSELING STRATEGIES IN DISASTER

active listening; facilitating; ventilation;

clarification; validation of feelings; not
undermining defenses; normalization of feelings;
reframing; and relabeling
assisting survivors in understanding and
accepting reality of situation, use of education
and anticipatory guidance to help survivors
understand crisis reactions and phases of the
recovery process, and teaching and reinforcing
constructive coping strategies, as well as
identifying negative coping strategies
Stress management topics:
Stress management techniques
Phases of disaster for workers 1. Stress inventory
Factors that influence disaster
workers stress reactions (factors 2. Breathing
related to the worker, the role, 3. Stretching
the setting, the community, and 4. Cognitive techniques
the disaster itself )
5. Relaxation
Sources of stress for disaster
workers 6. Meditation
Stressors in specific work 7. Imagination
environments 8. Humor
Stressors in specific roles, for 9. Creative expression
example, outreach worker, crisis
counselor, treating trauma 10. Time management
therapist, supervisor, and 11. Conflict resolution
manager
12. Resistance building and lifestyle:
Personal coping strategies for work schedule, rest, nutrition,
disaster workers before, during,
and after the disaster assignment exercise, social support,
relaxation, and recreation
Potentially traumatizing
are the following:
Natural disasters (earthquake,
hurricane, fire, and flood, etc.)
Technological or human-caused
disaster (large-scale environmental
pollution, structural collapse,
explosion, etc.)
Health disasters (famine, epidemic,
etc.)
Multiple injury/fatality accidents
Hostage situation
Violence in the workplace
Terrorism
Riot, civil disturbances
Child-related traumatic events
Homicide or suicide
High publicity crime of violence, sex,
or other unethical or illegal activity
Physical reactions:
Increased pulse, respiration, blood
pressure
Nausea, indigestion, diarrhea
Psychogenic sweating or chills
Tremors, especially of hand, lips, and
eyes
Muffled hearing
Visual focusing (tunnel vision)
Headaches
Feeling uncoordinated
Lower back pain
Feeling a lump in the throat
Faintness or dizziness
Exaggerated startle reaction
Fatigue, exhaustion
Appetite change
Change in sexual desire
Frequent colds, allergies
Physical reactions to consider for immediate
referral to healthcare personnel

Severe shortness of breath

Chest pain
Irregular heartbeat
Dizziness, collapse
Sudden weakness, numbness (especially of face, arm, and leg)
Difficulty speaking or being understood
Sudden severe headache
Heat stroke
Seizure
Continuing vomiting or diarrhea
Blood in vomit, stool, urine, and sputum
Loss of consciousness
Worsening of chronic health conditions
Cognitive reactions:
for referral to a mental health
professional:
Memory problems
Difficulty naming objects
Slight disorientation
Slowness of thinking, difficulty
comprehending
Mental confusion, difficulty
calculating
Difficulty using logic, making
judgments and decisions, problem
solving
Loss of ability to conceptualize
alternatives or to prioritize tasks
Loss of objectivity
Time distortion
Preoccupation with thoughts of
the event, intrusive memories
Recurring dreams or nightmares
Cognitive reactions to consider
Dangerously diminished
alertness to surroundings
Serious disorientation (to self,
others, place, time)
Significant disturbance of
memory
Preoccupation with a single
thought
Inability to make simple
decisions
Delusional or psychotic thinking
Suicidal or homicidal ideation
Significant amnesia
Episodes of dissociation
Emotional reactions: Emotional reactions to
consider for referral to a
Shock, numbness, disbelief
Feeling high, heroic, invulnerable
mental health professional:
Feelings of gratefulness for being alive, relief,
euphoria
Anxiety, fear Reactions so intense as to
Identification with victims endanger safety of self or others
Anger, resentment
Irritability, restlessness, hyperexcitability
Excessively flat emotion
Sadness, grief, depression, moodiness Persistent emotion out of context
Despair, hopelessness (e.g., hysterical laughing)
Recurrent dreams of the event or other
traumatic dreams; other sleep problems Depression and hopelessness with
Guilt, self-doubt suicidal ideation
Feeling isolated, detached, lost, or abandoned
Anxiety that impairs functioning
Apathy, diminished interest in usual activities
Denial or constriction of feelings; numbness Phobias
Worry about safety of others
Feeling overwhelmed, helpless
Unpredictable mood swings
Behavioral reactions:
Change in ordinary behavior
patterns
Difficulty communicating
Sleep problems
Decreased efficiency and
effectiveness of activity
Outbursts of anger; increased
conflict with others
Hyperactivity; inability to rest or
let up
Crying easily or frequently
Increased use of alcohol,
tobacco, other drugs
Changes in eating or sleeping
patterns
Social withdrawal, distancing,
limited contacts with others
Avoiding reminders of the event
Hypervigilance for danger;
startle reactions
Behavioral reactions to consider for
referral to a mental health
professional:
Inability to care for self or carry out
everyday functions
Extreme hyperactivity
Immobility, muteness
Extreme regression
Repetition of ritualistic acts
Abuse of alcohol or drugs
Persistent sleep problems
Inappropriate anger/abuse of others
Violence (or serious threat)
Loss of control
Self-destructive or antisocial acts
Frequent accidents
Spiritual reaction: Spiritual reactions to
consider for referral to a
spiritual care or mental
Crisis of faith (anger at health professional:
God, no longer
practicing faith,
withdrawal from faith Crisis of faith
community) Obsessive religious
Strengthening of faith thoughts
Newfound faith Compulsive religious
acts