Traumatic Stress Studies Division

Resources

Disaster Rescue and Response Workers: A National Center for PTSD Fact Sheet

The terrorist attack on New York and Washington, DC, is the greatest man-made disaster in United States since the Civil War. In dealing with its aftereffects on rescue workers, lessons learned from natural and human-caused disasters can help inform understanding about the unique stressors that rescue workers face, and their possible effects. Rescue workers face the danger of death or physical injury, the potential loss of their coworkers and friends, and the devastating effects on their communities. Rescue workers — police and fire fighters, National Guard members, emergency medical technicians, and volunteers — are also at risk for behavioral and emotional readjustment problems as well as physical danger.

What Psychological Problems Can Result from Disaster Experiences?

The psychological problems that may result from disaster experiences include:

• Emotional reactions: temporary feelings (i.e., for several days to a couple of weeks) of shock, fear, grief, anger, resentment, guilt, shame, helplessness, hopelessness, emotional numbness (difficulty feeling love and intimacy, or in taking interest and pleasure in day-to-day activities)
• Cognitive reactions: confusion, disorientation, indecisiveness, worry, shortened attention span, difficulty concentrating, memory loss, unwanted memories, self-blame
• Physical reactions: tension, fatigue, edginess, difficulty sleeping, bodily aches or pain, being startled easily, racing heartbeat, nausea, change in appetite, change in sex drive
• Interpersonal reactions in relationships at school, work, in friendships, in marriage, or as a parent, such as: distrust, irritability, conflict, withdrawal, isolation, feeling rejected or abandoned, being distant, judgmental, or overcontrolling

What Severe Stress Symptoms Can Result from Disasters?

Most disaster rescue workers only experience mild normal stress reactions, and disaster experiences may even promote personal growth and strengthen relationships. However, as many as one in three rescue workers experience some or all of the following severe stress symptoms, which may lead to lasting posttraumatic stress disorder (PTSD), anxiety disorders, or depression:

• Dissociation (feeling completely unreal or outside yourself, like in a dream; having "blank" periods of time you cannot remember)
• Intrusive reexperiencing (terrifying memories, nightmares, or flashbacks)
• Extreme attempts to avoid disturbing memories (such as through substance use)
• Extreme emotional numbing (completely unable to feel emotion, as if utterly empty)
• Hyperarousal (panic attacks; rage; extreme irritability; intense agitation)
• Severe anxiety (paralyzing worry, extreme helplessness, compulsions or obsessions)
• Severe depression (complete loss of hope, self-worth, motivation, or purpose in life)

Who Is at Greatest Risk for Severe Stress Symptoms?

Rescue workers who directly experience or witness any of the following during or after the disaster are at greatest risk for severe stress symptoms and lasting readjustment problems:

• Life-threatening danger or physical harm (especially to children)
• Exposure to gruesome death, bodily injury, or bodies
• Extreme environmental or human violence or destruction
• Loss of home, valued possessions, neighborhood, or community
• Loss of communication with/support from close relationships
• Intense emotional demands (such as searching for possibly dying survivors, or interacting with bereaved family members)
• Extreme fatigue, weather exposure, hunger, or sleep deprivation
• Extended exposure to danger, loss, emotional/physical strain
• Exposure to toxic contamination (such as gas or fumes, chemicals, radioactivity)

Studies also show that some individuals have a higher than typical risk for severe stress symptoms and lasting PTSD, including those with a history of:

• Exposure to other traumas (such as severe accidents, abuse, assault, combat, rescue work)
• Chronic medical illness or psychological disorders
• Chronic poverty, homelessness, unemployment, or discrimination
• Recent or subsequent major life stressors or emotional strain (such as single parenting)

Disaster stress may revive memories of prior trauma, as well as possibly intensifying preexisting social, economic, spiritual, psychological, or medical problems.

How Can You Manage Stress during a Disaster Operation?

Here are some ways to manage stress during a disaster operation:

• Develop a "buddy" system with a coworker
• Encourage and support your coworkers
• Take care of yourself physically, with regular exercise and eating frequently in small quantities
• Take a break when you feel your stamina, coordination, or tolerance for irritation diminishing
• Stay in touch with family and friends
• Defuse briefly whenever you experience troubling incidents, and after each work shift

How Can You Manage Stress after the Disaster?

After the disaster:

• Attend a debriefing if one is offered, or try to get one organized, two to five days after leaving the scene
• Talk about feelings as they arise, and be a good listener to your coworkers
• Don't take anger too personally — it's often an expression of frustration, guilt, or worry
• Give your coworkers recognition and appreciation for a job well done
• Eat well and try to get adequate sleep in the days following the event
• Maintain as normal a routine as possible, but take several days to "decompress" gradually

How Can You Manage Stress after Returning Home?

After returning home:

• Catch up on your rest (this may take several days)
• Slow down — get back to a normal pace in your daily life
• Understand that it's perfectly normal to want to talk about the disaster, and equally normal not to want to talk about it; but remember that those who haven't been through it might not be interested in hearing all about it — they might find it frightening, or simply be satisfied that you're back safely
• Expect disappointment, frustration, and conflict — sometimes coming home doesn't live up to what you imagined it would be — but keep recalling what's really important in your life and relationships so that small stressors don't lead to major conflicts
• Don't be surprised if you experience mood swings; they will diminish with time
• Don't overwhelm children with your experiences; be sure to talk about what happened in their lives while you were gone
• If talking doesn't feel natural, other forms of expression or stress relief such as journal writing, hobbies, and exercise, are recommended

Taking every day one at a time is essential in disaster's wake. Each day is a new opportunity to FILL-UP:

• Focus Inwardly on what's most important to you and your family today;
• Look and Listen to learn what you and your significant others are experiencing, so you'll remember what is important and let go of what's not;
• Understand Personally what these experiences mean to you as a part of your life, so that you will feel able to go on with your life and even grow personally.