CERT volunteers must be prepared to deal with the psychological effects of the trauma

1. Fear

2. Anger

3. Intense Sadness

4. Frustration

5. Traumatic Grief

CERT volunteers prepare themselves for their role during and following a disaster by

1. learning about the

   1. Emotional

   2. Physical

      1. impact of disasters on them and others

2. Team organization concepts can help you both operationally and psychologically

   1. Working together and looking out for eachother are important aspects of successful teams.

3. Psychological first aid is not therapy

   1. it is a set of techniques to provide emotional intervention during field operations.

1. Dealing with your own personal losses

2. Working in your neighborhood

3. Assisting neighbors, friends, or coworkers who have been injured

4. Feeling unsafe and insecure

1. A common occupational hazard for disaster volunteers

   1. Compassion Fatigue

   2. Secondary victimization

   3. Secondary traumatic Stress

      1. is a a natural reaction of an individual exposed to a survivors trauma

2. A person who identifies too strongly with a survivor may take on that survivors feelings

3. Taking on a survivors feelings as your own can affect your ability to do your job as a rescuer

   1. it can have a long term impact

4. Taking ownership of others problems will

   1. compound your stress

   2. negatively affect your overall effectiveness

5. Be Alert to signs of disaster trauma in yourself

   1. as well as in disaster survivors and others

      1. such as fellow CERT volunteers

         1. so you can take steps to alleviate stress

6. Burnout is a different type of trauma

   1. individuals suffering from burnout can overcome it by distancing themselves from their work for a period of time

The five primary responses to stress

1. Freeze

   1. Stop look and listen

   2. be on guard and watchful

2. Flight

   1. Flee

3. Fight

   1. Attempt to combat the threat

4. Fright

   1. Tonic immobility when in contact with a predator or playing dead.

5. Faint

   1. Fear-induced fainting

1. Knowing in advance the possible psychological and physiological symptoms of disaster trauma.

2. Get enough sleep

3. Exercise regularly

4. Eat a balanced diet

5. Balance work, play, and rest.

6. Allow yourself to recieve as well as give

   1. you should remember that your identity is broader than that of a helper

7. Connect with others

8. Use spiritual resources

In addition to preventative steps, 

1. you should explain  to your loved ones and friends how to support you when you return from a disaster area

   1. listen when you want to talk

   2. Do not force you to talk if you are not ready

You may also want to share with your loved ones and friends the information on possible disaster-related psychological and physiological symptoms discussed earlier.

1. What is likely to be your greatest challenge?

   1. what kinds of events may be most difficult for you?

2. What skills do you have that may come in handy during a crisis?

3. How do you know that you are feeling stressed?

   1. List symptoms that characterize you when you are feeling stressed.

      1. Thoughts

      2. feelings

      3. body sensations

      4. behaviors

4. Make a list of things that help you relax

5. Make a list of things you need to avoid

   1. that you would likely do without consideration

   2. that will only add to your stress

6. We all need to talk about our experiences from time to time

7. Who are the top five people you can go talk to during or after a crisis

8. What things can others do for you When you are feeling stressed.

9. How can you tell others what you need?

10. How will you tell them?

Rank the following areas of daily things that we do that could effect our ability to respond to disasters (1-10)

1. Nutrition

2. Sleep

3. Manage Workload

4. Balanced lifestyle

5. Stress Management

6. Having Fun

7. Social Network

8. Exercise

Steps TL's can take to reduce stress

1. Brief CERT personnel before the effort begins on

   1. what they can expect to see

   2. and what they can expect in terms of emotional response

      1. in survivors

      2. in themselves

2. Emphasize the team aspect of CERT

   1. sharing the 

      1. workload

      2. emotional load

         1. can help to defuse pent-up emotions

3. Encourage rescuers to

   1. rest

   2. regroup

      1. to avoid becoing overtired

4. Direct rescuers to take breaks away from the incident area

   1. for relief from the stress efforts

5. Establish a culture of acceptance amongst the team

   1. Encourage volunteers to 

      1. verbalize their experiences

      2. normalize open communication

6. Encourage rescuers to eat properly and maintain fluid intake

   1. during the operation

   2. encourage them to drink water

   3. encourage them to drink electrolyte-replacing fluids

   4. avoiding drinks with caffiene or refined sugar

7. Encourage volunteers to be aware of changes in their teammates that 

   1. may indicate personal stress and 

   2. the need for a break or change

8. Rotate teams for breaks or new duties

   1. from high stress to low stress jobs

9. Encourage volunteers to talk with each other about their experiences

   1. to promote psychological health

10. Do not send home volunteers who just completed a highstress operation

    1. assign them a low stress responsibility

       1. So they can decompress gradually

11. Conduct a brief discussion with rescue workers after their shift during which they can describe and express their feelings about what they encountered. 

1. a variety of emotional responses

   1. be aware of what you may encounter

2. The Conditions associated with evacuation and relocation have pschological significance

3. When there are Physical hazards or family seperations

   1. during the evacuation process

      1. Survivors often experience post-traumatic stress reactions

   2. When the family is not together

      1. due to shelter requirements or other factors

         1. anxiety regarding the welfare of those not present

            1. may detract from the attention necessary for immediate problem solving

1. Pre-disaster Phase

   1. Communities will have varying degrees of warning

      1. depending on the type of disaster

         1. Earthquakes typically hit without warning

         2. hurricanes and floods typically strike within hours to days of a warning

            1. When there is no warning

               1. survivors may feel 

                  1. vulnerable

                  2. unsafe

                  3. fearful of future unpredicted tragedies

      2. The perception they had no control over protecting themselves

         1. or their loved ones can be deeply distressing

      3. Meanwhile when people do not heed warnings

         1. and suffer losses as a result

            1. They may experience guilt and self-blame

      4. While they may have specific plans for how they might protect themselves in the future

         1. Survivors often feel guilty or responsible for what has occurred.

2. Impact phase

   1. The impact phase of a disaster varies 

      1. from the slow, low threat buildup associated with some types of floods

      2. to the violent, dangerous, and destructive outcomes

         1. Associated with 

            1. Tornadoes

            2. explosions

      3. The greater the 

         1. scope

         2. community destruction

         3. personal losses

            1. associated with the disaster

            2. The greater the psychosocial effect

   2. Depending on the characteristics of the incident

      1. people's reactions may range from

         1. Constricted

         2. stunned

         3. shock-like responses

            1. to the less common overt expressions

               1. panic 

               2. Hysteria

   3. Typically, people respond initially with 

      1. confusion

      2. disbelief

         1. focus on the survival of and physical well-being of their loved ones

   4. When families are in different geographic locations

      1. during the impact of disaster

         1. Survivors will experience considerable anxiety until reunification.

3. Heroic Phase

   1. In the immediate aftermath of a disaster

      1. Survival

      2. Rescuing others

      3. promoting safety

         1. Are priorities

   2. Evacuation to

      1. shelters

      2. motels

      3. other homes may be necessary

   3. Post-impact disorientation gives way to adrenaline-induced rescue behavior

      1. to save lives and protect property

   4. While activity level may be high

      1. actual productivity is often low

         1. The capacity to assess risk may be impaired

            1. Injuries can result

   5. Altruism is prominent among both survivors and emergency responders.

4. Honeymoon phase

   1. in the weeks and months following a disaster

   2. Formal governmental and volunteer assistance may be readily available

   3. Community Bonding occurs from the shared experience of surviving a catastrophic experience 

      1. The giving and receiving of community support

   4. Survivors may experience a short-lived sense optimism

      1. that the help they will receive will make them whole again.

   5. When disaster behavioral health workers are visible and perceived as helpful during this phase

      1. they are more readily accepted and have a foundation from which to aid in the difficult phases ahead.

5. Disillusionment Phase

   1. Disappointment in a slower-than-expected pace of recovery

      1. can trigger the phase

   2. Disillusionment typically occurs in the second half of the year

      1. immediately following a disaster

         1. and after the disasters first anniversary

6. Reconstruction Phase

   1. The Reconstruction of physical property and recovery of emotional well being

      1. may continue for years following a disaster

         1. at this point survivors have realized they will need to solve the problems of rebuilding their own

            1. homes

            2. businesses

            3. lives 

               1. largely by themselves

               2. and have gradually assumed the responsibility of doing so.

A traumatic crisis is an event experienced or witnessed in which people's ability to cope is overwhelmed by;

1. Actual or potential death or injury to self or others

2. Serious injury

3. Destruction of their 

   1. homes

   2. neighborhood

   3. valued possessions

      1. loss of contact with family, volunteers, or close friends

Traumatic Stress may affect

1. Cognitive Function:

   1. Those who have suffered traumatic stress may act irrationally

      1. in ways which are out of character for them

         1. and they may have difficulty sharing or retrieving memories

2. Physical Health

   1. Traumatic stress can cause physical symptoms and health problems

3. Interpersonal Relationships

   1. Survivors of traumatic stress may undergo temporary or

   2. long-term personality change that make interpersonal relationships difficult.

Mediating Factors

The strength and type of personal reaction to trauma vary depending on a combination of the following factors

1. A person's prior experience with the same or a similar event

   1. the emotional effect of multiple events can be cumulative

      1. leading to greater stress reactions

2. Intensity of the disruption in the survivors lives;

   1. the more the survivor's lives are disrupted

      1. the greater their psychological and physiological reactions may become

3. The meaning of the event to the individual

   1. The ore catastrophic the victim percieves the event to be to him or her personally

      1. the more intense his or her stress reaction will be.

4. The emotional well-being of the individual 

   1. and the resources (especially social) that he or she has to cope

      1. People who have had other recent traumas may not cope well with additional stresses.

5. The length of time that has elapsed between the events occurrence an the present; the reality of the event takes to set in.

6. CERT volunteers cannot know and should never assume to know-what someone is thinking or feeling

7. Do not take the survivors surface attitudes personally

   1. Rescuers should expect to see a range of responses that will vary from person to person

      1. The responses they see will be a part of the psychological impact of the event

         1. and will not relate to anything that the CERTS have or have not done.

Stabilizing Survivors

1. The goal of on-scene psychological intervention on the part of CERT volunteers should be

   1.  to calm the incident scene by stabilizing individuals

   2. Address any medical needs 

      1. Observe survivors to determine their level of responsiveness

         1. decide whether they pose a danger to themselves or others

      2. Get uninjured people involved in helping.

         1. engaging survivors in focused activity helps them cope.

         2. give them constructive jobs to do such as organizing supplies

            1. This strategy is especially effective for survivors who are being disruptive.

2. provide support by

   1. Listening

      1. let them talk about their feelings and their physical needs

         1. survivors often need to talk about what they have been through

            1. they may want someone to listen to them

   2. Empathizing

      1. caring repsonses show survivors that someone else shares their feelings of pain and grief

   3. Connecting

      1. Help survivors connect to natural support systems such as

         1. family

         2. friends

         3. clergy

Psychological First aid (PFA)

1. an evidence-informed approach to assist 

   1. children

   2. adolescents

   3. adults

   4. an families

      1. in a disasters aftermath

2. Listen, Protect, connect is one method of PFA

3. Listen

   1. The first important step to help your survivors after an event is to listen

      1. pay attention to what they say and how they say it

      2. how they act

      3. and what they need right now

   2. Remember not all reaction are verbal or can be seen

   3. Let the Survivors know you are willing to listen and talk about the event

      1. when or if they would like to

   4. Understand that sometimes survivors are not ready to talk

      1. or do not want to talk and that is ok

   5. Check back with them on a regular basis to see if their reactions or needs have changed

4. Protect

   1. This step 

      1. helps survivors feel protected and allows you to protect them from added stress

      2. helps survivors feel better by taking actions to provide 

         1. support

         2. encouragement

         3. reassurance

      3. The listening step should have provided you with enough information 

         1. to make informed decisions about each survivors needs

         2. Provide information or resources

         3. answer questions simply an honestly

            1. clearing up and confusion they may have

         4. Empathize and let them know they are not alone in their reactions to the event.

         5. Provide opportunities for them to communicate but do not force them.

         6. Talk to them about what is being done to keep everyone safe from harm

         7. watch for anything in the environment that could re-traumatize them

            1. such as 

               1. sights

               2. smells

               3. sounds

                  1. and help them reduce contact with those elements

         8. Help them decide what their basic needs are and how to get access to them

            1. encouraging healthy behaviors such as food and rest.

5. Connect

   1. Connecting survivors to their 

      1. friends

      2. loved ones

      3. other resources

         1. has a positive impact on their recovery

   2. Assist survivors in reconnecting with friends and loved ones after a disaster

   3. Ensure you are connecting with them on a regular basis

   4. Help them find access ti resources that can offer support

1. Being an emphatic Listener 

   1. requires the listener to listen

   2. to let the survivor talk

2. Good listeners will

   1. put the listener in the speakers shoes to understand the speakers point of view more profoundly.

   2. Draw upon experiences or try to imagine how the speaker is feeling.

   3. To limit the effects of vicarious trauma

      1. be careful not to completely take on the speakers feelings

   4. Listen for meaning

      1. not just words

      2. pay attention to the speakers non verbal communication

         1. such as 

            1. body language

            2. facial expressions

            3. tone of voice

   5. Paraphrase the speaker periodically 

      1. to make sure he or she fully understood what the speaker said

         1. and to indicate to the speaker that you are listening

            1. this reinforces the communication process

3. Survivors can show evidence of being

   1. suicidal

   2. psychotic

   3. or unable to care for themselves

      1. be sure to refer these cases to EMS and or Mental Health professionals

         1. for support as soon as possible

1. When providing support you should stay away from the following phrases.

   1. On the surface you can say these phrases to comfort the survivors

      1. but they can be misinterpreted or not well received

2. Avoid the statements

   1. I understand

      1. in most situations we cannot understand unless we have had the same experience.

   2. Don't feel bad

      1. the survivor has a right to feel bad and will need time to feel differently

   3. Your strong or you'll get through this

      1. many survivors do not feel strong and question if they will recover from the loss

   4. Dont Cry

      1. it is ok to cry

   5. It's Gods will

      1. with a person you do not know, giving religious meaning to an event may insult or anger the person

   6. It could be worse, at least you still have___, everything will be ok

      1. it is up to the individual to decide whether things could be worse or if everything will be ok.

3. Rather than provide comfort

   1. these types of responses could elicit  a strong negative response

      1. or distance the survivor from the listener

4. It is okay to apologize if the survivor reacts negatively to something you said.

5. Learn to be comfortable with silence

   1. do not say something just to alleviate your own discomfort

1. Always ask permission to 

   1. enter their space, 

   2. provide help

   3. interact with them

2. Allow people to say what they need

   1. normalize what they are feeling and thinking using common phrases

      1. I'm sorry for your pain.

      2. I'm so sorry this has happened.

      3. Is it all right if I help you with ...?

      4. I can't imagine what this is like for you.

      5. What do you need.

One unpleasant task that CERT volunteers may face is dealing with a victim who dies while under his teams care.

The guidelines below are useful for dealing with this situation.

1. Cover the body; treat it with respect

2. Follow local laws and protocols for handling the deceased.

3. Talk with local authorities to determine the plan.