The Psychological Impact of

Disaster on Emergency Response

Workers, Victims and Communities
Deborah Renholm RN MS
 Disasters take many forms and demand
quick responses from emergency response
workers.
Disasters may be natural such as
earthquakes, hurricanes, or floods, or they
may be manmade such as mass violence
or terrorist attacks.
 It is a recent phenomenon that attention
has been focused on the mental health
impact of disasters (Politin et al, 2005).
Efforts are more commonly directed
toward the immediate physical health and
community infrastructure risks in the
aftermath of disasters.
 This focus overshadows the short and long
term mental health consequences of
disasters and the extent to which mental
health plays a role in the impact of a
disaster.
 For emergency response workers, there
can be serious physical and psychological
consequences prior to, during, and after a
disaster.
Oklahoma City Federal Building
Bombing April 19, 1998
 Mass violence or disaster exposes victims,
emergency response workers, and
communities to physical and mental
trauma that may result from exposure to
severely injured children, adults, dead
bodies or body parts, or the loss of
colleagues.
 Emergency responders must be educated
and supported in order to deal with their
own vulnerabilities and fears, and must
not become victims themselves (Briggs, &
Twomey, 2003).
Mental health concerns exist in most
aspects of preparedness, response, and
recovery (CDC, 2005).
 Stress and grief reactions are normal responses
to an abnormal situation (APA, 2004, p.15;
Briggs, & Twomey, 2003, p. 33; CDC, 2005).
Traumatic incidents can produce unusually
strong emotional reactions that may interfere
with the ability of emergency response workers
to function at the disaster scene or later.
 Some Symptoms of Stress
Experienced During or After a
Traumatic Incident Table 1
Physical Cognitive
Chest Pain Confusion
Difficulty Breathing Nightmares
Shock symptoms Disorientation
Fatigue Heightened or lowered alertness
Nausea/vomiting Poor concentration
Dizziness Memory problems
Profuse sweating Poor problem solving
Rapid heart rate Difficulty identifying familiar
Thirst objects or people
Headaches
Visual Difficulties Source for table 1:NIOSH, 2002
Clenching of jaw
Nonspecific aches and pains
 Table 1 continued
Emotional Behavior
Anxiety
Guilt Intense anger
Denial Withdrawal
Severe panic (rare)
Fear
Emotional outburst

Irritability Temporary loss or

Loss of emotional control
increase in appetite
Depression
Sense of failure Excessive alcohol
Feeling overwhelmed consumption, inability to
Blaming others or self rest, pacing, change in
sexual functioning
 Some emergency response workers may
even experience some form of post-
traumatic stress disorder by the end of the
first month following disaster. (APA,
2004).
September 11, 2001
 Most emergency workers only experience mild,
normal stress reactions, and disaster
experiences may even promote personal growth
and strengthen relationships.
However, 1 out of 3 rescue workers may
experience severe stress symptoms that leads to
lasting Post Traumatic Stress Disorder (PTSD),
anxiety disorders, or depression.
 Emergency response workers environment
often involves physical hardship, unclear
roles and responsibilities, limited
resources, rapidly changing priorities,
intrusive media attention, and long work
hours.
 Natural and man-made disasters not only affect
first responders, they also affect individuals,
families, and communities.
Emergency workers are concerned about their
own families too.
When a community mitigates a disaster, they
become safer, and the loss of property and life
is reduced (Ivanov, & Blue, 2008, p.627).
(CDC, 2005)
 Emergency responses can be more
effective in the community and human
suffering reduced when there is advance
warning and preparation for a disaster.
 Survivors respond when rescue workers
display interest and concern. Rescue
workers can offer survivors a listening ear,
encouragement, reassurance, and
comforting measures (APA, 2004; CDC,
2005; DHHS, 2005, p.2).
 Through helping with practical tasks
rescue workers often earn survivors trust,
and the privilege to support them when
they express their pain, fear, sorrow, and
anger (DHHS, 2005, p.6).
 Man-made disasters and acts of terrorism
are planned and carried out to instill fear,
terror, and suffering in their victims.
Those confronted with life threat, mass
casualties, overwhelming terror, and
human suffering may experience severe
psychological stress and trauma (DHHS,
2005, p.24).
Emergency Workers
 When rescue and recovery efforts
continue over a period of time, disaster
victims become uncertain of an ongoing
threat or another attack in the future.
This increases anxiety and vulnerabilities.
Traumatic realities of a disaster impact the
whole community.
 Stable social systems are important in
improving the lives of disaster victims. The
five essential elements of trauma
interventions are to promote safety,
calmness, efficacy, hope, and
connectedness (Norris, & Stevens, 2007,
p. 321).
 Communities must offer victims the
resources they need to get their lives back
in order. Dysfunction is followed by a
return to predisaster levels of functioning,
and interventions must work to normalize
and validate victims emotional reactions
(Norris, & Stevens, 2007, p. 322).
(CDC, 2005)
 Appropriate interventions will promote better
outcomes of resiliency and recovery among
victims after a disaster. Flexibility and local
control is needed when planning disaster
interventions. Communities can take charge of
local recovery efforts. Individuals can regain
their sense of collective and self-efficacy that
may have been injured by the trauma and
ensuing adversities (Norris, & Stevens, 2007, p.
324).
 Simple concrete tasks can be given and
rescue workers can help survivors focus
and take a more active role in coping.
Being reliable and following up, even
when there is nothing to report, helps
survivors gain control (DHHS, 2005, p.14).
People can be empowered to solve their
own problems.
Severity of Psychological Reaction
After a Traumatic Event
(CDC, 2005)
 First responders should monitor victims for the
following behaviors and symptoms, consult with
their supervisor, and refer for more specialized
treatment: disorientation, severe anxiety,
depression, mental illness, inability to care for
self, suicidal or homicidal thoughts or plans,
problematic use of alcohol or drugs, domestic
violence, child abuse, or elder abuse (DHHS,
2005, p. 15-16).
 Individuals at risk, such as the seriously
injured and those suffering from pre-
disaster mental health problems, should
be monitored closely at the disaster
healthcare site. If their conditions worsen,
these clients should be sent to nearby
hospitals for appropriate care, treatment
and follow-up discharge planning (APA,
2004, p.13).
Drill NYC May 19, 2009
Drill NYC
 Conclusion
Remember that anyone experiencing a disaster
is affected by it. It is important to implement
psychological first aid with medical evaluations
during recovery efforts. Psychological first aid is
a practical effort by meeting victims basic needs
for food, comfort, and safety. Connectedness at
the disaster site offers victims supportive
activities and opportunities for appropriate
treatment in the community.
 Appropriate interventions during disasters
promote resiliency and recovery. When
communities take charge of recovery
efforts, individuals can regain their sense
of control and well being. Victims and
communities can successfully move on
with their lives after the experience of a
disaster.
Poster
 References
American Psychiatric Association (APA), (2004), Disaster psychiatry handbook.
Retrieved March 4, 2010, from:
http://www.psych.org/Resources/DisasterPsychiatry/APADisaster
Briggs, S.M., Twomey, J.C. (2003). Basic Disaster Awareness for Healthcare
Providers, Boston Public Health Commission, Boston Emergency Medical
Services, and Delvalle Institute for Emergency Preparedness, Boston, Mass.
Centers for Disease Control and Prevention (CDC). (2005). Disaster mental
health primer: Key principles, issues and questions. Retrieved February 27,
2010, from http://www.bt.cdc.gov/mentalhealthprimer.asp
Ivonov, L.L., & Blue, C.L. (2008). Public Health Nursing: Leadership, policy &
practice. Clifton Park, N. Y.: Delmar Cengage Learning.
National Center for PTSD (2007). Disaster Rescue and Response Workers.
Retrieved May 28, 2010 from:
http://ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_rescue_workers.html
National Institute for Occupational Safety and Health (NIOSH) (2002).
Traumatic Incident Stress: Information for Emergency Response
Workers DHHS (NIOSH) Publication Number 2002-107.
Norris, F.H., & Stevens, S.P. (2007). Community resilience and the
principles of mass trauma intervention. Psychiatry, 70 (4), 320-328.
Polatin P.B., Young, M., Mayer, M., & Gatchel, R. (2005). Bioterrorism,
stress and pain: The importance of an anticipatory community
preparedness intervention. Journal of Psychosmatic Research.
58(4):311-6.
U.S. Department of Health and Human Services. (2005). Mental health
response to mass violence and terrorism: A field guide. DHHS Pub.
No. SMA 4025. Rockville, MD: Center for Mental Health Services,
Substance Abuse and Mental Health Administration.