|
As the piles of rubble that once
resembled an upright structure are cleared out
of the streets and victims are rushed to local
hospitals to seek the necessary medical care
for their physical injuries, what happens to
the emotionally injured victims of this brutal
event? We’re not just discussing those
victims who were present during the devastation,
but those who responded, observed, or had friends
or family members caught in the incident and
potentially suffer from emotional trauma as
well. After many such recent events, it is historical
fact that there is a strong probability for
everyone immersed (e.g., victims, onlookers,
friends, relatives, and first responders) in
either a naturally occurring catastrophic event
or an active shooter or terrorist situation
to have a traumatic emotional affect whether
it occurs immediately or after a delayed period
of time following such tragic incidents.
Naturally occurring catastrophic
events have a certain degree of historical predictability.
The unknown factor is intensity due to climatic
destabilization. If one lives in “Tornado
Alley” or along the Gulf Coast, there
is, traditionally, decades of emergency planning
and mutual aid for the evacuation, rescue and
recovery phases of the Emergency Management
Recovery Plan. Counseling is rarely addressed
in that plan. Post Traumatic Stress Disorder
(PTSD) is not limited to just combat troops
anymore. Those who dig through rubble caused
by catastrophic natural events looking for dead
children and body parts are never emotionally
the same again. Bottom line is that no one handles
those tasks well. Emergency management planning
should take its cue from law enforcement procedures
that mandate counseling for all officer involved
shootings.
A tremendous amount of emphasis
is deservedly placed in the planning, training,
and implementation of physical security measures
of the prevention phase of a man-made disaster.
Combined with proper tactics, techniques, and
procedures during the response phase, it is
the recovery phase that could prove invaluable
in the long-term survival of all those involved
in such a devastating attack. Regardless of
where your organization believes counseling
belongs in a crisis management plan, professional
crisis counseling must be made readily available
throughout and after the operational response
for all those involved in or victim to the varying
traumatic experiences involved in such an emotional
experience.
A crisis management plan is
established by emergency response agencies with
the intent of successfully taking effect during
a catastrophic event in an organized manner
conducive to immediate mitigation of any given
situation. With this in mind, it has been noted
through personal experiences that the recovery
phase is the most overlooked stage in the average
response plan. Furthermore, within the recovery
plan itself, an established posture dedicated
to coping with the emotional trauma of the victims
and first responders is sorely neglected in
the planning and preparation junctures of an
operational plan. Additionally, once the immediate
need is identified during an actual response,
those managing and operating the on-scene command
center are not properly trained to direct and
oversee the process necessary to establish an
area suited for counseling or having the appropriate
professionals on hand to deal with this type
of emotional crisis. (Note:
while there are several terms used to identify
a unit command center, such as tactical operations
cell, emergency operations center, etc., we
will forego the various labels and maintain
the phrase command center.) It is within the
command center that the focus for all operational
requirements are overseen with a “big
picture” mentality and the proper manning
of this critical response component will prove
invaluable in every facet of emergency response
and recovery.
Once a perimeter is created
and the command center has been established,
a primary task for the personnel assigned to
staff it is to create a collection area and
have responders in the field identify potential
victims who were involved in the attack and
would benefit from the trauma support provided
by the command center. This could include, but
is not limited to, witnesses to the attack,
the victim’s family, friends, and colleagues,
and first responders (to include both civilian
and emergency personnel). Once the dust settles
and the smoke clears, the emotional trauma remains
as a tertiary affect, and is often difficult
to manage for many of those directly involved
in such an incident. Immediate identification
and professional care of such victims is crucial
at this point in the recovery phase.
Initially, command center staff
should be purposefully and meticulously roaming
the area where the incident occurred in an effort
to identify those individuals who may be suffering
emotionally. Once these people have been cleared
of any medical emergency, they can be taken
back to a designated collection area where the
staff will be able to provide, water, food,
blankets, and phones to contact loved ones.
Personnel working the collection area will also
be able to provide information on which hospitals
victims have been taken to. Finally, the staff
will have the necessary information on hand
specifically designed to explain what to expect
during the aftermath of a violent incident,
both physically and emotionally. Crisis counselors
will be available for individuals who may need
immediate counseling support regarding the traumatic
event, but what are the immediate signs to look
for when attempting to identify an individual
who may be suffering emotionally?
There are obvious, and not
so obvious, signs that a person is in need of
trauma support, these can include:
- A blank stare
- Crying
- Franticly trying to return
things to order
- Wandering around without
a purpose
- Difficulty making decisions
regarding their next step
- Startling easily
- Looking confused
In the event an individual does
not want to go to the collection area for immediate
care and is clearly in distress, the roaming
counselor can provide that much needed face-to-face
support at the site, focusing on ensuring the
person’s immediate needs (e.g., medical,
water, food, etc.) are met, then moving on to
the emotional needs of the person. The mobile
staff members should have written materials
on hand providing information about possible
reactions to traumatic events and what to expect,
as well as resource cards with information about
local helping resources the victim could access
in the future. The response members dedicated
to finding and assisting trauma victims play
a critical role as they carefully maneuver in
and around the disaster scene, as well as outside
the established perimeter. While these particular
individuals do not have to be trained counselors,
they do play a critical role in the identification
and initial treatment of these victims.
Note: It is
important to staff your collection area with
enough counselors and supporting staff members
to ensure the victims of a traumatic event are
not overlooked. Support staff should be part
of the identification and referral phase and
can ensure the person is seen by a counselor
if interested. With proper planning, the counseling
staff may be augmented with non-government organizations
(e.g., Red Cross, Regional Church organizations)
or other local and state resources through the
utilization of Memorandums of Understanding/Agreement.
Thus far, we have focused on
the victims already on scene of a response incident
and potentially suffering as a direct result,
but what of the trained professionals who respond
to such incidents? As first responders, many
assume they are immune to such death and destruction
as if their personal emotions have been muted.
But, that is definitely not the case. Regardless
of how much training they have received or how
many incidents they have responded to, there
is always that sinking feeling in the pit of
their stomachs they must push through to better
serve those in need. Law enforcement, medical,
and rescue personnel are not machines with an
uncanny ability to turn emotions on and off.
They can, and often times do, fall victim to
emotionally charged stress just like any other
unsuspecting victim. To better facilitate continuous
and precise execution from first responders,
all emergency recovery plans should also include
post incident stress related evaluations and
counseling. While some individuals might find
this unnecessary, it will serve as a long-term
mechanism to help ensure a more emotionally
fit individual. Do not allow egos to step in
and disrupt this process as many type-A personalities
are the norm for those who choose to serve as
first responders. It takes a special kind of
personality to voluntarily go into harms way,
but that same personality will inevitably not
feel it necessary to receive their much needed
15 minutes of counseling support. Supervisors
should insist that all participate in such a
program if your first responding agencies are
to be emotionally prepared for the next attack
on our society.
Finally, what happens to the
victims once the traumatic incident is over,
the command center is dismantled, and clean
up is over? For the victims of this attack,
the trauma is not over and may linger for many
days, months or even years for some. It’s
at this time that the command center counseling
and support staff will need to be diligent in
providing the victims with resources and referrals
to support agencies and mental health professionals
who can carry on the work initiated immediately
after the attack. For complete recovery, a victim
may need more time to process the incident in
order to feel safe again.
Without the support of trained
crisis counselors and support staff, many victims
of natural and man-made disasters will fall
through the cracks and may never receive the
support they desperately need which may unnecessarily
prolong their trauma. Even emergency response
personnel, who may witness trauma on a daily
basis, will eventually burn out emotionally
if not afforded the opportunity to access counseling
related to their specific needs. Ultimately,
organizational supervisors and administrators
are responsible for both the physical and emotional
health of their emergency response teams, and
creating an internal recovery plan that outlines
and oversees the emotional fitness of first
responders will also better serve the community
in the overall perspective of keeping everyone
safe.
We would like to thank Dave
Mitchell for his professional assistance and
keen insight throughout the editorial process
of this article.
Richard Hughbank is a Major
in the US Army with over 20 years experience
in the Military Police Corps and the Founder
and Director of Extreme Terrorism Consulting,
LLC. He’s a certified Master Antiterrorism
Specialist and holds graduate degrees in Security
Management and Counseling. Richard is currently
assigned to the US Air Force Academy as an instructor
and antiterrorism officer and is currently part
of the team assessing and developing strategies
directly involved with traumatic response situations
at USAFA as it relates to active shooter scenarios
at a school or university. He also works for
the Center for Homeland Security at the University
of Colorado at Colorado Springs as a graduate
course instructor in terrorism studies and homeland
defense. Richard can be contacted through his
website at www.understandterror.com.
Michelle Cano is a Licensed
Clinical Social Worker. She graduated from the
University of Kansas with a Master of Social
Work in 1994. Since that time, Michelle has
gained a broad range of experience within the
field of mental health and most recently military
mental health care. While working with wounded
soldiers at Brooke Army Medical Center during
the first 3 years of Operations Enduring and
Iraqi Freedom, she witnessed the resiliency
of the human spirit in those soldiers. Currently,
Michelle works as a Clinical Social Worker in
the US Air Force Academy’s Counseling
Center in which she helps Academy Cadets achieve
success towards their goal to become Officers
in the US Air Force upon graduation. Michelle
is currently part of the team assessing and
developing strategies directly involved with
traumatic response situations at USAFA as it
relates to active shooter scenarios at a school
or university.
The views expressed herein are
those of the author’s and do not purport
to reflect the position of the US Air Force
Academy, the Department of the Army, or the
Department of Defense.
|
