Richard J. Hughbank, M.A., M.S., CMAS, CHS-IV and Michelle Cano, L.C.S.W.
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:
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.
Published by the American Academy of Experts in Traumatic Stress - 2020