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MISSOURI DIVISION |
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PROCEEDINGS OF THE SEPTEMBER 2000 POST EARTHQUAKE HIGHWAY RESPONSE AND RECOVERY SEMINAR HELD IN ST. LOUIS MISSOURI
THE EFFECTS OF STRESS BY JANETTE PETERSON
MR. WILKERSON: Good morning. My name is Jim Wilkerson, the moderator for next two sessions. The first session deals with personnel issues. We have three panelists. Our first panelist this morning is Janette Peterson. Jan is fresh off the fire line in Idaho. This morning she is going to talk about the effects of stress on people. I'm sure having fought fires for this entire summer, she knows a lot about stress. She is a safety manager with the Idaho Bureau of Land Management. She´s a disaster coordinator and she teaches EMS and other medical activities. She also runs the Medivac and the rescue efforts for that area.
MS. PETERSON: Good morning. I would be remiss if I didn't talk about some of the things that were happening in Idaho. I'm sure you've seen in the paper some of the fires that we have had. Believe it or not, my state is not made of potatoes and it's not just flat acreage. It is a beautiful mountainous wild country. It is also a very interesting fact that we're ranked No. 5 in the nation for earthquake potential. Usually only cows and miscellaneous wildlife shake so you usually don't hear about it in this part of the world. I´m going to talk about stress in relationship to disasters or incidents that are above and beyond our employees' coping mechanisms.
It's a very hard subject to talk to audiences about because there is always this discomfort that kind of sets in due to it being touchy-feely stuff.
I'd like to talk about my latest fire, which was a trail creek fire in Atlanta, Idaho.
Remember the Farkels in the T.V. program, Laugh In? They were born there. Anyway, we've got this whole community surrounded by fire. When we brought the media to the residents, the media asked, "How do you feel about this fire?" This one old timer looked over his glasses and said, "You know, we're only worried the beer truck won´t get in here". So minus a couple of teeth but with a great sense of humor, I just thought, what a character this guy is. I knew the Forest Service would have dropped a retardant container full of beer if we really needed it. So I didn't want to burst his bubble on that. I just thought that any step that would facilitate calming the community, other than promising a retardant drop of beer, might be okay. This little community had a wall of flames coming down on it. We almost put that thing out. But there is always that potential of it raging out of control again with the winds drying things out and feeding a new fire caused by lightning. Going through all this is very stressful on individuals.
It's important to define incident stress, critical incident stress debriefing, and all the types of tools that we have to deal with stresses that go beyond our normal coping mechanism.
I would like to give you a fair understanding from an employee viewpoint. And as a manager or even as a family member, you have a role in stress management and there are some things you can do to identify the build up of stress and how to mitigate it. I would like to provide you with an understanding of the difference between psychological injuries and mental health issues.They are definitely apples and oranges.
I'm an EMS instructor for structured fire departments. I love that interface and we have more and more people moving out west to the wilderness. We have more structures and wild fire engines that are kind of joint efforts.
We can easily understand tangible emergency care like s broken leg, a pulled arm, or whatever.You can see it. It is something you know will get better.
Unfortunately, stress type injuries can´t be seen and they are not tangible. And each of us has our own level of coping. Back in the old days, especially during wars, soldiers were actually labeled as being shell shocked or even deserters for behavior caused by post-traumatic stress disorders. You're making me feel better. So every person has his limitations. It difficult for some managers to see through all of this and they simply say, " Come old Fred, you should have come around by now, pull up your boot straps and get tough, blah, blah, blah, blah."So what we have is a misunderstanding of the person's limitations and that we differ as individuals. When it comes to stress damage and healing, the best thing you can have is patience. Patience is a tough one.
Each person has a right to his own feelings. They need to know that what they´re feeling is O.K. and their own personal issue. In a disaster, it may remind them of some chronic things that have stressed them out like marriage problems, a death in the family, and a disaster on top of all this. So what you have is a stair step to a person having psychological injury. And it's important to understand that for these people.
However, as humans, we are resilient. There can be a light at the end of tunnel and there are some great techniques and tools that our mental health care professionals use today. So, there is hope.
It doesn´t matter who you are or how long you have been doing something, you will be affected. Everyone involved with an incident, a disaster, or something out of the normal realm of daily activities is affected. It comes out of us in different ways.
I´ve been in emergency medicine for 30 years and started as a Candy Striper. I knew I needed to switch gears after being in emergency medicine. I was living MASH and not just watching it on TV. Not everyone is affected the same and every person is definitely affected by extreme stress or experiences to some degree.
The important thing about injury, whether it is mental or physical, is that someone needs to be in tune to recognize it. Recognition is the very key to know when someone is in need of help.
What are the signs? Now, this is the point in the lecture where people start looking sideways at old Jerold that they have been working who is exhibiting some of the stress signs. Some people behave in ways that mimic stress indicators as part of their everyday life and that is okay. So don't start looking sideways at others as you go out of the room today.
I would like to talk about the phases. The warning phase is usually pretty immediate.
I assist in coordinating the setting up the debriefing teams for a wild land fire community. In Utah we had an inmate crew that was struck by lightening on a ridge top. When they came down, they were in a bunch of boulders that had a ping pong effect on them. Seven people were hit by the lightening: two fatalities, two with critical injuries, and the rest burns and various injuries. So the people that were there actually went through and witnessed this terrible event. That's one example. A major earthquake can also have very damaging stress impacts on individuals. No matter what mechanism triggers an event, you need to watch for the signs. In the warning phase, we try and actually mitigate some of the problems before they get worse.
I've actually watched people bounce up and down through all four of these levels. I'll talk about the symptoms but won´t get in-depth about what post-traumatic stress disorder is or stress in itself.I would need a lot longer time.
But each one of these phases and their signs and symptoms are pretty important to be aware of.
Disturbing memories of an event is very common. These pop into the mind unexpectedly and can be termed, flashbacks. It's amazing how the public has become more and more aware of this phenomenon. Not until Vietnam did the general public realize that there was such a thing as post-traumatic stress disorder. A lot of our vets from previous wars suffered sometimes from these types of situations and had cumulative post-traumatic stress disorder. And so we used to say, "Yeah, old Bill was just never the same after he came back," or "Old Hattie, the nurse came back and she was never quite the same." It´s really sad that it took so long for us to understand that the mind can be injured too.
It's not planned, it happens, and it can happen to anyone. One person isn't more capable of fending off this injury than another. The dreams, the nightmares, and waking up in a cold sweat are common after traumatic incidents. The difference is how long they keep going. Then the feeling occurs that it will happen again. It's amazing. When I talk to people that have actually been through a flashback, they explained that they experienced a sight or a sound that suddenly triggered the memory of that traumatic incident and they had a flashback.
You need to understand you will likely have cumulative stress affects on you when you respond to an earthquake, disaster, or other natural phenomenon. You be out trying to clear up the wrecks in the midst of the havoc and getting things opened up in the vein of transportation. The event will basically put you into the chronic stress state. Sometimes you will be going day, after day, after day, after day dealing with the recovery effort under constant pressure. Whatever it is you experience, it may be horrific. But the fact is, it accumulates. So it's going to automatically put you into the stress syndrome category.
In Storm King we had 14 fire fighters that were burned and killed. I knew the 14. Every year on the anniversary day, there aren´t too many wild land fire fighters that don't think of them then. We actually have a quiet time in our fire camp.If you can picture retardant drops, C-130s, and helicopter bucket operations, the sky looks just like war. The fire fighters are just absolutely fatigued to the point of tears. My son and his wife are both smoke jumpers. They jump into those fires out of a perfectly good airplane. My family gets divided up in the summer. The last time I talked to him, he said that people are just very, very tired. So even during the middle of any chaos, many of us still bow our heads in remembrance of those 14 people.
When an incident like that happens and it has in other parts of the world like the earthquakes in Turkey and Mexico, remembering it at the anniversary date is part of our way of coping. It could easily go on for the rest of an individual´s life. It's how we deal with it. It is one of the tools that we have to understand that we received an injury and we need to treat it.
I think the Lord has blessed us with the mechanism for numbing of our emotions. This can be a benefit as well as a detriment. It stops us from listening to our body. When people become numb, they really don't care or may not have the same caring feelings they had before an incident or disaster.
I´m talking about when the numbing of emotions continues past the point of initial shock. We deal on adrenalin; we run on adrenalin. It's interesting that fight or flight-type situation sets in and your body says, "Okay, we´re going to survive no matter what." It starts making all the things we need to be powerful: the adrenalin starts running and the blood starts flowing. So now all of a sudden you are just running at high speed, your emotions are numb, and then, it's over with, the aftermath.
Over the years of debriefing or managing stress, we have learned that people oftentimes don't want to address what happened. They don´t want to talk about the event. In defusing and debriefing a situation, it's so important for people to get those initial feelings out. They need to get them out on the table because it's almost part of the surgical intervention, so to speak. Then, they can take care of it, dice it up how it needs to be, get the coping tools they need, and get on with life.
Sometimes a routine activity may remind people of the bad incident they during a disaster. They worked during the aftermath cleanup to mitigate damage and open up those important arteries of transportation. And it's amazing how it may affect employees or persons in the most bizarre way. Dealing with their feelings may be the real challenge for you folks. They may come in one day and they don't want to move that dozer as they had a thousand times before. They won't want to do this, because it may remind them in part of the disastrous event. So you may have some employee issues there that could be difficult to handle. They may have to have a job change.
Another real sign to watch for is waning interests in what they do; their interests seem to go, circle the drain. I call it CTD, circle the drain, in medicine. That also means advanced life support back in Idaho and that means a helicopter blade. So if you notice enjoyable things such as hunting, fishing, reading books, and going to plays are suddenly not enjoyable to them, you may have a problem on your hands. All of a sudden they don't want to go out and meet the McFarlands for cards, go to the club, play golf, and all those types of things. So you need to recognize all this is part of the injury.
Okay.Loving feelings. In my state there are a lot of relationships on the line because people seem to be gone forever. They go for 14 days and get one day off. Guess what they do with that one day. They're paying their bills and trying to lead a normal life. I ordered hay for my horse on my day off. At least he was very appreciative.
But loss of the loving feelings means that the mental door is closed, basically. It's closed in many ways:showing affection, normal, healthy life emotions, playing with your children, and playing with your grandchildren. It's amazing how it can manifest itself.
The other thing is startle reflex. A lot of the folks that I work with have a history of being in the military and are Vietnam vets. I had two friends who were going through facilitative instructor training. They were to getting their training papers to teach people. A big boom fired from the backside of the base and those two hit the deck. And I joined them because I didn't know for sure if there was something going on. All three of us were laying down in the parking lot when one of the secretaries walked past us. She remarked that we must have been up late last night. Yeah, we were up late and got up and moved along. It's one of those things that startles. It might be just a sight, a smell, or a sound that all of a sudden makes you jump. I am sure if I were to go boom right now, I would startle a whole bunch of you. You would be moving real fast because of your startle reflexes.
Emotional control is one the biggest issues for you and your employees. We don't like to lose control. We like to keep that focus or that image of not showing our emotions.We don't want to cry in front of people. And so what's happened, I was involved in -- one of my other hats is being an investigator for serious accidents. And we have teams that are located throughout the United States. My tour comes up September 16 through the 30. And one of the things, we need to brief a bunch of folks, fire fighters that were involved in two fatalities. There was one crew that didn't want to participate, didn't want to do anything and just didn't want to do it. So one of the them got up to go around and leave and as our type of model that we use for debriefing, the peer went out and followed the person around and sure enough he was just standing there just bawling his eyes out, but he didn't want to lose control or lose face in there. And I can understand that, I think we all can. And the reality of it is that oftentimes, you know, that person losing it and crying can also start the river with a lot of other people.But one thing I told this person, I don't know where it came from, I've got my suspicions, but I said, you know what, rock is carved by water. Water is very strong; tears are water, they carve character. So don't be afraid of tears; it will carve that character.
Okay, lets cover critical incident stress. Now, the thing that's important with this, there is many types of stress. There is everyday stress, and I'm not demeaning this by any means, and there can be a stair step effect, like I said. But usually critical incident stress is related to trauma, crime scenes, to disasters, environmental disasters, and those types of things where it's up and above our every day challenges. So with critical incident stress it's important to understand that you need to get this information out to your employees and not just at conferences. You need to go home and sit around and talk. Make some arrangements with your health care professional to come in and sit down with your employees and talk about it. Preplanning or pre-education is a big thing. And we have done this pretty much throughout the west. We educate our employees on stress, on critical incident stress.The defusing takes place within the first 24 to 48 hours. If you can get the people involved in the event to sit down and actually defuse or talk about the issues or the emotions that they're feeling, it will really help a lot. We heard about defusing when it first came out. This whole concept first described a police department going through defusing. It's even started showing up on TV so it must be true. People need to sit down and talk about what they went through and what they feel.It´s opening the emotional door and letting some of the stuff out. It still needs to be guided and dealt with in a good way.
There are many different critical incident stress-debriefing models with health care professionals. The one that works with our fire fighters is the Mitchell model. For us, you've got a peer or someone trained in fire fighting, and a health care professional trained in the process. They'll sit down with a group in a circle and they'll talk about their experience.The first thing that needs to be addressed are the current concerns of the employees.First of all, they need to know, all of what is said is kept confidential. When debriefing or defusing takes place, there aren't any notes taken. I was assigned to the Department of Justice for one of these cases where people were defused and debriefed. They sure tried to get notes on the session but there weren´t any. It´s confidential so no notes are taken to document the issues or what happened.Each person speaks for himself. The dynamics are very interesting especially when you have a foreman or supervisor that's in charge of a certain operation but it's important that each person speak for himself. The manager or supervisor is not the spokesperson. There is no rank.I think that's one of the things that's harder for people used to being in charge is learning to take a common seat next to their employee. Also let them know they do not have to talk.Even if they just sit and listen, they will benefit by listening to others who most likely have the same feelings or troubling thoughts.They don´t have to speak and they can't leave the room, by themselves, anyway. Usually they're told up front that we're going to have coffee for them and if they need to use the rest room, do it now because we´re going through the session without interruptions. It's important to stay together. I had one gentleman get up and left out the back and he was just losing it. The peer patting this guy on the shoulder was helpful to him. The others in the group could say they understand. That they had gone through Storm King and knew what he saw. We also put those bodies in the bag.It was important because right away, I think that really saved that particular person's mind in some way because somebody else could relate to the horror. Again, don´t use cameras or recorders. There may be events that happened during disasters like trying to do rescues where the stress of lifting the concrete off the cars and finding bodies. There can always be some feeling of delayed guilt or personal guilt. So it's not to find criminal behavior but basically just to put out the emotions or issues on the table to take care of it.
There are plenty of health care professionals now that deal with critical incident stress that debrief. There are several models that are successful. This is the one that we use and found it to be good for us.
I'm going to do is take you through the steps.In one instance there were two people involved in fatalities. They were caught in the middle of a firestorm that swept right across them. We had crews trying to help them. There were quite a few people involved. We broke the mass into groups of 20 and put them in a circle. There was a health care provider on one side and the peer on the other. They went around and introduced themselves and what their roles were. It's interesting that people oftentimes don't have all the pieces to the puzzle. The defusing and then hopefully a debriefing later on where it's a more formal setting, they will find out what happened. We start with their first thoughts, whether it was I felt helpless or I felt anger or I felt remorse, whatever the case, that's brought out one by one. They go around for those willing and wanting to participate. We discuss their worse feelings going around. At some point they start seeing some commonalities. They start seeing that others felt the same way.It's amazing, the first thoughts and the worst thoughts are often repeated. They realize at some point that they are not the only one feeling this way mentally.
They go through all the different cumulative trauma disorder symptoms that there are, including sleeplessness. They go through this process and they talk about what to expect. We let them know that this is normal to have these things and that there are some things they can do to help themselves including scheduling an appointment with a health care professional.
There are some things that you shouldn't do. We found out with the Storm King smoke jumpers that you don´t just bring any health care professional in to treat the jumpers. We had a gentleman come in and he didn't know their jargon. He didn't know what things meant to them and so couldn´t relate to them properly. So now we train those health providers in fire fighting. We had to put those smoke jumpers through a second debriefing with a health care professional that understood their jobs.
For mental stress, it is important to stay away from caffeine, that you eat, and work out.
The reentry phase is recognizing the symptoms and being taught what to do to mitigate it. So people go out and have some idea what to look for and know it can be treated. Whether you're a manager or an employee, your first job is to recognize what it is and to know and understand that if there is a disaster, you watch over each other. I call it the buddy check: making sure that you lookout for each other.
Education is just a must. Don´t be afraid to have a health care professional come in to do a presentation about critical incidents, about stress and those types of things. We had a fatality in one of our field offices. A gentleman was trying to just come home after long hours and he met a truck. The whole office was traumatized. A health care professional was brought in who was a specialist in grieving. It was amazing what was unleashed even though some people are not very comfortable talking to a health care professional about their feelings.For them it is sad, because there are some great tools they can give you to help handle the stress and grieving. Don´t be afraid to take that step to assure you can keep a good quality lifestyle going for you and your employees.
You have to deal with employee problems. This could mean putting them on a different job or in a different department. Restructure their job responsibilities by changing their job description. Being flexible is a key issue here.One of the most important things is supporting. Supporting is going to have to come in the form of patience. Patience is a big one. And also education is important. Getting a wellness program going could help. Getting some camaraderie going to boost morale.
Obviously, we know there are going to be earthquakes. Find out who or what is available in your area to help you out when a disaster occurs. Find out if there are debriefing teams now and don´t wait. Find out who your health care professionals are that deal specifically with critical incident stress debriefing or stress related issues. Get that stuff out into the open and given to your employees so they know that they have some coping avenues.
In closing I would like to say that I fly out tomorrow and I'm back in the system. So when you see Idaho and see all the satellite imagery of all these little flames all over, please think of us. We accept any kind of prayers or nice things talked about us over in this part of the world. I would like to thank you all.
MR. WILKERSON:Thank you, Jan. I've never been to Idaho, but I can quickly see there are a lot of similarities between southern states and Idaho. She's absolutely right about stress. I can say firsthand, having worked with the state emergency management agency in Mississippi and having worked several large-scale tornadoes that even sitting in the EOC situation behind a desk just answering phone calls for four, five, six days at a time begins to build up on you. It will sneak up and before you know it, it will impact you.
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