The Mental Trauma of Search and Rescue
No matter how prepared frontline workers consider themselves, there is inevitably a huge sense of shock when a disaster or catastrophe occurs. Strategies for dealing with disasters, both man-made and natural, include providing training for emergency responders and health professionals in disaster intervention strategies. Dr Nicola Davies examines the mental training Search and Rescue (SAR) workers undergo to make more effective decisions and avoid mental trauma.
Man-Made vs Natural Disasters
Pearl Guterman from the Department of Psychology at York University in Toronto, distinguishes in her report, ‘Preparedness for Disaster,’ between the psychological impact caused by natural disasters versus a terror attack. In the first instance, the disaster isn’t due to an act of ill will, but is simply natural forces at work, which can sometimes be exacerbated by human intervention (think of deforestation leading to higher incidence of mudslides). On the other hand, a terror attack is pre-planned, and the level of horror and outrage from the brutality of these attacks can cause severe mental trauma. Indeed, there is usually no warning for these attacks, so people are caught unawares and have no time to prepare themselves mentally.
In the case of a storm, flood or avalanche, nature often gives some sort of sign of what is to come. If the signs are ignored then we have only ourselves, or whatever agency failed to take action, to blame. For example, there were warnings of the possibility of the tsunami that struck South East Asia on 26 Dec 2004. Indigenous creatures had moved to higher ground, but people were unaware of the looming disaster. These signs are easier to identify in retrospect. Still, as a result of this catastrophic disaster, clearly marked tsunami escape routes were established and locals are now trained in the correct actions to take to protect their families should this ever happen again. In addition, greater attention is now paid to scientists working to track seismic activity in the region.
In the case of a terror attack, however, people are angered by the senseless waste of human life and are unable to comprehend how the perpetrators could be so cruel and hateful to attack their fellow human beings in such a way. Jim Lee, President of the Royal Canadian Marine Search and Rescue, says, “Man-made apocalyptic events have a much more profound affect on Search and Rescue personnel than those naturally caused.”
Immediate Responses to Disaster
In a disaster situation – whether natural or man-made – there are usually four ways in which people respond: blind panic, where people take extreme risks to escape, often injuring or killing themselves in the process. Few can forget the images of people jumping to their deaths from the towers in the 9/11 terror attacks. However, this is not a common response. More common is a fright or shock reaction where the person freezes and cannot physically do anything to help themselves; or disorientation, where a person is stunned and wanders aimlessly, unable to process what has happened or assess the situation and take appropriate defensive actions. The fourth reaction is where a person is able to quickly take stock of the situation, find an escape route, start helping survivors to safety, and initiate rescue attempts – even before the first responders arrive on the scene with the correct equipment.
This level-headed approach is why SAR responders train so hard – so it becomes second nature, no matter the magnitude of the disaster. Lee says various factors play a role in this cool-headed approach, such as the responder’s personal history of traumatic experience – does the present incident reflect a previous one? does the incident involve family, friends, or children? “The potential reaction can also escalate if the children are unknown to the responder but of similar age to his/her own children, or who have similar characteristics. To try to clarify further, an emergency responder seldom knows to whom he is responding. His degree of reaction will likely be greatly impacted if he discovers the child he is trying to save or extricate is his own.”
Critical Incident Stress Training
The Canadian Forces School of Search and Rescue runs an 11-month program, for which only 12 to 16 new students are selected each year. The bulk of its training resources goes towards improving the skills of existing SAR personnel. Recruits are trained to operate in remote and often inaccessible areas of Canada. Skills taught include administering life-sustaining medical care to people with many different injuries and levels of severity. Not only are the physical aspects of SAR taught; students also undergo rigorous mental training to help them cope with the traumatic situations they encounter.
Lee advises, “Training in the effects of Critical Incident Stress (CIS), and Post Traumatic Stress Disorder (PTSD), what to look for in self and others, identifying the psychobiological and physical symptomology is needed to make more effective decisions and avoid mental trauma.” He adds, “In my opinion, any SAR agency should be offering good programs educating their members about CIS and PTSD as part of the basic training package – normalizing the various responses that the members may experience, and normalizing the interventions that can be of great help.”
It is of interest to note that CIS isn’t a clinical diagnosis but “rather a neologism developed from work with police and fire personnel,” according to Dr Gerald Lewis, in his book ‘Critical Incident Stress and Trauma in the Workplace: Recognition, Response, Recovery.’ A “PTSD diagnosis should only be assigned to people who are symptomatic for at least one month,” asserts Lewis.
CIS training is “best done by peers who are well educated in CIS/PTSD intervention,” says Lee. “Peer CIS debriefers should be trained by professional Mental Health Providers with backgrounds in CIS/PTSD. Peer programs have proven to be very effective both as a prevention tool, and an intervention tool. I can’t stress strongly enough the importance of having CIS training as an integral part of any SAR training program.”
After a disaster, people commonly go through three stages: the rescue stage, the inventory stage where they take stock, and the recovery stage. During the rescue stage, people are on an adrenalin high and may display acts of heroism, feats of strength, and strong will in order to survive. During the inventory stage, some shock sets in and people may experience anger, grief and self-blame. Why did I survive when so many others didn’t? Why did I not react fast enough? Why wasn’t I strong enough to prevent casualties? Who did this? Why? These are all common questions that run through the minds of SAR Crews, as well as the victims of disasters.
During the recovery stage, people start coming to terms with what has happened – however, flashbacks, fears, anxiety and unusual behaviour can be experienced by an individual anywhere from a week after the incident to 25 years later.
Often, individuals who appear calm and normal at the time of a disaster will experience reactions only once the pressure is off. Symptoms may include night sweats, nightmares, excessive fear, anxiety, and aggression. For a rescue worker who confronts disaster situations on a regular basis, it is vital to come to terms with what they have experienced and work through emotions in order to regain a balance.
“I had a very good SAR crew lost due to unexpected reactions that are completely normal in circumstances that are anything but normal,” says Lee. “This was due to inadequate training that failed to help them or those working with them to understand CIS, and how to deal with it. In many provinces, PTSD is now recognized as a compensable work-related illness. Any organization needs to be well aware of this, and design their training programs with this fact in mind.”
Often, SAR personnel have been assessed as being disoriented or suffering from shock whereas, in fact, they may simply be exhausted from lack of food, water, sleep and warm clothing. They may have been working for hours to help others to safety, digging people out of rubble, trying to save possessions, or any one of the activities required to help reduce negative outcomes in a disaster situation. A well-trained SAR responder will be able to distinguish the difference in their colleagues.
Psychological First Aid
SAR personnel are trained in psychological first aid (PFA), which equips them with the skills to comfort, reassure and communicate effectively with traumatized survivors. By training not only the first responders, but also the public at large in PFA, people are better equipped to deal with an emergency situation and any associated psychological trauma can be minimized. Dealing with fatalities can be extremely stressful for responders. Training in disassociating themselves from emotions, much like a doctor when performing surgery, helps them cope with the task of recovering bodies while still being able to reassure survivors and provide a strong shoulder for those stricken by grief.
Lee is of the opinion that high Emotional Intelligence (EI) can enhance cognitive ability in stressful situations. “Clear emotional boundaries are important, as it is necessary that the responders not let their emotions negatively impact their effectiveness,” he says. “Self-awareness training – identifying individual traits that enhance or challenge the individual – can help mitigate negative reactions regardless of personality types or factors in most cases. In dealing with survivors, [those trained] in EI can help reduce shock and stress, as empathy has a calming effect, and those high in EI are usually high in empathy. To that I will add that empathy is quite teachable.”
Lastly, coping mechanisms and social support are vital in the prevention of PTSD among SAR personnel, says Lee. “Coping mechanisms that are healthy are teachable as part of a good training program. Awareness of CIS/PTSD causes and symptoms act as a preventative. Utilization of a close network of support – including family, friends, and colleagues – goes a very long way for both prevention and treatment.”
Search and Rescue teams should be trained not only to provide emotional support for those who have experienced great loss and trauma, but also in how to deal with their own range of emotional responses to the distressing and demanding situations they encounter on a regular basis.
It is vital that the psychological well-being of SAR workers be regularly monitored by their peers, superiors, and mental health professionals. They are the first to arrive at any rescue or disaster situation, and the lives of others depend not only on their physical and technical expertise, but on their mental attitude as well.
Although often faced with overwhelming situations, we should never underestimate the resilience of the human spirit in these exceptional people as they risk their lives or come face to face with disaster time and time again.
Dr Nicola Davies is a psychologist and writer with an interest in the psychology behind frontline work.
© FrontLine Security 2015