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ACCESSIBLE CERT TRAIN-THE-TRAINER UNIT NINE DISASTER Page 1 of 19 Creative Contributions Instructor Guide to Unit Nine: Disaster 1. The goal of this unit is to provide participants an understanding of the impact of disasters on CERT members and survivors of disasters. Further it will help CERT members recognize how stress and trauma manifests differently in members of a diverse community. 2. This is the content for Unit Nine: a. Understanding disaster and post-disaster emotional environments 15 minutes b. Identifying the steps rescuers can take to relieve their own stress 30 minutes c. Diverse communities and social locations 30 minutes o Elderly o Children d. Resource and Referral 15 minutes 2. Unit nine is scheduled for 90 minutes: Time spent on each unit can be maneuvered by dropping content and referring to its placement in the take-home materials. This permits flexibility on the part of the instructor and encourages participants to question or discuss course matters. It also holds the instructor to the time limit for the unit without expecting participants to stay overtime or to have instructors who follow to give up their time. 4. Supplies needed for Unit Nine: LCD projector Computer linked to LCD projector Computer disk containing Unit Seven power point presentation Instructor Guide for Unit Seven Participant’s Manual for CERT 5. Instructional staffing requirements: One instructor is required for this unit. Team teaching is encouraged. 6. Creative Contributions In the column to the right of each of the slides in this unit, there is space to take notes on teaching techniques that are fun, funky, and innovative. Use the classroom time in this train-the-trainer course to share ideas on how to reach people with different learning styles. Seal good ideas, generate some yourself, and utilize other’s ideas as a foundation to develop new training techniques that benefit all course participants! ---PAGE BREAK--- ACCESSIBLE CERT TRAIN-THE-TRAINER UNIT NINE DISASTER Page 2 of 19 Creative Contributions Community Emergency Response Training Disaster Community Emergency Response Training Unit Overview • Examine the impact of disasters on: • CERT members • Survivors • Understand CERT members role: • Learn about possible impacts to survivors and respondents • Manage reactions and work better with others Community Emergency Response Training Unit Objectives • Describe disaster and post-disaster emotional environment • Identify the steps rescuers can take to relieve their own stress • Recognize how stress and trauma manifests differently in members of a diverse community. 1. The concept of this unit is to understand how stress impacts those who respond to a disaster. It is not training participants to become counselors, rather, like the disaster medical units, to do triage. It teaches how to identify who is under stress and how to treat that stress simply on the scene or to refer the impacted individual onto professionals who will deal with the stress on a longer-term basis. ---PAGE BREAK--- ACCESSIBLE CERT TRAIN-THE-TRAINER UNIT NINE DISASTER Page 3 of 19 Creative Contributions Community Emergency Response Training Understanding disaster and post-disaster emotional environments Photograph Andrea Booher 3. People who respond to disasters need to have an understanding about how people might react to the event. Just as people are vastly different, so are their reactions. Community Emergency Response Training Defining Disaster • Disaster is a calamitous or catastrophic situation that brings overwhelming loss or destruction and requires outside resources for response and recovery – Relatively unexpected – Emergency services may be initially overwhelmed – Life, health, environment are endangered 4. Charles Fritz a groundbreaking researcher of disasters indicates a disaster is unusual and catastrophic. A disaster is either due to accidental or hard to control events society or a self-sufficient subdivision of society undergoes after an incident that disrupts all or some of the essential functions of that society. Fritz, Charles E. 1961. “Disasters.” Pp. 651-694 in Contemporary Social Problems, Robert K. Merton and Robert A. Nisbet (eds.). New York: Harcourt ---PAGE BREAK--- ACCESSIBLE CERT TRAIN-THE-TRAINER UNIT NINE DISASTER Page 4 of 19 Creative Contributions Community Emergency Response Training Vicarious Trauma • Empathy can become overgrown • Over-identifying with survivors – Take on their burdens • Occupational Hazard CERT goal – Take care of yourself in order to take care of others. 5. During a disaster, you may see, smell or hear things that will be extremely unpleasant. Even if you don’t experience such events first hand, you will likely interact with others who have. This can turn from empathy to Vicarious Trauma, which is a process of over-identifying with survivors (almost to the point of taking on their burdens as your own). It is an “occupational hazard” for helpers. Taking ownership of others’ problems will compound your stress and affect the overall effectiveness of response and recovery teams. 6. Be alert to (emotional) and physiological (physical) signs of disaster trauma in yourself, as well as in disaster victims, so that you can take steps to alleviate stress. Community Emergency Response Training Individual Well-Being • Transference – taking ownership of the problems, experiences and/or of another person • Self-monitoring – being alert to your ---PAGE BREAK--- ACCESSIBLE CERT TRAIN-THE-TRAINER UNIT NINE DISASTER Page 5 of 19 Creative Contributions Community Emergency Response Training • Irritability or anger • Blaming of self or others • Isolation and withdrawal • Fear of recurrence • Feeling numb or stunned • Feeling helpless • Mood swings • Sadness, depression, and grief • Denial • Concentration and memory problems • Relationship and marital discord • Inability to make decisions 7. This is a good point in the unit to ask participants if they have experienced other of stress. Community Emergency Response Training Physiological • Loss of appetite • Headaches or chest pains • Diarrhea, stomach pain, or nausea • Hyperactivity • Increased alcohol or drug consumption • Nightmares • Inability to sleep • Fatigue or low energy • Lack of coordination How can physiological conditions be masked as Example - dehydration 8. The question on this slide is good to use as a discussion starter. Participants can share their answers with a partner or the group they are sitting with and then some material can be shared with the whole class. How can physiological conditions be masked as ---PAGE BREAK--- ACCESSIBLE CERT TRAIN-THE-TRAINER UNIT NINE DISASTER Page 6 of 19 Creative Contributions Community Emergency Response Training Identifying the steps rescuers can take to relieve their own stress Photographer Paul Roszkowski, USCG 9. You should spend some time thinking about other ways to reduce stress personally. Only you know what makes you able to reduce stress within yourself. Expending the effort required to find personal stress reducers is before an incident occurs. Community Emergency Response Training Stress reduction activities • Rest & sleep • Exercise • Eat a balanced diet of frequent small meals high in protein and low in sugars • Avoid caffeine & carbonation • Balance work, play and rest • Receive as well as give • Connect with others • Maintain routines • Use spiritual resources Maintain previous routines and “rituals” 10. Are there other stress reduction activities members of the class have that work for them? ---PAGE BREAK--- ACCESSIBLE CERT TRAIN-THE-TRAINER UNIT NINE DISASTER Page 7 of 19 Creative Contributions Community Emergency Response Training Team Well Being • Emphasize personal safety first • Stress management training • Role play and exercises Community Emergency Response Training Team Well Being • Phase out workers gradually • Conduct brief discussion after shifts • Arrange for an informal and/or a professional debriefing 11. As a member of a response team you will need to watch for the physical and health of each other. This material is covered in-depth on pages 4 of the participant’s manual. People who have worked on teams that conduct their activities under high stress situations (e.g. medical teams) may want to share techniques with the rest of the group that relieve stress and encourage team building. Community Emergency Response Training The Four Basics… • Eat • Drink water • Physical activity • Avoid caffeine and alcohol Plus talk about your feelings with a “safe” person ---PAGE BREAK--- ACCESSIBLE CERT TRAIN-THE-TRAINER UNIT NINE DISASTER Page 8 of 19 Creative Contributions Community Emergency Response Training Critical Incident Stress Debriefing (CISD) • A comprehensive, multi-component crisis intervention system, carefully based upon the assessment of group needs • Not a stand alone event • Voluntary participation • Confidential 12. CISD is one type of intervention system that is based on a careful assessment of the needs of a group (or sub-groups within a larger organization). A CISD is a formal group process held between 1 to 3 days after the event and is designed to help emergency services personnel and volunteers cope with a traumatic event. Participation in CISD should be voluntary. Community Emergency Response Training Locating a CISD intervention specialists • American Red Cross • Local Fire or Police Department • Community Mental Health Agency • Local Emergency Management Agency 13. CISD should not be used as a stand-alone intervention it should be used in conjunction with other types of intervention (such as: personal stress reduction techniques, informal debriefings, or professional longer term counseling). To schedule a CISD, you should contact the Red Cross, local emergency management agency, or community mental health agency. You could also ask your local fire or police department for help in contacting the appropriate person. ---PAGE BREAK--- ACCESSIBLE CERT TRAIN-THE-TRAINER UNIT NINE DISASTER Page 9 of 19 Creative Contributions Community Emergency Response Training Critical Incident Stress Debriefing 1. Introduction and overview 2. Ask for factual information about the incident 3. Ask for initial thoughts and feelings 4. Sharing reactions since the event Community Emergency Response Training Critical Incident Stress Debriefing 5. Review of stress experienced by participants 6. Instruction of normal stress reactions 7. Closing and referring to professionals 14. If someone in the class has gone through a formal CISD, they might want to share their reactions to the process. Some people react well to this type of processing; others find it unnecessary. It is good to speak to the difference of opinion. There is NO ONE RIGHT WAY of dealing with individual or team stress. ---PAGE BREAK--- ACCESSIBLE CERT TRAIN-THE-TRAINER UNIT NINE DISASTER Page 10 of 19 Creative Contributions Community Emergency Response Training Recognize how stress and trauma manifests differently in members of a diverse community Photographer Melissa Ann Jannsen 15. Don’t let the media define disasters or disaster behavior for you! If you watch television or movie portrayals of people reacting to disasters you have seen disaster mythology represented. Hysteria, widespread irrational activity and dysfunctional behavior may be what can ‘sell the story’ but they are not factual. Community Emergency Response Training Disaster “It’s not Hollywood” • Panic Flight • Looting • Price Gouging • Contagion • Martial Law • Dependency • Disaster Shock • Evacuation Behavior • Shelter Use • Death, Injury, and Damage are dramatic and grotesque • These are all rare occurrences! 16. Disaster that assume that the norms that govern individual and social behavior collapse during a disaster have been proven wrong by many researchers and teams These are explained in detail on page 7of 27 in the participant’s manual, Unit 9. ---PAGE BREAK--- ACCESSIBLE CERT TRAIN-THE-TRAINER UNIT NINE DISASTER Page 11 of 19 Creative Contributions Community Emergency Response Training Disaster Behavior • People generally follow directions, when information is clear and concise • Remain calm • Do not panic • Altruistic • Desire to observe and survey damage • Tell their story • Become active in political process 17. General Patterns of Behaviors in Disasters Although the makers of the ‘movie of the week ‘and tabloid reports create images of hysteria and selfishness in survivors, the actual patterns of behavior of individuals and communities after disasters hit are in sharp contrast to such Social location refers to your place or position in a society. Think about three people sitting on a bench. • All are female. • All are 80 years old. • All live in Miami Beach Florida. • All of them will experience the same hurricane. • One of them is wealthy. • One of them is living with extended family and lives off of her social security and speaks English as a second language. • One is a former teacher who lives with her partner in a double-wide trailer in a retirement community. All these women are in the same geographic location. They share some demographic qualities (age and gender), but their social location (place in society) will impact the way they experience the disaster. How is that so? ---PAGE BREAK--- ACCESSIBLE CERT TRAIN-THE-TRAINER UNIT NINE DISASTER Page 12 of 19 Creative Contributions This makes for good discussion leading into the slide for Social Location Group Activity where people examine their own social location. Community Emergency Response Training Social Location - Group Activity Describe you social location 1. Age, gender, family and cultural upbringing 2. Education and training 3. Physical skills, abilities and limitations 4. Community, neighbors, friends, and support If there were a disaster while you were at home, how would your social location impact your experience? If your were 500 miles from home, how would your social location impact your experience? Community Emergency Response Training Social Location • Injury • Displaced • Personal losses • Degree of exposure • Stuck in/out of town • Newcomers • Isolated “loners” • Disabled • Pre-existing needs, problems, losses • Poor or homeless • Cultural groups • Primary language • Non-traditional families • Children • Elderly 18. Disaster researchers Enarson and Morrow indicate that when members of a community have to deal with issues like restricted housing choices, migration, poverty and other limits to choice they experience risk and disaster differently than those with economic, political or social means. Enarson, Elaine, Betty Hearn Morrow. 1998. The Gendered Terrain of Disaster: Through Women’s Eyes. Praeger, Westport, Connecticut. ---PAGE BREAK--- ACCESSIBLE CERT TRAIN-THE-TRAINER UNIT NINE DISASTER Page 13 of 19 Creative Contributions Community Emergency Response Training Elderly • Information limitations – Electronic communication – Written communication – Lack access to public space and information sharing • Social isolation – Personal – Social • Personal Situations – Financial – Physical Photographer – Andrea Booher 19. One special community you may encounter in a disaster might be the elderly. Some elderly citizens experience depression, trauma and death not directly due to the disaster, but because their ‘taken-for-granted’ life in the pre-disaster phase is so disrupted and cannot be restored in the post disaster period. Disaster research has indicated that older members of society will experience disasters differently due to their social isolation, personal situations and limited access to information. Hooper, Pattijean, Kathleen Fearn-Banks, 2005. “Finding Milton Wright: How Public Relations Disaster Campaigns Impact the Elderly.” The Journal of Promotions Management, vol 12, issue 3. Community Emergency Response Training Elderly • Increasing number of elderly • Barriers of diversity in elderly population • Sensory deprivation • Chronic illness • Multiple losses & emotion attachment • Stigma with welfare & bureaucracy • Loss of residence puts some in a state of uncertainty ---PAGE BREAK--- ACCESSIBLE CERT TRAIN-THE-TRAINER UNIT NINE DISASTER Page 14 of 19 Creative Contributions 20. Page 10 and 11 of the Participant’s Manual detail some of the specific needs elderly people may have during or after a disaster. This slide focuses on the negative issues. Community Emergency Response Training Helping the Elderly • Older people have experiences that can help others respond and recover better! • Older people are a great volunteer source for community service • Physical reactions are normal • Acknowledge feelings • Ask and accept help Photographer – Andrea Booher 21. Along with vulnerabilities that can come with age, older member of our culture can have more time to devote to CERT teams and disaster volunteer opportunities. They may have more life experience relating to trauma or disaster that could help others. This slide stresses the positive. Community Emergency Response Training Youth • Preschool (0 – 6 years) – Total support • Early Childhood (7 – 12 years) – Will follow direction – Need security • Adolescence (12 – 14 years) – Resource with caution • Late Adolescence (15 – 18 years) – Resource but distracted Photographer – Andrea Booher 22. Another specific community you may encounter in disasters might be children. Natural disasters can leave children feeling frightened, confused, and insecure. Whether a child has personally experienced trauma or has merely seen the event on television or heard it discussed by adults, it is important for ---PAGE BREAK--- ACCESSIBLE CERT TRAIN-THE-TRAINER UNIT NINE DISASTER Page 15 of 19 Creative Contributions parents and teachers to be informed and ready to help if reactions to stress begin to occur. Community Emergency Response Training Youth • How to help – Answer questions honestly and do not be afraid to admit where you can not – Do not diminish child’s capacity to understand – Allow and encourage discussion of feelings and concerns without judgments – Encourage expression of feelings particularly through art forms – Focus on facts, not blame or guilt. 23. Children respond to trauma in many different ways. Some may have reactions very soon after the event; others may seem to be doing fine for weeks or months, and then begin to show worrisome behavior. Knowing the signs that are common at different ages can help parents and teachers to recognize problems and respond appropriately. http://www.mentalhealth.samhsa.gov/publications/allpubs/KEN-01- 0093/default.asp Community Emergency Response Training Social Location - Youth • Remember cultural differences – Emotional expression – Children have a social position within their culture and may not be as apt to discuss • Repeated experiences Photographer – Andrea Booher 24. Preschool Age – Children from one to five years in age find it particularly hard to adjust to change and loss. Early Childhood – Children aged five to eleven may have some of the same reactions as younger boys and girls. In addition, they may withdraw from play groups and friends, compete more for the attention of parents, fear going to school, allow school ---PAGE BREAK--- ACCESSIBLE CERT TRAIN-THE-TRAINER UNIT NINE DISASTER Page 16 of 19 Creative Contributions performance to drop, become aggressive, or find it hard to concentrate. Adolescence – Children twelve to fourteen are likely to have vague physical complaints when under stress and may abandon chores, schoolwork, and other responsibilities they previously handled. Community Emergency Response Training Traumatic Stress • About 10% of post-disaster population • No time line – Immediate – Longer term Photographer – Andrea Booher Community Emergency Response Training Traumatic Stress • Trauma responses impact – Cognitive functions – Physical health – Interpersonal relationships • Personal reactions vary – Experience – Level of disruption – Cultural and social resources 25. The National Institute of Mental Health estimates that approximately 10% of survivors experience great distress after a disaster. This may be in the immediate aftermath or in the longer-term recovery process. There is no specific pattern or time-line for feeling traumatized. National Institute of Mental Health. Innovations in Mental Health Services to Disaster Victims. Washington, D.C.: U.S. Department of Health and Human Services; Publication No. (ADM) 90-537, 1990. ---PAGE BREAK--- ACCESSIBLE CERT TRAIN-THE-TRAINER UNIT NINE DISASTER Page 17 of 19 Creative Contributions Community Emergency Response Training Supportive Responses • Listen • Assess for injury or shock • Get uninjured people involved • Empathize • Connect to natural support networks • Referrals – Human Services – Mental Health – Spiritual care 26. The goal of on-scene intervention on the part of CERT members should be to stabilize the incident scene by stabilizing individuals and then referring them to longer term support systems if needed. Community Emergency Response Training Resources & Referral • Do some pre-event research of possible resources of help during and after a disaster – Local & Community Resources – Regional Resources – State Resources – Federal Resources – National Organizations 27. Local, Community, State, Tribal and Federal organizations or agencies that can help you better understand disaster and act as a support and referral system to you during disaster response are good to know before teaching this unit. Tailor this section of the unit to the available resources in your area. ---PAGE BREAK--- ACCESSIBLE CERT TRAIN-THE-TRAINER UNIT NINE DISASTER Page 18 of 19 Creative Contributions Community Emergency Response Training Local Community Resources • Government – Federal – State – Local • Businesses – Chamber of Commerce • Schools – Public and private 28. The more you know your neighborhood, workplace, and your community the more you will discover about the needs of your friends, neighbors, co-workers and fellow citizens. Encourage participants to know their community to be a better responder in a time of disaster. Participants may know of many organizations in the area that can be a part of a list of community resources. Community Emergency Response Training Local Community Resources • Neighborhoods – Geographical, socio-economic – Cultural, ethnic & language – Demographic age groups • Not-for-profit Organizations – National organizations - Community based organizations • Faith Communities – Ecumenical vs. Inter-faith 29. National Organizations - that support disaster response and recovery include The National Voluntary Organizations Active in Disaster (NVOAD) which coordinates planning efforts by many voluntary organizations. Member organizations provide more effective and less duplication in service by getting together before disasters strike. Once disasters occur, NVOAD or an ---PAGE BREAK--- ACCESSIBLE CERT TRAIN-THE-TRAINER UNIT NINE DISASTER Page 19 of 19 Creative Contributions affiliated state VOAD encourages members and other voluntary agencies to convene on site. This cooperative effort has proven to be the most effective way for a wide variety of volunteers and organizations to work together in a crisis. NVOAD serves member organizations through: communication, cooperation, coordination, education, leadership, development, mitigation, convening mechanisms, and outreach. Community Emergency Response Training Unit Summary • Describe disaster and post-disaster emotional environment • Identify the steps rescuers can take to relieve their own stress • Recognize how stress and trauma manifests differently in members of a diverse community. • Who can get traumatized? • What are causes of disaster trauma? • Physical and Physiological • Well being activities • Social Location • Empathy Responses • Referral groups Community Emergency Response Training Announcements before the participants are dismissed: If your CERT class continues on the same day, take your break and return to this classroom. Or If your CERT class continues on another day (next week or next month). Your Homework Assignment is to read Unit Ten: All Hazards.