Monday, May 23, 2011

Joplin tornado and psychological first aid

Last night Joplin Missouri was hit with an F4 possibly an F5 tornado.The devastation appears to be prolific. The trauma that many in Joplin are experiencing will only be worse based on the weather report. There has been nonstop rain and thunder since the original tornado struck. To make matters worse, they are predicting weather patterns that are indicative of producing more tornadoes all day and into the evening tomorrow and Wednesday.

I found out this evening that I will probably be going to Joplin. While there, I will be working with those who were impacted either directly or indirectly by the tornado. In order to do that, last night I read a field operations guide for psychological first aid. Psychological first aid intervention strategies will allow me to work with children, adolescents, parents, caretakers and families.

The guidebook discussed how to be nonintrusive and compassionate in making connections with those who were traumatized by the event. It also looked at providing emotional and physical comfort as well as how to remain calm as it orients emotionally overwhelmed survivors. Giving assistance and gaining information are important to allow us to assess people's needs in order to address their concerns and allow them to feel more comfortable.

In a disaster situation you attempt to take care of people's basic needs. To explain this, let's look at Maslow's hierarchy of needs. For those unfamiliar with Maslow, he developed a pyramid that represented a biopsychosocial perspective of the needs that humans have. He felt that we all had five basic needs. They needed to be met from top to bottom, because without the one below the one above was impossible to meet.


Let's look at each level of the pyramid from bottom to top:
1. Physiological needs – water, food, sleep
2. Safety needs – security, order, family
3. Belonging and love needs – friendship, family (psychological)
4. Esteem needs – self esteem, confidence, achievement
5. Self actualization – can only occur when the four lower levels are met



If we do not take care of the physiological needs such as water, food and sleep the safety needs are immaterial. They will not be met. So offer them water, something to eat or a blanket to insure that their physiological needs are taken are of. After the physiological needs are met we begin to look at their safety needs (calm them down by being calm and talking slowly and maintaining eye contact), and then they're belonging and love needs (also called their psychological needs) by listening to them if they want to talk and validating how they feel. Those are the main  things that we focus on in psychological first aid, the bottom three levels. The top two levels will seldom be reached over the first several days and weeks while we are on scene.

There are some things that need to be remembered when doing psychological first aid with disaster survivors and those who have experienced traumas. Never assume that you know what the person is experiencing, as everyone reacts differently to the same situation. Also never assume that the survivors want to talk about the trauma they have just survived. This can actually cause more harm than good.

Sometimes it is best just to be supportive and to remain calm. That allows you to be seen as a person who can give survivors the physical and emotional comfort that they need. Some of the survivors will simply want to be left alone, while others will need to talk. Be prepared to listen, as people will generally tell you how you can assist them and what they need if you listen without interrupting.

The most important goals of psychological first aid are to allow the survivor to function, assist them with their current needs and reduce their distress to the situation. We're not there to debrief the survivor. If we ask them to give details of the traumatic experience of loss they have experienced this could traumatize them even more. We are not there to help them work through their trauma. There are generally many survivors, and we do not have the time guide each of them through their grief. We're there to do psychological triage.

We should reassure them that how they feel is to be expected. We should let them know that they will be angry at times, sad at times and lonely at times. We also need to let them know that if they continue to feel depression, they should talk to a grief counselor.

Never tell them that you know how they feel, that they will feel better soon or that they need to grief. They already know that they need to grieve. Also do not discount how they feel, by saying things like it could be worse or they're better off where they are or everything happens for a reason. Instead allow them to grieve, show them compassion and empathy.

There are some things that will allow survivors to overcome their trauma. Having a strong religious belief, positive beliefs, remaining optimistic or seeing others acting altruistically to support them. We need to find ways to empower them by giving them hope and allowing them to have some dignity.

Finally treat people the way you would want to be treated. Don't talk down to people, don't spread rumors, if you don't know the answer admit it, don't label people and do not guess what people are thinking or feeling. When listening to someone lean in, make eye contact and give them your complete attention. Never forget to let them know you understand what they're saying by reframing questions/active listening and then validate how they feel.

Remember to try and stay calm. This may be difficult because you are in a disaster area. This can be very overwhelming for you. Realize that you may need to talk to somebody. Always use the buddy system. Rotate shifts with them, take breaks and always monitor your own level of stress. If you are stressed out, how can you possibly help someone else destress. Hope this helps anyone who is attempting to volunteer in disaster relief and traumatic situations.

My prayers go out to all of those who were impacted by the storms and tornados that swept across the United States over the past two days and today as well. I hope that you will join me in praying for those impacted as well as the volunteers who are rushing to help out either in person or by donating goods and giving blood.

3 comments:

  1. I live in Joplin. All thoughts and prayers are strongly appreciated - Especially as this new set of severe storms come through tomorrow night.

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  2. EXCELLENT!!! I just forwarded this link to my brother who is taking a team tomorrow. He was coordinating relief effort with another church and about half an hour ago, that church was notified by the Red Cross that they wanted them to be in charge of the handing out of supplies, clothing, etc for them. This article is PERFECT timing for them!!!

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  3. And for those of us who are dealing with people who have been there and are dealing with the aftermath of their emotions. Thanks, David!

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