Emergency and recovery service personnel, as well as staff members of hospitals, nursing homes, community and human service agencies and the media, may be secondary victims in disasters. Preimpact Assessment. Emergency and recovery services may already include psychological service providers at different hierarchical levels and in coalface teams. As trusted members, they can more easily assess and monitor implementations of lessons from previous disasters. Interventions include countering denial and facilitating implementation of lessons from past disasters in preparations and exercises for future ones. Education and training in biopsychosocial and personal responses in disasters encourages the addition of psychosocial and “human” dimensions to physical concepts. In recently reported disasters psychological services form part of the briefing process. They help to highlight define and facilitate clear roles, territories, cooperation with other services, lines of communication and responsibility (such as for prioritization of rescue efforts). Psychological services facilitate morale by support for leaders, encouraging humour and confidence, as well as realism and preparation for some disappointment as to what will be able to be achieved. Impact
54 Psychological service providers may be part of emergency teams, for instance mental health workers in medical teams. They may provide “psychological first aid” to rescue teams as well as to affected populations.
Assessment includes that of the efficacy and quality of leadership, group interactions, worker-victim interactions and of emergency personnel functioning. Interventions aid survival and preservation activities of the team. Psychological first aid may be applied while physical first aid is administered by others. The former may include holding victims’ hands, explaining procedures, giving reassurance for instance by reinterpreting excessively fearful appraisals. Victim “uncooperativeness” may be quickly clarified and resolved, by dealing with fear for relatives or special life meanings. At the same time staff need support in their stresses, such as recognition of needs to prioritise and thus leave some victims without ideal help. They may be reminded that it is the disaster, not they, which necessitates action according to the “survival calculus”, where scarce help is given where it is most efficacious. Other help may include reminding workers of the need for breaks, during which salient problems may be quickly discussed (decompression) and rosters facilitated. At the end of rosters or of rescue work, food and drink and short sharing of experiences and feelings can be facilitated and workers reminded about possible later responses and warned about potential for accidents (demobilization, defusion). Postimpact This is a time of taking stock, appraising achievements and losses and repairing dints in morale. Personnel need to feel particular and continued support from their managers at this time. They require personal needs arising from the work to be sensitively managed and to have ready access to consultation and counselling. Assessment.
Group and individual achievements and failed objectives, gains and losses, are assessed objectively and subjectively. This is often done in team debriefs. Debrief assessments have operational and psychosocial components. Operational components make objective assessments of services provided and where improvements may be made in the future.
Psychosocial components contrast objective assessments with subjective sense of achievements and failures. Psychosocial aspects of debrief assessments are also interventions in which objective and subjective assessments are realigned. Knowing the culture of the group, as well as individual members’ strengths and vulnerabilities is very helpful in both assessments and interventions.
55 Intervention. The same principles of tailored provision of psychological services and of stress and trauma mitigation as is provided to primarily affected people must also be applied to service personnel. As noted, correct application of these principles requires sophisticated psychological service skills and training which cannot be compressed into simple packages or didactic lessons such as, “Your responses are normal for abnormal circumstances”. Psychological services in this phase include