Preparing for the Stress of Disasters and Mass Emergencies - Federal Emergency Responders

Employees Action to Reduce and Manage Stress

4. Preparedness - Before the Disaster

4.1 Stress Education and Prevention

Our stress reactions reflect our physiological arousal or readiness to respond to demands or dangers in our environment. Through thousands of years of evolution, our stress reactions developed into an integrated finely tuned emergency response system. In response to a potential danger or threat, our stress arousal mobilizes our bodies for action, sharpens our thinking and focuses our attention.

We also quickly make several appraisals of a potential threat to our safety:

• Is the danger real?
• Have we been in this situation before?
• If so, how did we cope?
• Is help available? and
• Is there a vulnerable person who needs help?

In most instances, Emergency Responders will have the necessary personal and work resources to meet the demands and dangers of life and emergency work.

There are two stressful processes that may wear down even the most resilient Emergency Responder or team. First, occupational health research indicates that persistent occupational stress in an unresponsive, unsupportive environment erodes the well being of professionals. Secondly, emergencies and disasters may also become extreme traumatic events that challenge the coping resources of emergency responders.  Without preparation and support, traumatic and or persistent stress will eventually lead to wear and tear on one's health and disrupt one's family and work life, even in the most resilient person. 

The next sections will outline common stress reactions and individual protective actions that can be taken before a disaster.

Figure 1

Figure 1 illustrates how individual, workplace and emergency event factors combine to influence disaster related health outcomes.  The outcomes may range from normal stress reactions followed by healthy adaptation (see common reactions) or problems in work and living (such as family conflicts or loss of productivity or absenteeism) or specific physical health or psychological problems (such as hypertension, heart disease, depression or post traumatic stress).

Examples of individual factors include life experiences such as general health habits, personal and family preparedness or history of trauma and personal loss. Individuals are also born with different biological tendencies such as their temperament and how they physically respond to stress.  Federal agencies and organizations will have support systems in place that will enhance worker safety and health such as ongoing training, multi-jurisdictional emergency exercises and leadership support for both the technological and human side of emergencies. 

4.2 Emergency Event Conditions that may Increase the Level of Stress

• Shift work, long hours and time pressures in situations where events are uncontrolled, happening quickly and lives are threatened;
• Making decisions in chaotic situations, at times with incomplete information;
• Emotional demands of situations where people's health is at stake;
• Witnessing mass casualty incidents including exposure to grotesque situations;
• Interactions with disaster survivors and bereaved family members;
• Adverse work environments such as cramped or toxic environments or exposure to adverse weather conditions (cold, rain, snow, high winds);
• Intense public scrutiny pressure and high expectations to resolve the crisis.;
• Heightened media attention and scrutiny;
• Worry associated with exposure to chemical, biological, radiological, nuclear or unknown/invisible toxic agents;
• Worry or fear for the safety of one's family; and
• Being unprepared for multi-agency, multi-jurisdictional operations.

4.3 Common Stress Reactions

Common stress reactions during or immediately after emergencies and disasters tend to be experienced as mild or transient in emergency professionals. The stress response becomes problematic when symptoms last too long or interfere with daily life.  Early recognition of the signs and symptoms allows you to take steps to eliminate and reduce the source of stress and to initiate stress coping measures. It also enables co-workers and managers to be aware of workplace stress levels and when to offer support to their peers. 

Common Stress Reactions

Physical reactions (how your body responds)

• fatigue
• headaches, stomach aches, dizziness
• back pain, sore muscles
• tightness in neck/shoulders
• low energy or general tiredness
• increased/decreased appetite
• difficulty sleeping
• increased blood pressure, heart rate, respiration

Cognitive reactions (how you think)

• difficulty problem-solving
• shortened attention span
• slowness of thinking and comprehension
• concentration difficulties
• indecision
• worry
• self-blame
• denial

Emotional  Reactions (how you feel)

• anxious
• fear
• irritable / confrontational
• angry
• guilty
• sad
• numb

Behavioural Reactions (how you act)

• restless
• decreased effectiveness
• have difficulty communicating
• unable to rest or let go
• increased alcohol, tobacco or drug use
• being over-controlling
• decreased self-esteem
• social isolation

4.4 Traumatic Stress: Experiencing or Witnessing Life Threatening Events

Another type of occupational risk is traumatic stress.  This refers to stress that occurs following the direct experience or witnessing of life-threatening events. Other factors that may heighten traumatic stress include:

• Exposure to multiple casualties or grotesque sights and smells;
• The extent to which a community has been destroyed;
• Prolonged exposure to danger;
• Direct or suspected exposure to toxic contamination including unknown agents;
• Intentional injury or harm especially to children;
• Prolonged intense recovery work such as searching for human remains; and
• Intense emotional interactions with bereaved family members.

Traumatic events may lead to a condition known as Post Traumatic Stress Disorder (PTSD).  PTSD includes the experience of:

• Intrusive reactions such as difficulty stopping one's thinking about the event;
• Avoidance reactions, that is avoiding people and reminders of the event, including feeling numb or detached; and
• Physical arousal reactions such as easily startled, jumpy, hyper vigilant, irritable and having trouble relaxing.

The duration and intensity of the traumatic event and the availability of supportive resources affect stress reactions and the natural recovery time for the emergency responders. Health professionals who specialize in traumatic stress can often help people with persistent signs of post traumatic stress. The topic of when to seek health services will be discussed later in this guide.

4.5 Personal Action to Prepare for or Reduce Stress Before the Disaster

Maintaining a healthy and balanced lifestyle is an excellent stress prevention and management measure.

Healthy and well-balanced lifestyle includes:

• Healthy nutritional habits;
• Regular physical exercise;
• Recreational activities and hobbies;
• Family and social connections outside of work;
• Adequate sleep and rest;
• Learn positive ways to calm yourself - to relax and decompress after emergencies;
• Prepare an emergency bag in advance in case you are deployed; and
• Personal and family pre-deployment planning.

Family pre-deployment planning includes:

• Discussing your emergency management role with your family;
• Explaining the measures you, your colleagues and workplace will take to look after each other during an emergency or disaster;
• Providing loved ones with contact names and telephone phone numbers if they need to reach you.
• Developing a family emergency plan at home and have emergency supplies on hand, including food, water, emergency aid kits, battery-operated radio, flashlights, and extra batteries (see recommended resources);
• Posting a weekly schedule at home so that family members can be located in an emergency; and  
• Creating emergency plans for child care, elderly parents or relatives and animals/pets who count on you.