Last Updated: May 29th, 2012 - 03:07:02
| Helping Survivors in the Wake of Disaster
By Bruce H. Young, L.C.S.W., Julian D. Ford, Ph.D. and Patricia J. Watson, Ph.D.
Apr 17, 2008, 23:45
Take a look at the devastation left in the wake of Hurricanes Katrina, Rita, and Wilma
Source: Center for History and New Media
Helping Survivors in the Wake of Disaster
A National Center for PTSD Fact Sheet
by Bruce H. Young, L.C.S.W., Julian D. Ford, Ph.D. and Patricia J. Watson,
What are normal stress reactions in the wake of disaster?
Most disaster survivors (children and adults as well as disaster rescue or relief workers)
experience normal stress reactions after a traumatic
event. These reactions may last for
several days or even a few weeks and may include:
- Emotional reactions: shock; fear; grief; anger;
guilt; shame; feeling helpless or hopeless; feeling numb; feeling empty;
diminished ability to feel interest, pleasure, or love
- Cognitive reactions: confusion, disorientation,
indecisiveness, worry, shortened attention span, difficulty concentrating,
memory loss, unwanted memories, self-blame
- Physical reactions: tension, fatigue, edginess, insomnia,
bodily aches or pain, startling easily, racing heartbeat, nausea, change
in appetite, change in sex drive
- Interpersonal reactions: distrust, conflict,
withdrawal, work problems, school problems, irritability, loss of
intimacy, being over-controlling, feeling rejected or abandoned
What are some more severe reactions to a disaster?
Studies show that as many as one in three disaster survivors have severe
stress symptoms that put them at risk for lasting Posttraumatic Stress Disorder
(PTSD). Symptoms may include:
- Dissociation (depersonalization, derealization,
- Intrusive reexperiencing (terrifying memories,
nightmares, or flashbacks)
- Extreme emotional numbing (completely unable to feel
emotion, as if empty)
- Extreme attempts to avoid disturbing memories (such
as through substance use)
- Hyper-arousal (panic attacks, rage, extreme
irritability, intense agitation)
- Severe anxiety (debilitating worry, extreme
helplessness, compulsions or obsessions)
- Severe depression (loss of the ability to feel hope,
pleasure, or interest; feeling worthless)
What aspects of disaster are especially traumatizing?
Certain aspects of disaster are particularly likely to be traumatic. The following are likely to put survivors at
risk for severe stress symptoms and lasting PTSD if the survivor directly
experiences them or witnesses them:
- Life threatening danger or physical harm (especially
- Exposure to gruesome death, bodily injury, or dead or
- Extreme environmental or human violence or destruction
- Loss of home, valued possessions, neighborhood, or
- Loss of communication with or support from close
- Intense emotional demands (e.g., rescue personnel and
caregivers searching for possibly dying survivors, or interacting with
bereaved family members)
- Extreme fatigue, weather exposure, hunger, sleep
- Extended exposure to danger, loss, emotional/physical
- Exposure to toxic contamination (e.g., gas or fumes,
Which individuals are at risk for severe stress responses?
Some individuals have a higher than typical risk for severe stress symptoms
and lasting PTSD, including those with a history of:
- Exposure to other traumas (e.g., accidents, abuse,
assault, combat, rescue work)
- Chronic medical illness or psychological disorders
- Chronic poverty, homelessness, unemployment, or
- Recent or subsequent major life stressors or
emotional strain (e.g., single parenting)
Disaster stress may revive memories of prior trauma and may intensify
preexisting social, economic, spiritual, psychological, or medical problems.
What are the priorities for helping disaster survivors?
Helping disaster survivors, family members, and emergency rescue or disaster
relief personnel requires preparation, sensitivity, assertiveness, flexibility,
and common sense.
- The first priority is to be a team player by
respecting and working through the site chain of command. Being a team player also means pitching
in to provide basic care and comfort to survivors and workers.
- A close second priority is to make personal contact
in a genuine way with survivors and rescue workers. Listen; don't give advice. Ask the survivors how they and their
children are doing and find out what you can do to help. If they need it, provide them with
food, beverages, practical supplies (e.g., clothes, blankets, sunscreen,
magazines, writing implements, telephone), and a comfortable place to sit.
- A third priority is to help them "defuse"
by encouraging them to tell their story. Ask: "Have you ever been
through anything like this before?" "How's it going finding a
place to stay and getting the assistance you need?" "Is there
anyone I can help you get in touch with?" "What do you find
yourself remembering most since this all happened?" "Where were
you when this started?" "What are your top three main concerns
for the next few hours or days?"
- A fourth priority is to carefully assess the risk
factors and symptomatic problems for PTSD or other health problems.
Identify and set up referrals for the persons or families most likely to
be in need of further care.
What are the goals of mental-health providers in response to a disaster?
The goals of on-site mental-health care in the wake of disaster are:*
Help preserve survivors' and workers' safety, privacy, health, and self-esteem.
Get people where they belong; help them to organize, prioritize, and plan.
Help people communicate supportively with family, peers, and service providers.
Screen, triage, and provide crisis care to those at-risk for severe problems.
people to health, spiritual, mental-health, social, and financial services.
Use formal and informal educational opportunities to affirm the normalcy and
value of each person's reactions, concerns, ways of coping, and goals for the
What are the recommended interventions in the wake of a disaster?
- People have their own pace for processing trauma. It is important to convey
to them that they should listen to and honor their own inner pace.
- People should be encouraged to use natural supports and to talk with friends,
family, and co-workers - at their own pace. They should follow their natural
inclinations with regard to how much and with whom they talk.
- If someone wants to speak with a professional in the immediate aftermath
period, it would be helpful to:
- Listen actively and supportively, but do not probe for details and emotional
responses. Let the person say what they feel comfortable saying without pushing
- Validate normal, natural recovery.
Conclusions drawn from outcome studies of Psychological
Debriefing (PD) are mixed. Overall, the conclusions do not confirm the efficacy
of a one-session intervention shortly after the trauma. Psychological Debriefing does not
necessarily decrease psychological disturbances after a trauma . Some studies
found that, in the long run, a single session of psychological debriefing may
hinder natural recovery. Accordingly,
we do not recommend intervention in this initial aftermath period. If people do
present to clinics or counselors requesting help, single-session contact should
be avoided. In these instances people should be scheduled for 2-3 visits over
- For those who have previously experienced traumatic events, subsequent traumatic
experiences may stir up memories and exacerbate symptoms related to previous
traumas. Thus, some people will feel like the most recent trauma is opening
old wounds. These symptoms should also be normalized and are likely to abate
with time. It may be helpful to ask people what strategies they have successfully
used in the past to deal with trauma reactions, and encourage them to continue
using these techniques.
- Individuals who continue to experience severe distress that interferes with
normal functioning after three months are at higher risk for continued problems.
These individuals should be referred for appropriate treatment.
- The construct "Protect, Direct, Connect, Select" was developed
by Diane Myers, unpublished manuscript.
Related Fact Sheets
A critique on the available evidence for Psychological Debriefing (PD), Critical
Incident Stress Debriefing (CISD), and Cognitive-Behavioral Therapy as effective
methods of early intervention
A fact sheet about the risk factors for adverse outcomes in natural and human-caused
Symptoms of PTSD
Learn about how traumatic experiences affect people, what survivors need to know,
and the common symptoms of PTSD
Information on availble treatments for PTSD
Answers basic questions about the signs and symptoms of PTSD, who gets it,
how common it is, and what treatments are available
The information on this Web site is presented for educational purposes only. It is not a substitute for informed medical advice or training. Do not use this information to diagnose or treat a mental health problem without consulting a qualified health or mental health care provider.
All information contained on these pages is in the public domain unless explicit notice is given to the contrary, and may be copied and distributed without restriction.
For more information call the PTSD Information Line at (802) 296-6300 or send email to email@example.com. This page was last updated on Mon Jul 11 13:31:38 2005.
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