Helping to Manage Those Who Are Distraught in a Disaster

by Jane-Alexandra Krehbiel BS ES RN

Sooner or later it comes in the experience of human beings that we will experience an horrific event. It will either come within the scope of something personalized, as in the abrupt loss of a family member, or it may come in something extreme, perhaps of the scope of the Great Eastern Earthquake of Japan, and the subsequent tsunami and protracted nuclear crisis which followed. When these challenges to our humanity and psychological integrity come, it would help to have some plans, some touchstone with which to proceed. There is no true preparation for many things. We prepare for parenthood, finding that the intensity of the wave and its occasional demanding nature could not be fully anticipated, and disaster is no different. There are times however, that all we can do is follow a pre-written directive to ourselves, or what is remembered from a preparedness notebook we have collected, and there IS value in this.

Human beings respond very differently as individuals to crises. Even the same individual will respond differently given even slightly different circumstances. They say that if we live long enough, we will know loss, grief, and quite possibly terror, and I am no exception to that. I am not alone. I have done CPR on two of my children on two separate occasions many years apart. One survived, and another did not. Mother’s have found their children with gunshot wounds. Fathers have found their young wives dead in their beds in the morning with an uncertain cause. They have found family members drowned in hot tubs, and the imagery of those moments will stay with them forever. By examining these horrible moments we have a window into what may happen to someone in a natural disaster. Although we might be able to fathom seeing adults we did not know who are the victim of a natural disaster, we might not do so well when we see a child who experienced a similar fate, and we may not do well at all, when we see evidence of the demise of someone we knew, let alone loved. Many of us descend into shock and although we may effectively put off irrationality and being hysterical, we may also not be capable of taking the actions we need to in order to keep our remaining family safe. Again, temporary shock can be useful, so long as we have a plan which allows us to continue to go through the motions.

My goal in this article is to provide some touchstone essentials to surviving the initial disaster, gathering a safe environment, and THEN grieving what you have seen. In an emergency, your first goal is to secure a safe environment for yourself and your family. This means different things for different emergencies. In a sudden tornado, it means getting into your basement secure room with all your family immediately. In Sendai, Japan on that fateful March day, it meant getting your family as far from the ocean as was possible in the time which immediately followed the initial 9.0 quake. There was no time to grieve the loss of things, the destruction of homes, only time to deal with the single purposed goal of evacuation. In emergencies, many times it helps to remain focused and single purposed. If you are faced with a loved one who is in shock to the point of being unable to move, you may simply need to remove him or her physically to a vehicle and go.

Here are some essentials in moving forward during a terrible emergency:

1. Calmly attend to the family member who is in the most acute state of need. First attend to Airway issues, secondly Breathing Issues, and third Circulatory ones.(ABC)

2. When these are addressed, evacuate your family when necessary.

3. Your children and family will largely respond behaviorally to the stage you set. If you are calm and set the stage by giving them clear, calm specific orders, rather than to fall apart, they are very likely to perform the task you have assigned.

4. Always have your “Evacuation Kit” or “Bug Out Bag” available to go.

5. Deal with essential items first. Move your family when needed. Shelter in place if this is required.

6. A percentage of persons with anxiety disorders, behavioral disorders, or a variety of other mental health issues or medical issues may decompensate rapidly in an emergency. Remember this, and handle them gently and carefully. Keep your handguns and other weapons away from your more fragile family members.

7. Check yourself! Many of us sublimate or convert real fear into anger because we find it easier to manage, and because it is more familiar. Be careful that your spouse and children don’t think that you are angry with them when you calmly direct them.

8. Understand that children are very sensitive and very frightened during many emergencies. If you can, grab a favorite soft toy, if one is not already in your bug out bag.

9. One of the most important things you can do for your children during an emergency is to see that they are not separated from you. Following Hurricane Katrina, a number of children were separated from parents, and were so traumatized initially that they could not speak to tell people who they were. Perhaps you could arrange name and address emergency bracelets with name, address and contact data on them. Some authorities suggest that a permanent black magic marker with the child’s name, and pertinent data including parents name, could be written on a child’s back to ensure their rapid return to you should they become separated from you and your family.

10. Obviously, most of us in a frightening emergency will not have tranquilizers or sleeping medications available for our families. It would be a good idea to keep Diphenhydramine 25 mg. tabs (Benadryl) available for adults, normally used as an antihistamine, used for sleep or to calm an excessively nervous adult. An adult over 100 pounds could take two tablets at bedtime and this should aid sleep. Melatonin could also help in this regard. If you have children, you could purchase OTC Diphenhydramine 12.5 mg. Tabs chewable variety for the same purpose. Use the box as a dosage guideline. Since these are valuable medications for allergic emergencies, you should have them in your “Bug Out” bag anyway. This additional use might make you stock extra.

11. Once you are safe, allow your children, and your family to grieve. This should not be restricted. Some of us will grieve immediately, and some will not grieve until we have privacy or until there is some resolution to the disaster. Never tell a child, “Don’t cry”. It is important that grief finds a way to emerge following loss or natural disaster. Holding in grief for an extended period or failing to address the need to grieve not only heightens stress and can leave the person open to potentially serious illness, but grief will find a way to emerge and sometimes it may be inappropriate. I know a couple where the husband did not grieve the loss of his father. Things were simply too busy at work. There were estate matters and business to attend to, and he was on good terms with his father and was relieved that his Dad was no longer suffering after a long illness. He thought everything was fine. The very next time he and his wife attended a funeral, which was the funeral of a family member of someone with whom he worked, he became absolutely distraught. All of a sudden all of the feelings came tumbling out and he was in worse shape than the family members of the man who died, at that moment. Leave time and space for grief. Everyone is different, and they must experience it, in order to be healthy and continue in life, with all of its challenges, both expected, and unexpected.

12. If your family does become temporarily sheltered following a natural or an unnatural disaster, and a physician or prescribing nurse practitioner or physician’s assistant is available, you should allow them to speak briefly with your family members and medicate the members who are having difficulty. Families relate that shelter living, even for brief periods is enormously stressful, and we are seeing the results of this in Eastern Japan with so many sheltered families.

In conclusion, always take care of the essentials. Be ready, evacuate when necessary. Shelter in place when it’s viable and intelligent. Understand that those who are young, old, pregnant, or ill, will have a diminished tolerance to the stressors which invariably occur when life is turned upsdie down, even temporarily. Summon your own best efforts at support, and eventually find time and space for yourself as well. It would be unfortunate to survive a great tragedy, only to have your own life impeded by a new mental illness which was caused by it.

Read More Concerning the Support of Families and Children During Disasters:

http://healingtrauma.pdd.mcc.org/resources/sekar-psychosocial-care-in-disaster-management

http://www.medscape.org/viewarticle/516198

http://www.medscape.org/viewarticle/549999

http://hpod.pmhclients.com/pdf/advances-in-disaster-mental-health.pdf