Orientação e Informação para preparar teams para Mass-Casualty

ORIENTATION AND SELF-CARE INFORMATION FOR DISASTER RELIEF
AND RECOVERY WORKERS:
Guidelines for Mass-Casualty Assignments
John D. Weaver, LCSW, BCD, ACSW, CBHE

Airline accidents, bombings, and other mass-casualty events often result in some of the most intense, complex, and stressful disaster relief assignments workers will face. DMH workers offer emergency and preventive mental health services to people affected by disaster and to relief and recovery workers assigned to the operation. This includes providing educational information about current stresses (and future stresses that are predictable), their effects, and methods of coping. It includes offering crisis intervention, information and referral services, and opportunities for defusing and debriefing. DMH workers also provide similar education and support to families of workers that are out on an assignment.

PRE-BRIEFING

Given the unique and stressful nature of mass-casualty incidents, extra time must be taken to prepare all workers for what is to come. This becomes an excellent time for DMH involvement. Taking part in orientation sessions for all incoming staff, offered as workers arrive at the relief site, provides an opportunity to inoculate workers to some of the stresses they may encounter during their assignment. This will also allow DMH workers a chance to set the stage for later defusing and debriefing sessions. Here are some suggestions:

1. Encourage people to take care of themselves (drink enough fluids, take breaks, etc.).

2. Describe the work setting in detail, covering duties, schedule, ID process, and so on. Prepare everyone for the fact that the sights, sounds, and smells they encounter along the way will form memories that may come back to them from time to time.

3. If serving workers/volunteers acting in recovery/identification roles (e.g., those working at a crash site or a morgue), offer education and special precautions on the psychological impact of things with which they may not be familiar. This may include explaining biohazard precautions, stressful working conditions, talking about the other organizations involved and their roles, etc. Offer a graphic description of the sights, sounds, and smells people will encounter.

4. Allow an opportunity for anyone who may feel he or she cannot handle the job to gracefully exit (or be assigned less stressful duties). People already grieving a previous loss, folks who have recently handled another mass-casualty incident, and anyone who for any reason is having second thoughts should be encouraged to speak to their supervisor. They may need to explore a low-stress assignment or they may even need to stop now. If so, be sure to thank them for their concern and assure them they have made the right choice by stopping now. Have someone take them aside and process the feelings they have about their decision to stop.

5. Remind everyone that they may reach that same point of wanting to end their involvement within a few minutes, hours, or days and that it is OK to stop at any time they feel they must do so.

6. Tell everyone about the availability of support services and any requirements that they attend defusing/debriefing sessions. Try to make it a requirement!

7. Encourage use of a buddy system and group meetings, for peer support.

8. Also encourage people to consider journaling. It can help people externalize some things (self debriefing) and help them later, when things slow down and they want to review (and reflect upon) their assignment.
____________________

(UMA SEQUENCIA QUE TEMOS VINDO A ADOPTAR NAS MISSÕES INTERNACIONAIS E QUE PROPONHO PASSE A SER A SEQUENCIA PADRÃO A ADOPTAR PELA PSIC...

COMO SABEM, É-ME MUITO CARA ESTA PARTE DAS MISSÕES! comentário do lud)
retomando o texto...

____________________

DEFUSING AND DEBRIEFING

As important as the DMH role is in all relief operations, it is even more critical in mass-casualty situations. In most relief operations, workers are offered opportunities for defusing and/or debriefing at the end of their assignment, both before they leave and after they have gotten home. The individual or group defusing/debriefing sessions are voluntary and, despite their importance, the sessions may be declined by workers who believe they are too healthy, too macho, too cool, too anxious, and/or too busy.
In mass-casualty situations, daily defusing sessions and end-of-job debriefings are essential for all workers. Attendance at defusing and debriefing sessions should be required for everyone involved in these assignments. This is especially true for those volunteers and staff who are serving in recovery rolls (e.g., trackers and scribes in morgue operations, persons picking up pieces of a crashed plane, and anyone handling personnel effects).
The focus for daily defusing should be on sharing the most important issues of the day and answering any specific questions the workers may pose (e.g., people often want to know what to say to their children about the disaster). Teaching about any predictable stresses/reactions that are to come is another important activity. For example, if cafeteria trays were used to carry body parts or if Vicks was used to mask foul odors, the next time folks use these items they will be reminded of this tragedy. Telling them about this now will offer some measure of stress inoculation. Save any in-depth discussions of feelings for the close-of-business (end-of-job) debriefings, so as to not lower needed defenses and healthy denial too soon to allow completion of the tasks at hand.
Sometimes there will be a wealth of people offering support services. There may be CISM team members and mental health workers that are assigned to FEMA, the FBI, police/fire rescue units, the military, and the airline, in addition to other local volunteers. Other times DMH team members may have little support and may need to help cover everyone else involved. It is always nice to have enough help available to offer a variety of support personnel (representative of gender, racial, ethnic, cultural, and religious diversity) and allow people to select the person with whom they feel comfortable. In fact, many times it seems people prefer to share things with a total stranger than someone they already know or someone they fear may represent interests other than their own.