A Guide to Managing Stress in Crisis Response Professions

CHAPTER II. Managing Stress Before, During, and After an Event

• Pre-Event Planning
• During the Crisis—At the Scene
• After the Crisis

Everyone who experiences a disaster is touched by it, including crisis response workers and managers. Good planning can limit health and psychological consequences, minimize disruptions to daily life, and contribute to the growth and empowerment of the individual experiencing the disaster.

The Nation's mental health, substance abuse, public health, medical, and emergency response systems face many challenges in meeting the behavioral health needs that result from disasters. Management of the behavioral health consequences of disasters requires a range of interventions at multiple levels in the pre-event, event, and post-event phases.

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Pre-Event Planning

There are many preventive measures that you as a supervisor can put in place before an event occurs which can minimize stress. A thoughtfully planned comunications strategy can lessen the impact of stress while accomplishing the goal of delivering accurate and timely information within the organization and to the public (Federal Emergency Management Agency [FEMA], 2005).

A clear understanding of roles and procedures is critical to helping individuals manage stress. Training and preparedness in incident management procedures are therefore key to stress management.

The National Incident Management System (NIMS), developed by the U.S. Department of Homeland Security (DHS), establishes standardized incident management processes, protocols, and procedures that all responders— 8 A Guide to Managing Stress in Crisis Response Professions Federal, State, tribal, and local—will use to coordinate and conduct response actions (FEMA, 2005).

The NIMS Incident Command Structure (ICS) provides a consistent, flexible, and adjustable national framework within which government and private entities at all levels can work together to manage domestic incidents, regardless of their cause, size, location, or complexity. ICS helps all responders communicate and get what they need when they need it (FEMA, 2005).

NIMS ICS is composed of several components that work together as a system to prepare for, prevent, respond to, and recover from domestic incidents. These components include: command and management, preparedness, resource management, communications and information management, supporting technologies, and ongoing management and maintenance.

For more information on NIMS and NIMS ICS, go to: FEMA's Web site: http://www.fema.gov/nims/.

Following are some suggested action steps that may help you and your workers cope with stress in a more effective manner.

Minimizing Stress Before the Crisis

• Become familiar with the NIMS ICS and your organization's role in it; and train personnel in its use.
• Establish clear lines of authority and responsibility to minimize stress by eliminating confusion about who reports to whom (Call & Pfefferbaum, 1999; CMHS, 1994).
• Provide regular training on stress management techniques.
• Create a facility evacuation plan and practice drills regularly.
• Provide ongoing training to ensure that staff are thoroughly familiar with safety procedures and policies.
• Develop guidelines to help workers prepare for deployment.
• Maintain an updated list of family members' contact information for each employee.
• Have a pre-established plan for how employees will check on their families if disaster strikes during work hours (CMHS, 1994).

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During the Crisis—At the Scene

At the disaster scene, you, as a manager, can provide certain supports for workers to mitigate stress and help them effectively perform the tasks at hand.

Minimizing Stress During the Crisis—At the Scene

• Clearly define individual roles and reevaluate if the situation changes.
• Institute briefings at each shift change that cover the current status of the work environment, safety procedures, and required safety equipment (CMHS, 1994).
• Partner inexperienced workers with experienced veterans. The buddy system is an effective method to provide support, monitor stress, and reinforce safety procedures. Require outreach personnel to enter the community in pairs (CMHS, 1994).
• Rotate workers from high-stress to lower stress functions (CMHS, 1994).
• Initiate, encourage, and monitor work breaks, especially when casualties are involved (McCarroll, Ursano, Wright, & Fullerton, 1993). During lengthy events, implement longer breaks and days off, and curtail weekend work as soon as possible.
• Establish respite areas that visually separate workers from the scene and the public. At longer operations, establish an area where responders can shower, eat, change clothes, and sleep (CMHS, 1994).
• Implement flexible schedules for workers who are directly impacted by an event (CMHS, 1994). This can help workers balance home and job responsibilities.
• Reduce noise as much as possible by providing earplugs, noise mufflers, or telephone headsets (CMHS, 1994).
• Mitigate the effects of extreme temperatures through the use of protective clothing, proper hydration, and frequent breaks.
• Ensure that lighting is sufficient, adjustable, and in good working order.
• Lessen the impact of odors and tastes, and protect workers' breathing by supplying facemasks and respirators (McCarroll et al.,1993).
• Provide security for staff at facilities or sites in dangerous areas, including escorts for workers going to and from their vehicles (CMHS, 1994).
• Provide mobile phones for workers in dangerous environments. Ensure that staff know who to call when problems arise (CMHS, 1994).

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After the Crisis

The ending of the disaster assignment, whether it involved immediate response or long-term recovery work, can be a period of mixed emotions for workers. While there may be some relief that the disaster operation is ending, there is often a sense of loss and "letdown," with some difficulty making the transition back into family life and the regular job. Following are some action steps that can help ease the disengagement and transition process for workers (CMHS, 1994).

Minimizing Stress for Workers After the Crisis

• Allow time off for workers who have experienced personal trauma or loss. Transition these individuals back into the organization by initially assigning them to less demanding jobs (CMHS, 1994).
• Develop protocols to provide workers with stigma-free counseling so that workers can address the emotional aspects of their experience (CMHS, 1994).
• Institute exit interviews and/or seminars to help workers put their experiences in perspective (Bradford & John, 1991) and to validate what they have seen, done, thought, and felt.
• Provide educational inservices or workshops around stress management and self-care.
• Offer group self-care activities and acknowledgments.

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