Rescue Worker Handbook for Stress

8/12/2019 Rescue Worker Handbook for Stress

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TABLE OF CONTENTS

Preface

Introduction

CHAPTER I. Understanding the Stress CycleCommon Stress ReactionsExtreme Stress Reactions

CHAPTER II. Managing Stress efore! "uring! and After an E#entPre$E#ent Planning"uring the Crisis%At the SceneAfter the Crisis

CHAPTER III. Promoting a Positi#e &or'(lace En#ironmentMinimi)ing Stress

CHAPTER I*. Self$Care for Crisis Res(onse ProfessionalsSelf Monitor for Signs of StressMinimi)ing Stress

Preface

Dear Colleague:

The ongoing threat of both natural and human-caused disasters makes it imperative that we

support and encourage the brave men and women who prepare for and respond to these events

our crisis response professionals. These professionals include first responders, public health

workers, construction workers, transportation workers, utilities workers, volunteers, and a

multitude of others.

This easy-to-use pocket guide focuses on general principles of stress management and offers

simple, practical strategies that can be incorporated into the daily routine of managers and

workers. t also provides a concise orientation to the signs and symptoms of stress.

!hile every situation is uni"ue, this document provides some basic tools that can inspire andspread optimism and point the way to effective stress management.

Introduction

#tress prevention and management should address both the worker and the organi$ation.

%dopting a preventive perspective allows both workers and organi$ations to anticipate

stressors and shape responses, rather than simply reacting to a crisis when it occurs &Center

for 'ental (ealth #ervices )C'(#*, +.

Crisis response workers and managerswhich include first responders, public health

workers, construction workers, transportation workers, utilities workers, and volunteersareuni"ue in that they are repeatedly e/posed to e/traordinarily stressful events. This places them
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at higher-than-normal risk for developing stress reactions &0an %merican (ealth 1rgani$ation

)0%(1*, +2.

% 3uide to 'anaging #tress in Crisis 4esponse 0rofessions provides a framework for stress

management strategies for crisis response workers and managers. These strategies are

sufficiently broad so that individuals and groups can select those that best fit their needs andcircumstances. 5ducation about stress and its prevention and mitigation through planning are

essential.

Content Overview

Chapter provides a simple overview of the stress cycle and common stress reactions.

Chapter gives managers strategies for preventing and mitigating stress for

themselves and their workers before, during, and after an event.

Chapter makes suggestions for creating a positive and healthy workplace

environment that will reduce the potential for staff stress.

Chapter 6 offers tips on self-care for workers and managers alike.

Chapter 6 gives references and recommended reading.

Chapters 6 and 6 give selected #%'(#% resources and nternet sites for more

information.

CHAPTER I. Understanding the Stress Cycle

Common Stress Reactions

Extreme Stress Reactions

#tress is an elevation in a person7s state of arousal or readiness, caused by some stimulus ordemand. %s stress arousal increases, health and performance actually improve. !ithin

manageable levels, stress can help sharpen our attention and mobili$e our bodies to cope with

threatening situations.

%t some point, stress arousal reaches ma/imum effect. 1nce it does, all that was gained by

stress arousal is then lost and deterioration of health and performance begins &8u/art

Communications, +9.

!hether a stressor is a slight change in posture or a lifethreatening assault, the brain

determines when the body7s inner e"uilibrium is disturbed the brain initiates the actions that

restore the balance. The brain decides what is threatening and what is not. !hen we facechallenging situations, the brain does a "uick search. (ave we been here before; f so, how

did we feel; !hat was the outcome; Can we cope with the situation now; f there7s doubt as

to any of these "uestions, the stress response goes into high gear &'c5wen < 8asley, ++.

The following provides workers and managers with a list of common stress reactions. 'ost

people are resilient and e/perience mild or transient psychological disturbances from which

they readily bounce back. The stress response becomes problematic when it does not or

cannot turn off that is, when symptoms last too long or interfere with daily life.

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Common Stress Reactions
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Behavioral

ncrease or decrease in activity level

#ubstance use or abuse &alcohol or drugs

Difficulty communicating or listening

rritability, outbursts of anger, fre"uent arguments nability to rest or rela/

Decline in =ob performance absenteeism

>re"uent crying

(yper-vigilance or e/cessive worry

%voidance of activities or places that trigger memories

?ecoming accident prone

Physical

3astrointestinal problems (eadaches, other aches and pains

6isual disturbances

!eight loss or gain

#weating or chills

Tremors or muscle twitching

?eing easily startled

Chronic fatigue or sleep disturbances

mmune system disorders

Psychological/Emotional

>eeling heroic, euphoric, or invulnerable

Denial

%n/iety or fear

Depression

3uilt

%pathy

3rief

Thining

'emory problems

Disorientation and confusion

#low thought processes lack of concentration

Difficulty setting priorities or making decisions

8oss of ob=ectivity

Social

solation

?laming

Difficulty in giving or accepting support or help


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!hile the effects of 0T#D are serious and difficult to deal with, it can be treated by a variety

of forms of psychotherapy and medication.

CHAPTER II. Managing Stress Before, uring, and After an E!ent

Pre!Event Planning "#ring the Crisis$At the Scene

A%ter the Crisis

5veryone who e/periences a disaster is touched by it, including crisis response workers and

managers. 3ood planning can limit health and psychological conse"uences, minimi$e

disruptions to daily life, and contribute to the growth and empowerment of the individual

e/periencing the disaster.

The Bation7s mental health, substance abuse, public health, medical, and emergency response

systems face many challenges in meeting the behavioral health needs that result from

disasters. 'anagement of the behavioral health conse"uences of disasters re"uires 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 minimi$e stress. % thoughtfully planned comunications strategy can lessen

the impact of stress while accomplishing the goal of delivering accurate and timely

information within the organi$ation and to the public &>ederal 5mergency 'anagement%gency )>5'%*, +.

% 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 Bational ncident 'anagement #ystem &B'#, developed by the .#. Department of

(omeland #ecurity &D(#, establishes standardi$ed incident management processes,

protocols, and procedures that all responders A % 3uide to 'anaging #tress in Crisis

4esponse 0rofessions >ederal, #tate, tribal, and localwill use to coordinate and conduct

response actions &>5'%, +.

The B'# ncident Command #tructure &C# provides a consistent, fle/ible, and ad=ustable

national framework within which government and private entities at all levels can work

together to manage domestic incidents, regardless of their cause, si$e, location, or comple/ity.

C# helps all responders communicate and get what they need when they need it &>5'%,

+.

B'# C# 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 andmaintenance.
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>or more information on B'# and B'# C#, go to: >5'%7s !eb site:

htt&'//www(%ema(gov/nims/.

>ollowing are some suggested action steps that may help you and your workers cope with

stress in a more effective manner.

)inimi*ing Stress Be%ore the Crisis

?ecome familiar with the B'# C# and your organi$ation7s role in it and train

personnel in its use.

5stablish clear lines of authority and responsibility to minimi$e stress by eliminating

confusion about who reports to whom &Call < 0fefferbaum, 2@@@ C'(#, 2@@9.

0rovide regular training on stress management techni"ues.

Create a facility evacuation plan and practice drills regularly.

0rovide ongoing training to ensure that staff are thoroughly familiar with safety

procedures and policies.

Develop guidelines to help workers prepare for deployment.

'aintain an updated list of family members7 contact information for each employee.

(ave a pre-established plan for how employees will check on their families if disaster

strikes during work hours &C'(#, 2@@9.

ac' to To(

"#ring the Crisis$At the Scene

%t 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.

)inimi*ing Stress "#ring the Crisis$At the Scene

Clearly define individual roles and reevaluate if the situation changes.

nstitute briefings at each shift change that cover the current status of the work

environment, safety procedures, and re"uired safety e"uipment &C'(#, 2@@9.

0artner ine/perienced workers with e/perienced veterans. The buddy system is an

effective method to provide support, monitor stress, and reinforce safety procedures.

4e"uire outreach personnel to enter the community in pairs &C'(#, 2@@9.

4otate workers from high-stress to lower stress functions &C'(#, 2@@9.

nitiate, encourage, and monitor work breaks, especially when casualties are involved

&'cCarroll, rsano, !right, < >ullerton, 2@@. During lengthy events, implement

longer breaks and days off, and curtail weekend work as soon as possible.

5stablish respite areas that visually separate workers from the scene and the public. %t

longer operations, establish an area where responders can shower, eat, change clothes,

and sleep &C'(#, 2@@9.

mplement fle/ible schedules for workers who are directly impacted by an event

&C'(#, 2@@9. This can help workers balance home and =ob responsibilities.

4educe noise as much as possible by providing earplugs, noise mufflers, or telephone

headsets &C'(#, 2@@9.

'itigate the effects of e/treme temperatures through the use of protective clothing,proper hydration, and fre"uent breaks.
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5nsure that lighting is sufficient, ad=ustable, and in good working order.

8essen the impact of odors and tastes, and protect workers7 breathing by supplying

facemasks and respirators &'cCarroll et al.,2@@.

0rovide security for staff at facilities or sites in dangerous areas, including escorts for

workers going to and from their vehicles &C'(#, 2@@9.

0rovide mobile phones for workers in dangerous environments. 5nsure that staff knowwho to call when problems arise &C'(#, 2@@9.

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A%ter the Crisis

The ending of the disaster assignment, whether it involved immediate response or long-term

recovery work, can be a period of mi/ed emotions for workers. !hile there may be some

relief that the disaster operation is ending, there is often a sense of loss and Eletdown,E with

some difficulty making the transition back into family life and the regular =ob. >ollowing are

some action steps that can help ease the disengagement and transition process for workers

&C'(#, 2@@9.

)inimi*ing Stress %or +orers A%ter the Crisis

%llow time off for workers who have e/perienced personal trauma or loss. Transition

these individuals back into the organi$ation by initially assigning them to less

demanding =obs &C'(#, 2@@9.

Develop protocols to provide workers with stigma-free counseling so that workers can

address the emotional aspects of their e/perience &C'(#, 2@@9.

nstitute e/it interviews andFor seminars to help workers put their e/periences inperspective &?radford < Gohn, 2@@2 and to validate what they have seen, done,

thought, and felt.

0rovide educational inservices or workshops around stress management and self-care.

1ffer group self-care activities and acknowledgments.

CHAPTER III. Pro"oting a Positi!e #or$%lace En!iron"ent

)inimi*ing Stress

% proactive stress management plan focuses both on the environment and the individual. %

clear organi$ational structure with defined roles and responsibilities for linestaff responders,leads, supervisors, and managers reduces the potential for staff stress &Huick, Huick, Belson,

< (urrell, 2@@I. %n effective manager is familiar with the many facets of worker stress and

takes a wide range of steps to integrate stress management strategies in the workplace.

%s a supervisor or manager you must assume shared responsibility for promoting a positive

and healthy work environment, and not rely e/clusively on workers initiating their own self-

care practices. Jou should address the following dimensions when designing a stress

management plan that prioriti$es environmental and organi$ational health:

5ffective management structure and leadership

Clear purpose, goals, and training
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>unctionally defined roles

%dministrative controls

Team support and

0lan for stress management.

'anagers today face the multiple challenges of bringing energy and passion, promoting apositive attitude, and creating an environment in which people feel connected to their work

and their colleagues &8undin, 0aul, < Christensen, +. 'anagers can boost employees7

perception of strong management support through feedback, open communication, and high

visibilitythat is, through a dynamic and supportive leadership style, one . 0romoting a

0ositive !orkplace 5nvironment2 0romoting a 0ositive !orkplace 5nvironment which

engages with others in such a way as to raise one another to high levels of motivation &0eters

< !aterman, 2@A+.

>ollowing are some principles of leadership that you can apply in the ordinary course of your

daily life: 'eet challenges head on be curious and daring create a culture where failure and

error are looked upon as steps toward success demonstrate personal courage to galvani$e a

team or organi$ation that lacks resolve and when life or business deals a bad hand, have faith.

The most inspiring opportunities for courage come when you face the longest odds andys,

+.

ac' to To(

)inimi*ing Stress in the +or&lace

#et the tone by relating to workers with respect and valuing their contributions.

(old regular staff meetings to plan, problem solve, recogni$e accomplishments, andpromote staff cohesiveness &C'(#, +.

Clearly communicate the rationale behind procedural or supervisory changes and

performance e/pectations &C'(#, +.

Create a formal employee suggestion system &C'(#, + and encourage staff to

contribute.

4esolve conflicts early and "uickly &>igley, 2@@.

0repare workers for concrete tasks they may perform through technical training

&'cCarroll et al., 2@@.

%cknowledge that work is often stressful and connect staff to professional help if

necessary.

0romote an atmosphere where attention to one7s emotional state is acceptable andencouraged rather than stigmati$ed or disregarded

CHAPTER I&. Self'Care for Crisis Res%onse Professionals

Sel% )onitor %or Signs o% Stress

)inimi*ing Stress

#upervisors, managers, and workers must assume responsibility for their own self-care. #elf-

awareness involves recogni$ing and heeding early warning signs of stress reactions. There are

many things that you can do to alleviate stress before, during, and after a crisis occurs &seechart on facing page. This chapter outlines some ideas that can be put in place to help you
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and your family cope with whatever emergencies may occur. 0eace of mind and concentration

will be enhanced if you are prepared.

Sel% )onitor %or Signs o% Stress

?e familiar with the signs of too much stress. Common stress reactions are provided inChapter . sually, the symptoms are normal in every way, and simply suggest a need for

corrective action to limit the impact of a stressful situation &'itchell < ?ray, 2@@ #elye,

2@A9. nformation is also provided in Chapter about when stress becomes abnormal and

destructive &0T#D.

!hether you are a supervisor or worker, you may not be the best =udge of your own stress as

you become intensely involved in the disaster work. Therefore, a buddy system, where

coworkers agree to keep an eye on each other7s stress reactions, can be important.

Be%ore the Crisis

Jour entire family should be involved in developing and maintaining a family emergency

preparedness plan. 5/cellent materials on home emergency preparedness are available from

the .#. D(#, >5'%, local chapters of the %merican 4ed Cross, and local 1ffices of

5mergency #ervices.

>or more information on personal preparedness, go to www.ready.gov.

ac' to To(

)inimi*ing ,o#r Stress Be%ore the Crisis

0ost a weekly schedule at home so that family members can be located in an

emergency.

Develop a home safety and evacuation plan, and review and practice it regularly.

Create child care and pet care plans.

Design a plan for how family members will contact each other during a crisis.

>amiliari$e yourself with the disaster plans in your children7s schools and in each

family member7s workplace.

3ather and store emergency supplies including food, water, first aid kits, battery-

operated radio, flashlights, and e/tra batteries.

0repare an emergency bag in advance in case you are deployed. Take advantage of any pre-disaster training and orientation that your organi$ation

provides, including cultural sensitivity awareness.

"#ring the Crisis

tKs normal to e/perience stress during a disaster operation, but remember that stress can be

identified and managed &%id !orkers Betwork, +. Jou are the most important player in

controlling your own stress. There are many steps you can take to help minimi$e stress during

a crisis.

)inimi*ing ,o#r Stress "#ring the Crisis
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%dhere to established safety policies and procedures.

5ncourage and support coworkers.

4ecogni$e that Enot having enough to doE or EwaitingE are e/pected parts of disaster

mental health response.

Take regular breaks whenever you e/perience troubling incidents and after each work

shift. se time off to Edecompress.E 0ractice rela/ation techni"ues such as deep breathing, meditation, and gentle

stretching.

5at regular, nutritious meals and get enough sleep.

%void alcohol, tobacco, drugs, and e/cessive caffeine.

#tay in contact with your family and friends.

0ace self between low and high-stress activities.

A%ter the Crisis

Jou may finish a disaster response pro=ect in a state of physical and emotional fatigue, and

you may feel some ambivalence about giving up your disaster role. ?e aware that you may

e/perience some LletdownM when the disaster operation is over &C'(#, 2@@9. t is important

to give yourself time to stop and reflect on the e/perience and how it changed you. >ollowing

are some action steps that may be helpful to get closure in the weeks after the crisis.

)inimi*ing ,o#r Stress A%ter the Crisis

Consider participating in organi$ed debriefing or criti"ue.

4econnect with your family.

(ave a physical checkup.

Continue normal leisure activities. #tay involved with your hobbies and interests. Consider stress management techni"ues such as meditation, acupuncture, and massage

therapy.

Draw upon your spirituality and personal beliefs. Take advantage of faith-based

counselors and workplace counseling units.

%void using alcohol, tobacco, or drugs to cope with stress. #eek professional

substance abuse treatment if necessary.

se 5mployee %ssistance 0rograms if you need to.

-n S#mmary

#tress management is key to emergency management. #uccessful stress management is built

on prevention and planning, a solid understanding of roles and responsibilities, support for

colleagues, good self-care, and seeking help when needed.

Crisis response professionals may be repeatedly e/posed to uni"ue stressors during the course

of their work. #uccessful implementation of any stress management plan re"uires overcoming

some obstacles and barriers, including priority setting, resource allocation, organi$ational

culture, and stigma.

Taking action to prevent and reduce stress is a critical element of effective emergency

management and supports those in crisis response professions in their collective healing and

recovery.


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-n.ivi.#al A&&roaches %or Stress Prevention an. )anagement

)anagement o% +orloa.

#et task priority levels with realistic work plans.

4ecogni$e that Enot having enough to doE or EwaitingE is an e/pected part of disastermental health response.

Balance. Li%estyle

5at nutritious food and staying hydrated, avoiding e/cessive caffeine, alcohol, and

tobacco.

3et ade"uate sleep and rest, especially on longer assignments.

3et physical e/ercise.

'aintain contact and connection with primary social supports.

Stress Re.#ction Strategies

4educe physical tension by using familiar personal strategies &e.g., take deep breaths,

gentle stretching, meditation, wash face and hands, progressive rela/ation

0ace self between low and high-stress activities.

se time off to EdecompressE and Erecharge batteriesE &e.g., get a good meal, watch

T6, e/ercise, read a novel, listen to music, take a bath, talk to family.

Talk about emotions and reactions with coworkers during appropriate times.

Sel%!Awareness

4ecogni$e and heed early warning signs for stress reactions.

%ccept that one may not be able to self-assess problematic stress reactions.

4ecogni$e that over-identification with or feeling overwhelmed by victims7 and

families7 grief and trauma may signal a need for support and consultation.

nderstand the differences between professional helping relationships and friendships

to help maintain appropriate roles and boundaries.

5/amine personal pre=udices and cultural stereotypes.

4ecogni$e when one7s own e/perience with trauma or one7s personal history interfere

with effectiveness.

?e aware of personal vulnerabilities and emotional reactions and the importance ofteam and supervisor support.

Documents

Rescue Worker Handbook for Stress