A natural or manmade disaster can often lead to mass casualties as history showed us. This is actually a common occurrence in poorly developed countries, but it’s also starting to become a somehow familiar picture for the rest of us. Rescuers often experience the same psychological problems as victims. If you happen to survive a destructive event, you will become one of the rescuers, and you will have to deal with the emotional issues following the aftermath.
If we add earthquakes, storms, floods, and other natural disasters as well as the many other manmade disasters which have taken lives in wholesale quantities, we will have quite an impressive list. The point is, no matter where we are in the world, no matter how large or small our community is, the potential for a mass casualty incident exists.
Disasters are generally described in terms of time frame, utilizing five periods.
1st period of a disaster
The first period, the “pre-impact” period, is that period of time during which a high probability of disaster exists. The actual time involved may be hours, weeks, or even months. An example of the pre-impact period is when a community living on the coast learns of the existence of a tropical storm out to sea, which may be on a course towards them.
This stage is often characterized by the “It can’t happen here” train of thought. Unfortunately, a characteristic of this period is inactivity.
2nd period of a disaster
The second time period is the “warning” period. This is a time frame of minutes or hours in duration during which there exists an imminent threat of disaster. This would occur in the event of a declaration of war. In the example of the coastal town, this would be the period of time during which it is established that the tropical storm will reach land at that location.
According to first responders, this period is characterized by a frenzy of activity by those who are unprepared for such a disaster.
3rd period of a disaster
The third period is the “impact” period. This is the actual block of time during which the disaster occurs. Obviously, depending on the nature of the disaster, this time is quite variable.
Due to all the technology surrounding us every day, we can now witness the full force of various disasters and how the impact affects everything (nature, humans, structures, etc.).
Witnessing the impact of a SHTF event is actually a sudden wake-up call for many. They will no longer make the same mistakes, and they will be prepared for similar events.
4th period of a disaster
The fourth period is the “recoil” period. This period usually lasts only minutes. During this time most people will take stock of their surroundings, make a rapid damage assessment (as it applies to them) and initiate rescue operations.
However, the gravity of the disaster can increase timeframe for this period due to various reasons such as reachability of affected areas, insufficient and poorly trained personnel, and social panic.
5th period of a disaster
The last period is the “post-impact” period. This period continues for months after a disaster. During this time, people involved in the disaster realize the extent of destruction and develop their own coping mechanisms. Not surprisingly, rescuers experience the same psychological reactions, in the same percentages, as the survivors.
Coping with mass casualties
In a study conducted by Major Patricia Sanner and Colonel Barry Wolcott (Annals of Emergency Medicine. 7-27-83), it was learned that participants in five separate large military mass casualty simulations reacted similarly to their civilian counterparts involved in actual disaster situations. Two of the simulations were a week in duration; three were 72 hours long. The length of time of the simulations no doubt added the “real-time” effect and thus increased their realism.
Based upon the results of their study, as well as research done by Thomas Durham, Susan McCammon, and E. Jack-son Allison, Jr. (Annals of Emergency Medicine. 9-17-85), on the effects on rescue workers at the scene of an apartment house explosion [12 injured, 1 killed) and a study done by Charles Wilkinson (Am. Journal of Psychiatry 7-83) on the effects on rescuers at the skywalk collapse mentioned earlier, reactions, as well as coping mechanisms, are very similar.
The similarities are not only qualitative but, by percentage, quantitative as well. The majority of rescuers arrive at the scene during the survivor’s recoil and post-impact periods. For the rescuers, however, reactions to the disaster begin en route to the scene. These reactions approximate those of victims during the warning period. Their initial reaction upon arrival is shock at the sight of carnage. More experienced rescue personnel will enter the recoil period almost immediately, providing support and guidance to those rescuers not so experienced.
The emotional impact of mass casualties is much higher than we assume
As Captain Klaus Hartmann, and James Allison, pointed out in their study (Military Medicine 5-81), we are all members of the family of man, and as such, many will experience grief reactions similar to those of a personal loss. These include physical and emotional numbing, pining, restlessness, crying, and preoccupation with thoughts of death, guilt, and anger. Concern for their own safety was admitted by over half the rescuers.
This coupled with a feeling of inadequate resources, increased feelings of guilt. The phenomenon of survivor guilt was experienced. Simply stated, this is a feeling of guilt for having been spared death when many others have died. Guilt is intensified in those rescuers acting as triage officers.
Frustration and anger at the inability to “do more” are experienced as the incident progresses and resources are taxed by depletion of materials, fatigue, and the overwhelming number of injured. Even in simulations, it was noted that the participants began bickering with each other and interpersonal communication deteriorated to the point of shouting or silence. This was seen as an early manifestation of “burn out.”
Rescuers reach a point where they begin to question the value of their every action. At this time, their confidence diminishes to the point where they question their ability to function in their assigned capacity. It is essential that fellow rescuers recognize this change in attitude, and subsequent drop in efficiency, and assist the individual in returning to normal function. In an incident involving mass casualties, it may seem counterproductive to send a rescuer back to a rest area, but that is the only effective way to maintain efficiency in the rescue effort.
Helping Rescuers dealing with mass casualties
In nearly all the studies conducted to this day, it was found that one-third of those involved admitted problems of a psychological nature resulting from the incident. Another one-third did not admit to any problems, but in answering further questions were discovered to be indeed suffering from a reaction to the incident.
The other one-third did not admit to any post-incident problems, nor did they display any evidence of having such problems. It has been shown that when manifestations of burn out occur at the scene of an incident causing mass casualties, the most effective treatment is to remove the workers from work, but not the scene, and discuss their feelings after they have been given warm food and a rest period.
After such assistance the person can then be returned to the operation, performing simple, supervised tasks until effectiveness returns. The individual should be reassured that efforts are effective and though some are dying, many are being saved who would have died. The most often used (and also the most effective) coping method after the incident was to remind one’s self that things could have been worse.
Related article: What You Should Do Within 60 Minutes After SHTF
The second most often used (and also very effective) technique was to put the situation into a more realistic perspective. Not surprisingly, family and others who were at the scene provide the greatest support in overcoming associated problems. Often this support takes the form of merely allowing the individual to air feelings about the incident and his involvement with it.
The psychological problems of people associated with such an incident appear to peak within a few weeks of the incident and, for most, diminish from that time on. Between 75 and 85 percent will have repeated recollections of the disaster. Twenty to forty percent will suffer recurrent dreams. Other manifestations include sadness, fatigue, anxiety, depression, guilt, insomnia, and anorexia (loss of appetite).
Some of those involved reported experiencing severe depression at any reminder of the episode. For some, these manifestations may last for months. The continued manifestation of such problems has been termed Post Traumatic Stress Disorder (PTSD).
Reducing Problems for everyone involved
There are ways to reduce both the incidence and severity of the manifestations of PTSD. Preparation, including having large amounts of medical supplies stored and readily available is one way. An incident causing mass casualties is one in which the sheer number of patients overwhelms available resources.
As the research has shown, this “overwhelming” effect contributes greatly to the stress. By increasing resources available for such an incident we can decrease that stress. Having specific assignments for specific individuals working at such an incident reduces confusion, and therefore stress.
Pre-plan for mass casualties incidents. An aircraft carrying four passengers, crashing into a farmhouse will obviously not require the same response as a jumbo jet crashing into an office building in the middle of the afternoon.
It does little good to have plans that are untried. Realistic training is invaluable. Research has shown that “veteran” rescuers performed much more efficiently at the scene of a mass casualty incident than their inexperienced counterparts.
Realism, in terms of patient appearance, time, and the overwhelming of your available resources, is a necessary part of a mass casualty exercise. To have an exercise which is expected, where there are 10 ambulances responding to 15 patients in the middle of the day, that is completed in an hour is not realistic. Wouldn’t it be a lot more effective exercise if it were held at about 3:00 A.M., you had 10 professionally crafted (made up to appear injured) patients, four of them trapped under debris, and two pickup trucks for transport?
Even four patients and only one ambulance would be a lot more valuable training experience than what most communities attempt.
Related reading: Surviving Stress and PTSD after mass casualties
The point is, practice functioning under imposed, simulated stress so that you can function efficiently when your resources are overtaxed, and the blood is real, and the dead goes to a morgue rather than to their homes.
Many cities now require their emergency service personnel to speak with a counselor after an incident that is particularly traumatic to their psyche. Most municipalities will make provision, for personnel who request to see a counselor, but the individual must request it. As pointed out earlier, one-third of the rescuers involved in an incident causing mass casualties did not realize they were symptomatic of PTSD.
It was found that one-third of the rescuers who realized they were experiencing problems were reluctant to seek help. It’s obvious from this that a visit to a professional stress counselor should be mandatory for anyone involved in a mass casualty incident or any other unusually stressful incident.
In those areas where the involved people are left on their own to cope with their problems it is up to their peers to help them to talk it out and, when necessary, seek professional help. When a policy does not govern our undergoing counseling, we should be sufficiently mature to realize that we need to talk out something that’s bothering us.
It has been established that the majority of people involved in mass casualty incidents later exhibit one or several symptoms of Post-Traumatic Stress Disorder. The incidence and severity of these problems can be reduced by a three-part program: contingency planning and preparation for an incident that would tax all our resources, realistic training in the implementation of those plans, and post-incident counseling to help us recognize and deal with the psychological effects of such an Incident.
Until we realize that it’s okay to admit to being disturbed by certain aspects of our situation, and until we include contingencies for handling the psychological effects of disasters, the number of actual victims resulting from an incident causing mass casualties will continue to be larger than the statistics quoted in the statistics.
This article has been written by James H. Redford MD for Prepper’s Will.