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The face of catastrophe: managing psychological trauma in times of stress.

The day was beautiful, without a cloud in the sky. By mid-afternoon, however, the sky had darkened and forecasters talked about the possibility of late afternoon and evening thunderstorms. The weather continued to deteriorate throughout the balance of the day and by evening, the threat of severe weather was present.

At 9:20 p.m., a severe thunderstorm was in the area and a tornado warning was issued. An F4 tornado formed and touched ground at 9:36 p.m. and directly hit the first town in its path. The devastation was complete: more than 75 homes were either completely destroyed or severely damaged; stores and businesses were decimated; and the school sustained severe damage that rendered it useless as a place of shelter. The local hospital, while still functional, was operating on a generator, its staff overtaxed by the number of injured. The death toll was already at 32 and expected to rise. Three of the four places of worship in this community were severely damaged, their structural stability questionable.

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Within hours of this catastrophe, claim and recovery professionals began to arrive to begin the rebuilding process. Their challenge was to safely function in the presence of overwhelming tragedy for an extended period of time while working with highly distressed individuals in dangerous conditions.

Traumatic Environment

Our world is full of events that create crises for individuals and communities. Natural events such as hurricanes, tornadoes, floods, and wildfires take human life, destroy property, and disrupt the sense of normalcy in our lives. In addition, events of intentional human design are now part of our lives. The event may not be highly publicized and may take a more individual face such as an auto accident, illness, or injury. Regardless of cause, when these events occur, it becomes the responsibility of insurance and recovery professionals to assist in rebuilding lives, communities, and industry. Often, professionals are required to work for weeks and months with highly distressed people, in environments that are often dangerous.

What happens to those exposed to the stress of catastrophe? The impact of the event itself will produce powerful negative stress, as will the stress encountered in the catastrophe's aftermath while attempting to rebuild shattered lives. This stress is called traumatic stress. It refers to the emotional, cognitive, behavioral, and physiological experience of those individuals who are exposed to or witness events that overwhelm their coping or problem-solving abilities. The events, referred to as "traumatic incidents," are typically unexpected and uncontrollable. They compromise our sense of safety and security and leave us feeling insecure and vulnerable.

Policyholders who have experienced a traumatic event are subject to a host of traumatic-stress reactions. Claim and recovery professionals who must work with distressed individuals, as well as perform their jobs in dangerous environments for prolonged periods of time, also are vulnerable to the effects of traumatic stress.

What to Expect

What reactions are typically exhibited during traumatic exposure? The following responses are considered normal in the presence of a traumatic incident. They may occur immediately, or may manifest in the days, weeks, or months following a traumatic event.

* Emotional responses may include a highly anxious, active response or possibly a seemingly stunned, emotionally-numb response. Additionally, there may be fear, anger, hostility, uncertainty, and grief about the loss.

* Cognitive responses may include loss of focus and concentration, disorientation, confusion, and difficulty in making decisions and forgetfulness.

* Behavioral responses may include pacing, withdrawal, reluctance to abandon property as well as antisocial behavior.

* Physiological responses may include rapid heart beat, elevated blood pressure, difficulty in breathing, and chest pain. Take immediate action by contacting emergency care if these symptoms appear.

Being able to recognize and manage traumatic stress in the policyholder will assist claim and recovery professionals while working with distressed individuals. This understanding will improve the claim process by helping to build a trusting and supportive relationship.

The stress encountered by claim and recovery staffs while working with distressed individuals in difficult environments can be overwhelming. For that same reason, the same reactions mentioned above for the policyholder may appear in staff members, as well as the following effects:

* Fear of danger and concern for personal injury.

* Increase in error level and productivity as loss of concentration and focus are affected. * Increase in illness from fatigue and poor working conditions, which can lead to an increase in sick leave.

* Visual or auditory distortions that result in poor communication and inaccurate assessment of claim issues.

These reactions may occur immediately or may manifest in a delayed manner over days, weeks, or months. It is also important to realize that the stress encountered in the claim and recovery process is coupled with the normal stressors that staff members encounter in their lives beyond the job. This cumulative effect may present serious stress-related issues.

Caring for the Crew

Protecting the staff should be the primary mission of every organization. Every effort should be made to ensure the staff remains safe and healthy while working in dangerous environments with highly distressed people. The mission of management should be: Keep them safe, and send them home safe. In addition, the following guidelines should be established during incident engagement:

* Assess how your staff is doing, not what it is doing. Show concern for their well-being.

* Provide support as needed by tuning into their needs.

* Send them in prepared. Orient staff to location, GPS, maps, hazards and unique problems that they may encounter.

* Provide realistic expectations for their assignments.

* Create a safe zone, a place to allow them to briefly get away from the devastation lessening the imprints of horror.

* Limit staff exposure to negative sights.

* Set up briefing sessions to allow staff to meet and discuss their experiences.

* Provide updated information.

We live in a volatile, often unstable world that will present traumatic events from a variety of causes. During these times, it is the combined efforts of emergency responders and claim and recovery professionals to protect and rebuild shattered lives and communities.

Understanding the impact of traumatic stress on the policyholder will assist staff in developing a trusting relationship, thus improving the rebuilding process. Additionally; staff will be prepared to safely handle the stress encountered while working with distressed individuals in prolonged negative environments.

Stages of ATSM

The Acute Traumatic Stress Management (ATSM) model is a practical process that addresses emergent psychological needs. It requires no advanced training and is best performed by those who have first contact with individuals exposed to a traumatic event.

* ASSESS FOR DANGER AND SAFETY. Upon arrival at the scene of a traumatic incident, it is crucial that you assess the possible dangers environmentally and from those individuals you will encounter. The author suggests the following tips:

** Research the area and determine potential risks.

** When knocking on a door, stand to the side.

** Approach individuals in a protective stance. Do not stand flatfooted.

** Create a six-to-eight foot reactionary gap between you and the individual.

** Always have the door to your back.

** Avoid dangerous rooms--like kitchens--where knives are available. Always have the policyholder lead you down to the basement, never go first.

** Always let someone know where you will be working and when you expect to return.

** Trust your instincts.

* EVALUATE LEVEL OF RESPONSIVENESS. Those exposed to a traumatic event may appear emotionally numb and unresponsive.

* CONNECT WITH THE INDIVIDUAL. Statements such as, "You seem scared and alone right now," "This has been a difficult experience," and "It's OK not to be OK," demonstrate that you have an understanding of their situations.

* MANAGE EMOTIONS. Remain calm--you are the target not the cause. Allow them to vent. Check your body language, voice tone, and word choice.

* STOP NEGATIVE THOUGHTS. Ask them to tell their story. Help them to understand the normalcy of their reactions to the event.

* PREPARE THEM. The more information you can provide about what is to come, the more you will lessen the fear of the unknown.

Dr. Raymond Shelton is the director of professional development for the American Academy of Experts in Traumatic Stress. He provides training and consultation to the claim and recovery industries in the management of traumatic stress. He may be reached at 516-681-3976, drrayshelton@att.net.
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Title Annotation:Feature Story
Author:Shelton, Raymond
Publication:Claims
Date:Oct 1, 2008
Words:1361
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