The following information was graciously provided by Chaplain Tim Serban, MA, BCC, Co-Author of "Disaster Spiritual Care" and Director of Spiritual Care at Providence Regional Medical Center in Everett, Washington.
The aftermath of a disaster can have far reaching effects on a person or family's ability to return to a normal life. In some cases, the emotional impact can far surpass any structural or personal property loss.
Coping with a Disaster or Traumatic Event
You have just come through a traumatic event which may have required medical attention. You and/or your family's need for medical care may end when you leave the emergency room, however, "emotional aftershocks" often follow the impact of a traumatic event and may occur within hours or take days or even several weeks to appear. These signs and symptoms include physical, emotional, spiritual, behavioral, and thinking processes which may become altered. These are common reactions to a disaster or traumatic event but which often surprise us when they occur. All too often, we do not know what to do or who to turn to if and when they appear.
Common Signs and Symptoms Following a Traumatic Event
It is very common, in fact quite normal for people to experience emotional aftershocks when they have gone through a disaster or traumatic event. Sometimes the emotional aftershocks ( or stress reactions) appear immediately after the traumatic event, or in some cases, weeks or months may pass before the stress reactions appear. The following table shows some of the most common side effects that can be experienced after a traumatic event.
What To Do Next
The signs and symptoms of a stress reaction may last a few days, a few weeks, or a few months and occasionally longer depending on the severity of the traumatic event. With the understanding and the support of loved ones the stress reactions usually pass more quickly. Those in the fields of health care, emergency response, disaster recovery, and public safety have structured processes for addressing critical incident stress.
For the general public, we often rely on the support from the American Red Cross, professional counseling, faith community leaders, each other, or our inner resilience as a means of coping with a crisis. What is important after a personal disaster, is knowing the common signs and symptoms that occur immediately following the disaster and how to get help. Occasionally the traumatic event is so painful that professional assistance from a counselor may be necessary. This does not imply craziness or weakness. It simply indicates that the particular event was too powerful for the person to manage by themselves. In the rare event that a serious symptom such as a heart attack, chest pain or pressure, or shock symptoms are experienced, seek medical attention immediately.
Helping Children Cope
Children are impacted by a disaster just like adults. There is no age limit where children are unaffected. All disasters no matter how big or small will impact a child. Parents are encouraged to pay close attention to a child's reactions following a disaster. Help children feel safe!
Children need to:
- Know how to "be safe"
- Know how to "make a plan" at home, at school, or where to go to be safe between home and school
- Know what to do about "dreams and nightmares". This may be the hardest times for kids and adults alike. Fear of going to sleep is common. Help a child plan their dreams by having them draw a happy picture and place it under their pillow before going to sleep
- Seek help from teachers, school counselors, child grief counselors through your local hospice, children's hospital or on-line
Be patient with yourself and the children. As adults we have the ability to talk about our fears and experience. Children often lack the verbal skills that adults have. Very often their grief and fears show up in their play or their drawings. Find ways to help them "be safe", by being honest and reassuring.
Additional Disaster Related Stress Information from FEMA
The following information was obtained from FEMA and can be viewed here. Also, FEMA provides a publication titled "Helping Children Cope with Disaster", which can also be viewed here.
Disasters can leave children feeling frightened, confused, and insecure. Whether a child has personally experienced trauma, has merely seen the event on television, or has heard it discussed by adults, it is important for parents and teachers to be informed and ready to help if reactions to stress begin to occur.
Children may respond to a disaster by demonstrating fears, sadness, or behavioral problems. Younger children may return to earlier behavior patterns, such as bedwetting, sleep problems, and separation anxiety. Older children may also display anger, aggression, school problems, or withdrawal. Some children who have only indirect contact with the disaster but witness it on television may develop distress.
Who is at Risk?
For many children, reactions to disasters are brief and represent normal reactions to "abnormal events." A smaller number of children can be at risk for more enduring psychological distress as a function of three major risk factors:
- Direct exposure to the disaster, such as being evacuated, observing injuries or death of others, or experiencing injury along with fearing one's life is in danger
- Loss/grief: This relates to the death or serious injury of family or friends
- On-going stress from the secondary effects of disaster, such as temporarily living elsewhere, loss of friends and social networks, loss of personal property, parental unemployment, and costs incurred during recovery to return the family to pre-disaster life and living conditions
What Creates Vulnerabilities in Children?
In most cases, depending on the risk factors above, distressing responses are temporary. In the absence of severe threat to life, injury, loss of loved ones, or secondary problems such as loss of home, moves, etc., symptoms usually diminish over time. For those that were directly exposed to the disaster, reminders of the disaster such as high winds, smoke, cloudy skies, sirens, or other reminders of the disaster may cause upsetting feelings to return. Having a prior history of some type of traumatic event or severe stress may contribute to these feelings.
Children's coping with disaster or emergencies is often tied to the way parents cope. They can detect adults' fears and sadness. Parents and adults can make disasters less traumatic for children by taking steps to manage their own feelings and plans for coping. Parents are almost always the best source of support for children in disasters. One way to establish a sense of control and to build confidence in children before a disaster is to engage and involve them in preparing a family disaster plan. After a disaster, children can contribute to a family recovery plan.
A Child's Reaction to Disaster by Age
Below are common reactions in children after a disaster or traumatic event.
Birth through 2 years: When children are pre-verbal and experience a trauma, they do not have the words to describe the event or their feelings. However, they can retain memories of particular sights, sounds, or smells. Infants may react to trauma by being irritable, crying more than usual, or wanting to be held and cuddled. The biggest influence on children of this age is how their parents cope. As children get older, their play may involve acting out elements of the traumatic event that occurred several years in the past and was seemingly forgotten.
Preschool - 3 through 6 years: Preschool children often feel helpless and powerless in the face of an overwhelming event. Because of their age and small size, they lack the ability to protect themselves or others. As a result, they feel intense fear and insecurity about being separated from caregivers. Preschoolers cannot grasp the concept of permanent loss. They can see consequences as being reversible or permanent. In the weeks following a traumatic event, preschoolers' play activities may reenact the incident or the disaster over and over again.
School age - 7 through 10 years: The school-age child has the ability to understand the permanence of loss. Some children become intensely preoccupied with the details of a traumatic event and want to talk about it continually. This preoccupation can interfere with the child's concentration at school and academic performance may decline. At school, children may hear inaccurate information from peers. They may display a wide range of reactions-sadness, generalized fear, or specific fears of the disaster happening again, guilt over action or inaction during the disaster, anger that the event was not prevented, or fantasies of playing rescuer.
Pre-adolescence to adolescence - 11 through 18 years: As children grow older, they develop a more sophisticated understanding of the disaster event. Their responses are more similar to adults. Teenagers may become involved in dangerous, risk-taking behaviors, such as reckless driving, or alcohol or drug use. Others can become fearful of leaving home and avoid previous levels of activities. Much of adolescence is focused on moving out into the world. After a trauma, the view of the world can seem more dangerous and unsafe. A teenager may feel overwhelmed by intense emotions and yet feel unable to discuss them with others.
Monitor and Limit Your Family's Exposure to the Media
News coverage related to a disaster may elicit fear and confusion and arouse anxiety in children. This is particularly true for large-scale disasters or a terrorist event where significant property damage and loss of life has occurred. Particularly for younger children, repeated images of an event may cause them to believe the event is recurring over and over.
If parents allow children to watch television or use the Internet where images or news about the disaster are shown, parents should be with them to encourage communication and provide explanations. This may also include parent's monitoring and appropriately limiting their own exposure to anxiety-provoking information.
Use Support Networks
Parents help their children when they take steps to understand and manage their own feelings and ways of coping. They can do this by building and using social support systems of family, friends, community organizations and agencies, faith-based institutions, or other resources that work for that family. Parents can build their own unique social support systems so that in an emergency situation or when a disaster strikes, they can be supported and helped to manage their reactions. As a result, parents will be more available to their children and better able to support them. Parents are almost always the best source of support for children in difficult times. But to support their children, parents need to attend to their own needs and have a plan for their own support.
For more information on grief counseling services provided bx FEMA, call 1-800-621-FEMA (TTY 1-800-462-7585)
Trauma Intervention Programs, Inc. (TIP)
In the event a disaster causes severe injury or a loss of life, there are caring people available in your local community to help. One organization that is devoted to trauma intervention and grief counseling is Trauma Intervention Programs, Inc. (TIP National).
TIP is a group of specially trained and thoroughly screened citizen volunteers who provide emotional and practical support to survivors of traumatic events and their families in the first few hours following a tragedy. The volunteers are usually called to crisis scenes by police officers, firefighters, and hospital emergency room personnel. TIP volunteers are citizens of all ages and occupations who have a deep desire to help others. Many of the volunteers have been through a traumatic experience themselves and realize the importance of immediate support from a caring, compassionate, and knowledgeable person.
TIP is a national non-profit, tax exempt organization, whose services are provided to survivors and their families free of charge. These services are made possible by donations from local government, businesses, and individuals.
TIP also provides a "Citizen Resource Guide" that contains a wide range of resources including (but not limited to) community support groups, basic needs, counseling, hotline numbers, senior services, pet loss support, and much more.
Local volunteers are available to respond immediately to crisis situations on a 24-hour, 365-day a year basis. For more information on TIP, visit their website at www.tipnationaI.org.
Additional Resources
The American Red Cross, The Salvation Army, and FEMA, all provide crisis counseling. To find out more about the services these organizations offer, contact the American Red Cross at 1-800-733-2767, The Salvation Army at 562-436-7000, and FEMA at 1-800-621-3362.
The U.S. Department of Health and Human Services, Center for Mental Health Services, provides a valuable booklet on stress management titled "A Guide to Managing Stress in Crisis Response Professions". This useful guide can be viewed at the link above or you can order a copy by calling 1-800-789-2647.
