Practical Tips for Responder Support

Pat Santucci, MD

Many of us will be responders and many of us will be caring for first
responders.

To keep our first responders and our fellow healthcare professionals
functional, WE MUST UNDERSTAND RESPONDER STRESS..

The unfortunate suicide of 3 New Orleans police force makes a specific
point that first responders are a great risk for not only PTSD,domestic
violence, depression but suicide.

Unfortunately, many of these individuals often belong to a culture that
seem to be the last to seek help. The reasons are many: mental health
stigma is too threatening, the fear of job security and "fitness for
duty" , lack of assess to mental health resources or preference for
talking to peers or high performance expectations .

What we saw in New Orleans was an example of how the extreme demand for
services, the antagonism and outright violence toward responders extreme
fear , distress, anxiety, uncertainty of protection, casualities ,
triage decisions and communication difficulties can lead to tragedy. Add
to this long hours, uncertain duration, unfamiliar settings , new
challenges ,criticism and cases where these first responders and our
healthcare workers were not only victims of the hurricane but also of
lawlessness.

**What are some signs that disaster response workers may need stress
management assistance:**

Wandering aimlessly

Shock like state

Isolation from group

Difficulty in remembering instructions

Refusal to follow orders/ leave the scene

Argumentativeness

Difficulty communicating thoughts, making decisions

Limited attention span

Physical signs

Risk taking behaviors

Loss of objectivity

Inability to let down

Substance abuse

Unusual or inappropriate behavior

**On the job stress management:**

Limit work shifts\_ 12 hrs max

Remember: judgment deteriorates with fatigue

Limit exposure to traumatic scenes

Rotate from high intensity to low intensity- off scene to on scene

Emphasize breaks

Use the buddy system

Encourage self monitoring and self regulation

Ample water, healthy snacks, change of clothing, , rest and sleep and
EXERCISE!

Take some private time

Maintain contact with family

Instruct in SELF CARE AND STRESS MANAGEMENT exercises- deep breathing,
relaxation, visual imagery, take time to listen to music, read a book,
etc

Help group look at maintaining positive coping and recognize negative
coping skills'

Positive:

Exercise

Sleep

Minimize alcohol, caffeine ( sure) and sugar ( donuts!)

Find humor

Identify and express feelings

Spend time with others

Prioritize demands

Find spiritual support

Negative:

Destructive venting of anger

Blaming

Risk taking

Poor regulation of rest/work cycle

Impulsive behaviors

Withdrawal

Giving up

HAVE AN END POINT !

Praise performance and provide encouragement

Be sure you have a disaster orientation and start of shift briefing, end
of shift session and an after-action review!

**Returning home:**

Others have kept things going while we were away so there may be
expected positive response from your family, work or even friends.

Take care in relating your experience

Resume routines as soon as possible

Be sensitive to family needs

If you are having difficulty, seek help

How can we help:

There are several programs that might be helpful:

The Florida Center for Public Health Preparedness has an excellent CD on
Understanding Compassion Fatigue . To register online:
[www.fcphp.usf.edu/courses](http://www.fcphp.usf.edu/courses)

In addition, there has been a very successful program called POPPA:
Police Organization Providing Peer Assistance. Peer Officers and mental
health professionals team together .

This is a confidential, voluntary, non-departmental assistance program
for the NYPD started in 1995 in response to 26 NYPD suicides between
-94-95. The components of this program consist of a :

24 hr help line

Trauma response team

Peer outreach program

Peer support groups

Family program

This type of model may be very useful with other disaster responders.