Center for the Study of Traumatic Stress
CSTS | Department of Psychiatry | Uniformed Services University | 4301 Jones Bridge Road, Bethesda, MD 20814-4799 | www.CSTSonline.org

Sustaining the Psychological Well-Beingof Caregivers While Caring
for Disaster Victims
The magnitude of death andbeen separated from his/her
destruction in disasters andfamily.
Supporting caregivers and encouraging
the often difficult nature of the■■ Poorly resourced areas.
them to practice self-care sustains their
medical response require special
Post-disaster clinical settings
ability to serve victims of disaster.
attention to the needs of healthcare
are often substandard, andproviders. Supporting providers andhealthcare providers mustencouraging them to practice selfadapt to work in under-resourced
care sustains their ability to serve victims of disaster.
environments. Diagnostic tests (e.g. laboratory
Challenges for the Healthcare Provider in the PostDisaster Environment■■ Ruined and socially unstable areas. Disaster areas
are often physically and socially unstable. Accessing
a disaster area to establish a clinical setting can bedifficult due to disturbances of critical infrastructuresuch as airports, roads and communications. Ensuring
the physical safety and security of providers (as well aspatients) is a top priority, but can be a challenge.
■■ The magnitude of suffering. The suffering of thelarge number of people needing assistance, theextreme physical injuries being treated and the almost
unbearable losses that many disaster victims haveexperienced can challenge the fortitude of even themost seasoned healthcare provider and responder.
Disasters often produce mass physical trauma, and theinjuries seen may be more severe or, because of delays
in treatment, more complicated than many providers
are accustomed to treating. Disfiguring injuries such ashead/facial trauma or burns can be especially difficult
emotionally. Disasters may result in the deaths or severe
injuries of children, which can be particularly disturbing
for all involved.
■■ Providing support as well as medical care. Manypatients in the post-disaster setting are distressed andfilled with a range of emotions. They may not havefamily or friends. Healthcare providers often take on
extra support roles. This is especially the case when thepatient is a child who is injured and may have lost oror radiographic studies) and interventions (e.g.
medications or surgeries) that are clinically indicatedmay not be possible due to limited resources. Disastervictims may die from illnesses that clinicians regard
as quite treatable. Some interventions may take place,but in suboptimal conditions. For example, life-saving
amputations may need to be performed, even without
proper anesthesia. It is difficult for healthcare providers
to inflict pain on patients (especially children), even if
necessary.
■■ Unfamiliar and unexpected conditions. Working in adisaster setting often means traveling to an unfamiliar
place, usually away from one’s family and other social
supports. Accommodations may be rudimentary andprovisions of food and water may be somewhat sparse.
■■ Psychological stress of healthcare in disaster settings.
While healthcare providers find the experience ofassisting in a post-disaster environment gratifying,
many also experience the intense emotions andthoughts of loss and concern as part of their work. Somecommon reactions include:
xx Physical and emotional exhaustion
xx Identification with the victims —“It could havebeen my child, my spouse…”
xx Feelings of grief, hopelessness, helplessness, sadness
and self-doubt
xx Difficulty sleeping
xx Guilt over not being able to do more, or having
resources back home that their patients do notContinued

xx Frustration and anger at the healthcare delivery
systemStrategies for Mitigating Psychological Distress in
Healthcare Providers■■ Communicate. Communicate with colleagues clearly
and in an optimistic manner. Identify mistakes ordeficiencies in a constructive manner and correct
them. Compliment each other—compliments canbe powerful motivators and stress moderators. Shareyour frustrations and your solutions. Problem solving
is a professional skill that often provides a feeling ofaccomplishment even for small problems.
■■ Monitor basic needs. Be sure to eat, drink and sleep
regularly. Becoming biologically deprived puts you atrisk and may also compromise your ability to care forpatients.
■■ Take a break. Give yourself a rest from tending topatients. Allow yourself to do something unrelated
to the traumatic event that you find comforting, funor relaxing. This might be taking a walk, listening tomusic, reading a book, or talking with a friend. Somepeople may feel guilty if they are not working full-timeor are taking time to enjoy themselves when so manyothers are suffering. Recognize that taking appropriate
rest leads to proper care of patients after your break.
Remember that your family and friends are awaiting
you at home.

■■ Connect. Talk to your colleagues and receive support

from one another. Disasters may lead people to isolatethemselves due to fear and anxiety. Tell your story andlisten to others.
■■ Reach out. Contact your loved ones, if possible. They
are an anchor of support outside the disaster area.
Keeping in contact may help them better support youupon return home.
■■ Understand differences. Some people need to talkwhile others need to be alone. Recognize and respectthese differences in yourself, your patients and yourcolleagues.
■■ Stay updated. Participate in meetings to stay informedof the situation, plans and events.
■■ Check in with yourself. Monitor yourself over time
for any symptoms of depression or stress disorder:
prolonged sadness, difficulty sleeping, intrusive
memories, hopelessness. Seek professional help ifneeded.
■■ Honor your service. Remind yourself that despite
obstacles or frustrations, you are fulfilling a noble
calling—taking care of those most in need. Recognize
your colleagues—either formally or informally—for
their service.

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org