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Ns. BASMANELLY, M.Kep., Sp.Kep.J

Barton : Quarantelli suggested eight aspects
that were important in
a. Scope Of Impact understanding the stress of disaster:
b. Speed Of Onset
c. Duration Of Impact, And Social a. preparation of the involved
Preparedness. b. social centrality of the affected
c. length of involvement of the
Berren and associates proposed affected population in the crisis
a five-factor typology which: d. rapidity of involvement by the
population in crisis
a. Examines disasters in terms of e. predictability of involvement in a
type of disaster agent f. unfamiliarity of the crisis
b. Duration of disaster g. depth of involvement of the
c. Degree of personal impact population in the disaster
d. Potential for recurrence h. recurrency of involvement.
e. Control over future impact
a. terror and horror e. sociocultural changes such as activities of
involved in experiencing daily living, control over events, social
or witnessing the event support
b. duration of impact; f. networks in the postdisaster environment
unexpectedness of the g. symbolism of events (the meaning of the
event (i.e., those events event to an individual, particularly the
without warning having differentiation between acts of God
the maximum and human-caused technological or
psychological impact) terrorism events)
c. threat, as determined h. interactive and cumulative effects of
by preimpact these and other pre- and postdisaster
interpretation of risk issues upon victims and helpers, who vary
d. impact ratio, or greatly in personality types, predisaster
proportion of the emotional state, and ability to manage
community directly stress
affected or suffering loss
1. Factors related to the individual worker (health, preexisting
stresses, previous traumatic experiences, coping skills, prior
disaster experience, self-expectations, and perception and
interpretation of the event)
2. Interpersonal factors (strength of social support system,
preexisting stresses in relationships, expectations and needs of
others, and status of family members in disaster)
3. Community factors (size of the community, previous degree of
social solidarity, prior disaster experience, amount of social
disruption due to the disaster)
4. Factors related to the disaster (warning, contrast of scene,
type of disaster, nature of the destructive agent, degree of
uncertainty, time of occurrence, duration of the disaster or
continued threat, scope of the disaster, and location of the
Stressors predicting psychological impact for
disaster workers include the intensity and
duration of interactions with families of
deceased victims, identification with the victims,
and role conflict (Bartone, Ursano, Wright, &
Ingraham, 1989; Hodgkinson & Shepherd, 1994).

1. Change in behavior
2. Fear and anxiety: relate to injury, death,
separation, and loss.
3. Reexperiencing the disaster
4. Confusion
5. Regression
6. School problems
7. Sleep problems
8. Physical complaints.
Behavioral Physical
Loss of appetite
Resumption of bed-wetting, Stomachaches
thumb-sucking Nausea
Clinginess Sleep problems, nightmares, refusing
Separation anxiety to sleep alone
Fears of the dark, animals, or Speech difficulties
weather Tics
Avoidance of sleeping alone Loss of bladder or bowel control
Increased crying
Regression Emotional and cognitive
Incontinence Fears
Dependency Anxiety and insecurity
Helplessness and passivity Powerlessness
Hyperactivity Irritability
Lack of verbalization ngry outbursts, temper tantrums
Withdrawal Sadness
Aggressive behavior Confusion
Difficulty identifying feelings

Give verbal assurance, support, rest, and physical comfort

Provide frequent attention
Arrange for consistent caretaking
Provide comforting bedtime routines
Avoid unnecessary separations
Allow time-limited regression
Permit child to sleep in parents room temporarily
Encourage expression regarding losses (i.e., deaths, pets, toys)
Give names to feelings
Offer repeated clarifications when child is confused
Provide explanations of death, if necessary
Monitor media exposure to disaster trauma
Encourage expression through play activities
Behavioral Physical
Decline in school performance Change in appetite
School avoidance Headaches
Aggressive behavior at home or Stomachaches, nausea
school Sleep disturbances, nightmares
Disobedience Hearing or visual problems
Hyperactive or silly behavior
Whining, clinging, acting like a
Emotional and cognitive
younger child Trouble concentrating, distractibility
Fighting with siblings or friends Irrational fears
Increased competition with younger ear of darkness
siblings for parents attention Irritability
Decline in previously responsible Depression
behavior (chores, etc.) Angry outbursts
Inability to enjoy previously Obsessive preoccupation with disaste/ safety
pleasurable activities Responsibility and guilt for the trauma
Withdrawal Monitoring parents anxieties
Traumatic play and retelling Separation anxiety
Excessive concern for others
Give additional attention Listen with understanding to the childs
and consideration repeated retelling of disaster event
Provide realistic, age-appropriate
Patience and tolerance
information about what happened
Relax expectations of and will happen next
performance at home and at Identify and discuss triggers and
school temporarily reminders that bring up memories
Set gentle but firm limits for and feelings
acting out behavior Involve the child in preparation of
Provide structured but family emergency kit, home drills
undemanding home chores Rehearse safety measures for future
and rehabilitation activities disasters
Encourage verbal and play Develop school disaster program for
expression of thoughts and peer support, expressive activities,
feelings education on disasters, preparedness
planning, identifying at-risk children
Behavioral Physical
Decline in academic performance Appetite changes
Rebellion at home or school Headaches
Resistance to authority Gastrointestinal problems
Decline in previous responsible behavior Skin eruptions
Agitation or decrease in energy level, Complaints of vague aches and pains
apathy Sleep problems
Aggressive behavior Menstrual irregularity
Antisocial behavior
Social withdrawal
Substance abuse
Emotional and cognitive
Loss of interest in peer social activities,
Life-threatening acting out (suicide, hobbies, recreation
reckless driving, unsafe sex)
Sadness or depression
Premature adult behaviors and attitudes
(too old, too soon) Feelings of inadequacy and helplessness
Lack of involvement in community Shame and guilt
recovery activities Self-consciousness, preoccupation with self

Give additional attention and consideration

Relax expectations of performance at home and school
Encourage discussion of disaster experiences with peers and
significant adults
Avoid insistence on discussion of feelings with parents
Encourage physical activities
Rehearse family safety measures for future disasters
Support resumption of social activities, athletics, clubs, and so on
Urge participation in community rehabilitation and reclamation
Address suicidal ideation and reckless behavior
Develop school programs for peer support and debriefing,
preparedness planning, volunteer community recovery, identifying
at-risk teens
Behavioral: Physical
Fatigue, exhaustion
Crying Sleep problems (insomnia,
Anger and aggression nightmares, early wakening)
Hyperactivity and restlessness
Arousal and increased startle
Robot-like behavior
Increased level of activity in response to response
disaster-related demands Appetite changes, weight gain or
Decreased efficiency and effectiveness of loss
Headache, bodyaches and pains
Decline in job or academic performance
Absences from work
Muscle tension
Increased irritability, conflict, and Gastrointestinal distress
estrangement within family Impaired immune response
Domestic violence Increase in allergies
Hypervigilance for danger Worsening of chronic health
Excessive disaster planning and preparedness conditions
Isolation and withdrawal Increase in blood pressure
Change in eating patterns Change in libido
Substance abuse Menstrual irregularities
Avoidance of reminders of the disaster
Trigger and anniversary reactions
Emotional and cognitive: Concern about the future:

Shock, disbelief, numbness Despair, hopelessness, helplessness

Changes in religious faith (strengthening
Need for information or weakening of beliefs)
Intrusive thoughts, memories, Decreased self-esteem
or flashbacks Loss of pleasure from regular activities
Sadness and depression Suicidal ideation
Grief about loss of loved ones, Guilt, self-doubt, self-blame
home, health, lifestyle, Memory problems
community Disorientation and confusion
Lost sense of control over life Dissociation (e.g., perceptual experience
Irritability, anger seems dreamlike,
Mood swings spacey, or on automatic pilot)
Frustration with relief efforts Depersonalization, derealization
Decline in cognitive abilities (problem
Anxiety solving, setting priorities,decision making)
Fear, worries, insecurity Impaired concentration and attention
Time distortion
Provide supportive listening and opportunity to talk in detail about disaster
Give opportunities for grieving over losses
Assist with prioritizing and problem solving
Offer information on disaster stress, coping, childrens reactions, and impact of
disaster on the family
Facilitate communication among family members
Encourage use of social supports
Urge practical steps to resume ordinary day-to-day routines
Facilitate resumption of normal family, community, school, and work roles
Assist survivors in taking practical steps to resolve pressing immediate problems
caused by the disaster
Teach relaxation techniques
Address physical health problems or exacerbation of prior conditions
Assess and refer when indicated
Provide information on referral resources
Self-help and coping suggestions
Disaster mental health worker should refer:
Significant disturbance of memory Excessively flat emotional expression
Disorientation to person or place Serious withdrawal
Inability to perform necessary Suicidal or homicidal talk or actions
everyday functions Reckless behavior that may be life-
Inability to care for ones personal threatening (driving under the influence
of drugs or alcohol, unsafe sex, etc.)
Psychotic symptoms
Loss of simple decision-making skills
Frequent and disturbing occurrence of
Inability to recognize familiar people flashbacks, excessive nightmares, and
Preoccupation with a single thought excessive crying
Repetition of ritualistic acts Persistent inappropriate emotion such
as laughter or uncontrolled anger
Extreme hyperactivity or immobility
Serious regression
(inability to be aroused to action)
Inappropriate anger or abuse of others
Abuse (rather than misuse) of
Episodes of dissociation
alcohol or drugs
Inappropriate reaction to triggering
Talk that overflowsshows events
extreme pressure in speech
Disaster mental health Traditional mental
services health services
Goals Prevention of disasterrelated Assessment, treatment planning,
stress reactions and restoration to and treatment, leading to
predisaster level of functioning reduction in or management of
symptoms and long-term
change in the person
Target Normal persons affected Persons identified as having a
Population by disaster diagnosed mental disorder
Objectives Support, education, and Identification of illness that can
development of resources be treated, managed, or cured
Methods CODE-C (consultation, outreach, Psychotherapy, medication, case
debriefing, education, and crisis management
intervention and brief crisis
Settings Community-based, where Office-, clinic-, or hospitalbased
people live, work, congregate,
or seek assistance
Crisis counseling Traditional
a. Active a. Passive
b. Restoration and b. Explorative
enhancement of coping and c. In-depth historical
problem-solving approach
c. Strategic history d. Insight oriented
d. Educational e. Psychological
e. Problems of daily living understanding
f. Prevention f. Intensive treatment or
case management or

Helping the person deal with the current situational crisis

Protecting the person from additional stress or harm
Instilling a sense of hope
Assisting the person in organizing and mobilizing resources, both
internal and external
Helping people return to at least their precrisis level of
functioning: to restore and enhance coping abilities; to restore and
enhance problem-solving capabilities; and to restore and enhance
use of social support
Doing everything possible to promote growth as an outcome
Preventing negative or destructive outcomes
Psychological testing
Personality reconstruction
Reconstruction of defense mechanisms
Development of insight
Working-through of unconscious conflicts
Working-through of historical issues or prior
Family therapy
Treatment of mental disorders
Long-term psychotherapy

active listening; facilitating; ventilation;

clarification; validation of feelings; not
undermining defenses; normalization of feelings;
reframing; and relabeling
assisting survivors in understanding and
accepting reality of situation, use of education
and anticipatory guidance to help survivors
understand crisis reactions and phases of the
recovery process, and teaching and reinforcing
constructive coping strategies, as well as
identifying negative coping strategies
Stress management topics:
Stress management techniques
Phases of disaster for workers 1. Stress inventory
Factors that influence disaster
workers stress reactions (factors 2. Breathing
related to the worker, the role, 3. Stretching
the setting, the community, and 4. Cognitive techniques
the disaster itself )
5. Relaxation
Sources of stress for disaster
workers 6. Meditation
Stressors in specific work 7. Imagination
environments 8. Humor
Stressors in specific roles, for 9. Creative expression
example, outreach worker, crisis
counselor, treating trauma 10. Time management
therapist, supervisor, and 11. Conflict resolution
12. Resistance building and lifestyle:
Personal coping strategies for work schedule, rest, nutrition,
disaster workers before, during,
and after the disaster assignment exercise, social support,
relaxation, and recreation
Potentially traumatizing Physical reactions:
are the following:
Increased pulse, respiration, blood
Natural disasters (earthquake, pressure
hurricane, fire, and flood, etc.)
Nausea, indigestion, diarrhea
Technological or human-caused
disaster (large-scale environmental Psychogenic sweating or chills
pollution, structural collapse, Tremors, especially of hand, lips, and
explosion, etc.) eyes
Health disasters (famine, epidemic, Muffled hearing
etc.) Visual focusing (tunnel vision)
Multiple injury/fatality accidents Headaches
Hostage situation Feeling uncoordinated
Violence in the workplace Lower back pain
Terrorism Feeling a lump in the throat
Riot, civil disturbances Faintness or dizziness
Child-related traumatic events Exaggerated startle reaction
Homicide or suicide Fatigue, exhaustion
High publicity crime of violence, sex, Appetite change
or other unethical or illegal activity Change in sexual desire
Frequent colds, allergies
Physical reactions to consider for immediate
referral to healthcare personnel

Severe shortness of breath

Chest pain
Irregular heartbeat
Dizziness, collapse
Sudden weakness, numbness (especially of face, arm, and leg)
Difficulty speaking or being understood
Sudden severe headache
Heat stroke
Continuing vomiting or diarrhea
Blood in vomit, stool, urine, and sputum
Loss of consciousness
Worsening of chronic health conditions
Cognitive reactions: Cognitive reactions to consider
for referral to a mental health
Memory problems
Difficulty naming objects
Slight disorientation Dangerously diminished
alertness to surroundings
Slowness of thinking, difficulty
comprehending Serious disorientation (to self,
others, place, time)
Mental confusion, difficulty
calculating Significant disturbance of
Difficulty using logic, making
judgments and decisions, problem Preoccupation with a single
solving thought
Loss of ability to conceptualize Inability to make simple
alternatives or to prioritize tasks decisions
Loss of objectivity Delusional or psychotic thinking
Time distortion Suicidal or homicidal ideation
Preoccupation with thoughts of Significant amnesia
the event, intrusive memories Episodes of dissociation
Recurring dreams or nightmares
Emotional reactions: Emotional reactions to
consider for referral to a
Shock, numbness, disbelief
Feeling high, heroic, invulnerable
mental health professional:
Feelings of gratefulness for being alive, relief,
Anxiety, fear Reactions so intense as to
Identification with victims endanger safety of self or others
Anger, resentment
Irritability, restlessness, hyperexcitability
Excessively flat emotion
Sadness, grief, depression, moodiness Persistent emotion out of context
Despair, hopelessness (e.g., hysterical laughing)
Recurrent dreams of the event or other
traumatic dreams; other sleep problems Depression and hopelessness with
Guilt, self-doubt suicidal ideation
Feeling isolated, detached, lost, or abandoned
Anxiety that impairs functioning
Apathy, diminished interest in usual activities
Denial or constriction of feelings; numbness Phobias
Worry about safety of others
Feeling overwhelmed, helpless
Unpredictable mood swings
Behavioral reactions: Behavioral reactions to consider for
Change in ordinary behavior referral to a mental health
patterns professional:
Difficulty communicating
Sleep problems Inability to care for self or carry out
Decreased efficiency and everyday functions
effectiveness of activity Extreme hyperactivity
Outbursts of anger; increased Immobility, muteness
conflict with others
Hyperactivity; inability to rest or Extreme regression
let up Repetition of ritualistic acts
Crying easily or frequently Abuse of alcohol or drugs
Increased use of alcohol, Persistent sleep problems
tobacco, other drugs Inappropriate anger/abuse of others
Changes in eating or sleeping
patterns Violence (or serious threat)
Social withdrawal, distancing, Loss of control
limited contacts with others Self-destructive or antisocial acts
Avoiding reminders of the event Frequent accidents
Hypervigilance for danger;
startle reactions
Spiritual reaction: Spiritual reactions to
consider for referral to a
spiritual care or mental
Crisis of faith (anger at health professional:
God, no longer
practicing faith,
withdrawal from faith Crisis of faith
community) Obsessive religious
Strengthening of faith thoughts
Newfound faith Compulsive religious