First Aid For Disaster Stress Trauma Victims: A Guide and Self-help Manual
for The Lay Person Treating Disaster Stress Trauma Victims
Ralph W. Ritchie
Note: The free Ebook edition of this book is no longer available as of July 1, 2006. The Ebook is 14available for purchase both here and from the Google Book Partner Program. If you missed it we are sorry; it was available for almost a year.
Picture this:
It's over. In less than a minute, the earthquake did its damage. Your home and all of your possessions have been reduced to rubble. It begins to sink in. What do I do now? My family is safe, but shaken. My smallest one is curled up into a knot. His sister is crying. But we've never had an earthquake !
OR
We saw it coming. We all made it into the basement. There is nothing above us; it is all gone. We knew that we could be hit by a tornado, but we didn't get around to doing anything about it, other than knowing where to go and hide. Now what?
OR
The plane should be arriving in another minute. Let's go out where we can see it come in. Its late. Maybe we had better go in and find out if anything is wrong. Why are those people crying? It CRASHED? Oh, God.
OR
The house lights will dim in a minute and the concert will begin. What's that? Smoke? Why didn't I look for the exits?
OR
You could be one of the New Orleans refugees whose home and livelihood have vanished. Evacuation is only the beginning of their problems.
Take your pick. They happen to anyone, any time. Don't you think that you should do something NOW. Post Disaster Stress Trauma is the uninvited companion to everyone in all of these incidents. Here is a book that will ease the pain, simply by knowing what to expect and how to cope with it. I am concerned enough that I offer it to all who ask for it, jut click below and get your ebook copy. Download takes about three minutes or less.
Here is a book for the Lay Person to aid in coping with this kind of trauma.
Since this is a book for the Lay Person, the professional name displayed above will be the last time you will find a term not written in plain English in this book. It is for you and me when we need to cope with disaster trauma every bit as necessarily as putting a band aid on a wounded finger.
Circumstances may not permit all trauma cases to be treated by professionals. It is better to have non-professionals provide some intelligent treatment, guided by this book, than to have no treatment at all. In another situation, this is called First Aid.
The purpose of this book is to provide guidelines and understanding for the lay person who may find it necessary to deal with disaster stress trauma.
Terrorism has entered the list of possible disasters, more insidious because of its origin in man. Unlike natural disasters, we have little clues as to when, what, how, or duration. The book has been updated to include this topic, too
Considering the widespread occurrence of major disasters in recent years, there will be many more Disaster Stress Trauma Victims than the professionals can treat, much less identify all those who need help in a timely manner. This book should be part of every emergency pack. When you need it, you really need it.
The effect of the stress is universal, although it may originate from a fire, a natural disaster, waiting for a plane that won?t arrive, or discovering that there has been a shooting at your child?s school. All of these events disrupt life and coping with their result is essential.
The Guide describes symptoms, needs, and cautions of disaster stress trauma treatment. It will also provide you with a vicarious trauma experience through the story of a fictitious family during and after a major disaster so you may better understand the problems and know why you are reading the book.
Written specifically for the lay person, the Guide avoids professional terms wherever possible and presents the necessary information in plain English.
A printed, bound edition, 5 1/2" X 8 1/2",is available: ISBN: 0939656-18-3
The Ebook edition, Adobe PDF format, is also available: ISBN 0-939656-87-6
Chapter 1
The Story
How does a fateful, momentous day begin? Just like any other day. The problems of life go on and the day begins the way so many others have begun.
"John? I have a meeting today. Could you bring home something for dinner?"
"Sure. What'll it be? Dominoes? The Colonel? Or the Golden Arches?"
"Your choice, dear." He nodded acknowledgment.
"Sally? Have you thought any more about vacation?"
"Disney World will be just fine, dear. Terri still wants Arthur to come along, though."
He laughed, "Well, if we have to pay his way, she'll have to stay home. He can go if he can pay his way. We'll take care of the hotel, if he'll bunk with Jimmy."
Sally laughed, "That's not what Terri has in mind."
John called out excitedly, interrupting his shaving, "Well, I'm not ready for the two of them to . . .. No, those are my terms!"
"I'm sure she'll agree. I don't think she could live away from Arthur for a week."
"Fine. Any problems with Jimmy?"
"No, dear. Not if they will allow a leash."
"Well, that kid has got to mind sooner or later."
"He'll probably want Joey to come along when he hears about Arthur."
"Oh, boy. I'll see you tonight. Bye."
John and Sally Wilson are happy and content. They live in a good neighborhood, their two children are doing well in school. John has a steady job and he sees a future in it. Sally is involved in the community. Everything is great; vacation comes up in two months; they're on top of the bills. Yes, everything's great.
Earthquake! In less than one minute, without a hint of warning, everything changes: Their home becomes a pile of rubble. John's job vanishes as the tractor factory is destroyed.
Sally's first thought is for the children; she is panic stricken about their safety. The high school is several miles away; the middle school is not very close. Are my children safe?
At home:
When the quake started, Sally managed to run from the house. Now she stands outside with slippers and a housecoat as her only possessions.
An emergency pack by the back door would have given her the things she needs desperately.
I need some clothes. She starts toward the rubble that was their house, another tremor rattles everything and strikes fear into her heart. She stares at the pile, only now she refuses to go in for anything.
Part II
Chapter 4.
TREATMENT
To help people effectively as a lay person, you need some idea of what a professional therapist might do. That becomes part of our story, too.
Each person will approach the task of treatment according to his/her personality and background: any insight into treatment will help.
Time has passed, We are at The Park
Ellie studied the woman sitting by the fire. She didn't move; she just sat on the overturned bucket, wearing slippers and a thin housecoat, nearly immobile and oblivious of the activity around her. Each tremor seemed to drive her more tightly into a knot.
Here's one. She needs help, but how do I reach her?
Ellie found a box, moved over to the fire, and sat down beside her. She waited until the woman shuddered and huddled closer to the fire. She was cold, even with the flames nearby.
"Hi, my name's Ellie . . .. What's yours?"
Silence.
She waited a while. "Why don't you come over to my car? We're about the same size and I have some extra things that might fit you. That housecoat is no match for this weather."
The woman seemed to come out of her stupor; she looked at Ellie.
"My name's Ellie."
"I'm Sally, Sally Wilson."
"Have family around here?"
"I saw my husband after . . .."
"Where is he?"
"I don't know!" The tears came easily. "He left me to go to school to find our children. He hasn't come back. I should have gone with him. A neighbor, I think, brought me here."
"Where do you live, Sally?"
"On Elm Street, 1496. There's nothing there any more. It's all gone."
"How about that coat?"
"Okay." She tried to get up. Ellie could see she was unsteady and put an arm around her.
They moved out of the light, stumbling, until their eyes adapted.
"Here's my car. Wait a moment." Ellie had managed to grab extra things and there was the emergency pack always in the car. She handed a pair of jeans to Sally.
"Here, these should fit you. We're about the same size." Sally took them and looked around in the dimness.
"Where can I change?"
Ellie laughed, "Who could see you, even if they were looking?" Sally began to pull on the jeans under her housecoat.
"Now, try on this shirt." The housecoat came off and Sally hurriedly donned the shirt.
"Brr, this shirt feels good."
"Here's the jacket."
Sally tried it on and turned to hug her new friend, then she cried in Ellie's arms.
Ellie broke the spell of remorse. "Here is a pair of socks and try these tennies."
Sally stopped crying and leaned against the fender to put on the socks, then the shoes, accepting the fit.
"We need something hot to drink. I think there's a coffee wagon down there. Let's find it."
They sat by a fire and sipped the steaming brew. "How long has your husband been gone?"
"I don't know. He was going to the high school first for Terri, then the middle school for Jimmy. . . oh, God." She broke down again.
"Well, owing to the roads and the distance, not to mention downed trees and power lines, I wouldn't expect them until morning. If he doesn't have a flashlight, they'd be safer traveling after dawn. That's a long wait, but I'm sure they are all right. No need to worry." Sally acknowledged her words.
"Come, we'll find something to do. It will help." Sally nodded, still in a trance with her thoughts.
Sally served coffee for a time and Ellie kept an eye on her while she made notes and tended to other matters. When she began to tire, Ellie took her to a fire.
"Let's talk, Sally. Tell me about your family."
Sally was alert now, she began to describe each of them and tell Ellie about their plans. ". . . and we're going to Disneyland next month and . . . Oh God!" She began to cry.
"Sally. Crying won't help and I'm sure my makeup would be all wrong for you. You don't want to look waterlogged and puffy when they come, do you?"
Sally stopped and brushed away the tears.
Ellie had found Sally in time. She was still responsive and with a little help, was recovering. If she had been in a state of shock, she was over it now and quite able to help at the coffee wagon.
Ellie didn't tell her that the clothes came from a Salvation Army emergency truck. It didn't matter; she was warm and could function now.
"Sally, I'm Ellie Johnson, I'm a Disaster Trauma Therapist. If we don't see each other before the family arrives, you can reach me in the Park, I won't be far from here. I want to meet them. " She smiled and hugged Sally.
"Thanks for all you've done. I think I can make it now. Yes, I want them to meet you, too. Thanks again, Ellie." They hugged and Ellie left. Sally went back to the coffee truck and found ways to help.
Time passes, and Sally has made an appointment for her family. Now she knows how to get John to come.
"My name's Eleanor Johnson, you can call me Ellie, if you want."
"How about shrink!" John had submitted to this meeting to pacify Sally, but he made a point of the entire thing being nonsense. He wasn't going to cooperate.
"John! That's not polite! Just sit still and listen." Sally was furious, but she contained her anger-- most of it. John realized her state and shut up. Both of the children knew storm signals when they saw them. They sighed and waited patiently for this meeting to end and they could escape, as they had done so many times before. Both were grateful that they weren't the center of attention with both of their parents angry.
Ellie ignored the comment, smiled and continued, "The first thing we must understand is that everyone - all your neighbors, everyone who experiences an earthquake has the same feelings. You are not alone."
She waited a moment to let that sink in, then she continued, "The second thing to understand is that every individual perceives the event differently, and as a result the effects are different for every one of us, as many different reactions as there are individuals. No one can feel exactly like you do. Do you understand?" They all nodded positively, but she knew how long it would take for them to really understand.
"How are your hands, John?"
He glanced down at his hands, now without bandages, but still tender. "How'd you know about my hands?"
Sally had told her, but Ellie didn't reveal that. "Heroic acts don't go unnoticed. I've done my homework." He smiled, now more attentive.
"And you, Jimmy, keeping that whole class calm was a real talent."
"Yeah?" Jimmy felt the warmth of praise that he hadn't felt for a long time.
"And Terri, I don't know what prompted you to take first aid, but it certainly was timely and proved your heroism-- in the Wilson tradition." John quietly put his arm around his daughter's shoulders.
"And Sally, your task has been unending and thankless: In addition to your own burden, you have shouldered all the problems of each of the others. That took real courage not to fall apart." They all looked at Sally, wife and mother, with a new insight.
Ellie smiled at them. "There's hardly a single person in town who can't thank you Wilsons for your efforts. You can all be proud."
Ellie has turned hostility and apathy into new feelings of self worth and cast family values into a new mold. Now each member looks at the others in a new light, and each of them has added personal pride. She has put the knowledge gained from the initial talks with Sally to good use. Already, family hostilities have softened and new family pride has surfaced. That is the foundation upon which a new family life will grow.
Ellie continued, "What we have to do is put this experience behind us and establish new goals, work together and start from where we are now. The past won't come back, but there are new experiences, new friends, and a new life ahead."
She noticed Terri's frown, "The Mall will reopen, and what young man wouldn't want an attractive young lady like you as a date."
"But my clothes. . .." She still frowned.
"You'd look good in a burlap sack!" John burst out, with pride.
"I know where there's a burlap sack!" Jimmy's eyes twinkled. They all laughed.
Terri's eyes cast downward, she was embarrassed, "Mother! Make them stop." John hugged his daughter again. She was smiling when she looked up into his eyes.
Sally has joined a therapy group. She doesn't talk about her problems at home or mention the anxious moments she suffers until her family is together at the end of the day. She has improved with the group meetings; sharing seems to help. There's always someone with problems greater than hers, but she hasn't forgotten those long hours alone, not knowing the fate of her loved ones.
Therapy Session
Sally's knuckles are white as she grips the chair. Listening to the plight of others brings back her own anxiety. This is a tough group session. Each story ended on a note of desperation:
"His insurance only covered the bills. I still have to find a job. It's up to me, now."
"We had put off insurance so we could buy our home."
"I'm all alone. My family's gone. I need work, but what is a housewife trained for?" Sally reached out and took Mary's hand, giving it a reassuring squeeze.
"I'm helping at the hospital so I can be with Jerry. He's getting better. Yesterday he recognized me and I bawled like a baby. It was so wonderful." Her husband was one of the lucky ones who was pulled alive from the wreckage at the factory.
There's nothing about the group session that is pleasant, but at the end of it, Sally is refreshed and she feels very fortunate. She has invited Mary to have dinner with them and she resolves to find something to do for each of these women. She has found a way to relieve her own burden by helping others.
There is some question as to whether the Therapist was right in bringing all those severely stressed women together in one session.
On the positive side, the pain and suffering was shared; those with lesser problems were relieved and strengthened, just as Sally was, by trying to help those with greater problems and by placing their own difficulties in a different perspective.
On the negative side, almost everyone in the group wanted individual counseling after the session, including Ellie, who sought help from a colleague. Everyone there relived the disaster as each of the ladies told her story.
Appendix B
Initial and Later Responses to Trauma
1. Initial Responses. Pre-impact to 3 days Post-impact)
a) Physical Responses:
Increased heart rate
Shortness of breath, or asthma
Hyperventilation
Nausea and Vomiting
Extreme trembling or shaking
Excessive sweating
Dizziness
Feeling faint (light-headedness and unsteadiness)
Blurry vision
Hot flashes or flushing
Tingling sensations in arms or hands (paresthesia)
Diarrhea or Urinary problems
Ringing in the ears
Headaches
(b) Mental and Emotional Responses:
Disbelief or denial
Disorientation
Helplessness
Nervousness
Outbursts of anger
Inability to remember recent events
Restlessness
Hypersensitivity to sudden or rapidly changing stimuli (noise, light)
Sleep disturbances
Nightmares
Irritability
Difficulty in concentrating
Difficulty in making decisions
Feeling that familiar things are strange or unreal.
End of excerpts.