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the piles of rubble that once resembled an upright
structure are cleared out of the streets and victims
are rushed to local hospitals to seek the necessary
medical care for their physical injuries, what happens
to the emotionally injured victims of this brutal
event? We’re not just discussing those victims
who were present during the devastation, but those
who responded, observed, or had friends or family
members caught in the incident and potentially suffer
from emotional trauma as well. After many such recent
events, it is historical fact that there is a strong
probability for everyone immersed (e.g., victims,
onlookers, friends, relatives, and first responders)
in either a naturally occurring catastrophic event
or an active shooter or terrorist situation to have
a traumatic emotional affect whether it occurs immediately
or after a delayed period of time following such
tragic incidents.
Naturally occurring catastrophic events have a
certain degree of historical predictability. The
unknown factor is intensity due to climatic destabilization.
If one lives in “Tornado Alley” or along
the Gulf Coast, there is, traditionally, decades
of emergency planning and mutual aid for the evacuation,
rescue and recovery phases of the Emergency Management
Recovery Plan. Counseling is rarely addressed in
that plan. Post Traumatic Stress Disorder (PTSD)
is not limited to just combat troops anymore. Those
who dig through rubble caused by catastrophic natural
events looking for dead children and body parts
are never emotionally the same again. Bottom line
is that no one handles those tasks well. Emergency
management planning should take its cue from law
enforcement procedures that mandate counseling for
all officer involved shootings.
A tremendous amount of emphasis is deservedly
placed in the planning, training, and implementation
of physical security measures of the prevention
phase of a man-made disaster. Combined with proper
tactics, techniques, and procedures during the response
phase, it is the recovery phase that could prove
invaluable in the long-term survival of all those
involved in such a devastating attack. Regardless
of where your organization believes counseling belongs
in a crisis management plan, professional crisis
counseling must be made readily available throughout
and after the operational response for all those
involved in or victim to the varying traumatic experiences
involved in such an emotional experience.
A crisis management plan is established by emergency
response agencies with the intent of successfully
taking effect during a catastrophic event in an
organized manner conducive to immediate mitigation
of any given situation. With this in mind, it has
been noted through personal experiences that the
recovery phase is the most overlooked stage in the
average response plan. Furthermore, within the recovery
plan itself, an established posture dedicated to
coping with the emotional trauma of the victims
and first responders is sorely neglected in the
planning and preparation junctures of an operational
plan. Additionally, once the immediate need is identified
during an actual response, those managing and operating
the on-scene command center are not properly trained
to direct and oversee the process necessary to establish
an area suited for counseling or having the appropriate
professionals on hand to deal with this type of
emotional crisis. (Note: while
there are several terms used to identify a unit
command center, such as tactical operations cell,
emergency operations center, etc., we will forego
the various labels and maintain the phrase command
center.) It is within the command center that the
focus for all operational requirements are overseen
with a “big picture” mentality and the
proper manning of this critical response component
will prove invaluable in every facet of emergency
response and recovery.
Once a perimeter is created and the command center
has been established, a primary task for the personnel
assigned to staff it is to create a collection area
and have responders in the field identify potential
victims who were involved in the attack and would
benefit from the trauma support provided by the
command center. This could include, but is not limited
to, witnesses to the attack, the victim’s
family, friends, and colleagues, and first responders
(to include both civilian and emergency personnel).
Once the dust settles and the smoke clears, the
emotional trauma remains as a tertiary affect, and
is often difficult to manage for many of those directly
involved in such an incident. Immediate identification
and professional care of such victims is crucial
at this point in the recovery phase.
Initially, command center staff should be purposefully
and meticulously roaming the area where the incident
occurred in an effort to identify those individuals
who may be suffering emotionally. Once these people
have been cleared of any medical emergency, they
can be taken back to a designated collection area
where the staff will be able to provide, water,
food, blankets, and phones to contact loved ones.
Personnel working the collection area will also
be able to provide information on which hospitals
victims have been taken to. Finally, the staff will
have the necessary information on hand specifically
designed to explain what to expect during the aftermath
of a violent incident, both physically and emotionally.
Crisis counselors will be available for individuals
who may need immediate counseling support regarding
the traumatic event, but what are the immediate
signs to look for when attempting to identify an
individual who may be suffering emotionally?
There are obvious, and not so obvious, signs that
a person is in need of trauma support, these can
include:
- A blank stare
- Crying
- Franticly trying to return things to order
- Wandering around without a purpose
- Difficulty making decisions regarding their
next step
- Startling easily
- Looking confused
In the event an individual does not want to go
to the collection area for immediate care and is
clearly in distress, the roaming counselor can provide
that much needed face-to-face support at the site,
focusing on ensuring the person’s immediate
needs (e.g., medical, water, food, etc.) are met,
then moving on to the emotional needs of the person.
The mobile staff members should have written materials
on hand providing information about possible reactions
to traumatic events and what to expect, as well
as resource cards with information about local helping
resources the victim could access in the future.
The response members dedicated to finding and assisting
trauma victims play a critical role as they carefully
maneuver in and around the disaster scene, as well
as outside the established perimeter. While these
particular individuals do not have to be trained
counselors, they do play a critical role in the
identification and initial treatment of these victims.
Note: It is important to staff
your collection area with enough counselors and
supporting staff members to ensure the victims of
a traumatic event are not overlooked. Support staff
should be part of the identification and referral
phase and can ensure the person is seen by a counselor
if interested. With proper planning, the counseling
staff may be augmented with non-government organizations
(e.g., Red Cross, Regional Church organizations)
or other local and state resources through the utilization
of Memorandums of Understanding/Agreement.
Thus far, we have focused on the victims already
on scene of a response incident and potentially
suffering as a direct result, but what of the trained
professionals who respond to such incidents? As
first responders, many assume they are immune to
such death and destruction as if their personal
emotions have been muted. But, that is definitely
not the case. Regardless of how much training they
have received or how many incidents they have responded
to, there is always that sinking feeling in the
pit of their stomachs they must push through to
better serve those in need. Law enforcement, medical,
and rescue personnel are not machines with an uncanny
ability to turn emotions on and off. They can, and
often times do, fall victim to emotionally charged
stress just like any other unsuspecting victim.
To better facilitate continuous and precise execution
from first responders, all emergency recovery plans
should also include post incident stress related
evaluations and counseling. While some individuals
might find this unnecessary, it will serve as a
long-term mechanism to help ensure a more emotionally
fit individual. Do not allow egos to step in and
disrupt this process as many type-A personalities
are the norm for those who choose to serve as first
responders. It takes a special kind of personality
to voluntarily go into harms way, but that same
personality will inevitably not feel it necessary
to receive their much needed 15 minutes of counseling
support. Supervisors should insist that all participate
in such a program if your first responding agencies
are to be emotionally prepared for the next attack
on our society.
Finally, what happens to the victims once the
traumatic incident is over, the command center is
dismantled, and clean up is over? For the victims
of this attack, the trauma is not over and may linger
for many days, months or even years for some. It’s
at this time that the command center counseling
and support staff will need to be diligent in providing
the victims with resources and referrals to support
agencies and mental health professionals who can
carry on the work initiated immediately after the
attack. For complete recovery, a victim may need
more time to process the incident in order to feel
safe again.
Without the support of trained crisis counselors
and support staff, many victims of natural and man-made
disasters will fall through the cracks and may never
receive the support they desperately need which
may unnecessarily prolong their trauma. Even emergency
response personnel, who may witness trauma on a
daily basis, will eventually burn out emotionally
if not afforded the opportunity to access counseling
related to their specific needs. Ultimately, organizational
supervisors and administrators are responsible for
both the physical and emotional health of their
emergency response teams, and creating an internal
recovery plan that outlines and oversees the emotional
fitness of first responders will also better serve
the community in the overall perspective of keeping
everyone safe.
We would like to thank Dave Mitchell for his professional
assistance and keen insight throughout the editorial
process of this article.
Richard Hughbank is a Major in the US Army with
over 20 years experience in the Military Police
Corps and the Founder and Director of Extreme Terrorism
Consulting, LLC. He’s a certified Master Antiterrorism
Specialist and holds graduate degrees in Security
Management and Counseling. Richard is currently
assigned to the US Air Force Academy as an instructor
and antiterrorism officer and is currently part
of the team assessing and developing strategies
directly involved with traumatic response situations
at USAFA as it relates to active shooter scenarios
at a school or university. He also works for the
Center for Homeland Security at the University of
Colorado at Colorado Springs as a graduate course
instructor in terrorism studies and homeland defense.
Richard can be contacted through his website at
www.understandterror.com.
Michelle Cano is a Licensed Clinical Social Worker.
She graduated from the University of Kansas with
a Master of Social Work in 1994. Since that time,
Michelle has gained a broad range of experience
within the field of mental health and most recently
military mental health care. While working with
wounded soldiers at Brooke Army Medical Center during
the first 3 years of Operations Enduring and Iraqi
Freedom, she witnessed the resiliency of the human
spirit in those soldiers. Currently, Michelle works
as a Clinical Social Worker in the US Air Force
Academy’s Counseling Center in which she helps
Academy Cadets achieve success towards their goal
to become Officers in the US Air Force upon graduation.
Michelle is currently part of the team assessing
and developing strategies directly involved with
traumatic response situations at USAFA as it relates
to active shooter scenarios at a school or university.
The views expressed herein are those of the author’s
and do not purport to reflect the position of the
US Air Force Academy, the Department of the Army,
or the Department of Defense.
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