Acute Traumatic Stress Management

Whatever happens to us during peak emotional experiences in our lives, the gifts of life & the losses of life, will stay with us forever.

In the same way that negative experiences are etched in our minds, so too may the positive force of Acute Traumatic Stress Management. Having someone say & do the right thing, at the right time, can dramatically affect an individual's recovery.

It's important to realize that addressing emergent psychological needs in the aftermath of a tragedy doesn't require an advanced degree in mental health. In fact, the best help is often rendered by people on the front lines - people who take the time to listen & say the right things at the right time.

However, it's important for caregivers to know what to say & do before they reach out to help others. Traumatic experiences, by their very nature, compromise our ability to think clearly & often leave us feeling out-of-control. By having a plan, a traumatic stress response protocol, caregivers will be in control. They'll know what to say & do. They'll be prepared.

Beyond having an understanding of traumatic events & traumatic stress, caregivers must be equipped with practical tools that they can use to help others in the face traumatic exposure. This is the primary goal of Acute Traumatic Stress Management (ATSM).

ATSM was developed as a 10 stage model in order to provide structure during an unstructured period of time - & to enable caregivers to "read off the same page."

i.e., if I was helping an individual to remain in a functional state, by focusing on the facts of a given situation, it would be unfortunate & potentially problematic for another caregiver to walk over & ask, "How ya feeling?"

In fact, this situation was described to me by a New York City police officer in the wake of September 11th. He reported that he was talking with a colleague about extricating bodies when, "...some nut in a red jacket came over & asked me how I was feeling.... I told him to get the ____ out of here. I wanted to kill the bastard!" There's a right thing to say & a right time to say it.

Following, is a brief overview of the 10 Stages of ATSM. For additional information, caregivers are encouraged to read Comprehensive Acute Traumatic Stress Management (www.ATSM.org).

Noteworthy, is that ATSM was built on a strong, empirically-based foundation. The first 4 stages of this model are of primary importance to emergency medical personnel & have to do with considerations surrounding situation management & emergency medical care. The latter 6 stages may be implemented by all caregivers.

It's important to recognize that time constraints & the intensity of individuals' reactions, will vary. Consequently, appropriate intervention may not fall neatly into a linear progression of stages. Caregivers will need to be flexible given the presenting circumstances.

1. Assess for Danger/Safety for Self & Others

Upon arriving at the scene, assess the situation in order to determine whether there are factors that can compromise your safety or the safety of others. You'll be of little help to someone else if you're injured; i.e., don't enter a building that has obviously sustained structural damage. If possible, remove people from the location in order to risk further traumatic exposure.

2. Consider the Mechanism of Injury

Form an initial impression of those impacted by the event. In order to understand the nature of an individual's exposure, it's important to assess how the event may have physically impacted the person - that is, how environmental factors transferred to him.

i.e., if people are unconscious, it's important to know what factor, or factors led to their loss of consciousness. It's also important to consider the perceptual experiences of victims.

i.e., directly observing the bodies of children who have drowned will have a powerful impact on observers. Similarly, the sounds of people moaning will etch a lasting impression in the minds of all who arrive at the scene to help.

Ask yourself whether it's necessary for you to expose yourself to the inner perimeter. Direct exposure to a gruesome scene can compromise your ability to address emergent psychological needs.

3. Evaluate the Level of Responsiveness

It's important to determine if an individual is alert & responsive to verbal stimuli. Does he feel pain? Is he aware of what's occurred, or what's presently occurring? Is he being influenced by a substance?

In the aftermath of Rita & Katrina, it's quite possible that people are experiencing "emotional" shock. Therefore, symptomatology may mimic acute medical conditions (i.e., rapid changes in respiration, pulse, blood pressure, etc.). Recognize that a psychological state of shock may be adaptive in preventing the individual from experiencing the full impact of the event too quickly. Keep in mind that during traumatic events, people can experience a wide range of emotional reactivity.

4. Address Medical Needs

5. Observe & Identify

Observe & identify those who've been exposed to the event. Very often, these individuals will not be the direct victims. They may be secondary or hidden victims.

As I stated previously, witnessing, or even being exposed to another individual who has faced traumatic exposure, can cause traumatic stress.

As you observe & identify who has been exposed to the event (i.e., directly &/or indirectly), begin to observe & identify who is evidencing signs of traumatic stress.

An awareness of the emotional, cognitive, behavioral & physiological reactions suggestive of traumatic stress is important. Carefully look around you.

Anyone, including yourself, may be a direct or hidden victim. This observation & identification stage of ATSM may be viewed as the first traumatic stress - specific stage.

6. Connect with the Individual

Introduce yourself & let people know your role (e.g., "My name is Ron, I'm a social worker"). If the individual isn't physically injured & he has been cleared by emergency medical personnel, move him away to prevent further traumatic exposure.

Begin to develop rapport by making an effort to understand & appreciate his situation. A simple question such as, "How are you doing?" may be used to engage the individual. Use appropriate non-verbal communication (e.g., eye contact, body turned toward him, a gentle touch, etc.).

Recognize that during a traumatic experience, individual reactions may present on a continuum from a totally detached, withdrawn reaction to the most intense displays of emotion (e.g., uncontrollable crying, screaming, panic, anger, fear, etc.).

In view of the magnitude of these hurricanes, you may likely find yourself working to connect with small groups of individuals.

7. Ground the Individual

When you have established a connection with an individual or small group of individuals (e.g., eye contact, body turned toward you, dialogue directed at you, etc.), you can initiate this grounding stage. Begin by acknowledging the hurricane at a factual level.

Here, you attempt to orient the person by discussing the facts surrounding the event. Address the circumstances at a cognitive, or thinking level. While we don't discourage the expression of emotion, attempt to focus on the facts in the here-&-now & help the individual to know the reality of the situation.

His "reality" may be seriously clouded due to the nature of the event. Remember, traumatic events overwhelm an individual's coping & problem-solving abilities. Assure him that he's now safe, if he is. He may still be "playing the tape" of the event over & over in his mind.

By reviewing facts, you may disrupt "negative cognitive rehearsal" (i.e., repetitive, potentially destructive thinking), help the individual to function & enable him to deal with the circumstances at hand.

It's important to "place the individual in the situation." Encourage him to "tell his story" & describe where he was, what he saw, what it sounded like, what it smelled like, what he did & how his body responded. Encourage him to discuss his behavioral & physiological response - rather than "how it felt."

8. Provide Support

Factual discussion & the realization of a severe hurricane, may likely stimulate thoughts & feelings. This is often the time when individuals who are exposed to trauma need the most support.

However, in reality, it's also the time when many people look the other way. Many individuals feel terribly unprepared to handle others' painful thoughts & feelings. Oftentimes, they fear that they'll "open a can of worms" or "say the wrong thing."

Generally, a reasonable attempt to help others is preferable to avoidance.

It's important to establish & maintain a facilitative or helping attitudinal climate. Here, you attempt to understand & respect the uniqueness of the individual - the thoughts & feelings that he's experiencing.

You strive to "give back" a sense of control that has been "taken from" him by virtue of his exposure to the event. You support him & you allow him to think & feel.

Due to the magnitude of these storms, many people will experience an overwhelming sense of aloneness & withdraw into their own world. You should make a respectful effort to "enter that world" & to help the individual to know that he isn't alone & that his unique perception of his experience is important.

Don't attempt to talk a person out of a