The damages caused as a result of disasters are significant, but the moral injuries are way worse and need immediate reaction of an emergency rescuing team. As members of emergency aid teams, counselors are the leading representatives that can contribute their power and knowledge in order to help in such cases. The counselors are trained to obtain specific skills and professional expertise in planning of all possible emergency cases. They are always ready to response to any kind of disaster. Moreover, their help is essential during the most difficult times in the beginning of recovery phases and make one of the most effective emergency responses after disasters. Planning is an essential process as it was mentioned by the professional Red Cross counselor that participated in an actual case of disaster response. The importance of planning is accentuated by the Mental Health All-Hazards Disaster Planning Guidance from the U.S. Department of Health and Human Services what proves the competence of workers that react to disasters in real life situations. The counselors have to be trained and practice in order to obtain all the required skills and knowledge because their role is significant and reconnects the victims with life after disasters.
The leading role of the counselor is evident in cases of reaction of emergency teams. The team of counselors can apply knowledge of psychological, sociological and developmental principles during their practices. Counselors should be familiar with the best practices that are evidence based and also work on the research gaps providing the necessary information in cases that were not disclosed earlier. The paper is meant to address the essential role of a counselor as a significant member of Emergency Management Team. In order to get the most relevant information, the facts are based on the interview with the professional counselor and a number of documents.
Paul Amaisemeier is a professional Red Cross mental health counselor that worked during the disasters in the state of Oklahoma. In May of 2013, the number of disastrous tornadoes occurred in the state of Oklahoma injuring significant number of people and ruining houses along with their lives. According to local media reports, the disaster claimed the lives of over 90 people, including many children, hundreds of hospital admissions. Some of the wounded are in critical condition. Hundreds of homes were destroyed, power lines were damaged, and many trees uprooted. According to reports, the wind speed inside the funnel of a tornado reached 320 km/h. Tornado destroyed two schools in which children were studying in their elementary grades. Most children died under the rubble of the schools.
The city has turned into a vast field, dotted with rubble and debris. As a result of the disaster, 2.4 thousand houses were damaged, inhabited by approximately 10 thousand of people. Some neighborhoods and areas of the city with a population of 55 thousand people were completely destroyed. In addition, some of the on-site residential buildings there remained only the foundation. Rescuers and volunteers scoured the area in search of the dead and injured. To the search operation of fighters joined the National Guard.
To search for survivors and victims in the region soldiers from nearby USAF air base were sent, as well as search and rescue team from Texas consisting of 80 people. American Red Cross sent 25 ambulances to help the victims. U.S. President Barack Obama announced a number of areas of Oklahoma, affected by the devastating tornado disaster area. To the dismay of local residents, meteorologists do not exclude the possibility of new disasters in Oklahoma City.
The counselor agreed to answer questions concerning the Red Cross actions as a result of emergency helping operation after tornadoes in May, 2013 in the state of Oklahoma. He stated that the most important fact about the actions of a counselor is to evaluate the situation and act according to the plan. This will allow the whole Emergency Management Team work according to the best scenario to offer as much help as possible. Here are some of the questions that were asked to the professional counselor during the interview.
Interviewer: Can you give a specific example of an actual crisis, and the details of the communication structures that are involved in the plan?
Mr. Amaisemeier: As an example of an actual crisis, I would like to mention the situation that took place in the state of Oklahoma in May, 2013. A lot of people were injured by the tornado and its consequences. A significant number of the fatalities happened to children. The communication structures that were involved in the plan were directed into reassuring people to have contact and engagement. The plan was mean to set the actions that would provide safety and control, stabilization, offer practical assistance, gather all the necessary information on the number of injured, stress reactions, skills applied and establish resilience and unity.
Interviewer: What are the first actions of a mental health counselor during an emergency situation like the one happened in Oklahoma?
Mr. Amaisemeier: The first thing to consider is choosing the right place for placing a center of emergency help. The next is qualitative organization of information flow that will be available for those people who are safe and alive as well as for those who are still in extreme emergency. Some of the disaster victims can be under the ruined buildings and automobiles and in the places that are not immediately reachable by the rescuers.
Interviewer: What are the principles of choosing the order of people to offer help in the first place?
Mr. Amaisemeier: The main principle is a major injury. Usually, people who have suffered the most physical pain need the help of a counselor. The next technique is observation. The counselors are trained to critically evaluate the current situation and search for people that can unwillingly ruin the whole work of an Emergency Management Team. Most of people that are active and have fewer injuries just need strong assuring that the disaster is over, and they are safe. Some of them can be organized to help others.
Interviewer: What is the structure of the Emergency Management Team and what is the place of mental health counselor in it?
Mr. Amaisemeier: The Emergency Management Team consists of a number of volunteers that are trained to offer the first aid and to give the medicine, water and food to those who need. The professional team of rescuers is searching and rescuing those who became the hostages under ruined buildings. The Emergency Management Team also has a number of medical workers like surgeons and pediatricians who can give all the necessary medical help. The team of psychologists and mental consultancy team work is directed to give help to the disaster victims and monitor the general state of an Emergency Management Team. It is important to control the state of a rescue team, although they are trained to maintain calm, but some cases can be unpredictable and psychological help can be offered to a team member as well
Interviewer: What steps should the counselor consider in order to keep the situation safe for the rescuing team as well as for those who survived in the disaster?
Mr. Amaisemeier: The most important quality for the counselor is to maintain calm and to make observations in order to check and detect the cases of shock and other stress among the team members. The victims that were injured should be taken to the hospitals in order to make more places for help to those who still need it. The work of a rescue team is also important as their findings can either help or destroy the situation and the atmosphere in an emergency camp.
Interviewer: What is the stress classification and which of the kinds have to be taken care in the first place?
Mr. Amaisemeier: The first phase is acute emotional shock, which develops after a state of torpor and lasts from 3 to 5 hours. It is characterized by general mental strain, limiting mobilization psycho-physiological reserves, worsening perception and increase of the speed of thought processes, manifestations of temerity especially during the rescue of relatives. While reducing the critical assessment of the situation the patient maintains the ability to purposeful activity. An emotional state during this period is dominated by a sense of despair, accompanied by feelings of dizziness and headaches, palpitations, dry mouth, thirst and difficulty breathing. Up to 30% of such patients in the subjective assessment of the deterioration are noted to have an increase in efficiency by 1.5-2 times and more. Hence, this is the stage after which the mental health counselor is best to apply his knowledge and help. Other stages include the psycho physiological demobilization that also needs help of a counselor. The state of resolution comes in a 3 to 12 days period after the disaster, and most of people find recovery independently during that period. The final stage is recovery during which a person comes into a full harmony with the surrounding world.
Interviewer: What kind of training and knowledge should be obtained by a mental health counselor?
Mr. Amaisemeier: All counselors are going through specific trainings during which they study psychology and other corresponding subjects. After each segment of theoretical training they have to participate in training sections where they can apply all their knowledge in practice. They are organized to work along with the rescuing and firefighting teams in order to study how to keep calm in emergency situations and become aware with the state of danger and disastrous results.
Interviewer: What personal character traits are essential for leading a role of a mental health counselor as a member of Emergency Management Team?
Mr. Amaisemeier: Mental health counselors have to obtain highly moral standards, be responsible for his/her actions as well as to be able to explain it to other members of society. The counselor has to be healthy and keep calm in the most difficult situations. Professional counselor should be willing to help the humans and involve others to such activities.
Interviewer: What are the factors that signify that the work of the emergency helping team can be terminated?
Mr. Amaisemeier: The work of the Emergency Management Team ends with the last person who needed help. In the case of tornado in the state of Oklahoma, people needed some help including water and food as well as medication even several months after the disaster. Red Cross specialists lead a significant work helping parents to recover after losing their children. In that case out of 91 fatalities more than 40 of them were children. Mental health counselors have to be available for people even after a disaster as people can have memories and turn to them every time they have some free time and have nothing to think about. The cases of close relatives losing and death are the most difficult.
Interviewer: What is the main aim of a counselor as a member of Emergency Management Team?
Mr. Amaisemeier: The main aim of a counselor is to organize the process of quality help for those who need it. The counselor has to be available for people who need to talk to a specialist so that to hear all the necessary recommendations on their current and further actions as well as to get to know how to help others.
Analyzing the answers of Paul Amaisemeier, it is important to mention the significance of planning and fast reaction to the emergency situation. The most important thing is to maintain strong and calm psychological health within the team to provide the most effective and productive help. Planning is an essential element of every rescuing and emergency operation. The counselor has to lead a clear statistics and division of victims according to the category of their trauma severance.
Comparing the specialist’s answers to information from Mental Health All-Hazards Disaster Planning Guidance from the U.S. Department of Health and Human Services (DHHS), it is possible to mention the close connection between the real actions of an Emergency Management Team member with the required actions of U.S. DHHS. As it is mentioned in the Mental Health All-Hazards Disaster Planning Guidance, detailed planning of every segment of Emergency Management Team work is important and essential for quality help. Planning should involve all the direct and indirect participants of the process and involve the government. The guidance determines the role of a counselor as one of the leading members of an Emergency Management Team, determining the leading statistical functions that present a significant importance for the organization of further actions of the rescue operation.
According to the Ecosystemic Model for Crisis, depicted in the work of James and Gilliland a counselor participates in the actions as a member of reaction Emergency Management Team. The counselor’s place is in the Exosystem and he/she contacts the affected people that are in the Microsystem with the help of words and first aid actions. The interaction of a counselor and a patient takes place in the intersystem that is called primary Mesosystem. It is a place where people can accept help and find all the needed sources that are available as a reaction of the government and special national and local organizations that participate in the process of the first emergency help reaction. Therefore, the counselor is an essential component of the whole emergency management system, and they have to be well trained and skilled in order to be able to offer highly professional and effective help to all those suffering after the disaster (Haddow, Bullock, & Coppola, 2011).
Questions of psychological stability of a person are of great practical importance since the resistance protects an individual from disintegration and personality disorders, forms the basis of internal harmony, full of mental health and high efficiency. Disintegration of personality is understood as the loss of the organizing role of the top-level of the psyche in the regulation of behavior and activity, decay of hierarchy of vital meanings, values, motives and goals. Psychological stability of the individual directly determines its vitality, mental and physical health (Burtles, 2007).
The main problem in these situations is the psychological stress. This circumstance greatly affects the requirements for skilled emergency counselors (Perera-Diltz & MacCluskie, 2013). Specialist must possess the ability to promptly determine the symptoms of psychological problems in himself/herself and his/her comrades, own empathic abilities, the ability to organize and conduct training on psychological unloading, relieve general and emotional stress.
Possession of skills of psychological self-help and mutual aid in crisis and emergency situations is of great importance not only for the prevention of mental trauma, but also to increase resistance to stress factors and availability of rapid response in emergency situations (Gamino & Ritter, 2009). As a result of extensive research program by German psychologists Lasogga and Gash, they developed a series of recommendations for the counselors, or other expert volunteers working in an emergency (Perera-Diltz & MacCluskie, 2013).
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These recommendations are useful for mental health counselors and psychologists while working in mass disasters, and for the training of rescuers and employees of special services. The first thing to be considered is the common action plan for the whole staff of rescue services. The first is a need to make the victim acknowledged that help is coming and steps to salvation are already taken (Gamino & Ritter, 2009). Also, victims must feel that in this situation he/she is not alone. It is necessary to approach the victim and say, for example: “I will stay with you until help arrives.”
The victim should also be informed about what is happening at the moment and that help is already on the way. Curious looks are very unpleasant for a person in crisis, so it is important to organize a shelter for those who need help. If onlookers are not willing to go, a counselor needs to give them any instructions, for example, to lead the curious away from the place. Careful placing of the physical contact with the victim is very important. Lightweight body contact usually calms the affected. Thus, it is possible to take the victim’s hand or pat him/her on the shoulder. Speaking and listening is the most important in an emergency.
The counselors should listen carefully, do not interrupt, and be patient in performing their duties. Speak calmly is desirable, even if the victim loses consciousness. It is essential not show nervousness and to avoid recriminations. It is better to ask the victim whether there is something that the counselor can do for him/her. A counselor can express compassion for the victim. First-aid rules for the moral health counselors consist of the following steps. In a crisis situation, the victim is always in a state of mental excitement and it is normal (Perera-Diltz & MacCluskie, 2013). Optimum is the average level of excitation. It is important to tell the patient immediately what is expected from the therapy and how long the work on the problem will take. Chance and hope for success is better than fear of failure. Also, not taking action immediately is very important.
The first thing to do is to look around and decide what kind of assistance other than psychological the victims require, and who are the most in need. It is essential to give at least 30 seconds to one affected, and about five minutes in cases of multiple victims. There is a need to introduce and specify exactly which functions are performed by a counselor. During the establishing of physical contact with the victim, touching the head or other parts of the body other than hand is not recommended.
The counselor should take a position on the same level as that of the victim. It is important not to turn back to the victim. The professional counselor must not blame the victim. It is better to tell what action is required to assist in the case. Professional competence is soothing. A counselor can talk about his/her qualifications and experience (Gamino & Ritter, 2009). The most important thing is to give the victim a chance to believe in his own competence. Victim should talk and a counselor must actively listen to him, to be considerate of his feelings and thoughts. Retelling is very positive. The victim should know that a counselor will stay with him. When parting, a specialist must find alternate person and instruct him on what to do with the victim.
Attracting people from the inner circle of the victim to assist can be effective. Instructing them and giving them a simple assignment (Gamino & Ritter, 2009). It is important to avoid any words that may cause anyone feel guilty. Every member of an Emergency Management Team must try to protect victims from undue attention and inquiries. Stress can have a negative impact on the counselor. However, stress can occur in the course of such work and it makes sense fighting with it with the help of relaxation exercise and professional supervision. Supervision group should be lead by professionally trained moderator.
In the implementation of emergency psychological aid, the specialist should remember that victims of disasters suffer from the following factors caused by the extreme situation. Suddenness is the leading factor. Only few cases are possible when the potential victims can be warned. For example, flood gradually reaching a critical phase or hurricane looming storm. A sudden event is devastating for the victims (Guindon, 2011). The absence of such experience is the next factor. Since disasters are fortunately rare, people are often learning to experience them in the moment of stress. Duration is the next factor. This factor varies from case to case. For example, flooding can gradually develop so slowly and subside, and earthquake lasts a few seconds and brings a lot more damage. Nevertheless, some victims of prolonged extreme situations for example in cases of hijacking and hostages keeping, traumatic effects can be multiplied with each succeeding day (Burtles, 2007).
Lack of control happens in the case when no one is able to control events during disasters. It may take a long time before one can control the most ordinary events of daily life (Schellenberg, 2012). If the loss of control is long-lasting, even competent and independent people can show signs of helplessness.
Grief and loss are relevant factors as victims of disasters may be separated from their relatives or can lose someone close (Burtles, 2007). The worst thing is when people who survived have to wait for news about all the possible loss. In addition, the victim may lose social role and position because of the disaster. In case of prolonged traumatic events a person can lose all hope for a restoration of the lost. Constant changes happen as the destruction caused by the disaster may be unrecoverable the victim may be in completely new and hostile conditions.
Exposure to death and even short life-threatening situations can change human personality structure and its cognitive map. Repeated confrontation with death can lead to profound changes in the regulatory level (Burtles, 2007). Moreover, a close encounter with death is very likely to lead to the heavy existential crisis. Moral uncertainty can happen as the victim may face the system of values associated with solutions that can change lives for example, the need to save someone, to take risks, or to start blaming someone.
The role of a counselor as a member of Emergency Management Team is very important as he is responsible for an effective process of organizing help to all the victims of the disaster as well as for maintaining control of mental health in the rescuing team (Schellenberg, 2012). The skills of counselors should be well trained to make him/her effective worker and part of a team. The success of the Emergency Management Team depends on every segment of the team and if at least one of the parts fails this may lead to a failure of the whole operation.
For this reason, the level of qualification is very important for the counselors as well as for other members. The importance of recognizing of the leading psychological factors that are present in public health emergency cases was determined by the counselors and they can be helpful providing guidance and planning the most effective wording in determining effective messages directed to public or victims.
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The collaborative role of counselors is essential because they make the work of all the emergency segments easier, structured and more effective. Counselors can engage in planning of the actions as an answer to different emergency cases as well as for different operational aspects that may occur during a disaster. Counseling has a leading role in establishing of cultural diversity and building multi-cultural awareness as one of the most important values. Planning performed by the counselors is a guiding factor to the services counselors provide. The counselors play a significant part in the process of establishing effective and fast responses to all damaging and emergency situations all over the world.