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Section 2
Disaster Preparedness

Question 2 | Test | Table of Contents

In the previous section we discussed basic information about trauma and 10 reasons you can discuss with your client why they could not have prevented the natural disaster trauma.

In this section, we will discuss strategies to use during the trauma. They include situational evaluation, vital self-care actions, and self-evaluation of shutting down or fading out.

Often clients facing natural disaster trauma go through reactions that are either agitated or shut down at the moment of the trauma. The following guidelines are important for clients as a preparation for what to do during a trauma to take care of themselves and their family. As you look through the guidelines, think if you have clients, like Julie from the previous section, whose home was destroyed in a hurricane, that could have used this guideline when they were facing their natural disaster.

Situational Evaluation:
These questions are of value if you are in an area that experiences repeated natural disasters. I stated to Julie, "Even though you have already experienced a natural disaster and are facing trauma from it, I think it will be helpful for us to go over these ideas of how to emotionally cope with a natural disaster while it is happening." You might review them with your client to provide them with a tool to utilize during and after the natural disaster is occurring.
1st ask yourself, "Is this situation threatening? How much of a threat is there?"
2nd ask yourself, "Is the threat coming from inside or outside of me?" In other words is the fear something that is from an internal cause, thinking something may happen, or is there something outside of me that is happening, for example the potential of a wall collapsing that I am afraid of. Is my fear anticipatory fear or renumerating over past fears; or is there a real pending danger.
3rd ask yourself "What is my reaction level (encourage them to use a 1-10 point scale)?" By your client rating their reaction on a scale of 1 to 10, 1 being low and 10 being high, they become connected with present time.
4th ask yourself "Is what I am feeling fear or anger or is it more panic, hysteria, or rage?"
5th ask yourself "What is my body telling me now?"
6th ask yourself "Does it feel like time is slowing down?"
7th ask yourself "What are the ways that others are acting and reacting? Can they see something I don’t? Can I ask them?"
8th ask yourself "Is there evidence I can find to confirm how I am feeling and reacting?"

Vital Self-Care Actions:
When a client has self-evaluated that they are agitated by answering the preceding questions, they can use the following Vital Self-Care Actions. The seven Self-Care Action tools are listed and in parenthesis are specific actions your client can take to implement the tool:
1. Focus (focus on the present by ignoring imagination and memories)
2. Self-talk/ Other talk (use a calm and soothing voice to talk to yourself and others)
3. Imagery/ Expectations (envision a safe place and positive outcomes and actions)
4. Breath (use a soothing four-count breathing)
5. Relaxation (change your scenery and sit down)
6. Direction (find support and assistance and find something useful to do)
7. Activity (calm yourself by taking a walk, stretch, or another calming ritual)

Self-Evaluation of Shutting Down or Fading Out:
Clients can ask themselves the following eight questions to self-evaluate if they are shutting down or fading out. I stated to Julie, "Think about these questions in relation to what you experienced during and after the hurricane." Here are the eight questions:
1. Are things slipping out of control or beyond my understanding?
2. Am I starting to believe or feel things just don’t seem to matter?
3. What is my reaction level (encourage your client to use a seven-point scale)?
4. Am I still aware of my body?
5. Are others around me more agitated than I am?
6. Is time moving too fast?
7. Are people talking loudly or getting in my face?
8. What are others seeing that I am not?

If your client at the time of the natural disaster is shutting down or fading out, I suggest they use the Vital Self-Care Actions listed above of: Focus, Self-talk, Imagery, Breath, Relaxation, Direction, Activity but tailor the actions to ones that will awaken them and stop them from shutting down.

During the Natural Disaster – What Everyone Should Know:
Julie explained to me, "During the event, my husband and I were very distant and we both did not know how to support one another. We were in our own scary worlds."
Additionally, here are a few suggestions I gave to Julie in order for her to help provide support to individuals and her family now that the disaster had already occurred:
- Engage your family in conversation to reestablish a sense of control and normalcy.
- Ask questions about what others understand about what is happening.
- Make sure that everyone’s thoughts and feelings are clear and acknowledged.
- Show that you are trying to help through your words and actions.
- Don’t contradict others’ feelings or make false assurances.
- Use active listening by repeating back what they have said to ask for clarification. You can even ask "Is that what you mean?"
- Provide a clearer picture in words in order to avoid a misunderstanding of a situation.
- If family members are fading, help refocus them or if they are fearful or over excited help them relax.
- When needed, you can help manage serious reactions.
- Share with others what will happen next, as far as you know.

In this section we have discussed strategies to use during the trauma. They include situational evaluation, vital self-care actions, and self-evaluation of shutting down or fading out.

In the next section, we will discuss using the Future-Pull Approach to help natural disaster PTSD clients in order to focus on their future instead of dwelling on the past.

Source: Johnson
Reviewed 2023

Update
Disaster preparedness in healthcare professionals amid COVID-19 and beyond: A systematic review of randomized controlled trials

Su, Z., McDonnell, D., Ahmad, J., & Cheshmehzangi, A. (2023). Disaster preparedness in healthcare professionals amid COVID-19 and beyond: A systematic review of randomized controlled trials. Nurse education in practice, 69, 103583. https://doi.org/10.1016/j.nepr.2023.103583


Peer-Reviewed Journal Article References:
Everett, A., Sugarman, O., Wennerstrom, A., Pollock, M., True, G., Haywood, C., Meyers, D., Raines, A., Wells, K., Johnson, A., Arevian, A. C., Sato, J., & Springgate, B. (2019). Community-informed strategies to address trauma and enhance resilience in climate-affected communities. Traumatology. Advance online publication. 

Fox, J., Gupta, R., & Mitchell, G. (2018). Considering developmental concepts from attachment theory to inform graduate student training in global trauma and disaster psychology. International Perspectives in Psychology: Research, Practice, Consultation, 7(3), 189–201.

Seale, G. S. (2010). Emergency preparedness as a continuous improvement cycle: Perspectives from a postacute rehabilitation facility. Rehabilitation Psychology, 55(3), 247–254.

Weber, M. C., Pavlacic, J. M., Gawlik, E. A., Schulenberg, S. E., & Buchanan, E. M. (2019). Modeling resilience, meaning in life, posttraumatic growth, and disaster preparedness with two samples of tornado survivors. Traumatology. Advance online publication.

QUESTION 2
What are the seven Self-Care Action tools your client facing a natural disaster trauma can use to regulate their agitation while dealing with a natural disaster crisis? To select and enter your answer go to Test.

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