Recovery in the Wake of Hurricane Florence

With the efforts of thousands of in and out-of-state personnel and National Guard soldiers, over 5,000 people were rescued or evacuated from Florence’s path in North Carolina alone.1 Acknowledging the demands of such a feat also requires that we recognize the intense stress that accompanies this force of nature. 

Hurricane season brings with it a multitude of stressors that can be amplified for first responders. On top of the high intensity demands specific to their tasks, first responders are subject to the stressors that a hurricane brings to everyone in the cone of uncertainty; separation from families, managing child care and potential property damage to name a few. The demands of professional roles, years of exposure to trauma and fatalities, extended shifts, and personal impact of disasters on their own homes and families place first responders at higher risk for experiencing burnout and acute and posttraumatic stress. As stress builds up, and the physiological and hormonal fight-or-flight response remains at full alert, defenses and resistance to that stress begins decrease, leaving responders feeling overwhelmed in the face of large magnitude events. While often performing heroically, the magnitude of some natural disasters can lead to a sense of futility and sometimes a psychological phenomenon referred to as learned helplessness. 

Compassion fatigue and secondary traumatic stress can also impact psychological recovery from such events. Compassion fatigue involves a state in which first responders and other front-line professionals may develop emotional indifference and loss of empathy related to the extraordinary and repeated demands of dealing with numbers of traumatized individuals or those in distress. First responders often experience direct trauma in terms of being exposed to situations that are personally traumatic and life threatening and can experience secondary traumatic stress, from exposure to another’s traumatic event.

It is estimated 13 to 18 percent of firefighters will experience post-traumatic stress disorder (PTSD) one to four years after large scale events (Benedek, et al, 2007). Most first responders are aware of recognizing the symptoms of acute stress reactions such as tunnel vision, loss of cognitive flexibility, feeling as if things are not real and numbness. They are also often aware of posttraumatic stress symptoms such as repetitive re-experiencing of events, nightmares, sleep difficulties, or becoming increasingly startled. Common symptoms of compassion fatigue overlap those of PTSD but are often less obvious and debilitating.

These can include symptoms such as isolating from others, poor self-care, difficulty concentrating and excessive blaming of others.2 First responders might seem edgy, easily startled or constantly on guard, which might be accompanied by recurring thoughts and physical signs of stress when experiencing secondary traumatic stress. It is paramount that first responders know and monitor their personal signs of stress and communicate with their teammates and supervisors for rest or assistance when necessary. The Professional Quality of Life Scale can help first-responders assess if they are experiencing signs of burnout and compassion fatigue and is available on-line: https://proqol.org/uploads/ProQOL_5_English.pdf  

Following large scale disasters, it might be necessary to compensate for a lack of control that a hurricane inflicts. Gradually working back into a routine after a stressful situation and re-establishing a sense of normalcy and control by actively making decisions is a helpful startegy3. Efforts and decisions to re-establish good, restful sleep, well-balanced nutritional meals, and normal exercise are the basics. Avoiding over-focus on consequences of the disaster and engaging in pleasurable, distracting activities can help break the stress cycle. Relaxation, grounding and meditation exercises can help. Attending to and becoming skilled in stress reduction techniques while monitoring stress levels, can improve self-confidence and reduce post-traumatic symptoms and burnout. Furthermore, these techniques are helpful in combating the next challenge which a first responder may face.

While meditation, guided-imagery, and other traditional relaxation techniques are often effective, research also recommend promising and effective interventions involving an element focused on teaching and/or bolstering resilience (Cocker and Joss, 2016). The National Institute of Occupational Health has a set of recommendations for recovery following a natural disaster. If the suggested approaches don’t seem to help or symptoms are bothersome for more than two to four weeks, consulting with a psychologist or Employee Assistance Program provider can be helpful in regaining self-confidence and a sense of control. Some individuals with pre-existing trauma may need to seek more prompt attention or intervention, but returning to work, debriefing with fellow responders and re-establishing routines also helps restore resiliency.

• Reach out—people really do care
• Consider keeping a journal
• Do not make any big life decisions
• Make as many daily decisions as possible to give yourself a feeling of control over your life.
• Spend time with others or alone doing the things you enjoy to refresh and recharge yourself.
• Be aware that you may feel particularly fearful for your family. This is normal and will pass in time.
• Remember that “getting back to normal” takes time.
   – Gradually work back into your routine. Let others carry more weight for a while at home and at work.
• Be aware that recovery is not a straight path but a matter of two steps forward and one back. You will make progress
• Appreciate a sense of humor in yourself and others. It is okay to laugh again
• Your family will experience the disaster along with you. You need to support each other. This is a time for patience, understanding, and communication
• Avoid overuse of drugs or alcohol. You do not need to complicate your situation with a substance abuse problem
• Get plenty of rest and normal exercise. Eat well-balanced, regular meals.

As hurricane season rages on, it is important to cultivate good stress management strategies, and to be prepared for the high intensity demands of the occupation. Burning out is never conducive to performance when helping others. Reach out to your support circles, supervisors and teammates, but always remember one needs to monitor and care for oneself in order to help others.

References and Resources

Benedek, David M., Fullerton, Carol, and Ursano Robert J.   First Responders: Mental Health Consequences of Natural and Human-Made Disasters for Public Health and Public Safety Worker. Annu. Rev. Public Health 2007. 28:55–68

Cocker Fiona, and Joss, Nerida. Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review. Int J Environ Res Public Health. 2016 Jun; 13(6): 618.

1. North Carolina Department of Public Safety
   https://www.ncdps.gov/hurricane-florence-storm-statistics
2. Compassion Fatigue Awareness Project
   https://www.compassionfatigue.org/pages/symptoms.html
3. The National Institute for Occupational Safety and Health (NIOSH)
   https://www.cdc.gov/niosh/topics/traumaticincident/default.html