|Handbook for Emergencies - Second Edition (UNHCR, 1999, 414 p.)|
|22. Coping with Stress|
5. Emergency personnel are exposed to many types of stress and what is needed is to have the "ideal" level. Too little causes boredom, lack of stimulation and fatigue, too much and we become overwhelmed physically and mentally. The names given to the harmful types of stress are cumulative stress and traumatic stress.
6. Cumulative (or chronic) stress builds up slowly as a result of the magnitude and multi plicity of demands, lengthy working hours and daily frustrations and difficulties of living and working in emergencies. Because stress reactions develop so slowly and imperceptibly it is quite often difficult to notice them in oneself, they are, however, usually noticeable to close colleagues.
Once removed from a stressful situation and with the possibility for rest and relaxation, a person generally recovers quickly and may become aware of the difference in how one responds to situations when one is not experiencing stress.
Individuals in emergency work, who are experiencing high stress levels, are not the best judges of their own ability to cope.
Team leaders need to be particularly observant of individual reactions during an emergency.
7. Symptoms of stress can be physical and psychological. There could be changes in ordinary behaviour patterns, such as changes in eating habits, decreased personal hygiene, withdrawal from others and prolonged silences. Symptoms of cumulative stress can be seen in every facet of our lives. The following non-exhaustive list gives an indication of some of the most observed symptoms:
Dry mouth, impression of having ones heart in ones mouth, nausea, vomiting, sensation of bloating, heartburn, abdominal pain, appetite changes diarrhoea, constipation;
Elevated blood pressure, rapid heart beat, hot flushes, cold hands and feet, sweating;
iii. Respiratory problems
Breathlessness, panting, sensation of not being able to breathe;
Cramps, back pain, trembling, nervous ticks, grimacing;
i. Emotional Anxiety, anguish;
Sleep problems, abuse of cigarettes alcohol or drugs, modification in ones libido;
Concentration difficulties, memory difficulties, problems with reasoning and verbal expression.
8. The presence of several of these symptoms may mean that a person's coping ability is diminishing and work performance is being affected. However, the signs and the degree of stress presented by a person in any given situation will vary, depending on the level of stress experienced, previous emotional experiences and the personality of the individual.
If the cyclic causes and resultant symptoms of cumulative stress are not promptly addressed, exhaustion sets in, leading eventually to "burnout". Should this happen one needs rest and counselling.
10. Traumatic stress is brought on by unexpected and emotionally powerful events ("critical incidents") that overwhelm the individual's usual coping abilities. Critical incidents may arise in the context of a major disaster or emergency, and could be, for example, injury or death of a colleague, hostage taking, deaths of children, undergoing great personal risk, being a powerless witness of violence, or seeing or being associated with a tragic event accompanied by intense media coverage (especially if this is inaccurate).
Staff might experience acute reactions during a critical incident or a delayed stress reaction minutes, hours or days after the event. In rarer cases reactions may come after a few months or years.
12. The reactions after a critical incident can resemble those of cumulative stress but they can be much more pronounced. Vomiting instead of nausea as an example. The following are mental survival mechanisms that allow us to deal with the event:
Emotional numbing, changes in the perception of time, along with a sense of ones live flashing before ones eyes, highly focused attention or tunnel vision, hyperarousal with sharpened senses.
These initial responses can be replaced in the period of time immediately after the incident by:
Hyperactivity, exaggerated humour, argumentativeness, social withdrawal, fear, anxiety, sadness, grief, memory problems, poor concentration, slow thinking and loss of perception in addition to the physical symptoms mentioned above.
It should be emphasized that these symptoms are normal reactions to abnormal events and in most cases will disappear.
14. However, occasionally a serious condition termed Post Traumatic Stress Disorder (PTSD) can result from critical incidents. The risk of PTSD can be considerably reduced by preparation, on-site care, and post incident defusing or debriefing.
15. The diagnosis of PTSD is made by a psychiatrist or psychologist based on the presence of various elements which include:
i. Invasive memories (flashback);
ii. Nightmares and sleep disturbance;
iii. Repeated reliving of the event;
v. Avoidance of trigger persons or situations;
vii. Anxiety, depression, grief, anger;
viii. Suicidal thoughts;
ix. Reactions intensifying over time;
x. Clear alteration of personality;
xi. Withdrawal from others;
xii. Continued rumination about event;
xiii. Constant expectations of a new disaster;
xiv. Persistent sleep difficulties;
xv. Total absence of reactions;
xvi. Phobia formation;
xvii. Reactions continuing for 3 to 4 weeks.