Cover Image
close this bookStress Management in Disasters (Pan American Health Organization (PAHO) / OrganizaciĆ³n Panamericana de la Salud (OPS) - WHO - OMS, 2001, 144 p.)
View the document(introduction...)
View the documentCourse Objectives
View the documentPreface
View the documentSection 1: Overview of Disasters
View the documentSection 2: Psychological Responses to Traumatic Stressors
View the documentSection 3: An Overview of SMID
View the documentSection 4: An Basic Introduction to Counseling and Crisis Intervention
View the documentSection 5: Therapeutic Groups
View the documentSection 6: Demobilizations and Defusings
View the documentSection 7: Debriefings
View the documentSection 8: The SMID Team
View the documentAppendix 1: Score Interpretations
View the documentAppendix 2: Quiz Answers
View the documentReferences
View the documentBack Cover

Section 6: Demobilizations and Defusings


Figure

PAHO/WHO

The Lakes Field Hospital SMID Team conducted a defusing for the eight paramedics who had worked at the scene of the tragic East Park Road accident. (See description of event on page 16)

DEMOBILIZATIONS

Definition

A demobilization is a brief, informational and rest period immediately after personnel have been released from active duty at the scene of a large scale (requiring 100 personnel or more) traumatic incident, and before they return to routine duties.

Overview

A defusing can be substituted for a demobilization if the size of the incident allows for the lengthier defusing process and if the personnel are not too weary. It is not a one-off procedure and there is always a need for follow-up services to be provided after a demobilization.

Contraindications

Demobilizations are not indicated for the following:

· Use after routine events;
· Use for small scale incidents;
· Use after a line-of-duty death;
· As a substitute for debriefings or psychotherapy.

Providers

Demobilizations can be provided by any trained SMID Team member. Mental health professionals do not have to be present.

More than one group of persons is handled in a demobilization at any one time. Each group is assigned to its own circle of chairs in the presentation room and has its own SMID Team presenter.

Location

The facility where the demobilization is going to be conducted should be near enough to the scene of the incident for personnel to be easily transported there once they have been released from duty. It should consist of two large, adjacent rooms: one to provide the information sessions in small work groups and the other to provide food and rest.

The media and other uninvolved persons must be denied access to the place where the demobilization is being conducted.

Goals

1. To provide information about the incident and the reactions of the personnel involved;

2. To provide information about stress reactions, stress management and available support services;

3. To provide an opportunity for rest and food before returning to routine duties;

4. To mitigate the impact of the event;

5. To establish positive expectations about the future;

6. To do a preliminary assessment of the well-being of the personnel after the incident and their need for follow-up services.

Procedure

A demobilization consists of two main segments. The first segment is a 10-15 minute period in which personnel are given information which might be helpful to them in understanding and managing possible stress reactions. The second segment is a 20-30 minute period of time to eat and rest before returning to normal activities.

Each team of workers (e.g., disaster workers, policemen and firemen) are handled as a "unit" in the demobilization. Each "unit" sits in a set of seats that are arranged in a circle. It is best to keep fellow workers together (for example, fire-fighters with fire-fighters who work together on the same operation units) since they derive support from each other.

No one except the team member presenting in the demobilization has to speak but if anyone wants to speak then they may do so. No note taking or record keeping is allowed.

Demobilizations usually take the following format:

· An introduction by the presenter;

· A brief description of a demobilization;

· An assurance that the talk section of the demobilization will be limited to 10-15 minutes and that the knowledge to be gained will be potentially beneficial;

· A10-15 minute talk which should include:

(a) A description of the nature and course of possible stress reactions that may follow exposure to a traumatic event;

(b) An assurance that stress symptoms are normal under the circumstances;

(c) A description of the common cognitive, physical, emotional and behavioral signs and symptoms of stress;

(d) Brief suggestions about managing stress reactions;

(e) Outline of the various follow-up services that will be available;

(f) An invitation for anyone who wants to make a statement or ask questions to do so;

(g) A summary statement.

· The distribution of handouts on stress reactions and stress management techniques;

· The provision of food (low in salt, fat and sugar) for 20-30 minutes in a separate room;

· Announcements by senior personnel and the return of personnel to normal duties;

· The availability of SMID Team members to the group once the demobilization is over.

Cautions

Demobilizations can sometimes prove difficult to organize because of the logistics of providing such a service.

Only persons who have been released from the particular scene for the rest of that shift and for the rest of that day are demobilized. Such personnel may work elsewhere but not at the scene of the incident from which they were just released. This is because the demobilization process increases one's vulnerability to severe stress reactions at the scene of the incident, but a different scene is usually viewed as not being associated with the previous incident and can normally be handled without problems.

If the incident is going to require a prolonged operation, then demobilizations should only be applied during the first 2 or 3 shifts of work after personnel would have completed their first exposure to the scene. Hence, as the operation proceeds, one-to-one interventions with obviously distressed individuals should be utilized instead.

Demobilizations are not provided after line-of-duty deaths; debriefings (and in special circumstances defusings) are done instead.

DEFUSINGS

Definition

A defusing is a small, structured group meeting (4-8 persons) or discussion of persons who normally work together, e.g., nurses, police, paramedics, fire-fighters, etc., and who have been exposed to a traumatic event. Occasionally, it is necessary to combine various groups of emergency response personnel together for a defusing but this is only done when all of the parties to be combined were involved together in the same incident.

Overview

A defusing is likened to a shortened debriefing. Both the defusing and the debriefing techniques were initially developed by Dr. Jeffrey T. Mitchell (1996) and they are believed to have similar mechanisms of action. The defusing is nonetheless much less organized and more immediate in its application.

Such meetings are provided as soon as possible after the traumatic event and not later than 8 hours after it. When a particularly traumatic incident occurs at the beginning of a shift and the personnel must work through the remainder of that shift, it is very helpful to bring the group together and provide a defusing. On the other hand, if a traumatic incident occurs at the end of a shift, it is better to provide a defusing before the group goes home.

Defusings last for 20-60 minutes and they are aimed at the core working group that was most seriously affected by the events.

Defusings and demobilizations can usually substitute for each other. One or the other is provided for an incident, but not both. Unlike demobilizations, defusings are never provided at the scene of the incident.

After exposure to a traumatic event, the affected persons take time to put up their emotional guards and like other persons dealing with very stressful situations, they are generally receptive to assistance. Consequently, defusings can significantly reduce the psychological impact of such events.

Follow-up services are always necessary after a defusing to ensure that the personnel are managing their stress adequately.

Contraindications

Defusings are not indicated for the following:

· Use after routine events;

· Usually not employed after large-scale events, e.g., major disasters, unless they are used as part of a larger SMID program;

· If the traumatic incident occurred more than 8 hours earlier;

· After a line-of-duty death once a debriefing team is available;

· As a substitute for a debriefing or psychotherapy.

Providers

Defusings can be provided by any trained SMID Team member, even in the absence of mental health professionals. It is best that a defusing team be made up of at least two persons.

When peer support personnel conduct a defusing in the absence of mental health professionals, they should go over what was done with one of the team's mental health professionals within 8-12 hours of the defusing.

Location

A defusing should be held in a private, quiet, comfortable environment, which is free from distractions and away from the scene of the incident. The media and other uninvolved persons must be denied access to the place where the defusing is being conducted.

Goals

1. To provide information about the incident and the reactions of the personnel;

2. To provide information about stress reactions, stress management and available support services;

3. To rapidly reduce the intensity of the reactions to the traumatic event;

4. To reinforce the social network of the group and dispel feelings of uniqueness;

5. To establish positive expectations about the future and reinforce the value of the personnel;

6. To do an assessment of the well-being of the personnel involved to determine their need for follow-up services.

Procedure

A defusing session consists of three main segments that are linked to each other in a free-flowing conversation about the traumatic event.

The introduction phase usually takes 5 to 10 minutes and allows for the intervention team's members to be introduced, the process to be explained and expectations to be set. The exploration phase takes 10 to 35 minutes and allows for the traumatic experience to be discussed through the participants' disclosure of facts, cognitive and emotional reactions and symptoms of stress related to the traumatic event. The information phase takes 5 to 15 minutes and seeks to cognitively normalize and educate the participants about traumatic stress.

If a defusing takes longer than 60 minutes, it is likely that a debriefing is needed in the next few days. Persons attending a defusing may speak or they may be silent and no note taking or record keeping is permitted at any time.

Because there is usually very little time to prepare for a defusing, refreshments are seldom served at the end of the procedure.

Defusing format

The Introduction Phase of a defusing includes the following steps:

· Introduce the facilitator;
· Outline the purpose of the defusing;
· Reassure participants that the procedure is not an investigation;
· Describe the process;
· Outline the main guidelines of a defusing;
· Call for strict confidentiality;
· Outline the goals;
· Encourage those present to participate;
· Encourage mutual support;
· Attempt to alleviate fears about the defusing process;
· Call for any questions before proceeding; and
· Offer additional support.

The Exploration Phase includes the following:

· Ask participants to describe what just happened;

· Ask the minimal number of clarifying questions;

· Gently encourage the participants to discuss their experiences, thoughts, feelings and reactions;

· Assess the need for follow-up services; and

· Reassure the participants as necessary.

The Information Phase of the defusing includes the following:

· Note and summarize the information provided by the group in the exploration phase;
· Answer any queries that the participants might raise;
· Normalize the experiences and/or reactions of the group;
· Teach practical stress management techniques;
· Summarize the proceedings;
· Organize a follow-up debriefing if one seems indicated; and
· Be available to the group once the defusing is over.

End of Section Quiz

Please circle the correct answer.

1.

Defusings can be done up to 48 hours after exposure to a traumatic incident.

T

F

2.

Refreshments are always served as part of a demobilization.

T

F

3.

Persons can be demobilized and returned to the same traumatic scene to work.

T

F

4.

Generous helpings of chocolate cake should be served at demobilizations.

T

F

5.

Refreshments may be served at defusings if the necessary arrangements can be made.

T

F

6.

Defusings usually last about 2 hours.

T

F

7.

Only mental health professionals can conduct demobilizations.

T

F

8.

Defusings are usually provided at the scene of the incident.

T

F

9.

A defusing consists of 7 main segments.

T

F

10.

Participation in a defusing is optional.

T

F

Note: Answers to questions are on Appendix 2. Quiz Answers.

NOTES

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________