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LAPORAN TUTORIAL SKENARIO 2 RELAWAN BENCANA

BLOK 4.2 DISASTER NURSING

KELOMPOK 6
Anggota:
Wisnu Wijaya

(15890)

Atika Dwi Astuti

(15891)

Fajrul Falah Farhany

(15892)

Nakhoda Rizky P.S

(15893)

Melinda Diah Asmoro

(15895)

Handayani Samosir

(15896)

Candra Fatchurohmah

(15897)

Sherli Damara Pratiwi

(15899)

Hanin Assyifa

(15900)

Nur Yusrin Husnati

(15902)

Marsita Nugraheni

(15903)

Diyah Fitri Indriati

(15904)

PROGRAM STUDI ILMU KEPERAWATAN


FAKULTAS KEDOKTERAN
UNIVERSITAS GADJAH MADA
2016

SKENARIO 2
Relawan Bencana
Pemerintah mengumumkan bencana nasional yang dikarenakan gempa bumi 9 skala
richter di Daerah Antah Provinsi Berantah. Ns. Adi ditugaskan sebagai salah satu dari Tim
Medis Darurat (TMD) yang akan diberangkatkan (deploy) ke daerah bencana tersebut. Bagi
Ns. Adi menjadi relawan bencana merupakan pengalaman pertama sehingga Ns. Adi masih
belum memahami beberapa hal seperti gambaran bekerja sebagai relawan, peran dan
tanggungjawab serta akuntabilitas seorang relawan, program pelayanan kesehatan di daerah
bencana, kolaborasi dengan relawan bencana lainnya.
STEP 1 Mencari Kata Sulit
STEP 2 Mengajukan Pertanyaan
1. Apa saja syarat menjadi relawan?
2. Apa saja tanggungjawab seorang relawan?
3. Hal apa sajakah yang harus disiapkan seorang relawan?
4. Bagaimana kolaborasi relawan medis dengan relawan lainnya?
5. Apa saja program layanan kesehatan pada daerah bencana?
6. Bagaimana gambaran peran Ns. Adi sebagai relawan bencana?
7. Apa saja sanksi kepada relawan yang tidak melaksanakan tanggungjawab?
8. Apa saja kompetensi yang harus dimiliki oleh seorang relawan medis?
9. Apa yang dimaksud dengan akuntabilitas seorang relawan?
10. Siapakah yang berwenang dalam perekrutan seorang relawan?
STEP 3 Menjawab Pertanyaan
1. Dikukuhkan oleh organisasi, mempunyai basic pengetahuan dan keterampilan yang
berperan dalam bencana, pernah mengikuti pelatihan kebencanaan, usia minimal 18
tahun, berdedikasi tinggi, WNI, dapat bekerja sama secara mandiri dan tim, sehat
jasmani dan rohani, bebas dari masalah hukum atau sedang tidak menjalani proses
hukum, mampu berkomunikasi, memenuhi syarat organisasi, koping kuat, mampu
menguasai pemetaan, dan mampu mengelola posko.
2. Membantu semaksimal mungkin sesuai dengan peran masing-masing, menaati
peraturan dan prosedur, menjamin keamanan, keselamatan diri sendiri dan orang lain,
pelaporan atau dokumentasi harus jelas.

3. Harus siap secara jasmani dan rohani, kompetensi, logistik (disaster kit), memastikan
keamanan dahulu, serta alat komunikasi.
4. Kolaborasi dijalankan sesuai sistem komando, memberi info, mengolah data, sistem
komunikasi satu arah (ICS) agar tidak simpang siur atau tidak tersampaikan.
5. Program layanan PHBS, gizi seimbang, konseling, trauma healing dengan play
therapy, perawatan luka bakar, konseling ibu hamil, pemantauan kadar gula darah,
penyuluhan tentang ISPA, assessment, pengobatan kepada survivor, pendirian barak
pengungsian.
6. Peran Ns. Adi tergantung dari komando, pendamping psikologis, evakuasi, menangani
korban langsung kedaruratan, dapat membantu di bagian lain sesuai komando,
melakukan triase, memberi perlindungan terhadap kelompok rentan terutama untuk
evakuasi, trauma healing, perawatan minimal, kaji cepat, mendata SDA dan SDM
yang ada, melakukan SAR, pemenuhan kebutuhan, pendampingan spiritual,
melakukan BLS.
7. Jika relawan tidak melaksanakan tanggungjawab dapat diberi teguran secara lisan,
tertulis, skorsing, pemberhentian sampai dengan pemberian sanksi hukum.
8. Kompetensi yang harus dimiliki seorang relawan medis adalah mampu melakukan
triase, memberikan pertolongan pertama, melakukan transportasi dan delivery,
mampu melakukan penyuluhan, pelatihan, pengurangan faktor risiko, mampu
melakukan trauma healing, berkomunikasi yang baik, berkoordinasi pada fase
preparedness, mampu mempertahankan gizi survivor.
9. Akuntabilitas adalah pertanggungjawaban atas tindakan yang diberikan terhadap
korban dan dapat dipertanggungjawabkan kepada hukum.
10. Organisasi yang berperan dalam penanganan bencana seperti MDMC, lalu dilaporkan
ke BPBD selanjutnya dilakukan pelaporan ke BNPB agar dicatat dalam database dan
mempunyai nomor anggota.

STEP 4 Mind Mapping


Syarat

Apa saja yang harus dipersiapkan


(kompetensi, skill, pengetahuan, dll)

Relawan

Pra Bencana

Bencana

Kolaborasi

Pasca Bencana

Peran

Berhasil

Gagal

Penghargaan

Sanksi

STEP 5 Penentuan LO
1. Apa saja kontribusi perawat dalam program bencana?
2. Bagaimana kolaborasi masing-masing bidang di dalam bencana?
3. Apa saja penyebab PTSD pada relawan?
STEP 6
Mencari referensi di rumah (jurnal, buku, web resmi)

STEP 7 Pemaparan LO
1. Kontribusi perawat dalam program bencana
Mitigation and preparedness measures go hand in hand for vulnerability reduction and
rapid professional response to disasters. The Bhuj earthquake in January, 2001 brought
out several inadequacies in the system. The search and rescue teams had not been trained
professionally; specialized dog squad to look for live bodies under the debris were not
available; and there was no centralized resource inventory for emergency response.
Although army played a pivotal role in search and rescue and also set up their hospital
after the collapse of Government hospital at Bhuj, the need for fully equipped mobile
hospitals with trained personnel was felt acutely. Despite these constraints, the response
was fairly well organized. However, had these constraints been taken care of before hand,
the response would have been even more professional and rapid which may have reduced
the loss of lives. Specialist search and rescue teams from other countries did reach Bhuj.
However, precious time was lost and even with these specialist teams it was not possible
to cover all severely affected areas as quickly as the Government would have desired. It
was, therefore, decided that we should remove these inadequacies and be in a stage of
preparedness at all times.
The Central Government are now in the process of training and equipping 96
specialist search and rescue teams, with each team consisting of 45 personnel including
doctors, paramedics, structural engineers etc. Ten teams have already been trained. These
teams will be located at various centres around the country for specialised response.
These teams will have the latest equipment as also dog squads for locating survivors in
the debris.Sumber: Disaster Management in India
Comprehensive Disaster Management Programme Phase II

Nurse Involvement
Nurse involvement requires understanding the basic concepts of radiation exposure
versus contamination, an awareness of the signs and symptoms of acute radiation
syndrome and the skills and abilities to participate in population-based radiation
screening. Hospital-based nurse receivers will need to understand the underlying
pathophysiology and medical and nursing interventions for radiation poisoning, and their
specic role in the treatment of victims. The immediate role of nurses in a radiation
disaster will be determined by several factors including their current place of
employment and whether they are on scene at the response, at their place of work, or
whether they go out in the community as part of the broader public health response. In
any case, at a minimum, nurses will need to be aware of their institutional radiation
disaster response plan, their role within the Incident Command System and the personal
protective equipment (PPE; eg, protective gloves, shoe covers, outer protective clothing,
and eye covering, based on current Occupational Safety and Health Administration

guidelines) available to them for their own safety. It is only when nurses are safe that
they are able to render care to others.
On-Scene Assistance
Nurses and other health care personnel at the scene may be called on to treat or triage
victims suffering from the effects of exposure to high levels of radiation. Nurses should
take all possible precautions to avoid accidental exposure or uptake of radioactive
materials. These pre-cautions include not eating or drinking in contamination zones,
promptly irrigating and covering open wounds, and thoroughly swabbing patients skin
before giving injections or drawing blood. Nurses entering a contaminated area must
wear appropriate PPE at all times. Nurses leaving a contaminated area should remove
their protective clothing (including gloves and shoe covers) before exiting the area.
Whenever possible in disaster situations (ie, when patient care will not be compromised),
all personnel patients included should be surveyed for contamination before exiting any
contamination area. In fact, nurses must survey themselves before leaving an area
approved to hold radioactivity as it is strictly required and monitored by the Nuclear
Regulatory Commission (NRC, 2014). All equipment exiting the area should also be
surveyed before release or should be properly labeled, sealed in plastic bags, and stored
in appropriately shielded containers for later survey and release (If contaminated but not
stored in properly shielded containers, the equipment would be radiating anyone nearby,
people transporting it, or anyone working with it later).
Population Screening Programs
Screening programs must be implemented as a primary public health response when
large numbers of people are potentially exposed to radiation.Nurseswill in all likelihood
participate as members of the radiation exposure screening/population monitoring team
in conjunction with radiation safety experts and other health care providers. The Centers
for Disease Control and Prevention (CDC) advocates establishing Community Reception
Centers (CRCs) in the aftermath of a sufciently large radiologic event. The purpose of a
CRC is to provide radiologic screening for uninjured or lightly injured people, to provide
decontamination when necessary, and to refer those with likely internal contamination on
for radiologic assessment and (if appropriate) medical countermeasures (Centers for
Disease Control and Prevention, 2014). Nurses may be asked to provide screening and
rst aid in CRCs (if established), and a virtual community reception center educational
module (vCRC) is available on the CDC web site. If CRCs are not established in the
aftermath of a radiologic or nuclear event, members of the public will appear at hospitals

requesting radiologic screening, quickly over whelming available resources and clogging
emergency departments.
When screening individuals for radiation exposure, nurses should wear PPE at all
times and dosimeters to monitor personal exposure. Care must be taken to establish
clearly delineated lines for entry and exit into the screening area to prevent cross
contamination. It should be anticipated that lines will be long and that accommodations
will need to be
made for those with limited mobility, the elderly, and families with young children.
Geiger-M uller counters will be used to scan the entire body over clothes based on a
predetermined screening level. Individuals who exceed the maximum acceptable level
will require either partial external cleansing (removal of clothing and shower and
shampoo) or full body decontamination. Removal of clothing and shower and shampoo
will remove up to 90% of the radiation in exposed individuals (Veenema, 2012). The
goals of skin decontamination are to decrease the risk of dermal injury, lower the risk for
internal contamination, and to reduce the contamination of health care personnel and the
environment (http://www.remm.nlm.gov/ext_contamination.htm#personnel). An Internal
Contamination Clinical Reference application is available for Android and iOS devices
that estimates reference radionuclides in urine and can be downloaded from the CDC
web site.
Care of Children
Fetuses, infants, and young children are the most vulnerable to the negative effects of
radiation exposure, both short and long term. For this reason, one could argue that
children and pregnant women deserve a higher priority for screening. Highly
proliferative cells are the most prone to damage from radioactivity. In adults, these are
the white blood cells, red blood cells, epithelial tract, and so on; but in children, this can
be nearly every body system depending on their age and stage in development because
almost all their cells are growing/dividing.
Children will be extremely fearful of screening by health care providers dressed in
full PPE. Special ac- commodations should be made to keep children with their parents
or caregivers as much as possible. In terms of treatment/prevention of radiation-induced
cancer of the thyroid, KI is only useful for incidents involving the release of radioactive
iodine, such as a nuclear power plant accident or a nuclear explosion. The use of KI will
be recommended by the state or federal government if it is appropriate. KI is usually
recommended only for children (and occasionally young adults) and only when the

projected radiation dose to be averted is in excess of 5 rem to the thyroid. Nurses should
know that administering KI carries a slight risk of allergic reactiondit should only be
administered when the risk from the radiation exposure is greater than the risk of
administering KI.
Establishment of Shelters and Health Site Activities
Management of internally displaced persons was a major issue at Chernobyl (Dallas,
2012) and would be similarly here in the United States if a large-scale radiation event or
nuclear war were to occur. Massive evacuations in which thousands to several millions
could be seen as people seek to escape exposure. As was seen after the Fukushima
disaster, many people left with only the clothes on their backs and the belongings that
they were able to take with them from their homes were limited (Noto et al., 2013).
Evacuees will need to be sheltered in a safe location that is outside of and upwind from
the risk zone and that has secure electricity and water available for drinking and bathing.
They will need food, pharmaceuticals, non-food items, and health care services. They
will need to have their functional needs met in compliance with the Federal Emergency
Management Agency, 2010 Functional Needs Support Services Guidelines (Federal
Emergency Management Agency, 2010). Shelters will need to accommodate individuals
presenting with low-level radiation exposure. All organizations who provide shelter and
mass care in the United States under Emergency Support Function #6 of the National
Response Framework (Federal Emergency Management Agency, 2013) should have a
written plan for sheltering after a large-scale radiation event. This includes the American
Red Cross and those participating members in the National Voluntary Organizations
Active in Disasters (National Voluntary Organizations Active in Disasters, 2014). At a
minimum, this plan should include clothing collection and replacement and showering
facilities to accommodate a sudden surge of exposed individuals.
Psychosocial Support
Disasters cause a large psychologic and mental health burden to individuals because
of their sudden onset and unpredictable nature. The mental health needs of affected
persons are higher in nuclear disasters because concepts of nuclear science are
misunderstood and
frightening to laypersons, and even more compounded if the nuclear event is the result of
an attack on the United States as war presents its own unique set of psychologic insults.
Nurses responding to nuclear disasters must be able to include psychologic support into
all aspects of their care during immediate, short-term, and long-term responses to the

incident. Survivors and residents of Three Mile Island and Chernobyl have reported
increased psychologic effects years after the event.
Nurses responding to nuclear disasters also report increased psychosocial stress
because they must balance the roles of being a responder and caretaker while also being
a victim of the disaster. Public health nurses responding to the disaster in Japan reported
psychologic strain because they felt underprepared as civil servants and were involved in
the incident (Kayama et al., 2014). Health care workers must be aware of the
psychologic impact that a disaster can have on them and seek help when indicated.
Nurses cannot tend to the needs of others if they are excessively burdened themselves;
but by preparing for disasters and seeking assistance when needed, they can lessen their
own burden to become more effective health care providers.
Providing psychosocial support to victims is imperative to mitigate the long-term
mental health burden of the event (Reifels et al., 2013). Achieving an all-encompassing
psychosocial support to populations affected by disasters requires multilevel support
strategies and an interdisciplinary team. Nurses must be aware of their role in this team,
the infrastructure, and resources available in the area in which they work, and their
responsibilities within their scope of practice.
Nurses are trained inmental health assessment and interventions. They should also be
comfortable in applying psychologic rst aidwhen needed or referring an individual to
trauma-focused cognitive behavioral therapy as indicated (Reifels et al., 2013). Because
themental health effects of disasters exist over time, public health nurses must
continuously assess their communities for longstanding needs. Working with community
leaders and organizations to build resilience will ease the mental health burden of the
disaster (Wizemann, Reeve, & Altevogt, 2013), but nurses must also advocate for and
build systems that will address the psychosocial impact nuclear disasters carry.
Veenema, T. G., & Thornton, C. P. (2015). Understanding nursings role in health systems
response to large-scale radiologic disasters. Journal of Radiology Nursing, 34(2), 6372.
https://doi.org/10.1016/j.jradnu.2014.11.005

2. Kolaborasi multi disiplin


Disaster Management has to be a multi-disciplinary and pro-active approach. Besides
various measures for putting in place institutional and policy framework, disaster
prevention, mitigation and preparedness enunciated in this paper and initiatives being
taken by the Central and State Governments, the community, civil society organisations

and media also have a key role to play in achieving our goal of moving together, towards
a safer India. The message being put across is that, in order to move towards safer and
sustainable national development, development projects should be sensitive towards
disaster mitigation.
Inter-organizational collaboration among disaster management organizations is
essential. Trust and control are viewed as core aspects for building confidence among
collaboration partners. This article sheds more light on this trust control nexus by
studying inter-organizational disaster response and recovery in the Netherlands. On the
basis of documents and interviews, the roles of trust and control in the relations between
the Dutch armed forces and traditional responders are examined. Findings suggest that
trust and control are complementary and mutually reinforcing, while both concepts
require multi-level studies to distinguish between inter-personal and inter-organizational
trust and control. Trust and control are viewed as the core aspects for building confidence
in network partners and can be viewed as complementary and mutually reinforcing. This
study sheds more light on the trust-control nexus in collaborative disaster response and
recovery in the Dutch context. On the basis of analysis of documentations and a series of
interviews with military liaisons, the roles of trust and control in the relation between the
Dutch military and traditional disaster responders were clarified. The data shows not only
how trust and control develop over time, but also that trust and control need to be
balanced to ensure consistency and flexibility in the collaboration. The influence that the
individual liaisons exercise over the inter-organizational relations is particularly
noteworthy. The findings therefore emphasize that future studies need to take into account
the different hierarchical levels of collaborating organizations. Lastly, additional research
needs to be conducted on the role of power to unravel the influence of organizational
interests and power struggles in inter-organizational disaster response and recovery.
Inter-organizational disaster management projects: Finding the middle way between
trust and control Jori Pascal Kalkman Erik J. de Waard, 2016
NGO Response to 1999 Cyclone. NGOs active in Orissa responded to the 1999
cyclone in three phases: immediate, short-term, and long term. In the immediate phase,
the NGO response focused on emergency food relief, carcass disposal, temporary shelter,
emergency medical aid, debris removal and habitat restoration, trauma counselling, and
raising awareness for reconstruction. second phase, actually an extension of the initial
relief phase, focused on interim food security, restoration of community assets, revival of
schools, social mobilisation and group formation. The third phase focussed on livelihood

restoration, multi-purpose cyclone shelters, and community based disaster preparedness.


Immediate Phase: After the Cyclone, NGOs active in Orissa carried out relief operations
and supplemented government efforts in dealing with the unprecedented disaster. About
40 local and international NGOs set up an emergency response network called Orissa
Disaster Mitigation Mission (ODMM) to their coordinate relief and restoration work.
ODMM ran a control room at the state capital and shared information with the
government regarding problems faced in affected areas. Another NGO network formed
earlier called Orissa Development Action Forum also played an active part in emergency
response. NGOs ran community kitchens in hundreds of villages providing cooked food
to people. Professional NGOs utilised such food relief to initiate immediate
restoration activities in partnership with local communities, which included clearing
village roads, schools, cleaning water sources, disposing carcasses, etc. Alongside the
State Health Department and visiting medical teams from other parts of the country,
NGOs provided medical aid to the ailing cyclone victims by running mobile health
camps. Preventive measures taken by NGOs included distribution of medicine, and
efforts to raise disaster health awareness amongst people by organising community health
camps. The government provided temporary shelter building materials to all affected
families. Some NGOs also distributed temporary shelter materials among people soon
after the cyclone. Rejuvenating peoples spirits and raising awareness about
reconstruction challenges was an important part of NGO intervention. Death and
devastation had filled the victims with a sense of gloom. Cases of depression and trauma
were reported in many affected villages. Some NGOs tried to raise peoples depressed
spirits by organising street theatres and participatory cultural shows, while some others
set up Trauma Care Centres and undertook trauma counselling in worst affected villages.
Some NGOs ran Legal Aid Centres to sensitise people about their rights to compensation
offered by the Govt. NGOs also played a crucial role mobilising volunteers for relief
work. ODMM set up a Volunteers Hub at the state capital and ran a volunteers base camp
at Erasama, the worst hit area to facilitate volunteers participation in relief activities.
While smaller NGOs withdrew from the affected area after the relief phase, the bigger
and sincere NGOs continued their rehabilitation efforts in the cyclone-hit areas beyond
the immediate phase. Problems experienced in ensuring GO-NGO coordination during
relief operations could be attributed to several factors. The government had no previous
experience of working with so many NGOs in a disaster situation as NGOs never before
took part in disaster response on such a large scale. The absence of a clear framework for

information sharing and coordination of NGO activities made it difficult for the
government to identify who deserved facilitative support and who not.
Government - NGO Collaboration for Disaster Reduction and Response: The India
(Orissa) Experience. Mr. Aurobindo Behera Managing Director, Orissa State
Disaster Management Authority

Menya, A. A., & KAkumu, O. A. (2016). Inter-agency collaboration for fire disaster
management in Nairobi City. Journal of Urban Management, 5(1), 3238.
https://doi.org/10.1016/j.jum.2016.08.001
3. PTSD pada relawan
Pre-disaster
Occupational factors
Unsurprisingly, different occupational groups/professional levels respond differently to
disaster. Several studies demonstrated significant differences in stress reactions between

professional and non-professional (volunteer) responders. In several studies professionals had


lower levels of post-traumatic stress disorder (PTSD), preoccupation and unpleasant
thoughts, and found it easier to talk about their experiences than non-professionals although
one study found that professional fire-fighters had greater levels of PTSD than volunteers. A
small number of studies showed differences between occupational groups. For example, one
study found differences in PTSD rates between different branches of the emergency services,
another reported greater resilience in nurses than civilians and another reported higher PTSD
in health service staff who carried out domestic/ home help duties than in medical staff.
Several studies found that longer employment acted as a protective factor, associated with
lower stress, depression, burnout and PTSD. However there were three studies which found
that individuals with longer employment reported greater psychiatric and post-traumatic
morbidity and four further studies showing nosignificant association. Chang et al. suggest
that rescue workers with more years of service are more likely to have had traumatic
experiences (and perhaps residual symptoms from previous experiences). So, it may be that
the conflicting results are due to previous work experiences: those with long employment and
successful experiences may have positive outcomes, while those with long employment and
experience of traumatic incidents or unsuccessful operations may have poor wellbeing.
General perceptions of ones workplace and role pre-disaster also appeared to influence
wellbeing outcomes post-disaster in a small number of studies. Low job satisfaction and lack
of pride in the job were associated with PTSD in two studies.
Specialised training and preparedness
Many studies found that provision of pre-disaster training and information enabled
individuals to be emotionally and cognitively ready for the realities of what they may face,
leading to better wellbeing outcomes. Resulting from preparedness, confidence in ones
competence and knowledge appeared to impact post-disaster wellbeing. High sense of
professional mastery and assurance in personal and team capabilities were found to reduce
distress while feeling that training had not prepared them well was associated with greater
distress. One study revealed no significant difference in distress between emergency care
workers who had received training (related to psychological reactions to trauma) and those
who had not; however, rather than suggesting that training in general is not useful, the authors
suggest that the training received was inadequate.

Evidence regarding the benefits of previous disaster experience was inconsistent. Some
studies found prior experience was associated with greater distress. However several studies
found no significant wellbeing differences between those who were involved in previous
disasters and those who were not and one study found that previous experience was a
protective factor. It may be that the impact of previous disaster experience is mitigated by
other factors: for example, one study suggested that body handlers are a resilient group and
have protective factors such as a strong sense of community.
Life events and health
Significant pre-disaster life events, including personal traumas and psychiatric history,
were consistently found to be a risk for post-disaster mental health problems. Past mental
health diagnoses increased the likelihood of reporting mental health symptoms post-disaster:
it should be noted that many studies described this as psychiatric history or pre-existing
psychopathology and did not describe which particular mental health diagnoses were
reported. One study found that previous psychiatric illness predicted anxiety but not
significantly. Several studies found the risk of probable mental health problems to increase
with increasing number of pre-disaster life events. It should be noted that while most studies
specified that negative life events or adversity predicted poorer wellbeing, several studies
simply reported on prior life events without specifying whether these were adverse events.
One study reported no significant differences between those with history of substance abuse
and those without while anotherfound that experiences during the disaster had a bigger
impact on wellbeing than pre-disaster events. Two other studies showed no significant effect
of previous trauma history.
During-disaster
Exposure
A substantial body of research has found that disaster exposure (in terms of severity and
type of exposure) has multifaceted implications for psychological wellbeing. Many papers
reported that traumatic exposure alone (irrespective of exposure type) predicted a range of
psychological complaints and disorders, including anxiety, depression, general distress and
PTSD. One study found that disaster-exposed nurses had higher levels of PTSD, depression
and psychosomatic symptoms during the disaster than non-exposed nurses, but lower
psychosomatic symptoms after the disaster. Rates of distress were higher among those with

repeated or high exposure and there was a doseresponse relationship between the number of
traumatic events experienced during a disaster and depression or PTSD. One study found that
exposure was correlated with distress but this was not significant in regression analysis, while
four studies showed no significant effect of exposure on psychological wellbeing. Proximity
to the epicentre of the disaster appeared to play an important role in psychological wellbeing.
With the exception of fire-fighters, rescuers responding to victims in the epicentre of a
disaster appeared to suffer more PTSD symptoms than those farther out.
Dealing with serious injury or dead bodies appeared be a risk factor for psychological
distress and post-traumatic stress responses. Workers with such exposure experienced stress,
somatic complaints, fatigue symptoms, and were more likely to develop PTSD, depression,
alcohol problems and anxiety. Some research suggested that the type of exposure made a
difference, with exposure to burns and child victims increasing the likelihood of PTSD.
Conversely, several studies did not demonstrate associations between exposure to
bodies/injuries and mental ill-health. Again this inconsistency of evidence suggests there may
be important mitigating factors making certain groups more resilient; one study suggested
that good team spirit and morale may explain low levels of psychiatric morbidity in police
body-handlers. Few studies explored the relationship between disaster trauma exposure and
positive outcomes, reporting that post-traumatic growth (PTG) was associated with higher
levels of trauma exposure.
Duration on site and arrival time
Duration on site and number of hours spent in one shift generally appeared to be risk
factors for mental ill health, although there was some inconsistency in the findings. Working
long hours on the disaster site and not taking a day off each week significantly increased the
risk of mental distress, job dissatisfaction and subjective health complaints [18, 36, 48, 54,
78, 92, 93] with increased likelihood in non-professional or non-traditional workers who may
lack appropriate physical, mental and emotional preparation. Equally, prolonged time spent at
a disaster site also significantly promoted distress. One study found that the number of days
spent on site was predictive of PTSD and depression, with evidence of more than 28 days, 90
days and 120 days most significantly increasing the likelihood. However, some studies found
evidence contrary to the above, with neither number of hours nor number of days being
associated with psychological distress. It may be the case that the participants in these studies
were particularly resilient: for example, one found that their participants were generally a

resilient group with 81.0 % meeting the studys criteria for resilient (i.e. not meeting PTSD
criteria at any of the studys time points); similarly only a small percentage of participants in
another study met the criteria for full (as opposed to subsyndromal) PTSD suggesting they
were particularly resilient.
Several studies found that earlier arrivals on the disaster site i.e. being one of the first
on the scene were significantly associated with greater PTSD and depression. The impact of
the arrival time appeared quite specific. For example, arriving at the World Trade Center in
the morning of 9/11 led to an increased risk for PTSD and depression that was significantly
greater than even arriving in the afternoon of 9/11 [74]. Arrival in the afternoon was of a
similar risk to arrival several days after the attack. Similarly, other studies found that the
earliest of arrivals increased the likelihood of PTSD by as much as six times. One study
demonstrated that the prevalence of PTSD in the following 510 years was determined by
time of arrival.
Conversely, several studies found no significant associations between arrival time and
psychological distress post-disaster. This inconsistency in the literature may be due to many
studies not controlling for training, preparation, equipment, or severity of disaster exposure: it
is likely that those first on the scene will be less prepared, the evolving situation may be more
ambiguous and they may be less well-equipped and going into a more dangerous
environment than those arriving later. One study found that (in non-traditional responders
only) earlier arrival time was negatively correlated with PTSD. The authors acknowledge that
this contradicts other research, and attribute it to the heterogeneous occupational composition
of the sample and delayed traumatic exposure inworkers without training who joined the
recovery efforts late.
Emotional involvement
Several studies reported that employees identified with victims and became overly
emotionally involved in the disaster. One study found that stress increased along with the
stress of the survivors being dealt with, while another found that workers with a high level of
identification with survivors had greater intrusive, obsessive and compulsive thoughts.
Identification with victims as a friend (i.e. envisaging the deceased as a friend; this could
have been my friend), as oneself, or as a family member were associated with PTSD.
Peri-traumatic distress/dissociation

Peri-traumatic dissociation during an incident increased the likelihood of acute stress


disorder, PTSD and alcohol problems, while the number of dissociative symptoms further
increased that likelihood. High levels of peri-traumatic distress were associated with greater
burnout and depression, psychiatric impairment and PTSD. One study found no significant
correlations between peri-traumatic dissociation and post-traumatic stress symptoms;
however it should be noted that this was based on a small sample (n = 25). A further study by
the same authors noted that rescue personnel experienced peri-traumatic dissociation but not
any post-traumatic reactions, though they suggest that perhaps the post-traumatic response
begins later, and suggest that the level of dissociation should be mapped from an early stage
to predict whether it affects post-traumatic stress in the long term.
Role-related stressors
Work-related stressors were found to predict PTSD. Role ambiguity and having
insufficient job-related information were associated with increased anxiety, secondary
traumatisation and job burnout. Being involved in tasks outside of usual remit, such as
providing supervision when not in a leadership role and police officers fighting fires,
increased the risk of PTSD. Other studies found that working on damaged rooftops more than
once and fire-fighters performing construction duties increased the probability of
psychosomatic disorders and PTSD respectively. Furthermore, direct victim and local
community contact substantially added to stress and distress. Certain tasks such as rejecting
victims in need of help due to lack of resources or manpower, treating people who had been
injured, cleaning up destroyed areas, handling residents complaints and being involved in
crowd control were associated with PTSD and psychological distress. Not being able to
predict or control events, as well as feeling a lack of control over the nature and extent of
victim injuries, were associated with post-traumatic stress in fire-fighters. Other job-related
predictors of poor mental health outcomes included: longer assignments, increased time with
child clients, working with fire-fighters, and clients who discussed morbid material, for
disaster mental health workers; and qualitatively heavy workload for emergency service
personnel.
Some studies reported no significant associations between job-related stressors and
outcomes. For example, one study [30] found no association between high case load and
psychological distress in social workers offering psychological support to disaster victims;

another showed that high work demand was associated with increased alcohol and tobacco
use in public health workers responding to hurricanes but not with PTSD or depression.
Perceptions of safety, threat and risk
Many papers showed a relationship between wellbeing and perceived safety (or risk)
during the disaster. Low perceived safety (i.e. greater perceived risk to oneself ) was
associated with anxiety, depression, general psychiatric symptoms and post-traumatic stress.
Subjective perception of danger to oneself was the single best predictor of PTSD in utility
workers. One study found that worries about personal safety were predictive of PTSD, while
feeling not enough safety measures were in place and concern about equipment quality were
associated with anxiety.
Two studies reported non-significant findings regarding perceptions of personal safety,
both by the same author and looking at fire-fighters. Perceived threat was significantly
correlated with distress but did not remain significant after other factors were controlled for
in regression analysis, while another study by the same author found that volunteer firefighters with and without PTSD did not differ in terms of perceived threat.
Harm to self or close others
Having a near-death experience, being seriously injured or having a severe mental
trauma during the rescue predicted PTSD in rescue workers after an earthquake: those who
experienced one of these had a rate of PTSD 25.6 times higher than those who had not.
Developing lower respiratory symptoms or skin rash were significantly associated with PTSD
and depressive symptoms. Being injured predicted PTSD, depression, panic attacks and
general anxiety. However, several studies showed no significant relationship between
physical injury to the self and mental health outcomes.
Knowing someone injured or killed during the disaster was predictive of outcomes in
many studies. Loss of someone close was associated with PTSD and distress. Several studies
also suggested that specific relationships (i.e. whether the person was a family member,
colleague, friend or acquaintance) might predict outcomes differently. One study found an
increase in PTSD risk for each additional death of a colleague [97] while another found that
loss of a co-worker led to a near 4-fold increase in elevated PTSD and more than a 2-fold
increase in use of a counselling service. Having family members who died or were injured

was associated with PTSD and depression and losing a family member appeared to have a
greater impact than losing a friend. Only one study found no relationship between knowing
anyone killed or injured and post-traumatic stress.
Social support
Many studies explored social support, generally finding that poor support was associated with
reluctance to seek treatment; PTSD, anxiety and depression; stress and illness; secondary
traumatisation and burnout; and greater obsessive/compulsive and preoccupied symptoms.
One study showed that general social support was not associated with either peri-traumatic
dissociation or PTSD.
Several studies focused on organisational support in particular. Work culture support and
supervisor support appeared associated with job satisfaction, work engagement,
psychological strain and turnover intentions. Conversely, poor relationships with line
managers and co-workers predicted PTSD and dissatisfaction with supervisory support was
associated with depression, while poor workplace communication significantly increased the
risk of mental distress. High need for support and lack of organisational support in the
disaster aftermath were the strongest contributors of depression in Red Cross volunteers.
However some studies found no significant associations between organisational support and
outcomes.
There were mixed results on the effect of friends/family support. Satisfaction with home
support was not correlated with post-traumatic stress in one study while family support was
found to be protective in another. Other studies found mixed results: for example, one study
found that social support from friends acted as a significant moderator on the relationship
between trauma exposure and intrusion symptoms for UN soldiers but not for relief workers,
while in another study number of sources of family support predicted full PTSD, but not
subsyndromal PTSD.
Negative social behaviours were generally associated with poor wellbeing: being a target
of harassment was associated with stress and being assaulted (e.g. during crowd control
activities) was a risk factor for PTSD in police.
Post-disaster

Professional support
Though several studies examined whether employees felt immediate professional help
(particularly debriefing) was helpful, only few examined whether receipt of professional help
influenced mental health outcomes. There were mixed findings from those which did.
Not receiving psychological counselling during the rescue mission was predictive of
PTSD in military responders following an earthquake while Critical Incident Stress
Debriefing (CISD) was found to help emergency medical workers cope. Satisfaction with
workplace debriefings was not associated with PTSD in fire-fighters; however, participants
with other non-PTSD disorders were less likely to report satisfaction with the debriefings or
recommend them to others. Participation in a group counselling service was not associated
with depressive symptoms. One study found that CISD led to higher avoidance, though this
did not remain significant in multivariate analysis. Since so few studies explored the impact
of debriefing on outcomes it is difficult to draw firm conclusions.
Impact on life
There were mixed results regarding the effect of having ones personal life affected by the
disaster. Having to spend nights away from ones own home in the days following disaster
did not predict PTSD in community volunteers after an earthquake, but needing food/ water
aid, clothes aid and financial assistance were predictive of PTSD, as was suffering financial
difficulties due to the disaster. In a study of Red Cross volunteers, loss of their own resources
(home, food, water,clothing or income) was the most influential exposure variable for
depression. Another study found that rare family contact and uninhabitable home were
associated with depression. However, several studies showed that personal loss was not
significantly associated with mental health outcomes. Losing ones own property was a
predictor of distress in several studies with only one study finding no association between
losses and PTSD.
Having ones professional life affected by the disaster appeared to be predictive of
wellbeing. Changes in the time and place of work, immersion in professional role and role
expansion were correlated with post-traumatic growth. Difficulty functioning at work postdisaster was associated with PTSD and acute stress, while job loss was also associated with
PTSD. Functional job impairment and taking mental health-related medical leave were
associated with PTSD.

Life events
Exposure to significant post-disaster life events (e.g. divorce, relationship break-up) was
significantly associated with distress, PTSD, anxiety and depression. However in one study,
exposure to subsequent fires did not influence mental health outcomes in volunteer firefighters.
Media
Watching television for 4+ hours per day, 1 month post-disaster, was predictive of PTSD
symptoms in rescue workers while another study found that volunteer fire-fighters with
persistent delayed-onset, persistent chronic and resolved chronic PTSD were all significantly
more distressed by television reminders of the disaster. A third study also reported a positive
correlation between anxiety and watching television. Conversely, watching 3+ hours of daily
media coverage was not associated with emotional distress in emergency care workers.
Coping strategies
Several studies explored the relationship between well-being and both positive and
negative coping strategies. Most commonly, the studies considered avoidance or denial.
Avoidance coping, i.e. deliberate avoidance of traumatic thoughts, was associated with
greater psychological distress and predicted traumatic stress. Avoidant thoughts appeared to
predict PTSD more strongly in fire-fighters with low exposure than intense exposure.
In terms of positive coping mechanisms, proactive coping and positive thinking were
associated with post-traumatic growth.

Another study found that confrontive coping,

distancing and planned problem-solving significantly reduced the effect of direct rescue effort
involvement on general psychiatric morbidity.
Only one study found no significant relationship between coping strategies and outcomes.
Table 2 shows the prevalence of resource loss amongst the volunteers, indicating
that resource loss was always related to higher value of PTSD symptoms, signicantly
in 5 out of 6 times. The same could be said for subjective health complaints although
it only was signicant in 3 out of 6 questions. In addition to resource loss, 49% of

the volunteers reported having had damage to their home and 33% needed to relocate
as their house was structurally unsafe, 5% were physically injured in the quake, 24%
had family members physically injured and 25% had family members or someone
close to them buried under rubble. Furthermore, 47% of the volunteers reported
uncertainty about the welfare of their loved ones. Exposure to dead bodies or body
parts was reported by 58% of the volunteers and 34% heard cries of trapped people.
The above types of exposure t criterion A1 of PTSD symptoms (DSM-V).
At 6 months post-earthquake, 28% of the volunteers reported a high level (above
cut off score of 33) of PTSD symptom severity and 20.5% at 18 months. At 18
months the subjective health complaints were 19.78 (SD = 13.72). The subscales had
the following results:
Flu 2.03 (1.51); Musculoskeletal 7.47 (5.02); Pseudo Neurological 5.69 (4.45);
Gastro intestinal 3.71 (3.94).

Brooks, S. K., Dunn, R., Amlt, R., Greenberg, N., & Rubin, G. J. (2016). Social and
occupational factors associated with psychological distress and disorder among disaster
responders:
a
systematic
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(2014). The impact of disaster work on community volunteers: The role of peritraumatic distress, level of personal affectedness, sleep quality and resource loss, on
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