A Brief Look at Some Mental Health Issues When You're Helping Others

Planning on being in a disaster? Well, no, of course not. It's not the sort of thing you generally plan for (except for a few of us in places like the American Red Cross and the Marin County Health and Human Services folks). But still, in a matter of minutes, you might find yourself in a disaster area and, if you are among the uninjured, you might end up helping your friends and neighbors.

One thing you'll find whether you go to a disaster area on purpose to help out or just find yourself in a disaster area by an unhappy coincidence is that the care and sheltering aspect is huge. And, while not everyone is a trained medical professional treating broken bones and bruises, virtually everyone is by default a mental health worker.


For that reason, you'll need to know a few basics. Just having read a blog post sometime in which a few granules of information embedded in your brain can be enough, so let's give it a go!

The Marin County Health & Human Services Department recently hosted a training at its Canal Neighborhood San Rafael Campus. While it had a lot of useful information in it, I've also peppered in some information from the American Red Cross and from some personal experience.


If you find yourself working in a shelter, let's say a community center, a school gym or a church that's been turned into a shelter, everyone who walks in is a mental health patient to some extent. They are all suffering from stress to some degree and your job is to comfort them and to determine if they are in need of speaking to a mental health professional.

Image Credit: Affinity Rescue

Emergency room nurses and doctors speak of The Golden Hour. That's the very first hour from when a patient is in need of care, perhaps from an accident or a stroke. If they can make it to the hospital for treatment within that first hour, their odds of survival are much better statistically. For every additional minute after that first hour that they are not yet in a doctor's care, the odds of their survival become increasingly worse.


In the disaster mental health field, they talk about The Golden Month. People that are diagnosed and treated for mental health in the first 30 days after being affected by a disaster are less likely to have Post Traumatic Stress Disorder (PTSD) as a result of their experience. So, as someone helping people at the scene of a disaster or a location they've been evacuated to, you are the front line of mental health treatment. You are best positioned to quickly get a survivor the mental health assistance he or she might need.


At this stage, it's also useful to mention Retraumatization. That's something you want to try and minimize. Otherwise, it is a like a mental hammer to the head being applied over and over before someone who was at least okay is no longer doing fine and is at risk for PTSD.

So, what's Retraumatization?

An overwhelmed television media creates a PTSD nightmare
by reairing the same images of the towers over and over.

The best example that comes to mind (no pun intended) is the television media airing the collapsing of the Twin Towers over and over and over while people who were involved were still trying to mentally process what they had just been through. The more they watched, the more they felt the same sensation of the world collapsing around them over and over and over.


In a shelter setting, addressing retraumatization may be as simple as pulling a shade over a window that shows the fire ravaged landscape outside or putting a Disney movie on a television that was previously showing a building collapsing during the earthquake that just happened repeatedly. It's really common sense. Try and look at the environment you are in through the eyes of those affected by recent events and see if there's anything that makes them feel unsafe or vulnerable.

This actually is not Dr. Chip
Schreiber but Leiv Schreiber
is a damn good looking man
and this blog article seemed a
little on the dry side.

Dr. Chip Schreiber, who was quoted often in the Marin Health Services training, recommends disaster victims be addressed with "Listen, Protect and Connect." So, what does that mean in practice? Let's take a stab at that.

1. Listen: Resist that urge to complete a registration form or other related paperwork to rush to get to the next person. Ask about loved ones, neighbors (who may or may not be in the previous category), pets and their personal well being. Ask them what the experience was like. And, above all, listen to what they have to say and ask them to elaborate on points that seem to strike a nerve with them. If they are talking to you, that's a great sign. It means they are processing and sharing.
2. Protect: Tell them why they are safer now. Is the shelter out of a fire zone? Was a built to withstand a major earthquake like they one they just experienced? Is it above the flood level during a flash flood crisis? Are there trained doctors and nurses onsite to help just in case someone needs them? Is there ample food and water? Are there ways for loved ones to check online to find out they are safe and secure? Explain why they can now safer than they were an hour ago and that will give them permission to get out of survival mode and perhaps get a little rest.
3. Connect: Be real. No, really, be real. Don't tell them you "understand what they're going through" or that "other people have made it through worse." As a matter of fact, if their situation sucks because they've lost a home or can't find a pet or something like that, tell them that it sucks and that you are sorry they have to go through something like that. Let them know you are there for them. One Marin County worker in our class who was an admitted introvert, said one of the nicest things someone could do for her in a time of need was to sit there and ask nothing and say nothing for hours. Just be there. Don't try and solve anything. Don't try and say that when you were helping out in Whogivesablankistan that you saw much worse conditions. Just be real and be there and that's enough.

But, with all your good intentions, there are going to be people that you can't help on your own. Remember? Even Dr. Seuss told us:

Except when you don't.

Because, sometimes, you won't.

I'm sorry to say so

but, sadly, it's true

that Bang-ups

and Hang-ups

can happen to you.

In this case, that means you'll need to be ready to get a mental health professional involved. By "getting involved," I don't mean it's like ringing the bell at Trader Joe's when someone brings their own bags and yelling "I've got one that's three sockets short of a full set of wrenches here!" No, it's more like just making it part of the natural welcome to the shelter flow by matter of factly saying "There's one more person I'd like you to meet before we get you settled in." and introducing the person in need of some assistance to a mental health professional with a simple "Steve, this is Beth and she's going to finish up your registration." (No "Dr" please.) 


Naturally, you might be asking when you need to get a mental health professional involved. Here are a few things to look for:

• Disoriented: Do they seem like they aren't quite sure where they are or how they got there? Are they detached from reality?
• Depressed: Are they sleepy? Does it seem like they just don't care what happens going forward now that they've been through this disaster?
• Anxiety: Are they having trouble sitting still? Are simple decisions impossible to make? ("Would you like some water?" "I'm not sure.") Are they irritable?
• Mental Illness: If asked about their medication, do they include any prescriptions for anxiety or depression? Do they have difficulty remembering their name, the date, who's president?
• Addiction: Are they shaking, especially the hands? Are they scratching? Are their pupils remaining dilated? Slurred speech? How are they on Day 3, if they are still there? That's the day withdrawal from alcohol and many drugs becomes the most intense.
• Abuse: Do they seem inordinately afraid of other people? Are they concerned about whether a spouse can walk in and ask if they're at the shelter (Red Crossers know, they can't)? Do they flinch or startle easy when handed something, even a pen or a bottle of water?

Ty Webb, Philosopher to Teens of the 1980s

To wrap this up, I really want to reassure you as someone who is always trying to learn a little more, but never seems to know enough about any particular thing, it's okay you aren't an expert. If this blog article or a class you took with your employer or a relief organization like the Red Cross gave you just one tip, that's enough. Just trying to help people, however imperfectly we all do it, is enough. If your heart is in it and you sincerely care, those you are helping will see that and they'll immediately be on your team. In other words, to quote Ty Webb (Chevy Chase in Caddyshack): "Be the ball." And really, in this case, it's true. Be the ball and the rest will just figure itself out. 



And, if Ty Webb isn't your thing when it comes to your philosophy about helping those in a disaster, it turns out there are also a few quotes from Mother Teresa on the subject.

"We ourselves feel that what we are doing is just a drop in the ocean. But the ocean would be less because of that missing drop."

Tis the Season!

This blog is intended to provide a little information and perspective colored heavily by sarcasm from someone involved in the Marin County California disaster preparedness and response effort. It should not be interpreted as instructive nor the official position of any government or non-government organization. So, really, don't take this so seriously, okay?

Okay, "Tis the Season" kind of sounds like it's time to go out and get a gift, right? Well, actually, it's fire season in Marin and like that other season of the year it tends to sneak up on you rather quickly. The Marin Red Cross Chapter has been sent on Disaster Action Team (DAT) responses to support our local and CDF firefighters (more than 100 of them at one fire) three times over the past week. That's unusual.

So, yes, it's that time of year. If you haven't gotten that special firefighter something to kick off the season, a gift to mark the season, no worries. They love it when you give them defensible space around your house, especially if that has you removing junipers that might still be growing next to your home from the 1970s when those stickery, bug-infested firebombs were considered landscaping. Now-a-days, they are just considered "fuel" by firefighters who really hate to see them when they pull into a neighborhood on a windy, dry afternoon.

Red Cross Disaster Worker Micah Joins San Rafael Fireman on the Ridge Above Albert Park Last Saturday

So what's the situation? To clarify for Jersey Shore Vacation viewers, in this case The Situation I'm talking about is an actual situation and not a Dude who does laundry, gym and cocktails as a weekend routine. (What? No teenage children at home? Just ignore that one.) The situation in Marin is that the fuel load is fairly high, but, for the most part, our fire departments, many of which have battalion chiefs that specialize in vegetation management, are on it. Why do I say "for the most part?" Well, there are some areas of West Marin that are currently carrying fuel loads 25% larger than they were before the Vision Fire and that has the Golden Gate Rec Area Fire Chief watching things very closely. That's the thing about protected land. There are some environmental groups that are not excited about you mowing it or removing all the junipers just because of the fire issue. That's not meant to be political. That's just life in Marin. One man's protected wild turkey is another man's dinner.

You may have noticed that the Marin Fire Crews have been out a lot this week doing controlled burns. Though it looks like a PG&E crew digging a hole (one man digs, 8 men watch), there is actually a method to the madness. There are firemen lighting grass using torches on one side while other firemen stop the fire on the other side using a hose fed by their 800-gallon tender. All those firemen watching and leaning on shovels are there in case a gust comes up and throws a monkey wrench into the plan. So, the next time you pass them by, be happy they are out there preventing something unplanned and probably worse from happening by reducing the fuel load with a controlled burn.

When there is a fire, or the three grass fires we've had so far this week, there's a coordinated response. Local firemen are deployed to work from neighborhoods toward the fire so there is a growing buffer of safety. In the case of the San Rafael fire above Albert Park, they came through a neighborhood bordering the top and brought hoses up through side yards and back yards. They also go out on the hill and tackled the fire itself, attacking from the bottom, where "Smores Night" at a homeless camp turned out to be a bad idea, and the middle. In this case, it was large enough that prison inmates were also used for the task of shoveling and putting out hotspots.

Red Crossers Arrive on the Ridge in a 4X4 turck with Water, Coffee,
Burritos, Energy Bars, Gatorade and Other Items for Fire Crews.
Down below is a Red Cross Emergency Response Vehicle (ERV
referred to as "Irv" as in "go get water from the Irv!") that has
more capacity, but is hard to navigate on the narrow dirt roads
being used by large firefighting equipment. Kevin gets us there!

Above it all are CDF tankers circling full of fire retardant. They receive radio communications from the incident commanders (usually assistant fire chiefs or battalion chiefs coordinating with the fire chief for the local area) letting them know where they'd like a drop. Also, the tankers and their helicopters act as an eye in the sky directing fire crews toward suspected hotspots.

The unsung heros you might not think about are folks from the police and, yes, parking enforcement, that are deployed to keep citizens sheltered in place and off roads being used by fire equipment and serve as impromptu traffic cops up in the fire area as tankers and tenders and fire engines bring men and equipment back and forth in cramped quarters (often, calling the road a "one lane road" is overly optimistic.)

In the middle of all of this, is the American Red Cross bringing in food, water, coffee or anything else the firemen need while we await orders from the fire chief concerning any need for evacuation or medical triage where Red Cross brings the ERV into a neighborhood to help with care and sheltering. In cases where damage is very minor, we just pass out cleaning supplies. I know, I know. Not super sexy and you aren't likely to see a movie where Dwane Johnson hops out of a Red Cross vehicle and hands someone a mop and a bottle of Mr. Clean as the citizens go, "Thank goodness you got here when you did!"

What's Oooey and Gooey and Stuck to Your Tender? 

One thing that was learned by at least one fire department this past week is that before you tell the CDF tanker to drop a load of fire retardant, it's a good idea to move the fire equipment out of the way. Who knew? It turns out (and you'll just have to take their word for this) that fire retardant has a big "goo factor" (sorry for the technical jargon) and that it sticks really good to things that aren't on fire.

And I Should Do What?
If you are wondering just what all of this has to do with you and if there's something you should do, the answer is yes. But, don't stress over this. You local fire departments and their volunteer support groups like the American Red Cross have been preparing and practicing with joint exercises and disaster drills (always thought that was kind of bad branding, by they way. I mean if someone invited you to something called a "neighborhood disaster drill," wouldn't you assume it was just that crazy neighbor who walks his dog while wearing flip flops and black socks just lighting his garbage cans on fire yelling, "Wooohooo. Now, that's a disaster!!!"?) Anyhow, back on point, a lot of preparedness professionals have been, well, preparednessing or something like that. You can too.

When Firemen Bring Their Own Water, They're Serious

And you should too. Here's how. Walk around your house or apartment building (if you live on a boat in Sausalito, maybe not) and look at it as there was a fire across the street about to move over to your lawn. Are there branches or bushes right up against your house? Are there dead plants or weeds in your yard? Well, remove them. Get rid of anything that looks easy to burn that's touching your home. That's step one. Step two: Get a fire extinguisher. That's so you can create enough of a gap to get yourself out of the house even if your door is on fire. You aren't going to try to put out the fire by yourself. Just get out and get safe. Step three: Put together a go bag. Nothing crazy, just enough medication (blood pressure pills?), copies of vital records, bottle of water, bandaids and granola bars you can use if you have go evacuate to a shelter. A flashlight is a great idea, because sometimes disasters don't follow our recommended daytime-only scheduling recommendation.

"Excuse me, but I'm pretty sure I have the right of way.
Okay, maybe not."

Want bonus points? A thumb drive with your vital records is a great idea. And, step four: Let Red Cross come to your home and put in our free 10-year Kidde smoke detectors and give you a quick home fire safety check. It's fast and free. Sure, there's a lot more you can do and I'd be happy to send you Red Cross literature that would give you a day's worth of work, if you'd like. But, for now, if you just spend a quick hour or two preparing, then you can make yourself safer. 

That's the skinny on fire season as it starts. Any questions? Visit your local fire station. A plate of cookies and get you a lot of really useful information. Want us to come to you? The Red Cross does that in Marin and we'll even check out your smoke alarms and add some new ones while we're there. Want to know the people most-likely to help you as the very first responders in a fire or other type of disaster, say hello to your neighbors? Make sure you know each other just a little bit. Are there neighbors with special needs? Are there kids at home during the day?

And Now a Word from Our Sponsors!
It's always especially nice when I get to eat crow in public, so let's get to it. I've been vocally NOT drinking coffee from "evil corporate death star Starbucks" for years. I'd walk into meetings with my coffee cup from some local coffee place and proudly display that I was a rebel who only drank manly Marin chai tea with coconut milk (ya, that's how I roll) that wasn't from evil corporate people trying to Walmart-ize neighborhood coffee. Then, and here comes the crow part, I started with the Red Cross and needed to do things like pick up last minute coffee travelers for 125 firemen who need it right now or groups of volunteers installing smoke alarms in apartments in the Canal Neighborhood. And, well, the folks at the San Rafael 4th Street Starbucks turn out to be some of the nicest supporters of anything we are doing and when it's for the firemen, their policy is pretty much "take whatever you need!" Want more cream? Sure. More cups? Sure! More Coffee? Sure! Do any drink decaf? No? Well take some anyhow. So, with a mouth full of crow, I have to say, Thank You San Rafael 4th Street Starbucks for being one of our best supporters who help us help and ask for nothing at all in return.

Thank You San Rafael 4th Street Starbucks for All You Do and for Not Being an Evil Corporate Death Star!

Is Your Social Network Ready for the Big One? A Glimpse of Epicenter 2018

This week about 150 disaster preparedness professionals gathered in San Francisco's Presidio for Epicenter 2018, a conference on disaster preparedness hosted by the San Francisco Department of Emergency Services and the Salvation Army. Although, as the name implies, the main topic was preparing for the big shaker, there was also some valuable information passed along from lessons learned during the recent Wine Country wildfires and the tsunami at Fukushima. While it's impossible to summarize everything covered in two days, here are some interesting tidbits.

But first, a little background. Why are all of these disaster preparedness officials and nongovernment organizations (NGOs) gathering now?

Unfortunately..."You Are Here" on this fault map

California and, specifically, the San Francisco Bay Area is overdue for a 7+ quake on both the Hayward and San Andreas faults. Sandwiched between those faults are Marin County and San Francisco. Crossing those faults from east to west are most of the communications and infrastructure (freeways, power grids, water conduits) connecting these areas to the rest of the state. It's expected that when the big shaker comes, movement in the Hayward fault in particular will snap the communications and power lines crossing that fault and the resulting isolated Bay Area will be on its own. The term disaster preparedness folks in the Bay Area often use for this is "Haywired." (Get it? Literally the wires across this fault will not be able to take a slip and they'll just snap).

San Francisco has Invested to Get Ready
According to San Francisco Mayor Mark Farrell and City Administrator Naomi Kelly, who both spoke at the conference, the city has been preparing for this expected event every since Loma Prieta. "Our strategy has been taking small bites out of a big problem," said Kelly, who reported San Francisco has spent $11 billion in infrastructure including a new self-sufficient communications system to prepare itself. This was evident by the several mobile command posts and communications trucks on display in the parking lot outside of the event.

The Challenge in Los Angeles
According to Leslie Luke, the deputy director of the Los Angeles County Office of Emergency Management, Southern California is attempting to be equally prepared, but the challenges they face are even more monumental. Here are some of the considerations they are facing:

• More than 2.7 million people will need to be fed in Los Angeles County after a large earthquake or similar disaster. That's 5.5 million meals a day.
• More than 58,000 homeless people live in LA County on an ongoing basis. They'll need to be housed and fed as well.
• More than 125,000 tourists are in LA County on any given day. They'll need to be cared for and sheltered with the rest of the population.

Carol Parks, community preparedness and engagement division chief for the City of Los Angeles Emergency Management Department, noted that 6 million people are in the LA area on any given day. These people rely on a network of mom and pop markets and 230 large grocery stores run by brand name chains. These stores are in turn supplied by 37 food distribution centers to the east. Her concern is that a major earthquake could knock out freeways and eliminate power needed to pump gas at gas stations therefore making it impossible for trucks to move food and other supplies from the distribution centers in the east into the Los Angeles Metro Area.

"Eighty percent of the problem (post a disaster) is trucks, drivers and gas," added Philip J. Palin, principal investigator for supply chain resilience at the Institute for Public Research.

Sometimes It's Who You Know, Not What You Know

Dr. Daniel Aldrich

Though there were many valuable presentations given on earthquake response from government authorities, one of the out of the box talks came from Dr. Daniel Aldrich, professor of political science, public policy and urban affairs for Northeastern University.

Dr. Alrich and his students have conducted massive surveys of the victims of Katrina and Fukushima to find and measure variables key to both survival and the desire by victims to return to an affected region and rebuild. What they found is that those in regions affected by storms, floods and tsunamis have different experiences based on their social network. In general, people that have a good network of friends and actually know their neighbors report less anxiety and improved mental health in general and, more important for a region's recovery, decide to return and rebuild.

Dr. Aldrich refers to neighbors as "Zero Responders." Because they are there even before first responders (i.e. firemen) and second responders (i.e. The Red Cross), they are the first to help neighbors dig themselves out of debris and find safety. Where do you find this "first line of defense" prior to an actual disaster taking place? Dr. Aldrich recommends attending community meetings, joining your PTA Board and generally getting to know the folks around you so when a disaster strikes, they are looking for you and concerned about your well being. Dr. Adrich noted that these community connections or, "horizontal connections" as he put it:

• Saved lives during the Fukushima tsunami
• Sped up recovery of neighborhoods after Katrina 
• Improved the mental health of survivors in both situations.

Santa Rosa's McGlynn

Sean McGlynn, city manager for Santa Rosa, noted that this "neighbors helping neighbors" phenomenon was also a key factor during last year's wildfires in the wine country. "The community helped themselves," noted McGlynn. "If your neighbor didn't help you then it wasn't going to be a good end of story for you. He said this also helped the city begin to address recovery issues "almost from the beginning.

This was especially important for the piece of mind of those staffing the Emergency Operations Center as they balanced dealing with community needs and the needs of their own families. "Sixty-two of our employees lost their homes during the fires," noted McGlynn.

No Really...Get to Know Your Neighbors and Your Local Government

We've all seen the list of things you need to get ready for a big disaster like an earthquake. One gallon of water per day per person...check. Food you can consume without adding water or heat to prepare it...check. A battery operated radio with lots of spare batteries...check. A five-gallon bucket with liner bags and wipes you can use for personal sanitation...ewwww, but check. ...and the list goes on from there.

But, what came out of Epicenter 2018 and Dr. Aldrich's contribution to it was that, while supply chain resilience and the quick actions of first reponders are crucial, the connections between people that, as he put it, "bond, bridge and link" members of an affected community, are key to making it through something really big. Because, and I realize I'm stating the obvious, if cables across faults snap and bridges and freeways are either closed, flooded (hello Hwy 37) or congested, those bonds may become the most important in your life at a time when you need them the most.

eric.winkler@redcross.org

Active Shooter in a School: Statistics and Recommended Response

Note: As part of my duties for the American Red Cross, I've had the opportunity to join several disaster preparedness councils involving both government and non government organizations (NGOs). I've also had the opportunity to sit in on some very informative training sessions. Here's a recap of a four-hour Department of Homeland Security training that was offered through the Marin Sheriff's Office. The topic is timely, and, yes, a little scary if you are a parent like me: School Violence & the Active Shooter, taught by the Public Safety Training Institute.

On April 6, 2018, I attended a Homeland Security class at the Marin Sheriff's Office taught by the Public Safety Training Institute. The subject was what to do in an active shooter situation at a school and the attendees were deputies, policemen, firemen and educators. The class was four hours and taught by two former policemen with a combined 59 years on the job. One was a former SWAT commander. You may have seen the class covered on ABC Channel 7 News. While I won't try to duplicate all of the valuable information we received during this training, I will try to pass along a few bullets that might be of interest. 

Image Credit: Public Safety Training Institute

Goal: First responders on the scene of an active shooter in a school are taught to go after the shooter first to eliminate the threat, even before attempting to rescue and treat those who are injured. Their goal according to the instructor is "Not about saving everybody, but saving as many as we can."

Important facts:

 

• Because active shooters are usually attempting to scare and harm as many as possible and do not care about escaping to commit another crime as a common thief would, for example, they are considered both criminals and terrorists. 
• Most active shooter incidents last 12 minutes or less.
• 60 percent of active shooters either commit suicide or die by "suicide by cop" by placing law enforcement in a position where they must shoot them.
• Most school active shooter incidents happen in small or mid-sized communities.
• 37 percent of incidents last less than 5 minutes. 60 percent of incidents last less than 7 minutes. 
• 97 percent of active shooters are male.
• 57 percent of incidents are over before law enforcement arrives.

 

Fire Alarms: Of special interest to the American Red Cross and firemen considering the greater safety issue is that many schools are creating policies to have students stay in lock down mode indoors even if a fire alarm is set off. This is because in 1998 at an Arkansas middle school and at subsequent incidents fire alarms were used by perpetrators to herd students and teachers outdoors to make them easier targets.

When school fire alarms can add to a dangerous situation.

In Arkansas, this was done by 11 and 13 year-old boys resulting in the death of five. So, the school staff have the tricky challenge of training how to respond and not torespond to fire alarms on campus.

There Are Warnings: FBI studies of incidents have concluded that most active shooters feel the need to post on social media (sometimes even pictures of themselves holding guns), make threats to others and talk about suicide. These are all warning signs to educators that a problem may be percolating on campus. The FBI has determined this after reviewing 220 incidents between 2000 and 2015. In those incidents,  661 were killed.

Florida School Shooter's disturbing social media post.

The message to educators is that the popular belief that the kids "just snap" isn't true. These incidents do not "occur out of the blue." There are warning signs and there is time to intervene. Privacy laws are not a barrier if there is a perceived threat to public safety, the instructors pointed out.

Frequency: The average number of active shooter incidents at schools has increased to an average of 20 per year over the past three years. This is up from an average of 7.

Run If You Can (and you know where the shooter is). Hide If You Can't. Fight as a Last Resort.
Image Credit: University of Pittsburgh

Recommended Response:

 

1. Run (if there is a clear path and you know the active shooter is another area)
2. Hide (lock down, barricade the door, turn off the HVAC, have kids under desks with cell phones off and cover windows if possible). Be invisible.
3. Fight (as a last resort, fight with anything you can find if your barricade fails). 
   1. Weapons available in most classrooms are:
      1. Your classroom fire extinguisher, which can be used to blind and then as a blunt object to strike.
      2. Baseball bat
      3. Chairs
      4. Trash cans
      5. Flag poles (most have a pointed tip that makes them a viable spear. Desperate times call for desperate measures)

I know we all agree that we hope this never happens in Marin, but, like any other disaster, knowing a little about it and how best to respond will hopefully help us all be a little safer.

eric.winkler@redcross.org