An Aspect of the Physical Impact of Disasters on Staff and Volunteers

By Elisabeth Whitney, CBCP, MNA, MPH&TM Program Manager with SF CARD and Art Van Beek, Assistant Facilities Manager, and David Gustafson, Administrative Manager with Tenderloin Neighborhood Development Corporation.

There are so many aspects of the physical impact of disasters on staff and volunteers that it is almost impossible to put it into one article that isn't exhausting to read. Given the huge scope of this subject, I am concentrating on the effect of the physical environment rather than other physical effects of a disaster. And to make the situation even larger, the physical effects are just one aspect of the overall impact of disaster. 

So often, our thoughts tend toward First Aid in disaster management. All too often in a disaster we do not have the supplies we need, and we are grateful to have been able to address the basic life threatening problems we find. We ask if the impacted individual is breathing, bleeding or unconscious, and we are grateful to be able to address these life threatening problems. While these questions rightly should come first, they should not be the only questions we ask. After ascertaining the physical impact of disasters we need to continue to ask questions around the psychological and spiritual impacts of the disaster. Additionally, disaster management does not stop when the last disaster client's needs have been addressed. We also need to manage our people who responded to help.

The 9/11 Twin Towers disaster, while extreme, is an informative example of why the management of our responders and volunteers is so critical.

9/11 Twin Towers Disaster in New York City

"Up to 70,000 people took part in the massive operation at the site of the fallen Twin Towers, including police, firefighters and construction workers who came to New York voluntarily from all over the US. Many worked for months amid a toxic haze of dust and chemicals.

Amid the pollutants within the giant pile of 1.8m tons of debris and the surrounding air were 90,000 liters of jet fuel from the two stricken planes, about 1,000 tons of asbestos that was used in the construction of the Twin Towers, pulverized lead from computers, mercury and highly carcinogenic by-products from the burning of plastics and chlorinated chemicals.

As of Nov 12, 2009, five firefighters and police officers, all of whom were involved in the rescue and clear-up following the terrorist attack, have died of cancer in the past three months, the Guardian reports. Three died last month within a four-day period."

. . . Look at the ages of those who were reported to have died from the excerpt of this Guardian article. I am sure the numbers have significantly increased since 2009. . . 

"Those three were Robert Grossman, a Harlem-based police officer who spent several weeks at the emergency site and died of a brain tumor aged 41; fellow police officer Cory Diaz, 37; and firefighter Richard Mannetta, 44. In addition, John McNamara, a 44-year-old firefighter, died in September; and Renee Dunbar, a police officer in her late 30s, died in August. Without doubt, there have been more since then.

The James Zadroga 9/11 Health and Compensation Act, passed by Congress in December 2010, is designed to provide medical services and compensation for responders who were exposed to dangerous toxins while working at ground zero. The bill currently does not cover cancer, and earlier this year, the National Institute for Occupational Safety and Health, the agency evaluating which illnesses will be covered under the Zadroga Act, determined no connection between exposure to cancer and dust."

Source: http://www.telegraph.co.uk/health/6548435/Fears-over-cancer-cluster-among-911-rescue-workers.html  

With time, I feel sure this will be amended. Our debt as a nation to these courageous individuals can never be measured. We do owe them the respect to learn from the unfortunate post disaster experiences they suffered and died from. As we progress in disaster preparedness and planning, it is incumbent upon us to focus special attention to the future protection of staff, volunteers and clients in the post disaster setting. 

The Tenderloin Neighborhood Development Corporation April 5, 2011 Franciscan Towers Fire

On a local note, the Tenderloin Neighborhood Development Corporation (TNDC) has learned some best practices the hard way also, which they have kindly agreed to pass on to the rest of us in the nonprofit, for-profit and faith-based communities of the Bay Area. The Tenderloin Neighborhood Development Corporation's mission is to provide safe affordable housing with support services for low-income people in the Tenderloin community and be a leader in making the community a better place to live. Here is TNDC's report.

Hazardous Communication Planning

It has been almost a year since the fire on April 5, 2011 seriously damaged the Franciscan Towers, home to 124 people, as well as TNDC's corporate office and our Tenderloin After-School Program (TASP). The cause has still not been determined.

Fortunately there were only minor injuries. Unfortunately, 124 low-income people were evacuated from their homes without warning. Many residents rushed out with nothing more than the clothes on their back, and they have had severely limited access to their units and belongings since. Many residents of the Franciscan Towers were living their financial lives from week-to-week. Everything they owned fit into their SRO unit, and now much or all of it is gone. For some, this was their first real home after years of homelessness. For these residents, the prospect of facing homelessness again is devastating.

The fire broke out at night at our 217 Eddy Street building in the Tenderloin district of San Francisco and caused major fire damage. The three alarm fire was finally contained after three and half hours of intense fire fighting.  In the aftermath, we quickly realized that employee and client health and safety remained critical and needed to continue to be protected in the cleanup and recovery phases.

"As the incident commander for TNDC's first response team, a major concern we addressed was the fire induced hazardous material release. With hundreds of thousands of gallons of contaminated water filtering down to the basement, the site became environmentally too "hot" for safe entrance by non-trained individuals," described Art Van Beek.

"Here are some lessons learned that we are now implementing as part of our Disaster Response Plan.

1) Have a well thought out Hazardous Communication Plan in place administered by your ICS Safety Officer. It is vital that your Safety Officer is well versed in all applicable Federal and State OSHA statues and regulations. see link

2) Have your CEO endorse the Hazardous Communication Plan and communicate it through out your organization. By doing so, there is no confusion as to who has the authority and the responsibility to protect the health and safety of employees and clients.

3) Pre-disaster, determine a hazardous waste containment and clean up vendor. Work with the vendor to strengthen your Hazardous Communications Plan. This exercise helps define disaster expectations and responsibilities.

4) Address site security, during your recovery phase too.  It is important to monitor and minimize access to potentially hazardous environments. It can easily become a problem if employees and/or clients are not directed away from dangerous areas. Additionally, the removal of any contaminated material from a hazardous waste site has the potential to contaminate the environment that it is being brought into.  So, appropriate disposal of all items from the "hot" area whether office files or obvious building debris must be monitored carefully at all times.

Internally, develop an e-mail and have both Human Resources and your leadership endorse it. It needs to state that admittance to the property has to be approved in writing by the scene Safety Officer. Further, it is important to ensure that everyone involved understands that retrieved items may jeopardize a one's health. To do this, it is important to collaborate with the hazardous waste remediation vendor, your internal staff and your clients (tenants) on the appropriate procedures and limits for owner and tenant belongings retrieval. This step was the most challenging for us. 

So, here are some "Key Issues" to remember when dealing with a similar situation. Be sure to develop a plan as we did with SF CARD's guidance. Have Go-Kits in multiple locations, stockpile your disaster supplies, develop your disaster supply lists - battery chargers, supplies, contact numbers, etc. Develop a working relationship with emergency agencies prior to the disaster. Develop plans to meet staff and client needs prior to the disaster. Know that any major disaster will take time, money and patience. Anticipate that recovery may take months. 

The fire has shown us what it means to be a "safety net" organization, and we are working aggressively to restore the Franciscan Towers so that it can once again be home to people so desperately in need of a place to live. So, being informed and prepared will help you through the storm. This helped TNDC.

Reference Websites:

Local

San Francisco Dept. of Emergency Management 

San Francisco Dept. Public Health 

State

California Law 

California Emergency Management Agency

Federal

Dept. of Homeland Security

Centers for Disease Control

Occupational Safety & Hazard Administration, (OSHA)

The Psychological Impact of Disasters on Our Staff and Volunteers

Wilma Bass, MFT of Trauma Outreach Associates, Inc.

Exposure to a disaster produces a variety of psychological reactions in people. There is no one way or right way to respond. Everyone has a spectrum of reactions and the best way to regard these are as normal reactions by normal people to an abnormal situation.

We all go about our lives with regular ups and downs; surprises and glitches here and there. Our natural resourcefulness and flexibility enable us to bend and flow with changes and to re-calibrate ourselves in a regular oscillating rhythm.

When disaster strikes, our normal coping mechanisms are disrupted and we no longer recognize ourselves quite as sharply. The sudden, unexpected shock of a traumatic event shakes our stability so that we feel shocked, helpless, overwhelmed.

In the aftermath of an event that rocks our world, we can react in ways that are new and uncharacteristic for us. The following areas of functioning are all typically affected:

1. Physical
2. Behavioral
3. Emotional
4. Cognitive
5. Spiritual

If your organization is affected by a disaster or a critical incident, you will benefit by recognizing the signs and symptoms of trauma and acknowledging these reactions without judgment or pressure. For example, co-workers may complain of increased headaches or stomach upset; they may use drugs or alcohol more frequently or behave in ways that are unusual for them, like isolating themselves or being easily startled. People may be depressed, angry, irritable, anxious and afraid. In the cognitive realm people may have difficulty concentrating or experience memory problems or confusion. And spiritually, a crisis of faith may accompany the upset of a disaster.

In your efforts to promote robust recovery from a traumatic incident and to address issues of post-disaster psychological distress, the following areas or concern are important to watch out for:

1. Increased absenteeism
2. Medical claims
3. Low morale
4. Sleep Disturbance
5. Anxiety and depression
6. Anger and irritability
7. Efforts to avoid activities that are reminders of the event
8. Exaggerated startle response
9. Nightmares
10. Increase in addictive behaviors.

If management fails to recognize that signs of trauma are natural responses and should be appropriately acknowledged then the impact on continuity of operations might be compromised.

For more information on the signs and symptoms of trauma check out:

http://helpguide.org/mental/emotional_psychological_trauma.htm

Rev. Mr. R. Christoph Sandoval, Deacon of the Cathedral of Saint Mary of the Assumption/S.F. Crisis Care

"Man is not destroyed by suffering; he is destroyed by suffering without meaning"

Victor Frankl

The Holistic Model has been touted in Public health and Community Based Organizations for well over five decades. The walls between Spiritual Care, Mental Care and Physical Care have withstood implementation in spite of research, academic degrees in multidisciplinary practice and in community planning. Chaplains, clergy, spiritual caregivers and people of faith have had to operate in silos without real partners in mental care and physical care. What is Spiritual Care? Is it of value? How is it done? What are Guidelines for Spiritual Care Givers? Here is just a quick snapshot.

The Goal: The word compassion means, "to suffer with." Compassionate care calls spiritual care providers to walk with people in the midst of their pain. Spiritual Care is Compassion in action. The Spiritual Care Giver is the medium, the message and the messenger for the delivery of Compassion.

All persons have spiritual needs. Some persons have religious needs.

What do we mean by "spiritual needs"?

Spiritual needs and concerns usually relate to what we call the "big" questions of life. These questions can include:

            Why is this happening? Why is it happening to me?

            What does it all mean?

            How do I make sense of everything?

            How do I feel about changes in my life?

            What gives me comfort and hope?

            What do I call "good" in my life? What do I call "bad"?

            What am I grateful for?

            What do I trust? Who do I trust?

            Who is my "beloved community" -- who loves me and is loved by me, no matter what?

            What or who -- beyond myself -- do I believe is important in my life?

Who is God to me?

Is this a punishment from God?

Where do I go after death?

Am I going to hell?

Am I possessed?

Is there a heaven?

Why was I born?

What is the meaning of my life?

What is the meaning of my suffering?

Where is my beloved?

All of these questions relate to spiritual needs, concerns and resources. All people ask these questions during their lives, especially when they or someone they love are sick or in crisis or has died in a traumatic event. 

Some people find meaning, comfort, hope, goodness and community through their religious practice, beliefs and/or community of faith. Some people do not. Regardless of whether religious faith is a part of a person's life, spiritual concerns, resources and needs can still be very important, especially during or after a life threatening traumatic event. What are the driving forces and essential guidelines for Spiritual Caregivers? Here they are:

Guidelines for Spiritual Care Givers:

1. Compassion requires we dethrone ourselves from the center of our universe. We must put aside self-centered desires, needs and ambitions in order to provide other-centered safe sanctuary for survivors of traumatic loss where they can express their feelings and thoughts, fears and hopes in the context of their faith or spiritual tradition.

2. Compassion requires that we manifest compassion in thought and feeling, word and action. Spiritual Care Givers must consciously abandon aggression, control, and containment impulses that incarcerate our ability to offer consolation, community and connection to the higher power rooted in their life experience.

3. Compassion requires that we move beyond the finite boundaries of the rational mind into the infinite intuitive intelligence of the human heart. We must yield our need to know and allow the unknowing 'ultimate reality' of oneness to speak into our ways of being.

4. Compassion requires us to be passionate partisans of Love...a Love that defeats ego and individuation in order to stand in solidarity with those who undergo physical pain, emotional suffering and ultimately voyage into life-death transition journey into eternal life. The Spiritual Caregiver invokes a prayer of invitation to the Divine Mystery by opening all the portals of perception through the practice of prayer to receive strength for the journey.

5. Compassion requires that we create encounter that supports and sustains relationship. We must heal individual and collective betrayal through the practice of Forgiveness to our oppressors and asylum to their victims.

6. Compassion requires holy humility to receive the blessings and graces designed to come through us on their way to someone else. We must become conduits of spiritual care for people in the midst of their suffering, pain and loss. Spiritual Care giving offers healing, meaning and understanding through the treasure of connection to Spiritual Resources.Spiritual resources are practices, beliefs, objects and/or relationships that people often turn to for help in times of crisis or concern.

Some spiritual resources include:

Prayer

Meditation

Chant, mantras,

Family and friends

Religious leaders

• Priest, Minister, Rabbi, Imam, Medicine man, Monk, Guru, Friar, Priestess, Maharishi, Cleric, Sister

• Bible, Torah, Qur'an, Vedas, Tao Te Ching, A Course in Miracles, Theravada, The Kitáb-i-Aqdas

• Poetry, Devotional Materials, Prayer Books

• Sabbath menorah, Holy Rosary, devotional pictures, prayer rug

• Communion, Anointing

Religious ceremonies and practices

• Healing circles, sage, communal gatherings

1. Compassion requires a declaration of Self-Love that says, "I am what I am." We must put aside all self-loathing and embrace the "amness" of who we are.       We must make use of the wounds of our soul to journey with those who are wounded in Spirit, Mind and Body.

2. Compassion is invitation into the eloquence of active listening with the ear of the intellect and the ear of the heart to transform fear and confusion into prayerful skills of listening, feeling and responding.

3. Compassion requires Veritas (Truth). We must put aside underlying assumptions that truth is only spoken in logical thinking and move to a poetry that can cite what is elusive and true in order to process issues of powerlessness, paralysis and emotional pain.

4. Compassion requires that we acknowledge our God of our own personal understanding who is Love and the genesis, journey and destiny of every human being.

H2O Wound Care Management Supplies Recommendation:

In the event of a disaster in the Bay Area, (which may likely be an earthquake) health care clinics need to plan for a specific number of trauma patients to enable the estimate of healthcare response capabilities.

Assumptions:

We are using the "1 gallon of water per person per day" recommendation, which is commonly found in the disaster preparedness literature for human consumption, and the wound management water formula of "180 cc per wound per treatment" which is approximately 6 fl. oz. or a small bottle of water.

The health center has determined a pre-disaster number of trauma patients for which they are going to stockpile supplies onsite This number is determined based on storage space available* at the facility and the resources available to procure disaster supplies.

Each facility will determine if there are hot water heaters, which can be drained for potable water in the post disaster setting. The assumption here is that the water heaters are drained and cleaned annually.

Each facility has sufficient, adequate (out of sunlight) storage space for stockpiled water.

Water Calculations:

How much water do you need to stockpile on-site at each medical facility?

1. Human consumption:

Number of people x (1 gal./person) x number of days = X gallons of water for storage

2. Wound care water consumption:

Given: 180cc/wound = 6 fl. oz., 1 gal. = 128 fl. oz. = 21 wound treatment units

Number of projected wounds for treatment / 21 = X gallons of water for wound treatment

3. Hot water heaters potable water:

Total number of gallons in all water heater (with water drain spigot) - 10% = Number of useable gallons on-site in hot water heaters.

GENERAL CALCULATION:

Human consumption + wound care consumption - hot water heater supply = number gallons to stockpile.

*Storage Space Considerations and water handling considerations (weight of container)

Given: 1 gallon of water = 8.35 ponds - Fill in the chart below with the specifications from your vendor choice! The numbers already input for price are general.

Note: The 2.5 & 5 gallon containers are most easily used by an individual. (The 5 gallon container is about as heavy as a normal person can carry.)

Types of plastic: Type two plastic for water storage is a good option! It is both durable & strong and does not leak bisphenol A, (BPA) What is BPA?. 

Source: http://www.dnrec.delaware.gov/whs/awm/Recycling/Pages/What's_recyclable_in_Delaware.aspx  

Plastics type marks: the resin identification code - for more see information on plastics

1. PET (PETE), polyethylene terephthalate

2. HDPE, high-density polyethylene

3. PVC, polyvinyl chloride 

4. LDPE, low-density polyethylene,

5. PP, polypropylene

6. PS, polystyrene

7. Other types of plastics - Some type 7 plastics may leak BPA

Developed by the Chinatown Public Health Center Disaster Preparedness Committee and SF CARD, 2012.