I. OVERVIEW

You all have encountered a stressor outside of the realm of usual human experience. As a victim of this type of stress, you can expect to experience the after effects to varying degrees. We also want to alert you to the fact that there is a ripple effect through your family and loved ones. The acknowledgment of these emotional reactions helps to shorten recovery time and prevent complications through the natural healing process.

II. EXPECTED EMOTIONAL REACTIONS

A. Sense that life is out of balance
B. Disbelief
C. Flashbacks
D. Sleep disturbance
E. Sadness
F. Diminished sexual drive
G. Minimization of the critical incident
H. Anger/irritability
I. Forgetfulness
J. Cold-like symptoms
K. Survivor guilt
L. Increased substance use.
M. Social withdrawal
N. Emotional numbing
O. Feelings of being "Out of control"
P. Fears of "going crazy"
Q. Loss of feeling secure in the world
R. Self doubt - as parent and provider
S. Omens
T. Mood swings - high and low
U. Fear

Reactions can vary widely from one day to the next. Don't be alarmed by the re-emergence of emotional feelings after days, weeks, or months.

III. SELF-HELP TECHNIQUES

A. Don't push thoughts and memories of the event away, it is critical to talk about them.
B. Don't feel embarrassed about a repetitious need to talk to people.
C. Keep your life in balance.
        1. Diet/sleep/exercise
        2. Balance your work with rest
        3. Avoid new major projects in life
        4. Keep a familiar routine with familiar people and surroundings.

IV. ADDITIONAL CONSULTATION

A. Give yourself time to let the normal healing process unfold. If gradual reduction is symptoms does not occur, call for further assistance.

You have experienced a traumatic event or a critical incident (any incident that causes emergency service personnel to experience unusually strong emotional reactions which have the potential to interface with their ability to function either at the scene or later). Even though the event may be over, you may now be experiencing or may experience later, some strong emotional or physical reactions. It is very common, in fact quite normal, for people to experience emotional aftershocks when they have passed through a horrible event.

Sometimes the emotional aftershocks (or stress reactions) appear immediately after the traumatic event. Sometimes they may appear a few hours or a few days later. And, in some cases, weeks or months may pass before the stress reactions appear.

The signs and symptoms of a stress reaction my last a few days, a few weeks or a few months and occasionally longer depending on the severity of the traumatic event. With understanding and the support of loved ones, the stress reactions usually pass more quickly. Occasionally the traumatic event is so painful that professional assistance from a counselor may be necessary. This does not imply craziness or weakness. It simply indicates that the particular event was just too powerful for the person to manage by themselves.

Here are some very common signs and signals of a stress reaction:

Physical
    fatigue
    nausea
    muscle tremors
    twitches
    chest pain*
    difficulty breathing*
    elevated BP
    rapid heart rate
    visual difficulties
    vomiting
    grinding of teeth
    weakness
    dizziness
    profuse sweating
    chills
    shock symptoms*
    fainting
    fatigue
    nausea
    muscle tremors
    twitches
    chest pain*
    difficulty breathing*
    elevated BP
    rapid heart rate
    visual difficulties
    vomiting
    grinding of teeth
    weakness
    dizziness
    profuse sweating
    chills
    shock symptoms*
    fainting
    fatigue
    nausea
    muscle tremors
    twitches
    chest pain*
    difficulty breathing*
    elevated BP
    rapid heart rate
    visual difficulties
    vomiting
    grinding of teeth
    weakness
    dizziness
    profuse sweating
    chills
    shock symptoms*
    fainting

Cognitive
    blaming someone
    confusion
    poor attention
    poor decisions
    heightened or lowered alertness
    poor concentration
    memory problems
    hyper vigilance
    difficulty identifying familiar objects or people
    increase or decrease awareness of surroundings
    poor problem-solving
    loss of time, place or person orientation
    disturbed thinking
    nightmares
    intrusive images 
    blaming someone
    confusion
    poor attention
    poor decisions
    heightened or lowered alertness
    poor concentration
    memory problems
    hyper vigilance
    difficulty identifying familiar objects or people
    increase or decrease awareness of surroundings
    poor problem-solving
    loss of time, place or person orientation
    disturbed thinking
    nightmares
    intrusive images 
    blaming someone
    confusion
    poor attention
    poor decisions
    heightened or lowered alertness
    poor concentration
    memory problems
    hyper vigilance
    difficulty identifying familiar objects or people
    increase or decrease awareness of surroundings
    poor problem-solving
    loss of time, place or person orientation
    disturbed thinking
    nightmares
    intrusive images 

*Definite indication of the need for medical evaluation

Emotional
    anxiety
    guilt
    grief
    severe panic (rare)
    emotional shock
    uncertainty
    depression
    inappropriate emotional response
    apprehension
    feeling overwhelmed
    intense anger
    irritability
    fear
    anxiety
    guilt
    grief
    severe panic (rare)
    emotional shock
    uncertainty
    depression
    inappropriate emotional response
    apprehension
    feeling overwhelmed
    intense anger
    irritability
    fear
    anxiety
    guilt
    grief
    severe panic (rare)
    emotional shock
    uncertainty
    depression
    inappropriate emotional response
    apprehension
    feeling overwhelmed
    intense anger
    irritability
    fear

Behavioral
    change in activity
    change in speech patterns
    withdrawal
    change in communication
    alcohol consumption
    inability to rest
    antisocial acts
    hyper alert to environment
    startle reflex intensified
    pacing
    erratic movements
    change in sexual functioning
    change in activity
    change in speech patterns
    withdrawal
    change in communication
    alcohol consumption
    inability to rest
    antisocial acts
    hyper alert to environment
    startle reflex intensified
    pacing
    erratic movements
    change in sexual functioning
    change in activity
    change in speech patterns
    withdrawal
    change in communication
    alcohol consumption
    inability to rest
    antisocial acts
    hyper alert to environment
    startle reflex intensified
    pacing
    erratic movements
    change in sexual functioning

3.  CRISIS REACTION

All of these - feelings and reactions - are normal and natural - even though they may seem unusual and even though some are very different from others.

We are all individuals. We all respond in our own way, differently. Your memory will always be a part of your life. The incident cannot be erased.

Everyone moves at their own pace through the stages of crisis and of healing. Everyone has their own clock. For some people, there may be on-going problems.

POSSIBLE REACTIONS:
Numbness
Confusion
Crying
Concentration problems
Fatigue
Memory problems
Sleep Disturbances
Religious Confusion
Change in Appetite/Weight
Loss of Trust
Low Resistance to Illness
Flashbacks
Frustration
Anniversary Difficulties
Helplessness
Regression
Depression
Alcohol/ Drug Abuse
Despair
Excessive Use of Sick
Grief
Leave
Guilt
Work/School/Family Problems
Feeling Inadequate
Withdrawal
Anger
Suicidal Thoughts
Outrage
Difficulty Returning to Normal Activity Level
Insecurity
Fear
Anxiety
Irritability
Feeling Overwhelmed

SUGGESTIONS:

Talk about what happened

Talk about your feelings.

Don't Monday-Morning quarterback - we can always thing of what we or others could have done differently.

Take care of yourself physically - balanced diet, rest, exercise - maintain a routine. Avoid use of drugs and alcohol. Medication should be taken sparingly and only under the supervision of a physician. Substances may be addictive and interfere with the healing process.

4.   HELPING CHILDREN RESPOND TO TRAUMA

PRESCHOOL THROUGH SECOND GRADE

Response to Trauma

1. Helpless and passivity
2. Generalized fear
3. Cognitive confusion (e.g., do not understand that the danger is over)
4. Difficulty identifying what is bothering them
5. Lack of verbalizations - selective mutism, repetitive nonverbal traumatic play, unvoiced questions
6. Attributing magical qualities to traumatic reminders
7. Sleep disturbances (night terrors and nightmares; fear of going to sleep, fear of being alone, especially at night.
8. Anxious attachment (e.g., clinging to parents)
9. Regressive symptoms (thumb sucking, enuresis, regressive speech)
10. Anxieties related to incomplete understanding about death; fantasies of "fixing up" the dead, expectations that a dead person will return.

First Aid

1. Provide support, rest, comfort, food, opportunity to play or draw
2. Re-establish adult protective shield.
3. Give repeated, concrete clarifications.
4. Provide emotional labels for common reactions.
5. Help to verbalize general feelings and complaints.
6. Separate what happens from physical reminders such as the place where the trauma occurred.
7. Encourage them to let their parents know.
8. Provide consistent patterns (e.g., assurance of being picked up from school)
9. Tolerate regressive symptoms in a time-limited manner
10. Give explanations about t he physical reality of death.

 

THIRD THROUGH FIFTH GRADE

Response to Trauma

1. Preoccupations with their own actions during the event.
2. Specific fears, triggered by reminders.
3. Retelling and replaying of the event (traumatice play).
4. Fear of being overwhelmed by their feelings (of crying, of being angry).
5. Impaired concentration and learning.
6. Sleep disturbances (bad dreams, sleeping alone).
7. Concerns about their own and others' safely.
8. Altered and inconsistent behavior (e.g., unusually aggressive or reckless behavior, inhibitions).
9. Somatic complaints.
10. Hesitation to disturb parent with own anxieties.
11. Concern for other victims and their families.
12. Feeling disturbed, confused and frightened by their grief; fear of ghosts.

First Aid

1. Help to express their secretive imaginings about event; issues of responsibility and guilt.
2. Help in identify and articulate traumatic reminders.
3. Permit them to talk and act it out; address distortions, and acknowledge normality of feelings and reactions.
4. Encourage expression of fear, anger, sadness, in your supportive presence.
5. Encourage to let teachers know when thoughts and feelings interfere with learning.
6. Support them in reporting dreams; fear of providing information about why we have dreams.
7. Help to share worries; reassure with realistic information.
8. Help to cope with the challenge to their own impulse control (e.g., acknowledge "it must by hard to feel so angry").
9. Help identify the physical sensations they felt during the event and link when possible.
10. Offer to meet with children and parent(s), to help children let parents know how they are feeling.
11. Encourage constructive activities on and behalf of the injured or deceased.
12. Help to retain positive memories as they work through the more intrusive traumatic memories.

 

ADOLESCENTS (SIXTH GRADE AND UP)

Response to Trauma

1. Detachment, shame and guilt.
2. Self-consciousness about their fears, about sense of vulnerability; fear of being labeled abnormal.
3. Post traumatic acting out (e.g., drug use, delinquent behavior, sexual acting out, etc.) as effort to numb their responses to the event.
4. Life threatening reenactment, self destructive or accident-prone behavior.
5. Abrupt shifts in interpersonal relationships.
6. Desires and plans to take revenge.
7. Radical changes in life attitudes which influence identity formation.
8. Premature entrance into adulthood (e.g., leaving school, getting married), or reluctance to leave home.

First Aid

1. Encourage discussion of the event, feelings about it, and realistic expectations of what could have been done.
2. Help them understand the adult nature of these feelings, encourage peer understanding and support.
3. Help to understand the behavior, voice their anger over the event.
4. Address the impulse toward reckless behavior in the acute aftermath; link it to the challenge to implies control associated with violence.
5. Discuss the expectable strain on relationships with family and peers.
6. Elicit their actual plans of revenge; address the realistic consequences of these actions; encourage constructive alternatives that lessen the traumatic sense of helplessness.
7. Link attitude changes to the event's impact.
8. Encourage postponing radical decisions in order to allow time to work through to their responses to the event and to grieve.

FAMILY

It is suggested that "first aid" may be administered to children in the family. These suggestions might be mailed to families or sent home with the students.

1. Give children special and directed support by keeping things fairly structured and adjusting for fears, especially at bedtime.

2. Help re-establish a sense of safety by assuring that the house is locked, and that the child knows the parents' whereabouts at all times. This may mean transporting to and from school for awhile.

3. Offer reassurance when traumatic reminders intrude on thinking, feeling, or behavior.

4. Validate the expression of all feelings by tolerating them and not dismissing them.

PREDICT AND PREPARE

Preparation for handling deaths at school, before a trauma happens, is essential. It is the only way to assure rapid and sensitive handling of deaths invading the psychological sanctity of schools. Chaplains or Mental health professionals might be engaged to teach small group techniques to teachers so that student groups could be quickly organized with skilled leaders if a tragedy occurs. In-service training programs for teachers on handling grief and loss should be elevated to necessity rather than choice. Teachers can learn how to use art, musical expression, poetry and storytelling as expressive outlets for grieving or traumatized children.

Today's "typical American family" includes family disintegration, mobility, and multiple and compound losses. Death can tip the scale to a position that stressed children find impossible to comprehend and accommodate. Schools must be prepared to play a larger role in substituting for values, structure and solidarity which may be lacking in the nuclear family.

4.   HELPING CHILDREN RESPOND TO TRAUMA

PRESCHOOL THROUGH SECOND GRADE

Response to Trauma

1. Helpless and passivity
2. Generalized fear
3. Cognitive confusion (e.g., do not understand that the danger is over)
4. Difficulty identifying what is bothering them
5. Lack of verbalizations - selective mutism, repetitive nonverbal traumatic play, unvoiced questions
6. Attributing magical qualities to traumatic reminders
7. Sleep disturbances (night terrors and nightmares; fear of going to sleep, fear of being alone, especially at night.
8. Anxious attachment (e.g., clinging to parents)
9. Regressive symptoms (thumb sucking, enuresis, regressive speech)
10. Anxieties related to incomplete understanding about death; fantasies of "fixing up" the dead, expectations that a dead person will return.

First Aid

1. Provide support, rest, comfort, food, opportunity to play or draw
2. Re-establish adult protective shield.
3. Give repeated, concrete clarifications.
4. Provide emotional labels for common reactions.
5. Help to verbalize general feelings and complaints.
6. Separate what happens from physical reminders such as the place where the trauma occurred.
7. Encourage them to let their parents know.
8. Provide consistent patterns (e.g., assurance of being picked up from school)
9. Tolerate regressive symptoms in a time-limited manner
10. Give explanations about t he physical reality of death.

 

THIRD THROUGH FIFTH GRADE

Response to Trauma

1. Preoccupations with their own actions during the event.
2. Specific fears, triggered by reminders.
3. Retelling and replaying of the event (traumatice play).
4. Fear of being overwhelmed by their feelings (of crying, of being angry).
5. Impaired concentration and learning.
6. Sleep disturbances (bad dreams, sleeping alone).
7. Concerns about their own and others' safely.
8. Altered and inconsistent behavior (e.g., unusually aggressive or reckless behavior, inhibitions).
9. Somatic complaints.
10. Hesitation to disturb parent with own anxieties.
11. Concern for other victims and their families.
12. Feeling disturbed, confused and frightened by their grief; fear of ghosts.

First Aid

1. Help to express their secretive imaginings about event; issues of responsibility and guilt.
2. Help in identify and articulate traumatic reminders.
3. Permit them to talk and act it out; address distortions, and acknowledge normality of feelings and reactions.
4. Encourage expression of fear, anger, sadness, in your supportive presence.
5. Encourage to let teachers know when thoughts and feelings interfere with learning.
6. Support them in reporting dreams; fear of providing information about why we have dreams.
7. Help to share worries; reassure with realistic information.
8. Help to cope with the challenge to their own impulse control (e.g., acknowledge "it must by hard to feel so angry").
9. Help identify the physical sensations they felt during the event and link when possible.
10. Offer to meet with children and parent(s), to help children let parents know how they are feeling.
11. Encourage constructive activities on and behalf of the injured or deceased.
12. Help to retain positive memories as they work through the more intrusive traumatic memories.

 

ADOLESCENTS (SIXTH GRADE AND UP)

Response to Trauma

1. Detachment, shame and guilt.
2. Self-consciousness about their fears, about sense of vulnerability; fear of being labeled abnormal.
3. Post traumatic acting out (e.g., drug use, delinquent behavior, sexual acting out, etc.) as effort to numb their responses to the event.
4. Life threatening reenactment, self destructive or accident-prone behavior.
5. Abrupt shifts in interpersonal relationships.
6. Desires and plans to take revenge.
7. Radical changes in life attitudes which influence identity formation.
8. Premature entrance into adulthood (e.g., leaving school, getting married), or reluctance to leave home.

First Aid

1. Encourage discussion of the event, feelings about it, and realistic expectations of what could have been done.
2. Help them understand the adult nature of these feelings, encourage peer understanding and support.
3. Help to understand the behavior, voice their anger over the event.
4. Address the impulse toward reckless behavior in the acute aftermath; link it to the challenge to implies control associated with violence.
5. Discuss the expectable strain on relationships with family and peers.
6. Elicit their actual plans of revenge; address the realistic consequences of these actions; encourage constructive alternatives that lessen the traumatic sense of helplessness.
7. Link attitude changes to the event's impact.
8. Encourage postponing radical decisions in order to allow time to work through to their responses to the event and to grieve.

FAMILY

It is suggested that "first aid" may be administered to children in the family. These suggestions might be mailed to families or sent home with the students.

1. Give children special and directed support by keeping things fairly structured and adjusting for fears, especially at bedtime.

2. Help re-establish a sense of safety by assuring that the house is locked, and that the child knows the parents' whereabouts at all times. This may mean transporting to and from school for awhile.

3. Offer reassurance when traumatic reminders intrude on thinking, feeling, or behavior.

4. Validate the expression of all feelings by tolerating them and not dismissing them.

PREDICT AND PREPARE

Preparation for handling deaths at school, before a trauma happens, is essential. It is the only way to assure rapid and sensitive handling of deaths invading the psychological sanctity of schools. Chaplains or Mental health professionals might be engaged to teach small group techniques to teachers so that student groups could be quickly organized with skilled leaders if a tragedy occurs. In-service training programs for teachers on handling grief and loss should be elevated to necessity rather than choice. Teachers can learn how to use art, musical expression, poetry and storytelling as expressive outlets for grieving or traumatized children.

Today's "typical American family" includes family disintegration, mobility, and multiple and compound losses. Death can tip the scale to a position that stressed children find impossible to comprehend and accommodate. Schools must be prepared to play a larger role in substituting for values, structure and solidarity which may be lacking in the nuclear family.

5.   GENERAL PROFILE OF CRISIS

1. Sense of Bewilderment (I never felt this way before.)
2. Sense of Danger (I feel so nervous and scared--something terrible is going to happen.)
3. Sense of Confusion (I can't think clearly, my mind isn't working right.)
4. Sense of Impasse (I feel stuck, nothing I do seems to help.)
5. Sense of Desperation (I've got to do something - don't seem to know what though.)
6. Sense of Apathy (Nothing can help me. I'm in a hopeless situation.)
7. Sense of Helplessness (I can't manage this myself, I need help.)
8. Sense of Urgency (I need help now.)
9. Sense of Discomfort (I feel miserable, so restless and uncomfortable.)

6.  MENTALLY AND EMOTIONALLY DISTURBED PEOPLE:

HOW TO HANDLE 5150

1. POINTS TO REMEMBER: Mental illness is becoming increasingly common. It afflicts all age groups, all levels of society, and all ethnic groups. A police officer should be prepared to encounter disturbed persons at any time.

2. When these cases are dealt with in a competent, professional manner, they rarely cause trouble.

3. Distraught people sometimes behave in eccentric ways. Tactful handling may keep this behavior from becoming exaggerated in some way that would draw a crowd. It can save the officer from being compelled at the same time.

4. Mental disorders are of two types:

a. Organic disorders, in which physical damage to the brain has been caused by such things as head injuries, alcohol, drugs, disease, or old age.
b. Functional disorders, in which the brain refuses to work properly although there is no sign of actual injury.

5. Two levels of mental illness are generally recognized: