Managing Traumatic Incident Stress for Deepwater Horizon Response and Volunteer Workers

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Introduction

Workers and volunteers may experience stress and fatigue when they respond to environmental disasters, both natural and human-caused. As a Deepwater Horizon responder, you are at risk of feeling uncomfortable levels of stress from what mental health professionals refer to as a traumatic incident. The term traumatic is used because of an unexpected and troubling change in the natural order of things, such as the untimely death or injury of oil-covered wildlife and the impact on fishing communities and the environment. This pamphlet describes the range of ordinary reactions to stress that you may experience during your work, or in the weeks or months that follow. It is important to monitor your health and well-being during this entire period, even months after your response work has ended. Following these recommendations will help you to manage your stress and fatigue during and after a response.

Symptoms of Stress

You may experience many physical, thinking, emotional, or behavioral symptoms of stress. These symptoms may occur immediately at the scene, or may occur weeks or months later, or not at all. Some of these symptoms may be the result of fatigue.

Physical Complaints

Physical complaints may include fatigue, upset stomach or vomiting, dizziness, heavy sweating, thirst, headaches, vision problems, jaw clenching, nonspecific aches and pains or disturbed sleep. You should seek IMMEDIATE medical attention if you feel any of the following symptoms:

• chest pain or other severe pain
• difficulty breathing
• symptoms of shock such as shallow breathing, rapid or weak pulse, nausea, shivering, pale and moist skin, mental confusion, or dilated pupils.

Thinking Problems

If you become confused or have trouble thinking clearly while you are working, you may not be able to stay focused which could affect your ability to work safely. Thinking problems may include confusion, loss of awareness of time or place, changes in alertness, poor concentration, difficulty identifying familiar objects or people, memory problems, reduced attention span, or trouble doing math or solving problems.

Emotional Concerns

Strong emotions can be ordinary reactions to a traumatic or extraordinary situation! You should seek mental health support if any of the follow symptoms interfere with your daily life or if they don’t go away after several weeks: anxiety, guilt, denial, grief, fear, irritability, loss of emotional control, depression, sense of failure, feeling overwhelmed, blaming others or self, easy to startle, being overly sensitive or cautious, or severe panic (this is rare).

Behavioral Changes

Possible behavioral changes to be aware of include intense anger, withdrawal, difficulty with emotional control leading to emotional outbursts or unusual aggression, recent change in appetite, consuming too much alcohol, caffeine, and/or tobacco, inappropriate use of medications, use of street drugs, inability to rest, pacing, or changes in sexual activity.

Recommendations to Monitor and Maintain Your Health On-Site

You may not recognize the need to take care of yourself and to monitor your own emotional and physical health. This is especially true as response efforts stretch into several weeks. The following guidelines contain simple steps for you to help yourself and fellow response workers. You must stay alert while on the job to take care of your own health and safety. You must be able to stay focused on the job, especially given the chaotic and changing disaster work environment. Follow these guidelines while at your job site and again after you return home to help control your stress and fatigue.

Control the organization and pace of the rescue and recovery efforts:

• Pace yourself. Response efforts at the site may continue for days or weeks.
• Watch out for each other. Your coworkers may be intensely focused on a particular task and may not notice a hazard nearby or behind them.
• Be aware of those around you. You may feel exhausted, stressed or be temporarily distracted which may place you and your coworkers at risk.
• Take frequent rest breaks. Mental fatigue, particularly over long shifts, can place you at greatly increased risk for injury.

Maintain adequate nutrition, hydration and rest:

• Eat and sleep regularly. Maintain as normal a schedule as possible and adhere to the team schedule and rotation.
• Make sure that you drink plenty of fluids such as water and juices.
• Try to eat a variety of foods and increase your intake of complex carbohydrates such as granola bars or breads and muffins made with whole grains.
• Whenever possible, take breaks away from the work area.
• Eat and drink in the cleanest area available.

Monitor your mental and emotional health:

• Recognize and accept what you cannot change – the chain of command, organizational structure, waiting, equipment failures, etc.
• Talk to people when YOU feel like it. You should decide when you want to discuss your experience. Talking about an event may make you feel like you are reliving it. Choose your own comfort level.
• If your employer provided you with formal mental health support, use it!
• Give yourself permission to feel sad, tired or discouraged from time to time; you are in a difficult situation.
• Recurring thoughts, dreams, or flashbacks can be common – do not try to fight them. They should decrease over time.
• Communicate with your loved ones at home as frequently as possible.

Recommendations to Maintain Your Health After the Incident

Over time, your impressions and understanding of your experience will change. This process is different for everyone. No matter what the event or your reaction to it, you can follow some basic steps to help yourself adjust to the experience:

• Reach out for help and support – people really do care.
• Reconnect with family, spiritual, and community supports.
• Consider keeping a journal.
• Do things you that help you refresh and recharge yourself whether that is spending time with others or alone.
• Remember that "getting back to normal" takes time. Gradually work back into your routine. Let others carry more weight for a while at home and at work.
• Be aware that assuming your normal activities is not a straight path but can be a matter of two steps forward and one back. You will make progress.
• Appreciate a sense of humor in yourself and others.
• Your family may experience certain parts of the disaster along with you through your stories and the news media. This is a time to understand and communicate with them.
• Avoid the overuse of drugs or alcohol; they can lead to other problems.
• Get plenty of rest and regular exercise.
• Eat well-balanced, regular meals.
  

Additional Resources

National Institute for Occupational Safety and Health (NIOSH)
1-800-35-NIOSH, www.cdc.gov/niosh
Deepwater Horizon response resources - http://www.cdc.gov/niosh/topics/OilSpillResponse/
Traumatic incident topic page - http://www.cdc.gov/niosh/topics/traumaticincident/

Center for the Study of Traumatic Stress (CSTS)
Dealing with the Effects of Trauma: A Self Help Guide http://www.centerforthestudyoftraumaticstress.org/csts_items/SHG_Effects_of_trauma.pdf

U.S. National Response Team (NRT)
Guidance for Managing Worker Fatigue during Emergency Operations http://nrt.org/production/NRT/NRTWeb.nsf/AllAttachmentsByTitle/SA-1049TADFinal/$File/TADfinal.pdf?OpenElement

Substance Abuse and Mental Health Services Administration (SAMHSA)
Emergency Mental Health and Traumatic Stress
http://mentalhealth.samhsa.gov/cmhs/EmergencyServices/
Tips for Talking About Disasters http://mentalhealth.samhsa.gov/cmhs/EmergencyServices/after.asp

National Center for Post Traumatic Stress Disorder (PTSD)
Psychological First Aid: Field Operations Guide
http://ncptsd.va.gov/ncmain/ncdocs/manuals/nc_manual_psyfirstaid.html