BECOME A MASTER OF DISASTERGetting Getting

Organized for a Organized for a Community Community

Disaster Disaster ResponseResponse

October 30, 2014Weaving Connections:

Disaster Behavioral Health Planning

Summit

• Forest Fires

• Flooding

• Illness outbreak

• Highway collisions

• Train derailment

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Know What Could Happen:Possible Disasters

Anticipated in Northern Arizona

• Everyone in the community should be treated as a person we serve.

• Caring for people takes priority over funding, billing and documentation concerns.

• Self-care is critical. Use the airplane oxygen mask metaphor of putting on your own mask first and then helping others.

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Philosophy

When disaster strikes our communities. . .

• T/RBHAs support and defer to the local providers unless more direct assistance is requested.

• National agencies (e.g. Red Cross) may assume authority, but T/RBHAs and providers are there for long-term needs.

• Member outreach, support and ongoing communication are the keys to minimizing trauma. 4

PhilosophyCONTINUED

Activate Internal Manual policy and proceduresImmediate Jeopardy Contact

Notify Executive Team & PIOImmediate Jeopardy Contact

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Know What To Do:Immediate Response

Activate Phone TreesDirector of Facilities & SafetyImmediate Jeopardy Contact

Activate Crisis CommunicationsPIO

Hour 1 - Executive Team meets Coordinates resources and determine

action steps based on ADHS requests, provider needs, media concerns, community response needs.

Includes PIO to collaborate and inform on messaging.

Hour 2 – Team distributes all-users email covering:

Situation details Response team contacts Self-care Responding to Media

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The Next Day

• Executive Team• Crisis Services• Medical Team &

Utilization Mgmt• Pharmacy Help

Desk• Member Services• Data/MIS

• Clinical Services• Recovery Services• Cultural

Competency• Human Resources• Finance• Administrative

Support

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Know In Advance: Everyone’s Role for Response

• Keeping staff apprised of events and response efforts is critical.

• Use recommended official resources for updates instead of using media reports.

• Requests for community support response often come in during this time.

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The First Week

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The Importance of Media Use for Community Communication .

• Reporters and camera-staff can focus too much on the story and not see distress in people they approach for interviews.

• If you are there to assist victims, observe interviewee for signs of stress, trauma.

• Do not be afraid to step in and ask the victim if he/she is okay. Ask if they would like to step away from the interview. If yes. . .

• Look at the media representative and politely say, “This person appears to need some assistance. We are going to move to a care center. You are welcome to work in another location. Thank you.”

• Turn away and gently guide the person in stress to a sheltered area. 10

If Media Approaches Someone in Distress

• Model of responding to individuals, groups or agencies in the community after an individual or mass trauma event.

• Detailed structure of a debriefing, not intended as a therapeutic process.

• Requires certification in CISM or substantial clinical experience to facilitate model.

• Sometimes used more as a guideline for compassionate response than a formal debriefing response to meet community needs

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Critical Incident Stress Management (CISM)

• Inciweb

• Arizona Emergency Information Network

• Arizona Dept. of Health Services and local T/RBHA websites

• Official responder agency Facebook pages and Twitter feeds.

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Recommended Situation Resources

http://inciweb.nwcg.gov/

http://www.azein.gov

http://www.azdhs.gov

LEARNING FROMPAST DISASTERS

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• Largest fire in Arizona history

• White Mountains, Apache, Greenlee, Graham & Navajo counties (and small part of NM)

• 6,000 evacuees, including Springerville & Eagar

• 16 injuries; 0 fatalities

• 72 structures destroyed across 732 square miles

• Affected RA: Little Colorado Behavioral Health Centers

• Affected CSA: NAZCARE

• Dates: May 29 to July 8 (41 days)

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2011 Wallow Fire

• Initial response was minimal aside from coordination with LCBHC for community needs.

• Clinic Evacuation: As the fire approached Eagar and both it and Springerville evacuated, the LCBHC site at Springerville required assistance in medical records transfer to St. Johns.

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2011 Wallow Fire

At the beginning of a disaster, coordinate how many and which employees will be available for emergent community response for all varieties of volunteer work and/or support.

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2011 Wallow FireLesson Learned

• Valley of multiple tiny towns south of Prescott, Yavapai County into Maricopa County

• 600 evacuees, including Peeples Valley & Yarnell

• 23 injuries; 19 fatalities

• 129 structures destroyed across 8,400 acres

• Affected RAs: WYGC, SBHS & CFSS

• Affected CSA: NAZCARE

• Dates: June 28 to July 10 (13 days)

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2013 Yarnell Hill Fire2013 Yarnell Hill Fire

• Regional Providers WYGC, SBHS & CFSS completed their own outreach to affected members and families within the first 2 days.

• NARBHA reached out to and collaborated with Magellan to offer crisis services at the Wickenburg evacuation shelter.

• June 30: 19 Granite Mountain Hotshots (based in Prescott) firefighters were killed

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2013 Yarnell Hill Fire

• Prescott entered the national spotlight after the firefighter deaths.

• Media coverage was unprecedented.

• Community and media briefings occurred twice daily.

• NARBHA remained in contact with Crisis Prevention & Recovery of Phoenix, who offered support for firefighters and families of the victims.

• One CISM session was facilitated in Prescott19

2013 Yarnell Hill Fire

• Over 35 Staff from NARBHA, WYGC, SBHS and CFSS, members and family members volunteered to bring support, care needs and health monitoring during the service.

• Attended by more than 3,000 people.

• NARBHA support at more than half the stations around the perimeter as well as in the Command Center.

• Special recognition certificate from the Red Cross.

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2013 Yarnell Hill FireThe Prescott 19 Memorial

• Red Cross assumed behavioral health and medical responsibility for the evacuation shelters and local community; neither T/RBHA nor provider staff were allowed in to assist until preparation for the July 9 memorial service.

• Press releases in local newspapers reminding residents of T/RBHA & providers’ local, long-term support as well as immediate coping skills were effective.

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2013 Yarnell Hill FireLessons Learned

• An internal (temporary) Command Center would have allowed NARBHA to gather resource material, supplies, maps and provided a common place for team updates and response needs from the start of the event.

• Communications among internal staff and the executive team must be coordinated & controlled to reduce stress on team, staff, and provider staff as well as to improve efficiency and effectiveness of response activities.

• Contact information for various involved agencies (Red Cross, CISM response sites) must be centralized and updated constantly. 22

2013 Yarnell Hill FireLessons Learned

• Oak Creek Canyon burned, smoke affected Flagstaff, Sedona

• Hundreds of evacuees from OCC and Kachina Village

• 0 fatalities

• 0 structures destroyed across 21,227 acres

• Affected RAs: Spectrum, TGC, SBHS, CFSS

• Affected CSAs: NAZCARE, Hope Lives

• Dates: May 20 to June 4 (15 days)

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2013 Yarnell Hill Fire2014 Slide Fire

• The importance of outreach to those with cardiac and respiratory conditions was exemplified in saving the life of someone hours from death due to smoke inhalation.

• Community meetings may not always provide updated information, but are critical to networking with other responder agencies.

• Provide Orientation to new employees on Disaster Response

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2014 Slide FireLessons Learned

SELF-CARE ISCRITICAL

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• Educate yourself about the situation as much as possible before going in.

• Prepare yourself emotionally, mentally, physically.

• Be mindful and attentive of your own needs.

• Be aware that symptoms and reactions may not arise for days.

• Have a trusted friend, colleague that you can debrief with about YOUR experience. 26

Responders – Prepare with Self Care

• Recognize that caretakers may have dualistic needs related to being a caretaker and a disaster survivor.

• Respect their boundaries.

• Provide support, honor their expertise.

• Display empathy and concern.

• Encourage self-care. 27

Taking Care of Caretakers

• Shock, disbelief

• Tension and irritability

• Fear, anxiety, guilt

• Difficulty making decisions

• Emotionally numb

• Loss of appetite

• Anger

• Sadness

• Sleep disturbances, nightmares

• Feeling powerless and/or hopeless

• Headaches, back pain, stomach issues

• Fatigue, low energy

• Trouble concentrating

• Desire to be alone

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Common Symptoms

• Be mindful of your needs and honor them.

• Talk with others.

• Connect socially.

• Eat well.

• Exercise .

• Get plenty of sleep.

• Be kind and gentle with yourself.

• Maintain a routine.

• Take frequent breaks.

• Avoid drugs and alcohol.

• Remember – it will not always be/feel this way.

• Engage in your spiritual practice.

• Express your feelings in healthy outlets.

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Self Care Tips