Stability
The majority of people who experience a major incident will not need help to return to a stable state. They will of course have strong reactions that reflect the abnormal experience they have been exposed to.
These may include:
- Feeling numb.
- Lost for words.
- Disorientation.
- Confusion.
- Anxiety.
These feelings do not generally require anything in addition to respectful responses from responders. More intervention may be required when individuals exhibit the extreme of these emotions to the extent that they prevent the person from resuming a functional state.
Responders need to be vigilant for signs that survivors may be overwhelmed by their emotions. See below for some examples.
Signs that a survivor is overwhelmed by emotions
- Significantly disorientated or exhibiting vacant behaviour.
- Inability to reply to questions.
Loss of control
- Crying.
- Rocking.
- Extreme helplessness.
- Tremulousness.
- Frantic searching.
- Extreme incapacitation.
- Risk-taking.
Additional support
Providing these individuals with additional support ideally from family and friends can help to calm the person, in quieter surroundings if possible. Be aware that the person may be experiencing extreme panic, flashbacks or may have an underlying condition that compounds their distress. In this instance it is more helpful to focus on their immediate needs rather than trying to shift them to a calmer state.
Parents or carers of children or young people are best at helping them, so responders need to focus on bolstering the adults so they can help manage the children and young people’s needs. Responders also need to be mindful not to undermine parents or carers in any way, it is more helpful to make them aware that you are available if they require any additional support.
If either a child or young person is separated from their parents or carers and if they are not coping, there are various approaches that may be useful.
Giving them a bit of time to think, make them aware you will be back to speak to them.
Stay alongside them as a calm presence you don’t have to say anything if you think they may already be overwhelmed.
Be alongside talking to others and available when they are ready and provide simple information about where you are, what is happening to help them so they are more orientated.
If any adult is similarly overwhelmed it can be helpful to remind them that their emotions can come and go and that their responses are the result of exposure to an abnormal event.
Encouraging them to become calm through deep breathing and to utilise support from family and friends will also help reduce anxious feelings.
Grounding exercises are a way of helping people focus their attention on being present in the moment. They can also help to restore a sense of internal equilibrium.
Grounding Exercise
- Ask people to identify five non-distressing things they can see, followed by deep breaths.
- Ask people to identify five non-distressing things they can hear, again followed by deep breaths.
- Ask people to identify five non-distressing things they can feel, then again more deep breaths.
This approach can also be used for children and young people. Instead responders could ask them to name different colours. Or they make a game of asking them to find something green or red, etc.
When these approaches are not effective responders should seek guidance from a mental health or medical professional.
Medication is not generally recommended as a means of stabilising individuals following exposure to a major incident. Medication should only be used when all other approaches have been tried without success and where there is a specific purpose, to treat lack of sleep, pain, etc. It is important to be aware that for some vulnerable individuals including those with a diagnosis of a mental health condition and that this may be worsened at times of extreme stress. Lack of access to medication or monitoring devices such as those used by people with diabetes may also be distressing and potentially dangerous.
Responders can assist in gathering information from survivors about any medication or pre-existing conditions, gauging survivor’s compliance with medication, any concerns re substance misuse or recovery issues and any mental or physical health needs.
Some things to think about
- Either as a responder or a volunteer, are there opportunities to practice these skills?
- As a manager are you clear about what to do to support staff to ensure they are able to adequately support those in need?