Resiliencyin the

Face of Disaster and Terrorism

10 Things to Do to Survive

V. Alex Kehayan, Ed.D.

and
Joseph C. Napoli, M.D.

A Pocket Guide
 Resiliency in the Face of Disaster and Terrorism
10 Things to Do to Survive

Copyright © 2005 by V. Alex Kehayan and Joseph C. Napoli

All rights reserved.

No part of this book may be used or reproduced in any man-
ner whatsoever without written permission from the pub-
lisher and authors except in the case of brief quotations
embodied in critical reviews.

Queries regarding rights and permissions should be

directed to the publisher.

Published by
Personhood Press
P.O. Box 370
Fawnskin, CA 92333
800-429-1192
Email: info@personhoodpress.com
Website: www.personhoodpress.com

ISBN: 1-932181-18-0

Book and Cover Design by Christine Scharch of Tupelo Art

Printed in the United States of America

Library of Congress Cataloging-in-Publication Data.

iv
 To all the survivors with whom
we have had the privilege of working
 Foreword
Prior to September 11, 2001, Americans defined disasters
in terms of nature, traffic accidents, or domestic crime.
Terrorism, war, even the threat of large scale horrors, were
calamities to be feared by the rest of the world, tragedies that
fell upon other people. They were not anything we needed to
realistically fear here in our United States.
But on that Tuesday morning, we learned most person-
ally that disaster – terrifying, unexpected, violent tragedy –
does not only happen to someone else. It can happen to any-
one. It happened to me. On 9/11/2001, my husband John was
among the nearly 3,000 people killed when terrorists crashed
their airplanes into the World Trade Center. My world, my
children’s world, our nation’s world changed forever that
day. It has not been, nor will ever be the same.
As a result, we as a nation are left feeling vulnerable and
afraid. How are we to wake up and face each day confronting
our frailty, our mortality, the real chance that a disaster can
affect us personally? How can we be resilient? How can we
enjoy the beauty of life amidst the threat of danger? How can
we rise above the fear? It has not been an easy task for my chil-
dren or me. We are not blessed with the ability to turn our
faces away from the tragedy. We cannot pretend it did not
happen, or find a sort of solace in the fact that we were spared
and might continue to be spared. John is forever gone; the
violent circumstances of his death firmly and forever imbed-
ded in our minds and hearts.
“An ounce of prevention is worth a pound of cure.” A
simple adage, but a rule to live by. This plain sentence is a
priceless tool for all of us as we strive to be resilient in an

vii
unsettled world. Many people believe that explaining or dis-
cussing possible threats, risks, and after-effects of disaster
does nothing more than incite increased fear. Yet, as evi-
denced by the world-wide campaigns for self care and exami-
nation, and disease prevention, it is clear that the MORE
information to which an individual has access, the MORE
prepared he will be, and therefore, the LESS risk he will face
in almost every situation. Information REDUCES fear. A
future fraught with its share of adversity, but adversity for
which one is prepared, is a future that holds less risk of
tragedy.
We are human, and events like 9/11 remind us we are
fragile and vulnerable. This book, Resiliency in the Face of
Disaster and Terrorism: 10 Things To Do To Survive, by Dr. Joseph
Napoli and Dr. V. Alex Kehayan, can be your tool, your source
of information to be best prepared should disaster find itself
at your front door. Both authors have seen the effects of fear
in disaster survivors and in their patient populations, and
have dedicated themselves, through this book, to help even
more people fight the fear associated with today’s world.
They present their outreach experience and clinical expertise
in such a way as to be most useful for everyone, including
attention to special needs issues such as caring for children
and seniors. This book offers information as well as instruc-
tions on how best to prepare yourself for the future and how
best to strengthen your own resiliency.

MaryEllen Salamone
President
Families of September 11

viii
 Preface
Childhood trauma. Domestic violence. Fires. Homicide.
Industrial accidents and disasters. Motor vehicle accidents.
Natural disasters. Rapes. Suicides. Terrorism. Transportation
disasters. Violence. Genocide. War.
We have worked with survivors who have faced a multi-
tude of traumatic events. We have witnessed the resiliency of
many survivors. We give you the benefit of our expertise
derived from many years of experience, and share what we
have learned from the survivors of disaster and terrorism.
Our book condenses the essential collective knowledge in
the fields of disaster mental health, emergency management,
and public health. This simple, practical pocket guide will
assist you – the general reader – to be a more resilient and
effective disaster survivor. It will describe how you can help
yourself and others in your community to carry on.

Alex & Joe

ix
 Disclaimer

This is merely a guide. We do not make any claim that the

material contained in this book will guarantee a positive out-
come. Rather, if applied correctly and in an appropriate situation,
it can reduce the chances of a negative outcome. Your knowing
and applying these guidelines does not make you an expert.
Furthermore, the information we provide does not replace the
use of good judgment in any particular circumstance. If you have
any question or concern, you should not hesitate to seek profes-
sional help, especially, if you or someone else needs medical
attention, or needs to take action regarding someone’s potential
dangerousness. In particular situations, we advise that you seek
advice from an appropriate health professional, mental health
professional, law enforcement officer, or other expert. The
authors and publisher shall have neither liability nor responsibil-
ity to any person or entity with respect to any loss or damage
caused, or alleged to have been caused, directly or indirectly, by
the information contained in this book.
The knowledge we are providing is based on observable
data, expert consensus, and/or the latest research findings as of
the time that the book goes to press. At present it is the best prac-
tice available. However, new research and the accumulation of
new knowledge may alter these practices in the future.
We have attempted to confirm the accuracy of the informa-
tion set forth herein. Just before the book’s publication, we again
checked the websites, telephone numbers, etc. of the resources
that we have listed. Since such information is apt to change, we
recommend that you periodically check it. By updating this infor-
mation, as necessary, you will keep your guide up-to-date and
always ready to use. We do not vouch for the accuracy or com-
pleteness of any information obtained from outside sources. For
information we have obtained from outside sources, we have, to
the best of our abilities, accurately communicated that informa-
tion, but we have not verified whether the information obtained
from those sources is true, accurate, or complete.
Every effort has been made by the authors to respect gender
sensitivity, honor different cultures, and avoid biased language.
However, for simplicity of style, and clarity of expression, we have
taken the liberty to alternate the use of gender specific pronouns
where the content or an antecedent did not require the use of the
masculine or feminine pronoun. You may substitute the pro-
noun of the opposite gender in each instance where we have
alternated gender pronouns.

x
 Contents

Foreword vii
Preface ix
Introduction 1
1. DETERMINE WHAT MIGHT HAPPEN 5
2. LEARN WHAT TO EXPECT 16
3. PREVENT 29
4. PREPARE 52
5. LEARN HOW WE REACT 76
6. DECIDE WHEN TO GET HELP 101
7. SEEK HELP 126
8. HELP YOURSELF 141
9. HELP OTHERS 164
10. DO 1 TO 9 185
Appendix 187
Things to Do for Any Disaster 187
Disease Outbreaks: Causative Agent,
Transmission, Symptoms, and Things to Do 188
Things to Know for Chemical Terrorism 189
Things to Know for Bioterrorism 190
Learn More About It 191
Acknowledgments 194
About the Authors

xi
 Introduction
“Of a good beginning cometh a good end.”
John Heywood
1546

Why a guide about survival? We have produced this

guide because disasters challenge our survival. How do we
survive? We stay alive. We continue to function as individu-
als. We carry on as a society. The definition of disaster by the
World Health Organization (WHO), as “a severe disruption –
ecological and psychosocial – which greatly exceeds the cop-
ing capacity of the affected community,” addresses the
twofold dimension of disaster. On the one hand, a disaster is
a massive event that causes death and destruction. On the
other hand, a disaster tears the social fabric, disrupting our
human bonds and leading us to question the meaning of life.
Disasters can injure our psychological functioning and test
our ability to cope. Although the pocket guide emphasizes
disasters, it does not neglect crises, that is, everyday
tragedies, or “personal disasters,” that individuals and their
loved ones try to endure. Both crises and disasters are psy-
chosocial events that involve a threefold individual reaction.
We react biologically. We react psychologically. We react as
members of society. However, for convenience, we will use
the term “disaster” throughout this guide instead of using
“crisis” and “disaster.”
What about resiliency? Because we are mental health
professionals, we focus primarily on your psychological sur-
vival. We believe that giving you knowledge about disasters
and a set of practical tools strengthens resiliency, that is, the
capacity to “bounce back.” We give you tips on how to cope,

1
conquer, adapt, and re-equilibrate (regain your balance and
return to pre-disaster functioning or create a new level of
functioning). We help you to move on, so you are not a victim
of life’s catastrophic events but a survivor. We emphasize the
importance of respecting cultural differences when helping
others to survive disasters.
Since disasters also threaten life and limb, we also
emphasize what you can do to prevent death and bodily
injury. We highlight the importance of safety and preventive
measures. We outline specific actions that you should take to
protect yourself and others. Even those methods that may
not appear related to psychological wellness are actually basic
to maintaining your emotional well-being. By being prepared
and knowing what to do in the face of danger, you can elimi-
nate the irrational fear that leads to panic. By knowing the ten
basic things to do, you can act confidently and decisively.
What are the 10 things that you should do? You should
do the following: 1) determine the types and frequencies of
the disasters that might happen, especially in your commu-
nity, 2) learn what to expect when a disaster strikes, 3) prevent
disasters or lessen their impact, 4) prepare for disasters, 5)
learn the human reactions to disaster, 6) decide when you
need to seek help, 7) find out where to get help, 8) help your-
self, 9) help others, and 10) convince yourself that doing the
first nine things is essential for your survival and the survival
of others.
In this time of terrorism, Homeland Security Advisory
System alerts, Center for Disease Control and Prevention bul-
letins about new disease outbreaks, and daily media barrages
with the latest news of violence and tragedy, convincing
yourself to use this pocket guide should not be difficult. Do

2
we want to make you anxious? Yes we do! A little bit of anxi-
ety is a good thing. It keeps us vigilant and ready.
Nevertheless, too much anxiety interferes with our attention
and ability to function. Therefore, when fear seems to domi-
nate everyday life, we believe that you need to assess risk,
maintain a proper perspective, and manage your fear. This
book helps you manage your fear in two ways – it provides
you with fear reduction strategies, and as a pocket compan-
ion, it puts essential information at your fingertips. In the
words of Sir Francis Bacon, “Knowledge is Power.”
Disease outbreaks have occurred throughout history.
Although the particular infectious agents may be new and
the disease names – HIV, West Nile, SARS (Serious Acute
Respiratory Syndrome) – may be recently coined, large dis-
ease outbreaks have always plagued mankind. Pestilence has
always created the largest disasters. The wrath of Mother
Nature – volcanic eruptions, earthquakes, floods, tornadoes,
tsunamis – is very violent and more dramatic, but her stealth
invaders, especially bacteria and viruses, are more deadly. In
the Middle Ages, bubonic plague killed a third of the world’s
population. The estimated worldwide death toll of the great
influenza pandemic of 1918 was at least 50 million and possi-
bly as high as 100 million people. Therefore, we tell you
things to do when there is an outbreak of disease.
Some believe “no pain, no gain.” We reject this myth.
Although disasters cause sorrow and emotional pain, we do
not believe that severe suffering is necessary for psychologi-
cal development. Enduring torment is only one path to per-
sonal growth. Therefore, you need not fear that recovery from
a disaster will only occur if you embrace suffering. We prefer
to place our reliance on the resiliency of the human spirit.
Although we confront you with catastrophe and violence,

3
our message is one of hope. It is our wish that by using this
guide you will not be a victim of a disaster but a survivor who
may even grow from the experience.
Although some of the practical steps are geared to the
United States, the many principles that we present are uni-
versal and may be applied anywhere in the world. Most pri-
vate agencies listed in this guide are committed to global dis-
aster relief. Our descriptions of governmental disaster pre-
paredness, response structures, and programs in the United
States illustrate the role of governments in countries
throughout the world in helping their citizens survive
disasters.
How does our guide’s design help you? Simply put, it is
user friendly. Our chapter title pages give you the main
points and subject areas of each of the 10 things to do, so you
can go straight to the parts that you want to pursue. We use a
bullet format to emphasize things to learn, lists to remem-
ber, and the best actions to take. Our “Do You Know?” sec-
tions alert you to special topics. Boxes highlight important
procedures and specific organizations that provide help.
Other information is organized in tables for handy reference.
You can make enlarged copies of forms and kit checklists and
use them as part of your Family Emergency Preparedness
Plan.
Read this guide. Digest its information. Carry it with
you. Be prepared. Use your power to face traumatic events.
Then you will be able to meet the challenge of disasters and
help yourself and others to be resilient.

4
 What Might Happen
1 DETERMINE WHAT MIGHT HAPPEN

FREQUENCY OF EVENTS IN THE UNITED STATES p. 7

FREQUENCY OF EVENTS IN THE WORLD p. 9

NATURAL DISASTERS AND EMERGENCIES p. 10

CYBER INCIDENTS p. 13

CBNRE (CHEMICAL, BIOLOGICAL, NUCLEAR,

RADIOLOGICAL, AND EXPLOSIVE AGENTS) p. 13

5
 WHAT MIGHT HAPPEN
“We didn’t start the fire/
It was always burning/
Since the world’s been turning”
Billy Joel
1989

In general, we should take an all hazards approach and

be prepared for any disaster at any time. Nevertheless, it is
advantageous to know the potential for specific events. In
order to prevent, it helps to know what we are preventing. In
order to be ready, it is best to be specific with our prepara-
tions. Therefore, it is important to know what disasters might
occur, especially those that might typically occur in your
community.
What is the risk of a particular traumatic event occur-
ring? Which ones are more likely to occur? Which ones are
less likely to occur? How frequently do particular events
occur? How deadly and devastating are they? By answering
these questions, we are able to better prevent and prepare.
Below we provide partial lists of disaster or emergency
events that occur respectively in the United States and in the
world (including the United States). For comparison, we have
also included some non-disaster events such as fatalities due
to cancer or poverty. We present this data as approximate fre-
quencies, which are more dramatic than statistical measures
of percentages, risk ratios, and the number per 100,000 of
the population. However, bear in mind that these events do
not necessarily occur at regular intervals. The frequency
method spreads the events out over an entire year even
though they might have occurred in clusters within a year.

6
For example, several civilians might have died during a single

What Might Happen

terrorist attack, but these fatalities are accounted for as if they
occurred over time.

FREQUENCY OF EVENTS IN THE UNITED STATES

On average, every:
 1.6 seconds a person experiences a disabling injury due
to an accident
 2.5 seconds a person experiences a heart attack
 4.7 seconds an acre of forest is destroyed by wildfire
 5.0 seconds a motor vehicle accident occurs
 6.3 seconds a woman is the victim of domestic violence
 7.7 seconds a person experiences a workplace injury
 9.9 seconds a person experiences a motor vehicle
accident injury
 44.5 seconds a person dies from heart disease
 57.3 seconds a child is neglected
 57.3 seconds a person dies from cancer
 1.2 minutes an elderly person is abused
 1.3 minutes a tobacco related death occurs
 1.6 minutes a child is abused
 1.8 minutes an obesity related death occurs
 2.6 minutes a woman is raped
 2.6 minutes a person is hospitalized for influenza
 4.4 minutes a pregnant woman is involved in a motor
vehicle accident
 5.2 minutes an alcohol related death occurs
 5.3 minutes a thunderstorm occurs
 5.8 minutes a person is injured during a tornado
 6.8 minutes a wildfire ignites
 9.7 minutes a person dies due to an accident not
involving a motor vehicle

7
 12.3 minutes a person dies due to a motor vehicle
accident
 13.1 minutes a person becomes infected with HIV
 13.1 minutes a person dies from influenza
 15 minutes a fire breaks out
 18.2 minutes a person is shot to death
 18.6 minutes a person commits suicide
 18.8 minutes a person is injured in a fire
 32.7 minutes a homicide is committed
 34.5 minutes a person dies from HIV
 35 minutes an alcohol related motor vehicle death
occurs
 43.8 minutes an emergency vehicle accident occurs
 1.3 hours a candle ignites a fire
 1.6 hours a person dies in a fire
 1.6 hours a boating accident occurs
 1.7 hours a person dies due to a workplace accident
 2.4 hours a person dies due to a motorcycle accident
 2.5 hours an earthquake occurs
 18.3 hours a fetus is killed due to a motor vehicle
accident
 13.7 hours workplace violence occurs
 1.1 days a railroad crossing fatality occurs
 1.2 days a person is injured by lightning
 1.7 days a person dies due to a thunderstorm
 1.9 days an explosion occurs
 2.6 days a person dies due to a flash flood
 3.7 days a person dies due to lightning
 11 days a child is shot to death
 11 days a person dies in a landslide
 33.2 days a major landslide occurs
 34.7 days a person dies due to an aviation accident

8
 91.3 days a fatal train wreck occurs

What Might Happen

 162.3 days an aviation disaster occurs
 182.6 days an act of international terrorism occurred
(1991 to 2000)
 219 days a hurricane occurs
 219.2 days a school shooting involving mass casualties
occurs
 260 days a person died due to an act of international
terrorism (1991 to 2000)
 365 days a nuclear power plant accident occurs

(In stark contrast to the above events, there has

been only one major nuclear power plant acci-
dent which occurred in 1979. Also, twenty-two
individuals were infected and five died during
the anthrax terrorism in 2001.)

FREQUENCY OF EVENTS IN THE WORLD

On average, every:
 1.1 seconds a person is injured in a motor vehicle
accident
 2 seconds a thunderstorm occurs
 3.6 seconds a person dies because of poverty
 11.3 seconds a person dies from HIV
 17.3 seconds a child dies from malaria
 26.3 seconds a person dies due to a motor vehicle
accident
 60 seconds a person dies due to interpersonal violence
 1.7 minutes a person dies in an armed conflict
 1.8 minutes a woman is raped
 8.4 minutes a person dies due to a disaster
 16.9 minutes an earthquake occurs
 3.2 hours a person dies due to an aviation accident

9
  3.8 hours a civilian dies due to terrorism
 23.1 hours a terrorist incident occurs
 3.6 days a hurricane occurs
 7.1 days a volcano erupts
 15.4 days an aviation accident occurs

(The approximate death toll from the 2004 Asian

tsunami was 173,906 compared to an estimated
1,825,000 children who die from malaria each
year.)
NATURAL DISASTERS AND EMERGENCIES
Avalanches: An avalanche occurs when a mass of snow
breaks loose from a mountainside. It can travel at speeds over
200 mph (322 kmph).
Droughts: A drought is a prolonged period of drier than
normal weather. The US Weather Service defines a drought as
at least 21 consecutive days of 30% or less of the average rain-
fall for a particular area and season.
Earthquakes and Tsunamis: An earthquake is the pow-
erful shaking of the earth caused by the release of pressure
that has built up as two large sections (tectonic plates) of the
earth’s crust grind against each other along a fault line. The
amount of ground movement is measured using the Richter
scale devised in 1935 by geologist Charles Richter. A tsunami,
a Japanese word meaning “harbor wave,” is a wave triggered
mostly by an undersea earthquake. The wave grows to
tremendous size (up to 90 feet in height) as it travels at
speeds of up to 398 mph (640 kmph) and can reach several
miles inland. Alaska, California, Hawaii, Oregon, and
Washington are states that have experienced tsunamis.
Extreme Heat: Heat waves – prolonged high environ-

10
mental temperatures – create emergency conditions because

What Might Happen

they can cause illness and death, especially in the elderly,
young children, and those who are ill or overweight.
Floods: Floods can be caused by heavy rains, hurricanes,
melting snow, collapsing dams, etc. and account for over
40% of natural disaster deaths worldwide.
Hurricanes (tropical cyclone): A hurricane is an
intense tropical circulating weather system. The word hurri-
cane is from Mayan and Crib Indian roots and means “evil
spirit,” “storm god,” or “devil.” Hurricanes are classified
using the Saffir-Simpson Scale devised by Herbert Saffir, an
engineer, and Dr. Robert H. Simpson, former director of the
National Hurricane Center, that ranks hurricanes according
to degree of damage and rate of sustained winds. Less intense
tropical circulating weather systems are termed tropical
depressions and tropical storms. A storm surge is a large
wave of water between 50 to 100 miles wide that moves
across the coastline where a hurricane makes landfall. A
storm tide is a storm surge combined with the normal tide.
Therefore, when a storm surge occurs during high tide, the
height of the water is even greater. The storm tide of
Hurricane Camille in 1969 was 25 feet high. Hurricanes can
grow to 500 miles in diameter. The hurricane season starts in
June and extends through November. It peaks from mid-
August to mid-October. The Atlantic and Gulf coastal states,
and the Caribbean islands are at risk. In the Pacific Ocean,
Hawaii, Guam, American Samoa, and other islands are at risk.
In the western pacific, these weather systems are called
typhoons. They are referred to as cyclones when they strike
the coastlines along the Indian Ocean.
Landslides and Mudslides: These are movements of

11
huge masses of earth that may travel at speeds in excess of
200 mph. Earthquakes, heavy rain, and construction can trig-
ger them. Sinkholes are horizontal depressions in the ground
that develop suddenly and rapidly due to the loss of under-
ground support.
Thunderstorms and Lightning: These storms, which
cover a small area compared to hurricanes and winter storms,
can cause severe flooding and lightning damage. A thunder-
storm is described as “severe” if it produces either hail at
least three-quarter inch in diameter, winds 58 mph or higher,
or tornadoes. Lightning can occur anywhere, anytime, and
without any rain. Thunderstorms are most likely to occur in
the spring and summer, but can occur all year round.
Tornadoes: Tornadoes are rotating columns of air that
extend from swelling cumulonimbus clouds to the ground.
Although 40% of the tornadoes in the United States occur in
the central plains states from March through July, they can
happen anywhere. More tornadoes touch down in the United
States than any other country.
Volcanic Eruptions: There are about 600 active volca-
noes or vents through which molten rock escapes from
beneath the earth’s surface. Many erupt periodically without
any threat to human life or property. Some volcanoes pro-
duce a continuous lava flow; others cause powerful explo-
sions that hurl ash and volcanic fragments into the sky. After
being dormant for 123 years, Mount St. Helens in Washington
state erupted on May 18, 1980, producing an ash cloud fifteen
miles high, causing 60 deaths, destroying 123 homes, and
devastating tens of thousands of acres of forest.
Wildfires: These fires can spread rapidly, setting brush
and trees ablaze, and leaving the earth scorched. Wildfires

12
cause an average loss of 2 million acres a year in the United

What Might Happen

States. Hot summers produce tinder-dry conditions that
leave the countryside vulnerable to accidental or deliberate
man-made fires. Dwellings near wooded areas can easily be
engulfed in the flames of an advancing wildfire.
Winter Storms and Blizzards: Blizzards consist of sus-
tained winds or frequent gusts to 35 mph or greater and con-
siderable falling and blowing snow that reduces visibility to
less than a quarter mile. In March 1888, a blizzard devastated
the coastal northeastern United States from Washington, DC
to Maine and probably caused about 800 deaths.

CYBER INCIDENTS
Cyber (computers and their support systems) incidents
could be caused by natural disasters which could damage or
destroy equipment. In addition, financial, security, and trans-
portation information systems could be disrupted or
destroyed by the introduction of computer viruses or worms.
An intruder could hack into a computer system and take it
over.

CBNRE (CHEMICAL, BIOLOGICAL, NUCLEAR,

RADIOLOGICAL, AND EXPLOSIVE AGENTS)
Chemical: There are four categories of chemical
weapons: 1) blister agents: used to incapacitate by producing
eye, skin, and respiratory irritations and pain (mustard
agents, Lewisite, and phosgene oxime), 2) blood agents: used
to cause death by destroying tissues, thereby causing breath-
ing to stop and cardiac arrest (hydrogen cyanide and
cyanogen chloride), 3) nerve gases: used to block nerve func-
tioning and cause convulsions and death (Tabun, Sarin,
Soman, and VX), and 4) lung toxins: used to damage the

13
capacity to breathe (phosgene and diphosgene). In addition,
conventional explosives could be used to damage a chemical
plant and cause clouds of hazardous materials to disperse
over the surrounding population. Disasters involving haz-
ardous chemicals may also occur by accident during the man-
ufacturing process or while the chemicals are being stored or
transported.
Biological: Although there are numerous infectious
agents, the most likely biological agents that would be used
are rated by the CDC as highest risks (category A). They are
anthrax, botulism, plague, smallpox, T2 mycotoxins,
tularemia, and viral hemorrhagic fevers. Secondary agents
include brucellosis, glanders, melioidosis, psittacosis, Q
fever, ricin, and staphylococcal enterotoxin B.
Radiological: A dirty bomb or Radioactive Dispersal
Device (RDD) is a bomb made of conventional explosives
contaminated with a small amount of radioactive material.
When the bomb is detonated (most likely in a crowded area),
the explosion would cause structural damage and human
injuries, deaths in the adjacent area, and spew out radioactive
material so that it contaminates people over a wider area.
Radiological events could also occur by accident within
industrial, medical, or research facilities or during the trans-
portation of radioactive material or waste. However, the han-
dling and transportation of radioactive material is so highly
regulated and safeguarded that these events are of low fre-
quency and/or intensity. Since conventional explosives and
radioactive material and waste are plentiful, a dirty bomb sce-
nario is very likely.
Nuclear: Two possible nuclear scenarios are: 1) a terror-
ist piloted plane or planes carrying explosives could crash

14
into a power plant nuclear reactor causing an explosion and

What Might Happen

damage that allows radioactive gases to spew from the plant,
and/or 2) a small nuclear device or portable bomb could be
detonated in a crowded area. Fortunately, although such
bombs exist, experts believe that terrorist groups do not
presently possess them. Nuclear power plant events may
occur by accident. Two notable nuclear power plant acci-
dents occurred at Three Mile Island, Harrisburg,
Pennsylvania on March 28, 1979, and at Chernobyl in the for-
mer USSR on April 25-26, 1986.
Explosives: Conventional explosives are the most likely
type of terrorist weapon. The ingredients are inexpensive,
readily available, and easily assembled. Presently, this is the
most widely used method and includes the use of suicide
bombers, especially in crowded areas or on public transporta-
tion. In the United States there have been terrorist bombings
of cars and buildings. The Unibomber killed his victims by
sending bombs through the mail. The first attack on the
World Trade Center on February 26, 1993, and the bombing
of the Murrah Federal Building in Oklahoma on April 21,
1995, used bombs made of fertilizer that were carried respec-
tively in a van and a rental truck. Other terrorist bombings
include: the Fraunces Tavern in New York City that killed
four and injured sixty by the Armed Forces of the National
Liberation (Fuerzas Armadas de Liberacion Nacional (FALN))
on January 24, 1975, and the US Department of State building
in Washington, DC on January 29, 1975 by the Weather
Underground Organization during the Vietnam war.

15
 2 LEARN WHAT TO EXPECT

FOR ANY TYPE OF DISASTER (ALL HAZARDS) p. 17

Before a Disaster (Warning Phase) p. 17
Immediately after Impact (Response Phase) p. 18
Over Time after a Disaster (Recovery Phase) p. 19

SPECIFIC CONSEQUENCES OF
PARTICULAR TYPES OF DISASTERS p. 20
Disease Outbreaks p. 20
Natural Disasters p. 21
Other Disasters p. 21
Terrorism p. 21

GROUPS WITH SPECIAL NEEDS p. 23

Children p. 23
Physically Disabled p. 24
People with Serious Mental Illness p. 24
Seniors p. 24

DO YOU KNOW?

Disaster Phases p. 25

Response Sequence p. 27

16
 LEARN WHAT TO EXPECT
“If anything can go wrong, it will.”
Murphy’s Law

In this section we describe the details of what a disaster

could possibly do to your community before, during, and
after it strikes. Chaos is the essence of any disaster because

What To Expect
existing social structures and infrastructures are destroyed.
Even carefully planned responses by emergency workers are
often frenzied. The degree of chaos is proportional to the
magnitude of the disaster. However, even a disaster of low
magnitude may be experienced subjectively as extremely
chaotic.
First, we present a general list of things to expect that
apply to all hazards. Although chaos is part of any disaster,
the specific things that might go wrong are largely depend-
ent on the type of event, its intensity and size, its duration, its
location, how many people are involved, and what is impact-
ed. Then, we list specific consequences that are associated
with particular disasters.

FOR ANY TYPE OF DISASTER (ALL HAZARDS)

Before a Disaster (Warning Phase)

For events for which there can be warnings, there will be:
 Public broadcasts of public advisories and warnings
 Excited and anxious people
 Increased activity
 Increased traffic and traffic jams
 Shopping for water, food, and emergency supplies

17
 Evacuation routes bumper-to-bumper, if authorities
order an evacuation
 Roads and areas closed by law enforcement personnel

Immediately after Impact (Response Phase)

 Chaos! Chaos! Chaos!
 Damage and destruction
 Disruption of transportation
 roads and bridges blocked, damaged, or destroyed
 grounding of air travel
 Hazardous material conditions
 Lack of water
 contaminated water
 disruption of water supply
 Loss of communications including:
 cellular phones
 emergency communication systems
 pagers
 pay phones
 radio and/or TV transmission
 telephones
 Mass casualties and injuries
 Outbreaks of fires
 Power outages causing loss of:
 air conditioning

18
  ATMs
 computer (automated data processing) systems
unless battery operated backup
 electric appliances including microwave ovens and
electric stoves
 heat
 lights including street lights

What To Expect
 refrigeration
 television and radios unless battery operated
 traffic signals
 water for people who use well water obtained via
electric pumps

Over Time after a Disaster (Recovery Phase)

 Economic hardship
 Health hazards and disease
 Huge financial cost for reconstruction
 Increased prices because of shortage of goods due to
crop damage, disruption of production, and/or
increased demand
 People dislocated
 Waste accumulation due to:
 disruption of garbage collection
 spoiled food
 sewage processing plants unable to operate

19
 SPECIFIC CONSEQUENCES OF PARTICULAR
TYPES OF DISASTERS

Disease Outbreaks
The course and speed of a disease outbreak depends on
opposing forces. On the one side, the factors are lethality of
the biological agent (virulence), disease transmission, envi-
ronmental conditions, such as overcrowding or poor sanita-
tion, and human behaviors that might enhance the transmis-
sion of the disease. On the other side, working against the
spread of disease are countermeasures such as public health
surveillance, immunization, changes in human behavior,
medication, and quarantine, that is, isolating infected indi-
viduals so that they will not infect others. An epidemic can
be prevented or controlled by public health measures such as
educating the public, promoting sanitary conditions, report-
ing and tracking of new cases, and reducing the populations
of disease carrying animals (vectors).
SARS (Serious Acute Respiratory Syndrome) is an exam-
ple of a relatively contained disease outbreak. From
November 2002 through June 12, 2003, SARS, a potentially
severe form of pneumonia, infected 8,500 and caused about
800 fatalities worldwide. It is believed that this illness start-
ed in China and was identified in Vietnam in February 2003.
In July 2003, the World Health Organization (WHO) declared
the end of the global outbreak. In contrast, malaria is still a
huge health menace in underdeveloped countries. Although
the annual influenza outbreak is small compared to the
influenza pandemic of 1918, influenza still causes about
36,000 deaths each year in the United States.

20
 Natural Disasters
Geological and weather events may range from those
that inflict little or no damage on people and their living envi-
ronment to disasters that cause mass casualties, widespread
devastation, and billions of dollars in losses.

Other Disasters
 Industrial disasters may involve fires and explosions

What To Expect
that cause the release of hazardous materials into the
air, necessitating the evacuation of the surrounding
areas.
 Transportation disasters – motor vehicle accidents, avi-
ation disasters, naval disasters, train wrecks – may
involve many people and result in mass casualties, haz-
ardous material spills and fires. Trapped individuals
will need extrication.

Terrorism
 Cyber Terrorism
 corruption of data files
 disruption of information systems
 disruption of banking, transportation and/or utilities
 disruption of the availability of food and
pharmaceuticals
 disruption of government operations
 impact on economy
 CBRNE Agents
Chemical: People contaminated by a chemical agent
would become sick immediately. The degree of illness would

21
depend upon the type of chemical and degree of exposure.
The number of casualties would depend on the agent, the
amount released, the number of people exposed, and the
area in which it was released, for example, indoors or out-
doors. Hazardous material units would respond, set up
decontamination facilities, and decontaminate people.
Decontamination would also take place in facilities set up
adjacent to hospitals.
Biological: There would usually be no awareness of an
attack until several days after the release of the biological
agent. The first reported symptoms would not likely be rec-
ognized as terrorist related. As the number of individuals
reporting similar symptoms increases, public health surveil-
lance methods would detect the surge of cases, and bioterror-
ism would be suspected. An investigation would be
launched to determine the origin of the illness. As more indi-
viduals become ill and require treatment, an even larger
number of people may become exposed and need preventive
interventions. Treatment centers, called points of distribu-
tion (POD), would be set up in various locations and staffed
by health personnel to distribute antibiotics or administer
vaccinations. The National Pharmaceutical Stockpile would
provide medication and vaccines to augment the local sup-
ply. [See “Do You Know?” “National Pharmaceutical
Stockpile” in Chapter 4, p. 72.]
Radiological/nuclear: The degree of destruction would
depend upon whether a nuclear device is detonated (mos
destructive/very high radioactivity), a dirty bomb is exploded
(destruction depends on amount of explosives/ not much
radioactivity), or a nuclear power plant is attacked (not much
destruction outside the plant/could be high radioactivity). A
detonated nuclear device would be very devastating. There

22
would be a powerful shockwave causing buildings to
implode and generating a wind that would demolish struc-
tures and forcefully propel people and objects. Intense heat
and light from the thermal radiation would burn and blind
people and ignite fires. The electromagnetic pulse (EMP)
would destroy all electronic circuitry so that cars, computers,
and communication equipment would not function. People
exposed to a high level of radiation would develop acute radi-

What To Expect
ation sickness (ARS), causing serious tissue damage and pro-
ducing symptoms within minutes or hours. Those who sur-
vived the nuclear blast would probably have about a 15%
increased risk of developing cancer over the long term.
Explosives: The number of injuries and fatalities and
amount of property damage would depend upon the amount
of explosives, where they were placed, how many people
were in the vicinity, and whether the explosives were deto-
nated out in the open (less impact) or in an enclosed area
(greater impact).

GROUPS WITH SPECIAL NEEDS

There are individuals in certain groups that have special
needs compared to others in the general population. In this
chapter, we highlight these groups by listing the possible
additional disruptions and environmental changes that
might impact them. In subsequent chapters, we describe
other aspects about these groups specific to those chapter
topics.

Children
 Compromised school operations
 Disruption of activities outside of school

23
 Physically Disabled
 Disruption of service delivery
 Destruction of the usual accessible environment
People with Serious Mental Illness
 Disruption of service delivery:
 Service center, such as the Community Mental
Health Center, is impacted by the disaster.
 Provider resources are diverted to emergency
services for disaster victims.
 Changes in the environment:
 Client cannot get to service center because public
transportation is disrupted.
 Stabilizing psychiatric medications become
unavailable.
Seniors
 Disruption of service delivery:
 The senior center is impacted by the disaster and
cannot provide services such as meals and health
clinics.
 Health center services are disrupted or diverted to
care for disaster victims.
 Changes in the environment:
 Client cannot get to service center because public
transportation is disrupted.
 Disease stabilizing medications become unavailable.
DO YOU KNOW?

24
 DO YOU KNOW?
Disaster Phases

Do you know the different phases of a disaster?

Before
Mitigation: Before or in between disasters, we take steps

What To Expect
to prevent or lessen the impact of potential disasters. For the
community, this might consist of the government establish-
ing a water control project to reduce the possibility of flood-
ing. For a family, this might be installing smoke detectors in
the home. [See Chapter 3 – “Prevent” – p. 29.]
Preparedness: In this phase people plan and train for
emergencies, and perform practice exercises. At the local
level, a Local Emergency Planning Committee (LEPC),
Emergency Management Council, or similar government
group comprised of government officials, the Office of
Emergency Management Coordinator, representatives of the
emergency services, and citizens design an emergency plan.
Likewise, each family should develop their emergency or dis-
aster plan. [See Chapter 4 – “ Prepare” – p. 52.]
Warning: This phase starts from the time of the detection
of the threat and runs to the time of impact. For some disas-
ters, such as hurricanes and winter storms, there is a long
warning phase. For other disasters, this phase may be very
short, for example, not more than about on average 13 min-
utes for some tornadoes. There may be no warning for other
disasters, such as earthquakes or transportation accidents.
[See “Alert Systems” in Chapter 4, p. 59 and 67.]

25
 During
Impact: The disaster strikes. The duration of the impact
varies – minutes for an explosion, hours for a hurricane and
even days for a major flood. During this phase, if they have
not evacuated, individuals take action for their protection
and survival.

After
Response: During this phase responders are engaged in
immediate emergency action. The major goals are to keep
people safe and restore order out of the chaos caused by the
disaster. The objectives are to save lives, protect property,
and minimize psychological injury. Therefore, the tasks are
rescuing, combating the threat (for example, extinguishing a
fire), administering emergency medical care, protecting peo-
ple, caring for basic needs, and providing emotional support.
This phase may range from hours to days or even weeks
depending on the nature and size of the disaster.
The impact and response phases combined are also
referred to as the emergency phase.
Recovery: This phase extends over the long term and
may last years. The goal is to return to either the pre-disaster
state or fashion a new and better way of life. People attend
both to practical tasks such as repairing or replacing damaged
property as well as to psychological tasks such as grieving for
loved ones who died, coping with the loss of belongings, and
healing from the trauma. For a few, it is a period to recover
from physical injuries and/or receive treatment for mental
disorders caused by the traumatic event. Some individuals
may need to resolve deeper emotional issues that existed
before the disaster and have became worse. If not addressed,

26
these emotional issues would likely impair their ability to
cope with life’s responsibilities and experience life’s joys.
There are specific things that you can do to help yourself
and others during the emergency and recovery phases. [See
Chapter 8 – “Help Yourself” – p. 14 and Chapter 9 – “Help
Others” – p. 164.]
Response Sequence

What To Expect
Do you know the sequence of an emergency response
to a disaster?
Minutes to Hours: The local emergency services
respond – police, fire, emergency medical services. As the
incident grows in size, the Office of Emergency Management
(OEM) responds to provide coordination and supply more
resources. An incident command center is established near
the scene. The incident commander directs the emergency
response with the assistance of representatives from each of
the emergency services. The National Incident Management
System is the national standard method for directing an
emergency operation. It provides a common technical lan-
guage and emergency standard operating procedures (SOP)
throughout the United States. As the need increases for addi-
tional emergency resources, the incident commander
requests mutual aid responses from neighboring jurisdic-
tions and finally from state agencies. As the emergency oper-
ation grows, an Emergency Operation Center (EOC) housed
permanently in a specific location is placed into operation.
The staff at the EOC arrange for resources needed by the inci-
dent command. There are local EOC’s for local emergency
operations and state EOC’s for state level disasters.
State of Emergency: The local government declares a
“state of emergency” because of the magnitude and duration

27
of the disaster. The state government may also call a “state of
emergency” because it is impacting several local government
jurisdictions in the state. The governor may also activate the
state’s National Guard units.
Federal Response: Once a state declares a “state of emer-
gency,” the federal response is activated. Responding agen-
cies would include the Office of Emergency Preparedness
(OEP) and the Federal Emergency Management Agency
(FEMA), both of which are divisions of the Department of
Homeland Security. If the disaster requires a federal public
health response, the Center for Disease Control and
Prevention (CDC) is called in. Other government entities
such as the military may also respond.

28
 3 PREVENT

THINGS TO DO BEFORE p. 31
Keeping an Event from Happening or Preventing
Exposure to an Event (Primary Prevention) p. 31
Lessening the Impact of an Event
(Secondary Prevention) p. 34
Lessening a Permanent State of Impairment
(Tertiary Prevention) p. 36

THINGS TO DO AFTER p. 37
Lessening the Impact of an Event
(Secondary Prevention) p. 37
Lessening a Permanent State of Impairment

Prevent
(Tertiary Prevention) p. 38

DO YOU KNOW?

In the Workplace p. 38
Mail and Hazardous Materials p. 39
Insurance p. 40
Flood Insurance p. 40
Evacuate vs. Shelter in Place p. 41
Decontamination vs. Privacy p. 43
Disaster Grants, Loans, and Funded Services p. 45
1 vs. 2 or More Collapsed Victims Rule p. 49
Collapsed or Seriously Injured Victim p. 49

TABLE
Possible Protection for Terrorist Attacks p. 51

29
 PREVENT

“Watch out for danger and chaos when they are still formless
and prevent them before they happen.”
Sun Tzu
505-473 B.C.

Knowledge is power. Now that you have read the first

two chapters, and you know what to expect, use this as a
springboard to learn the appropriate preventive actions.
Why is prevention essential? Even a small preventive
step such as wearing an automotive seatbelt can yield enor-
mous benefit. An estimated 135,000 lives have been saved
from 1975 through 2000 by this simple change in our
behavior.
There are multiple ways to prevent or mitigate. Public
health uses the term “prevention.” Emergency management
uses the term “mitigate,” that is, to lessen. There are three
types of prevention: primary, secondary, and tertiary. Primary
prevention is lessening or eliminating exposure to a danger.
Secondary prevention is stopping the consequences (likely
effects) after being exposed. Tertiary prevention is stopping
the long-term effects once short-term effects develop.
In medical terms, primary prevention limits exposure to
what causes a disease. Secondary prevention wards off a dis-
ease after a person is exposed to a disease-causing agent or
event. Tertiary prevention lessens the likelihood of disability
developing after the onset of an illness or injury.
Using the example of a terrorist attack, primary preven-
tion begins with law enforcement investigation and surveil-
lance to detect an imminent attack. Suspected terrorists are

30
apprehended before the attack is carried out. You can prac-
tice primary prevention by being vigilant and reporting sus-
picious activities.
In secondary prevention, emergency personnel are
ready and respond quickly to an attack. After experiencing an
event, you can protect yourself and others from harm by tak-
ing certain actions. Decontaminating yourself after being
contaminated with a hazardous material is an example of
secondary prevention.
In tertiary prevention, government and relief agencies
provide assistance and funds for recovery. If your arm is
injured during a terrorist attack, you can practice tertiary pre-
vention by engaging in physical therapy to prevent perma-
nent disability.
The first principle of prevention or mitigation is “always

Prevent
place safety first.” We have listed procedures to maintain
your health and well-being, in addition to measures that
might prevent or limit exposure to an accident, crisis and/or
disaster. Although some of these actions provide secondary
and tertiary prevention, you need to do them before the
event, for example, purchasing insurance. Therefore, we
have organized what you should do in a chronological
sequence – “What to Do Before” and “What To After” – and
within each group according to the type of prevention. Since
this guide is not a first aid manual, we have not included any
first aid procedures. Instead, we recommend that you take
courses in first aid and CPR.
THINGS TO DO BEFORE
Keeping an Event from Happening or Preventing
Exposure to an Event (Primary Prevention)

31
 Practice safety principles and procedures. For example:
 Be mindful of risks and potential dangers.
 Avoid storing flammable materials in your home.
 Be careful about storing non-flammable hazardous
materials, for example household cleaning agents, in
your home, especially if children or pets are present.
 Be extremely careful if you use candles.
 Smoke safely, if you must smoke. For example,
refrain from smoking in bed.
 Keep all matches, lighters, and flammables out of the
reach of children.
 Lock medications away from children.
 Drive safely and defensively.
 Drive only when alert and fully awake. Be especially
careful when taking over-the-counter or prescription
medications that might make you drowsy.
 Drive only if sober.
 Stop friends and/or family members from driving
while intoxicated.
 Avoid talking on a cellular phone while driving.
 Practice bicycle safety, including wearing a helmet.
 Wear appropriate safety equipment when engaged in
sports.
 Practice gun safety if you own and/or use firearms.
 Avoid walking alone after dark.

32
  Practice safety procedures on your job. [See “Do You
Know?” – “In The Workplace” – in this chapter,
p. 38.]
 Live a preventive and healthy lifestyle, and practice risk
avoidance.
 Resist smoking tobacco.
 Avoid drug use.
 Make responsible decisions about drinking alcoholic
beverages.
 Maintain a healthy diet.
 Exercise regularly.
 Schedule time for sufficient rest and relaxation
(R & R).

Prevent
 Maintain good sleep habits.
 Get regular medical check-ups and screening tests as
recommended.
 Be aware of the risks of driving, having unprotected
sex, and using drugs; especially make certain your
teenagers are aware.
 Be mindful of security, and practice security proce-
dures. For example:
 Use your vigilance and intuition (“Listen to your
gut.”) to detect potential threats.
 Report suspicious activity to police or other
authorities such as security personnel.
 Safeguard your home with proper locks and lighting.

33
  Protect your identity by refusing to give any identity
information to unknown telephone callers.
 Practice health precautions when traveling, including
recommended immunizations.
 Practice electronic protection and cyberspace security.
For example:
 Protect your computer by using a surge protector.
 Use a backup battery for power outages.
 Use anti-virus and internet security software.
 Update virus definitions and security software fre-
quently.
 Open e-mail attachments only from known senders.
 Resist forwarding e-mail that you have received from
unknown sources.
 Download updates as soon as you are notified that
they are ready.
 Avoid suspect internet sites.
 Be careful about what you download.
 Evacuate, if directed, during the warning phase of an
impending disaster, for example, a flood, hurricane, or
tsunami.
Lessening the Impact of an Event (Secondary Prevention)
 Prepare for disasters. [See Chapter 4 – “Prepare” – p. 52.]
 Wear seatbelts, use safety cribs for babies, and safety
harnesses for children.
 Wear a medical information bracelet or neck chain to
identify medical conditions, allergies, medications you

34
 are taking that might cause dangerous drug interac-
tions, and/or special needs, for example, blood type; ask
your pharmacist for the names of the companies that
sell these bracelets and chains.
 Install smoke detectors in your home, and change bat-
teries at least twice per year (when you change your
clocks for daylight savings time in April and back to
standard time in October).
 Install a carbon monoxide detector in your home.
 Place an ABC fire extinguisher in your kitchen.
 Keep an emergency kit in your car or vehicle. [See –
“Car or Vehicle Emergency Kit Checklist” – in Chapter 4,
p. 66.]
 Strengthen your home against, natural disasters.

Prevent
 If you are building a home, follow the building code,
especially regarding special requirements for earth-
quakes, hurricanes, etc., in areas likely to be at risk for
specific disasters.
 Consider using construction methods to protect
your home from the potential damage of natural dis-
asters even if they are not required by the building
code.
 Bring an older home up to code.
 Practice electronic protection and cyberspace security.
For example:
 Create an emergency recovery disk.
 Keep the original disks of your software and make
back-up copies.

35
  Back-up your data files.
 Store back-up files in a secure place or places.
 Store second back-up files at a separate location.
 Use and periodically change passwords.
 Secure your financial data.
 Keep financial affairs up-to-date.
 Maintain essential financial records.
 Store financial records in a safe place, for example, a
waterproof, fire resistant safe box with a lock, or bank
safety deposit box.
 Protect your business.
 Use backup and data recovery software.
 Have a remote location to electronically store and
replicate critical business data.
 Install or arrange for a backup telecommunication
system.
 Arrange for an alternate place to conduct business.
Lessening a Permanent State of Impairment
(Tertiary Prevention)
 Maintain an inventory, preferably with photographs of
your valuable belongings.
 Get flood insurance if you live on a flood plain (your
regular home insurance does not cover flood damage).
[See “Do You Know?” – “Flood Insurance” – in this chap-
ter, p. 40.]
 Make sure your homeowners insurance includes cover-
age for terrorism.

36
 THINGS TO DO AFTER
Lessening the Impact of an Event
(Secondary Prevention)
 Take survival action.
 Evacuate, when necessary. *
 Rescue, if possible.
 Shelter in place, when appropriate. *
* [See “Do You Know?” – “Evacuate vs. Shelter in
Place” – in this chapter, p. 41.]
 Call 911.
 Decontaminate, if necessary. [See “Do You Know?” –
“Decontamination vs. Privacy” – in this chapter, p. 43.]

Prevent
 Practice safety.
 Attend to medical emergencies. [See “Do You Know?”
boxes – “1 vs. 2 or More Collapsed Victims Rule” and
“Collapsed or Seriously Injured Victim” – in this
chapter, p. 49.]
 Prevent further structural damage.
 Turn off utilities at main shut-offs, if not a risk to
do so.
 Secure structure. For example, board up windows
and entry doors.
 Attend to basic needs.
 Attend to mental health and social needs.
 Take essential financial records with you if you
evacuate.

37
 Lessening a Permanent State of Impairment
(Tertiary Prevention)
 Inspect your residence for structural damage, if safe to
do so.
 Document damage with written inventory and photo-
graphs.
 Get damage assessment from Red Cross and/or your
insurance company.
 Make repairs and keep copies of paid bills.
 Seek professional help when necessary for:
 health and/or mental health care
 legal advice and/or representation
 Seek aid and grant funds from government and/or dis-
aster relief agencies. [See “Do You Know?” – “Disaster
Grants, Loans, and Funded Services” – in
this chapter, p. 45.]

DO YOU KNOW?
In The Workplace
Do you know you have a right to a safe and healthful
workplace?
The Occupational Safety and Health Act of 1970 (OSH Act),
P.L. 91-596, assures safe and healthful working conditions for
working men and women throughout the United States. The
Occupational Safety and Health Administration (OSHA) in
the U.S. Department of Labor has the primary responsibility
for administering the OSH Act. To file a complaint, report an
emergency, or seek OSHA advice, assistance, or products,

38
visit the OSHA website: www.osha.gov or call: 1-800-321-
OSHA (6742)
Adapted from OSHA 3165-09R
Mail And Hazardous Materials
Do you know it is illegal and extremely dangerous to
mail restricted or prohibited hazardous materials?
With certain limited exceptions, the federal law Title 18
United States Code (18 USC) 1716 declares it is a crime to mail
anything which may kill or injure persons or harm property.
Persons violating the statute may be subject to fines, impris-
onment, or other severe penalties.
Although mailing of the most hazardous materials is
prohibited, the statute allows the Postal Service to adopt
rules prescribing preparation and packaging conditions

Prevent
under which certain hazardous materials may be mailed if
they are not “outwardly of their own force dangerous or inju-
rious to life, health, or property.”
To learn more about it:
1. See Publication 52, Hazardous, Restricted, and
Perishable Mail.
2. Contact your local post office.
3. Contact the Pricing and Classification Service Center
(PCSC).
New York PCSC
1250 Broadway 14th FL
New York, NY 10095
212-613-8676
Adapted from United States Postal Service Notice 107

39
 Insurance
Do you know how insurance might help?
Having insurance does not prevent a disaster from hap-
pening. It does not prevent damage from occurring when a
disaster strikes. However, insurance benefits can help you
rebuild and rehabilitate by providing funds for loss and dam-
age. Insurance may also provide funds for temporary shelter
while your residence is being repaired. It is a way to foster
recovery and lessen the possibility of the long-term effects of
disaster. Therefore, insurance is a form of tertiary prevention.
Homeowners should have homeowner insurance. Tenants
should consider buying insurance to cover the loss of their
personal property or renter insurance that may cover for
theft, damage, loss of personal property, and liability for acci-
dents. A landlord’s insurance covers the rental building; it
does not protect the tenant and the tenant’s personal proper-
ty.
To learn more about it, call the National Consumers
Insurance Helpline: 1-800-942-4242 or visit website:
www.iii.org
Flood Insurance
Do you know there is a national flood
insurance program?
Homeowner and renter insurance do not protect against
damage and loss caused by floods, although it is estimated
that 11 million homes in the United States are vulnerable to
flooding. Even residences that are not located near bodies of
water may be flooded or susceptible to landslides during
extremely heavy rainfalls. Therefore, if you are a homeowner,
renter, or business owner in a community that participates in

40
the National Flood Insurance Program (NFIP), created by
Congress in 1968, you can obtain coverage through this pro-
gram from agents that represent participating companies.
Unlike federal disaster aid, which is only available if the pres-
ident declares a federal disaster, flood insurance provides
benefits even if a disaster is not declared.
Special Flood Hazard Area
 high flooding risk
 mortgage lender may require flood insurance

Non-Special Flood Hazard Areas

 low or moderate flooding risk
 approximately 25% of floods occur in these areas

To learn more about it and determine what zone you are

Prevent
in, visit website: www.floodsmart.gov.
To learn more about it and obtain an agent referral, call:
1-800-720-1090.
Evacuate vs. Shelter in Place
Do you know when you should evacuate versus when
you should shelter in place?
Evacuation can take place before impact or after impact.
During a warning phase prior to impact, it is best to evacuate
areas that are likely to be the targets of certain events such as
hurricanes, floods, or wildfires. You should take your emer-
gency plan and evacuation kit with you [See Chapter 4 –
“Prepare” – p. 52.] and proceed to a designated shelter or to
lodging outside of the evacuation area. When there is a torna-
do warning, you may have an average of thirteen minutes to
dash to a pre-designated shelter.

41
 After impact, there are some situations in which it is bet-
ter to evacuate, and there are others in which it is better to
shelter in place, that is, stay in the building that you were in
when the emergency began. If the building was not directly
involved at the time of impact, it is usually better to stay in
place. If the building is structurally damaged or on fire, you
should evacuate immediately. To help yourself to evacuate,
think of the three “P’s” – pills, purse, and pets – so that you
remember to take them with you. People often rush out with-
out these, and then risk their lives attempting to go back and
retrieve them.
If a dirty bomb (Radioactive Dispersal Device) has been
detonated outside while you are inside, you should remain
inside and shelter in place so that you do not expose yourself
to the radioactive material. If possible, seal off the windows
and doors. Listen to emergency radio reports. If you are out-
side when the device is detonated, it is best to get away from
the contaminated area as soon as possible. Move away from
the area traveling against the wind. You can determine this
direction by looking at the direction of the plume of smoke
from the explosion, or which way a flag or other object is
flowing in the wind, and go in the opposite direction. If you
have become contaminated, you need to be decontaminated
as soon as possible. [See the next “Do You Know?” –
“Decontamination vs. Privacy” – p. 43.] Even if the bomb that
has been detonated consisted of only conventional explo-
sives, you should evacuate the area because there may be a
secondary device (another bomb set to go off after the arrival
of emergency responders in order to target them). You
should not let your curiosity keep you at the scene. This is a
time to remember “curiosity killed the cat.”
In the case of a nuclear power plant disaster (accidental

42
or terrorist attack), authorities would alert the public by
sounding sirens (within 10 mile radius), making announce-
ments using vehicles with public address systems (within 20
mile radius), and broadcasting on the Emergency Broadcast
System (within 50 mile radius). Once alerted, listen to radio
or television emergency broadcasts to learn if you should
evacuate or shelter in place. Evacuation would proceed along
designated routes.
Shelter in Place Actions
At home: during a biological, chemical, nuclear or radio-
logical event, you need to have a disaster supply kit that
includes ample food and water for one week, and supplies to
seal one room in order to create a safe-haven or safe-room.
Anywhere: when you shelter in place during a biologi-
cal, chemical, nuclear, or radiological event:

Prevent
1. Close and seal off windows and doors, if possible.
2. Turn off air-conditioning, fans, and heat.
3. Shut down air intake systems and block vents.
If you have been directed to shelter in place, you should
do so even if your children or other relatives are not with you.
[See “Do You Know?” – “Reunion vs. Safety and Security” – in
Chapter 5, p. 96.]
Decontamination vs. Privacy
Do you know the best way to decontaminate while
dealing with competing issues?
When confronted with possible contamination by a bio-
logical, chemical, or radiological agent, you might be faced
with the conflicting needs of self-preservation versus privacy.
Privacy is not an insignificant matter. If you are uncertain

43
whether you have actually become contaminated, you may
be inclined to choose privacy over undergoing decontamina-
tion (Decon) because it would require you to completely dis-
robe. Unlike an approaching fire, you cannot see radioactivi-
ty. Hazardous chemicals are often in the form of clear, color-
less, odorless gases. Biological agents are not visible to the
unaided eye.
Hazardous material enters your body if you ingest or
inhale it, or if it becomes absorbed through your skin. It may
also enter your system by injection, such as a puncture from
sharp, contaminated debris.
If there is any question that your skin might have
become contaminated, it is better to undergo Decon, even
though Decon would not be necessary if your skin was only
“exposed” by your being in the vicinity of a hazardous mate-
rial (HazMat). Although radioactive detection devices can
measure whether your skin has become contaminated with
radioactivity, such devices may not be readily available. If
your skin has become contaminated, you should not eat,
drink, place your bare hands near your mouth, rub your eyes,
or touch others until you have been decontaminated. If you
do not undergo Decon, you place others including children
at risk.
Even though undressing down to your underwear will
remove 85% of the contaminating agent, you will still need to
undress completely, wash thoroughly in a stream of water,
and scrub the natural crevices of your body. Individuals have
become ill by not undergoing this thorough procedure.
Shampoo and soap are not necessary, but you may use them
if they are available.
Place all your clothing in a thick plastic bag, if possible,

44
and seal it. If you are concerned about being naked, you
should know that emergency HazMat response units are
often outfitted with a supply of disposable gowns that indi-
viduals can easily put on before they remove their clothing.
These units are also usually equipped with Decon tents for
privacy and with heaters to warm the water used for shower-
ing and the air inside the tent.
You can wash under the loose fitting Decon gown. You
may be wondering, “Wouldn’t I still be contaminated since
the inside of the gown has touched my contaminated cloth-
ing?” The purpose of Decon is not to remove every particle of
hazardous material but to reduce the amount of contamina-
tion below a safe level. We are exposed to hazardous materi-
als all the time without being harmed. For example, we are
surrounded by natural background radiation without damag-

Prevent
ing consequences. A sufficient amount of hazardous materi-
al will have been removed even when the gown is used.
Nevertheless, you may change to a clean gown, if available,
and if that would help you feel more at ease.
Disaster Grants, Loans, and Funded Services
Do you know about the availability of disaster
grants, loans and funded services?
From Disaster Relief Organizations
Various disaster relief organizations provide shelter or
funds for temporary housing. They may also provide emer-
gency cash assistance or vouchers for purchasing essentials
such as clothing and food. Local charities and faith-based
organizations may provide services and financial support.
Contact the local chapter of a disaster relief organization
such as the American Red Cross or The Salvation Army, or

45
contact your local United Way.
[See “Resource Directory – Disaster Relief Organi-
zations” in Chapter 7, p. 132.]
From the Federal Government
1. Aid is only available when there is a presidentially
declared disaster.
2. You need to fulfill the eligibility requirements.
3. You need to apply.
Congress enacted the Robert T. Stafford Disaster Relief and
Emergency Assistance Act, 42 U.S.C. §§ 5121-5206 in 1988 to estab-
lish support for state and local governments and their con-
stituents when they are overwhelmed by disasters. This act
describes the disaster declaration process, the types of feder-
al financial assistance, and how to apply.
There are three categories of financial assistance:
1. individual assistance – aid to individuals and house-
holds
2. public assistance – aid to public and certain private
non profit organizations
3. hazard mitigation assistance – funds to institute
methods that may reduce future disaster losses
Individual Assistance: Individuals and Households
Program (IHP): This program provides funds and services for
those whose property is damaged or destroyed, when their
insurance does not cover these losses. There are funds for
temporary housing and grants to repair disaster damage to
your home. In unusual circumstances, there are limited
funds to replace your disaster damaged home or construct a
new home. There are grants for Other Needs Assistance

46
(ONA) such as medical, dental, funeral, personal property,
transportation, moving and storage, and other expenses that
might be approved.
Small Business Administration Disaster Loans:
There are three types of federally subsidized loans from the
Small Business Administration (SBA):
1. home disaster loans for renters and homeowners to
repair damage to home or personal property, or
replace damaged personal property
2. business physical disaster loans for business owners
to repair or replace damaged property
3. economic injury disaster loans that provide funds to
small businesses and small agricultural cooperatives
to help them through the disaster recovery phase

Prevent
Disaster Unemployment Assistance (DUA): This pro-
gram provides unemployment benefits and re-employment
services for victims who have become unemployed because
of a presidentially declared disaster. In order to be eligible for
DUA benefits, individuals must register with their state
unemployment office. DUA funds are for individuals who are
not covered by other unemployment benefits, such as farm-
ers, migrant and seasonal workers, and the self-employed.
Legal Services: This program provides free legal assis-
tance to low-income individuals through an agreement with
the American Bar Association’s Young Lawyers Division.
If you are the victim of a presidentially declared disaster,
call: 1-800-621-FEMA (3362) or TTY 1-800-462-7585 to learn if
you are eligible for any of these grants, loans or services, and
to register.
Tax Considerations: You may qualify to deduct casual-
47
ty loss from a declared disaster on your federal income tax
return. If you are due a federal income tax refund, the
Internal Revenue Service (IRS) can expedite your receiving
the refund.
Contact the IRS for Tax Questions to learn more about
these tax considerations. Call: 1-800-829-1040
Crisis Counseling Assistance and Training Program
(CCP): This program provides the funding for states to offer
two types of short-term counseling services without charge
to the recipients:
1. immediate – for the response to immediate mental
health needs with screening and diagnostic services,
counseling interventions, and outreach services such
as public information and community networking
2. regular – to provide up to nine months of crisis coun-
seling, community outreach, consultation, and edu-
cation services
Contact your state Office of Emergency Management
(OEM) to learn more about these programs in your state, and
what entity or entities administer them.
From State or Local Government
Various states have grants, loans, and funded services
that do not require a presidential disaster declaration.
Contact your state OEM office.
Local governments may allocate funds for temporary
housing or other services through their emergency manage-
ment offices or social service departments.
From Your Employer
Inquire if your employer maintains an emergency fund

48
for employees who are victims of disaster.

1 vs. 2 or More Collapsed Victims Rule

Do you know how to determine the presence of a
toxic subtance and what to do?
One collapsed victim: approach, as long as there is no
other danger, for example, a shooter or a collapsing struc-
ture, and assess the victim.
Two or more collapsed victims: If there is no obvious
sign of trauma, a toxic substance is most likely the cause.
Therefore, stay away and move out of the area immedi-
ately.
Always call: 911.

Prevent
Collapsed or Seriously Injuried Victim
Do you know what to do when a person has
collapsed?
Step 1. Assess for responsiveness and/or injury.
 Do not move victim if there is any evident or
possible injury to head, neck, or back unless
absolutely necessary since moving the victim
improperly may cause paralysis.
 Tap or shake gently and shout, “Are you ok?”
Step 2: If Call 911 for Emergency Medical Services
(EMS), especially if victim is unresponsive.
 Give following information:
 location (rural – give address, if known, and/or

49
 Collapsed or Seriously Injuried Victim
(continued)
nearest crossroad, including estimated dis-
tance and direction from crossroad; suburban
or urban – give address and nearest cross
streets so that the EMS responders know
which block you are in. Minutes, and even sec-
onds, count in an emergency.)
 telephone number you are calling from
 what has happened (motor vehicle accident,
fall, possible heart attack)
 how many individuals need help
 condition of victim or victims
 what help is being given to victim or victims
 Wait for instructions and/or permission to hang
up.
Step 3: If victim is unresponsive  check breathing
and check pulse  perform CPR (Cardio-
Pulmonary Resuscitation), if needed and if you
are certified.
Note: Two individuals can perform this strategy better
than one, since the first person can do step 2 as the second
person begins step 3. Try to recruit someone to help you.

50
 Possible Protection for Terrorist Attacks
Item/Cost Purpose Recommendations By Experts
Antibiotic to treat infectious disorders caused by biological individuals should not stockpile because:
agents such as anthrax, plague, etc. –will be available for treatment
–should only be prescribed, as necessary, for
prevention or treatment
–antibiotics can expire
Cyanide Antidote to counteract the effects of cyanide individuals should not obtain because:
–difficult to administer
–use requires trained medical personnel
–would only counter the effects of cyanide if
administered immediately
Escape Hood containing to protect eyes, mouth, and nose, and to prevent the worthwhile for those in high risk occupations
HEPA or high efficiency inhaling of biological and chemical agents while
particle arresting filter evacuating from contaminated building or area Note: No special fitting and only minimal training is
$200 (20-30 minutes) required, unlike a gas mask
Mark I Kit used to counteract nerve agents; contains an atropine
individuals should not obtain because:
auto-injector and two PAM (pralidoxime chloride) –available by prescription only
auto-injectors –requires training to administer

51
–can cause injury and adverse effects
–may be supplied to emergency responders
–medicine can expire
Mask – Face to provide protection from inhaling biological agents; could buy disposable type and keep one at each
disposable $2.75 may protect against radioactive dust but not location (home, work) but need at least N95 (blocks
reusable $15-20 chemicals out 95% of particles 0.3 microns in size)
Mask - Gas to protect eyes, mouth, and nose, and to prevent the having one is a personal choice, but:
$250-300 plus filter inhaling of biological and chemical agents –needs to be fitted
(canister) –requires special training
–may need different canister for different agent
–inconvenient to always have handy
–exposure likely to have taken place already before
mask can be donned
–wearer may feel claustrophobic
Potassium Iodide Tablets taken by mouth to protect the thyroid gland from only needed in 10 mile radius of nuclear power plant
absorbing radioactive iodine (isotopes of iodine) Note: Authorities advise you to take if a significant
Note: Potassium Iodide does not protect against dirty release of iodine isotopes from the power plant facili-
bomb radiation. ty has occurred.

Prevent
 4 PREPARE

PLANNING p. 54
Alert Systems p. 59

TRAINING p. 60
EXERCISE p. 61
FAMILY EMERCENCY PREPAREDNESS FORMS p. 63
Emergency Radio Station, Reunion Locations, and
Contact Information p. 63
Medication/Health List p. 64

KIT CHECKLISTS p. 65
Disaster Supplies Kit p. 65
Car/Vehicle Kit p. 66
Evacuation Kit p. 66
First-aid Kit p. 66

ALERT SYSTEMS p. 67
Homeland Security Advisory System p. 67
Disease Outbreaks, Flash Floods and
Floods, and Hurricanes p. 68
Thunderstorms and Lightning, Tornadoes,
and Winter Storms p. 69

DO YOU KNOW?

CERT p. 70
Exercises p. 71
National Pharmaceutical Stockpile p. 72
R.A.C.E. p. 73
Evacuating a Burning Building p. 74
Stop, Drop, and Roll p. 75
Types of Fire Extinguishers and Their Use p. 75
52
 PREPARE
“ . . . chance favors only the prepared mind.”
Louis Pasteur
1854

“Luck is the residue of design.”

Branch Rickey

Be prepared! Now that you know what might happen

and what to expect when a disaster strikes, you need to know
how to respond and recover. You want to have luck on your
side. Preparedness gives you an advantage.
Your preparation began in the first chapter when you
learned about the statistical probabilities of various disasters,
and continued through to the previous chapter when you
focused on prevention and the mitigation phase of emer-
gency management. It is essential that you have a prevention
mindset. In the “best of all worlds,” primary prevention –
keeping the event from happening or avoiding exposure to
the event – is the ideal. But in the “real world” it is not possi-
ble to eliminate disasters or to always avoid them. Therefore,
one needs to prepare for action in order to meet the chal-
Prepare

lenges of disasters.
Preparedness has three elements – planning, training,
and exercise. Exercise is learning by doing and practicing
what one has learned. For most people, training consists of
learning by reading. Reading and internalizing our guide is
part of this training. In addition, one can obtain other materi-
als in hardcopy form or from various websites. For some,
training may include taking courses to learn how to care for
themselves and their families or to be citizen disaster volun-
teers. Training may also be available at one’s workplace or

53
school. For others, training will be part of their emergency
services positions as police, firefighters, emergency medical
technicians (EMTs) and paramedics, or emergency manage-
ment (OEM) personnel.
In this section, we present what you need to plan for at
home, school, the workplace, and other locations. Disaster
preparedness guides usually focus only on what to do at
home. However, most people spend considerable time away
from their homes working, driving or using public trans-
portation, shopping, or engaging in recreational activity. In
addition, you may be traveling or on vacation when a disaster
strikes. Therefore, it is important for you to prepare a variety
of contingency plans. How will you contact each other? If you
are unable to contact each other, where will you meet?
PLANNING
Home
 Make an emergency plan.
 Determine which disasters are more likely to happen
in your community.
 Prepare for all disasters but especially those that are
more likely to occur.
 Find out the emergency evacuation routes in your
community. This is especially important for hurri-
canes and floods.
 Arrange for communication among your family mem-
bers during an emergency.
 Arrange for a meeting place for your family:
 in case of evacuation from your home (for exam-
ple, a fire) – a safe place outside home

54
  in case of evacuation from the area of your home
or when your family is scattered and it is not pos-
sible to return to home – a place outside the area
 Keep emergency telephone numbers near home
phones.
 Have a least one corded telephone. (When there is a
power outage cordless phones do not work.)
 List the radio stations that broadcast emergency bul-
letins in your area.
 Have back-up, back-up, back-up, and more back-up!
Redundancy is good.

(For example: Since cordless phones do not work

in a power outage, you should have at least one
corded phone in your home. (Have you noticed
that we said this twice? This is an example of
redundancy.) If telephone cables are damaged, a
cell phone will come in handy. What if your cell
phone’s battery might be run down, and you may
not be able to recharge it? It would help to have
charged cell phone batteries as a backup. If the
Prepare

cell phone system goes down, use pagers to con-

tact your loved ones. You can send messages on
an alphanumeric pager system. If both cell phone
and pager systems go down, use pay phones, if
they are working. Always carry a phone card or
spare change to be ready for this emergency. If the
telephone system disruption is widespread, you
may want to have walkie-talkies. If all communica-
tion technology is not working, you may need to
send a runner to deliver a message. Always have a

55
 pre-arranged meeting place to re-unite with your
loved ones. Finally, amateur radio is the most
dependable technology to use during a disaster. A
Ham radio operator can transmit and receive mes-
sages by using only a handheld unit powered by a
car battery. However, you need to pass an exam
and become licensed to be a Ham radio operator.)
 Include your pet(s) in your emergency plan.
 Determine which agencies will shelter your pet(s).
(The Red Cross does not allow pets in their shelters
for health and safety reasons.)
 Keep a carrying case or cases handy for evacuating
your small pets. (You may think you can just carry
your pet. However, this may not always be possible.)
 Find out which agencies will rescue your pet from
your home. (This would be necessary if you were not
home when the disaster occurred, your pet is strand-
ed, and you cannot get to your home, for example,
during a flood.)
 Place the names and telephone numbers of agencies
that shelter and/or rescue pets in your Family
Emergency Preparedness Plan.
 Assemble:
 disaster supplies kit (for home use)
 car or vehicle kit (keep in vehicle)
 evacuation kit (to take with you if you must evacuate
your home)
 first aid kit (for home use or evacuation)

56
 [See the two Family Emergency Preparedness Plan
forms and the kit checklists in this chapter, p. 63.]

(We recommend that you make enlarged copies of

these and use them as part of your written emer-
gency plan. Note: The Family Medication/Health
Needs List includes “relationship” and “date of
birth” for family members so you can give this
form to the relief worker who is assisting you.
This is necessary information for relief workers to
have as they arrange to get replacement medica-
tions for you or a family member. You may also
wish to include a few family photos and small
mementos in your evacuation kit.)
Workplace
 Inquire about your employer’s emergency plan.
 Find out the following information from that plan:
 What procedures are there for the various emergen-
cies that might occur?
 How will people be notified of an emergency?
Prepare

 What are the tasks recommended to be performed

during an emergency?
 Who is assigned to what tasks or positions?
 What are the evacuation procedures?
 Consider joining the emergency committee.
 If you are self-employed, you should have an emer-
gency plan for your business that includes:
 contingency plans if you are unable to operate your
business in its usual location because of the disaster

57
  backup systems for your records
 backup systems for communication
 Keep copies of your Family Emergency Preparedness
Plan forms at work or carry them with you.
 Determine the locations of emergency exits.
 Keep a small disaster kit at your workplace. (The Red
Cross has one for sale. There are small disaster kits
available from private companies.)
School
The United States Department of Education provides
emergency planning information for schools on its website
under the topic, “Safe Schools.” [See “ Resource Directory” in
Chapter 7, p. 132.]
 Inquire, as a parent, about the emergency plan.
 Learn under what conditions the school would be evac-
uated.
 Learn under what conditions the school would be
closed to anyone attempting to enter it and the stu-
dents would be sheltered in place, that is, in the
school.
 Find out where parents should report if a disaster were
to occur.
 Attend planning or educational forum meetings on dis-
aster preparedness.
 Middle and high school students should themselves
inquire if their school has a peer program in which they
can participate as peer helpers for disaster mitigation,
preparedness, response, and recovery.

58
 Other Locations
 Know where the exits are in public buildings.
 When traveling, inquire about hotel emergency proce-
dures that are specific for the disasters that may be par-
ticular to that area.
 Check the CDC website for disease outbreak advisories
before traveling overseas. [See “Alert Systems” below.]
Note: The Joint Commission of Accreditation of Health
Organizations (JACHO) requires that the hospitals that it
accredits have a disaster plan and conduct two disaster drills
per year. The plan must include procedures for emergencies
within the hospital and disasters outside the hospital for
which the hospital will provide services for victims.
Alert Systems
“Fore-warned fore-armed”
Miguel De Cervantes
circa 1605

There are various alert systems that issue advisories,

watches, and warnings for natural disasters. In addition, the
CDC has a notices and precautions system to advise travelers
Prepare

about disease outbreaks. These alert systems should be part

of your emergency plan because they inform you about the
various actions that you need to take for different conditions.
The Homeland Security Advisory System was set up
after 9/11 as a way to communicate information about terror-
ist threat conditions. It was designed primarily for law
enforcement and emergency response agencies to take spe-
cific actions depending upon the probability of a terrorist
attack. It has become part of our everyday lives. The public
has often wondered what they should do when a specific

59
level of threat is declared. The system includes information
as to what individuals should do to protect themselves, their
families, and their homes, in addition to what government
agencies should be doing at each threat level. The threat level
may not be the same throughout the United States. The
Department of Homeland Security may determine different
levels for particular geographical areas or kinds of industrial
facilities. [See the advisory system tables in this chapter, p. 67]
TRAINING
Useful for Any Location
 Read, understand, and know this entire pocket guide. If
you skipped over any parts, go back and study them.
 Take a first aid course.
 Learn CPR.
(Note: The American Red Cross offers a course that
includes instruction both for first-aid and CPR.)
 Become a Community Emergency Response Team
(CERT) member. [See “Do You Know?” – “CERT” – in
this chapter, p. 70.]
 Teach your children how to call 911 and report an emer-
gency.
 Learn the following procedures:
 R.A.C.E. – the actions you take when there is a fire
 how to evacuate a burning building
 stop, drop, and roll – used if you catch on fire
 PASS – how to use a fire extinguisher
[See these procedures in the “Do You Know?” section
in this chapter, p. 73.]

60
 Home
 Educate yourself and your family about emergency pro-
cedures.
School and Workplace
 Participate in disaster training programs conducted by
the organization.
EXERCISE
“Practice is the best of all instructors.”
Publilius Syrus
circa 42 B.C.

Emergency management uses the term “exercise” to

refer to the act of performing or practicing a task in order to
develop or improve specific skills. Individuals can train by
participating in drills and other exercises. Exercises are also
used to evaluate and test emergency plans. Although there
are different types of exercises, drills are the type your family
can engage in at home. For example, you and your family
should practice evacuation drills from your home and evalu-
ate how well you did. At work or school, you or a family mem-
ber may be involved not only in drills but also other exercis-
Prepare

es. In addition, the Office of Domestic Preparedness of the

Department of Homeland Security operates an exercise and
evaluation program to maintain a state of readiness through-
out the nation for potential terrorist attacks and other disas-
ters. Therefore, as part of your preparation it is worthwhile to
study the definitions of the different types of exercises. Then
you will be a better informed citizen about national prepared-
ness. For example, you will understand what is meant when
you are told that there will be a “tabletop exercise” at your
job. [See “Do You Know?” – “Exercises” – in this chapter, p. 71.]

61
 Home
 Rehearse escaping from your home as if there were a
fire.
 Drive the evacuation routes in your area to become
familiar with them.
 Practice taking refuge in your tornado shelter (for those
living in tornado areas).
 Go through the procedures, such as R.A.C.E. or using a
fire extinguisher, that you learned under training.
Workplace
 Be involved in the planning of disaster exercises.
 Participate in disaster exercises such as tabletop exer-
cises and drills.
 Participate in evacuation drills.
School
 Be a parent representative involved in planning disaster
exercises.
 As a parent you may wish to role-play in a disaster exer-
cise at your child’s school if there is an opportunity to
do so.
(Note: Depending upon school policy, your consent
may or may not be required for your child to participate
in disaster exercises. We advise that any school should
obtain your informed consent for your child to role-play
in a disaster drill.)

62
 Family Emergency Preparedness Plan
Emergency Radio Station, Reunion Locations, and Contact Information
Emergency Alert System Radio Station: Call letters Frequency
Reunion Locations:
1. Outside home:
2. Out of neighborhood:
Directions to 2.

Evacuation route:

Emergency Telephone Numbers:

911 or Fire: Hospital:
Ambulance: Police: Local OEM:
Poison Control:
Physicians: Primary: Pediatrician:
Other: Other:
Utilities: Electric: Telephone:
Gas: Water:
Pet Shelter: Pet Rescue:
Insurance:
Family Contact Numbers:
Name

Cell

Email

School Phone

Work Phone
Prepare

Friends and Nearest Relative Not Living at Home:

Contact Type  Local Nearest Relative Out of Area

Name

Address

Address

Cell

Email

Home Phone

Work Phone

63
 Family Emergency Preparedness Plan
Medication/Health Needs List
Name Relationship Date of Birth

Strength
Brand Name Generic Name Dosing
milligrams/dose

Special need (for example, wheelchair, medical apparatus):

Name Relationship Date of Birth

Strength
Brand Name Generic Name Dosing
milligrams/dose

Special need (for example, wheelchair, medical apparatus):

Name Relationship Date of Birth

Strength
Brand Name Generic Name Dosing
milligrams/dose

Special need (for example, wheelchair, medical apparatus):

64
 Disaster Supplies Kit Checklist

 Resiliency: 10 Things to Do  Mouthwash

 Family Emergency  Soap
Preparedness Plan  Tissues
 Batteries  Toilet paper
 AAA  Toothbrushes
 AA  Toothpaste
 C  Prescription medications
 cell phone  Insulin and needles
 D  Other
 6 volt  Vitamins and supplements
 Cash  Infant care items
 Clothing  Baby food
 Inclement weather gear  Baby wipes
 Work gloves  Diapers
 Documents  Formula
 Advance directives  Matches in waterproof container
 Bank account numbers and  Notebook and pen/pencil
pass books  Other supplies
 Birth certificates *  Paper plates and cups,
 Credit card information plastic utensils
 Deed or lease*  Plastic storage containers
 Immunization records  Pet Care
 Immigration and citizenship*  Food
 Insurance policies*  Medication (if applicable)
 Licenses*  Other Supplies
 Passport*  Radio (Battery operated with
 Will* National Weather Service Station
 Flashlight (NOAA))
 Fire extinguisher (ABC type)  Sanitation
 Food (non-perishable –  Antibacterial moist wipes
3 day supply)  Chlorine bleach
 Health Items  Detergent
Prepare

 Contact lens and eye supplies  Disinfectant

 Extra eye glasses
 First aid kit
 Dentures and supplies
 Non-prescription medications
 Antacid
 Anti-diarrhea
 Laxative
 Pain reliever – aspirin
and non-aspirin
 Personal hygiene
 Feminine hygiene
 Gel hand sanitizer
 Plastic garbage bags
 Plastic garbage container
with lid
 Tools
 Can opener (non-electric)
 Knife (Army multi-gadget)
 Knife (regular)
 Pliers, screwdriver
 Wrench (to shut off
gas and water)
 Water (1 gallon per person
per day) – 3 day supply

*Originals of these items could be kept in a bank safety deposit box. If so,
make sure you have box # and key. You may keep copies with you.

65
 Car or Vehicle Kit Checklist
 Resiliency: 10 Things To Do  Metal tracks
 Family Emergency Preparedness Plan  Rock salt
 Compass (for rural areas)  Tire chains
 Flashlight  Triangle reflectors
 Flares  Tire inflator (aerosol)
 Escape tool  Tire gauge
 Jumper cables  Tools
 Maps  Jack
 Evacuation route  Lug wrench – crossbar
 Other  Pliers
 Moist wipes  Screwdriver – phillips
 Legal documents  Screwdriver – straight blade
 Insurance card  Shovel – regular
 License  Shovel – snow (if applicable)
 Registration  Wrench – adjustable
 Notebook and pen/pencil  Wheel chucks - two
 Paper towels  Windshield scraper and
 Supplies to improve traction in ice brush (if applicable)
and snow  Windshield washer fluid
 Cat litter  Work gloves

Evacuation Kit Checklist

 Resiliency: 10 Things To Do  Infant Care Items *
 Antibacterial moist wipes  Pet care
 Army multi-gadget knife  Carry cases for small pets
 Batteries *  Food
 Cash  Medication (if applicable)
 Clothing (one change of clothes  Other supplies
and pair of shoes for each person)  Notebook and pen/pencil
 Flashlight  Personal Hygiene Supplies*
 Family Emergency Preparedness Plan  Radio (battery operated)
 Important Documents *  Sleeping bags
 Health Needs/Medication *  Toys and Games
 Family Medication/Health  Young child’s favorite stuffed
Needs List animal or toy
 Prescription medications * See Disaster Supplies Kit Checklist

First Aid Kit Checklist

 First Aid Manual  Emetic (to induce vomiting)
 Poison control telephone number  Gloves (non-latex disposable)
 Adhesive tape (hypoallergienc)  Instruments
 Alcohol (bottle and box of wipes)  Scissors
 Antiseptic soap  Tweezers
 Antiseptic spray  Mouth-to-mouth resuscitation
 Bandages barrier (disposable) (Use
 Gauze pads only if CPR certified)
 Roll gauze  Safety pins
 Triangular – 3  Thermometer
 Cotton balls (sterile)  Water purification tables

66
 Homeland Security Advisory System
Terrorist Attack Protective Action
Threat Level Government Action Individual Action
 Increase or redirect
RED personnel.
 Assign emergency
responders and mobilize
SEVERE special teams.
 Monitor, redirect, or
Risk constrain transportation.
 Close public and government
facilities not critical for
essential operations.
 Coordinate security efforts
ORANGE among agencies.
 Take further precautions at
public events.
HIGH  Prepare to execute
Risk contingency procedures.
 Restrict access to a
threatened facility.
 Increase surveillance of
YELLOW critical locations.
 Coordinate emergency plans
with nearby jurisdictions.
ELEVATED  Assess need for further
Significant refinement of protective
Risk measures.
 Implement contingency
plans as necessary.
 Check communications.
BLUE
 Review and update emer-
gency response procedures.
 Provide public with necessary
GUARDED information.
General
Risk
 Refine and exercise
GREEN protective measures.
 Train personnel.
LOW  Assess regularly for
vulnerabilities and work hard
Risk
to mitigate them.
Adapted from the Federal Emergency Management Agency’s Are You Ready? A
Guide to Citizen Preparedness.
67
 Avoid public gathering
places.
 Follow official
instructions.
 Contact employer
about work status.
 Listen to radio and TV
for advisories.
 Prepare to evacuate or
shelter in place.
 Review preparedness
measures.
 Avoid high profile or
symbolic locations.
 Be cautious when
traveling.
 Be observant and report
any suspicious activity.
 Contact neighboor
about their plans and
needs.
 Check school proce-
dure for reuniting
with chil-
dren and emergency
plan.
 Update household
communication plan.
 Update disaster
Prepare
supplies kit.
 Review household
emergency plan.
 Hold household meet-
ing to discuss plan.
 Discuss plan with
neighbors and friends,
if you have special
needs.
 Develop household
emergency plan.
 Assemble disaster
supplies kit.

Direction of Severity
and/or
Likelihood of Occurrence
Disease Outbreak
Center for Disease
Control and
Prevention
www.cdc.gov/travel
Flash Floods & Floods Hurricane
National Oceanographic NOAA
and Atmospheric National Weather Service
Administration (NOAA) www.noaa.gov
National Weather Service

Travel Health Warning Statement Hurricane Warning

There is an expanding outbreak Follow-up information Hurricane conditions are
not yet under control. Postpone regarding flash flood/flood expected, usually within 24
non-essential travel. If you do event. hours. Complete all storm
travel, take specific precautions. preparations and evacuate if
directed by local officials.

Travel Health Precaution Urban and Small Hurricane Watch

The infection is spreading over a Stream Advisory Hurricane conditions are
large area or between countries. Flooding of small streams, possible in the specified area,

68
streets, and low-lying areas,
such as railroad underpasses
and urban storm drains is
occurring.
usually within 36 hours.
During watch, prepare to take
action to protect your family
and property in case a
Hurricane Warning is issued.

Outbreak Notice Warning Tropical Storm Warning

An infectious disease is confirmed Flash flooding or flooding has Tropical storm conditions are
for a specific region and not been reported or is imminent. expected in the specified area,
spreading. Get immunization – Take necessary precautions at usually within 24 hours.
new or booster. once.

News Notice Watch Tropical Storm Watch

There is a sporadic outbreak. Flash flooding or flooding is Tropical storm conditions are
Traveler should avoid contact possible within watch area. Be possible in the specified area,
with patients. alert. usually within 36 hours.
 Thunderstorms & Lightning Tornadoes Winter Storms
Direction of Severity and/or NOAA NOAA NOAA
Likelihood of Occurrence National Weather Service National Weather Service National Weather Service
Storms

Severe Thunderstorm Warning Tornado Warning Blizzard Warning

Severe weather has been reported A tornado has been sighted or Snow and strong winds combine to
by spotters or indicated by radar. indicated by weather radar. If tor- produce a blinding snow (near zero
Imminent danger to life and prop- nado warning is issued for your visibility), deep drifts, and life-
erty to those in path of the storm. area and the sky becomes threat- threatening wind chill. Seek refuge
ening, move to your pre-designat- immediately!
ed place of safety.
Severe Thunderstorm Watch Tornado Watch Winter Storm Warning
The infection is spreading over a Tornadoes are possible in your Severe winter conditions have
large area or between countries. area. Remain alert for approaching begun or are about to begin in your
storms. area. Stay indoors!
Winter Storm Watch
Severe winter conditions, such as
heavy snow and/or ice, are possible

69
within the next day or two. Prepare
now!
Winter Weather Advisory
Winter weather conditions are
expected to cause significant incon-
veniences and may be hazardous. If
caution is exercised, these situa-
tions should not become life-
threatening. The greatest hazard is
often to motorists.
Frost/Freeze Warning
Below freezing temperatures are
expected and may cause significant
damage to plants, crops, or fruit
trees. In areas unaccustomed to
freezing temperatures, people who
have homes without heat need to
take added precautions.

Prepare
 DO YOU KNOW?
CERT
Do you know there are Community Emergency
Response Teams (CERT) that you may join?
As a member of a Community Emergency Response
Team, you would work with your fellow citizen members to
serve your local community when a disaster strikes.
County or local emergency personnel – Emergency
Management personnel, Emergency Medical Technicians
and Paramedics, Firefighters, Police – train CERT members
during a 20 hour course on disaster preparedness, basic dis-
aster response, fire safety, the Incident Command System,
damage assessment, disaster medical services, disaster psy-
chology, light search and rescue, and team organization. The
Community Emergency Response Teams are part of local
Offices of Emergency Management. Team members would
give critical support to first responders, such as firefighters
and police, and would provide immediate assistance to disas-
ter victims.
To learn more about it, visit website: www.ready.gov
CERT’s are a component of the Citizens Corps, a net-
work of volunteer organizations that utilize the skills and
abilities of the American people to prepare communities for
the threats of terrorism, crime, and disasters.
To learn more about Citizen Corps call: 1-800-WE-PRE-
VENT (1-800-937-7383) or visit website:
www.citizencorps.gov

70
 Exercises
Do you know the different types of exercises?
Workshops: Participants are organized into small
groups (break out sessions) and are assigned a task to com-
plete such as designing a plan, discussing a scenario, solving
a problem, or role-playing a specific procedure or skill. The
individuals in the small groups may have assigned roles,
such as group leader or recorder. After the breakout sessions,
all the groups assemble together under the direction of a
moderator to hear reports from the small groups and further
discuss issues. Workshops can be used either for training or
for producing a work product, for example, developing an
emergency plan.
Tabletop exercises: Participants engage in discussing
or role-playing a simulated situation led by a moderator or
exercise controller. Participants are key individuals such as
senior staff and elected or appointed officials. The group can
either focus on a scenario that is kept constant (basic table-
top) or on a scenario that is altered by the moderator
(advanced tabletop).
Games: Participants are organized into two or more
Prepare

teams to competitively perform tasks and make decisions

about an assumed situation. Games may use computer simu-
lations that provide a more realistic depiction of an actual
event. This exercise is used to perform “what-if” analysis, test
out policies and procedures, and develop new plans.
Drills: Participants engage in an emergency scenario
under supervision using actual equipment in an actual set-
ting to practice and test the operation of a single agency or
entity.

71
 Functional Exercises (FE): Participants from various
agencies engage in a disaster scenario using actual equip-
ment in an actual setting. The purpose of this exercise is to
test and evaluate individual capabilities and interdependent
functioning. It exercises plans, policies, procedures, and staff
of Incident Command and Unified Command.
Full-Scale Exercises (FSE): Participants from a variety
of prevention and response agencies mobilize over an
extended period to a designated locale in response to a simu-
lated attack. Operation TOPOFF is an FSE. It is a congression-
ally mandated, biennial, five-day national exercise directed
by the Department of Homeland Security involving federal,
state and local agencies to assess the response capability for a
terrorist attack involving weapons of mass destruction. It may
also involve international participation.
National Pharmaceutical Stockpile
Do you know that the federal government has prepared
for biochemical terrorism by stockpiling
pharmaceuticals?
The mission of the National Pharmaceutical Stockpile
(NPS) program is to deliver needed medical supplies and
medication to the site of a national emergency.
This program maintains “12 Hour Push Packages” at var-
ious locations throughout the United States. These 12 Hour
Push Packages contain a variety of medical supplies and
equipment, medications, and vaccines. The inventory is peri-
odically replenished with fresh supplies and medications.
The program guarantees to provide these Push Packages
by air or land within 12 hours after a request. Delivery of
these stockpiles would augment state and local resources.

72
 To learn more about it, visit the website:
www.bt.cdc.gov/stockpile

R.A.C.E.
Do you know what to do in case of a fire?
Rescue people in immediate danger.
Alarm: If you are in a public building, activate the
alarm, that is, pull the lever on the fire alarm box. If you are
not near a fire alarm box, but you are in a building with a
central telephone operator (for example, a hospital), call
the operator and report the fire. If you are at home, call 911.
Report the fire, give the location, and let the dispatcher
know if anyone might be trapped.
Close all doors or Confine the fire.
Exercise good judgment when deciding whether to
attempt to Extinguish the fire. Evacuate immediately, if
you decide not to attempt to extinguish the fire.

Prepare

73
 Evacuating a Burning Building
Do you know how to evacuate a room in a burning
building?
If you are in a hotel room or apartment and the door is
closed, DO NOT OPEN IT.
First, if there is a source of water in your room or apart-
ment, wet a towel or cloth.
Second, place your hand on the closed door.
Is it hot?

No Yes (Fire outside the door)

 Open the door.  Do Not open the door.
 Do not use the  Place the wet cloth along
elevator. bottom of the door to block
 Proceed to the near- the space against smoke.
est exit stairwell  Call the fire department.
that is not blocked.  Tell the dispatcher you are
 If the hall is smoked trapped.
filled, place the wet  Give your location:
cloth over your
If you are in a hotel, give
mouth and nose,
name of hotel, address, the
get low on the floor,
floor that you are on, and
and proceed to the
your room number.
exit stairwell.
If you are in an apartment,
 Exit the building.
give address, the floor you
are on, and your apartment
number.
 Go to a window and wait.
 If there is a balcony, exit to
the balcony, close the door
behind you, and wait.
 Do not attempt to climb
down.

74
 Stop, Drop, and Roll
Do you know what to do if you catch on fire?
Stop - Do not run.
Drop to the ground.
Roll on the ground to put the fire out.
If someone is with you, they can help by throwing a
blanket around you to smother the fire.

Types of Fire Extinguishers and Their Use

Do you know how to use a fire extinguisher?

Fire Extinguisher

A BC ABC
Letter
Type
Code
Water CO2 Dry Chemical
Ordinary
A paper, cloth, Yes No Yes
mattress
Flammable Liquids
B No Yes Yes
alcohol, grease, etc.

Electrical
C No Yes Yes
motors, equipment

P ull the pin.

A im the extinguisher at the base of the fire.
Prepare

S queeze the handle while holding the

extinguisher upright.
S weep back and forth to extinguish the fire.

Remember: Don’t let the fire get between you and the
exit.
After you use the extinguisher, place it on its side, or if
you used it at work, give it to the maintenance depart-
ment.

75
 5 LEARN HOW WE REACT

HOW WE REACT AS INDIVIDUALS p. 78

Before p. 78
During and Immediately After p. 79
Over Time p. 85

OUR FEELINGS p. 86

HOW INDIVIDUALS WITH SPECIAL NEEDS REACT p. 92

Children p. 92
Previously Traumatized p. 93
Seniors p. 93
People with Serious Mental Illness p. 93

HOW WE REACT AS A COMMUNITY p. 94

DO YOU KNOW?

Reunion vs. Safety and Security p. 96

Traumatic Dreams p.98

TABLE
Children’s Reactions to Disaster p. 100

76
 LEARN HOW WE REACT
“It seemed the ground heaved, and I stopped and turned and saw
this ungodly cloud with debris flying out of it rushing towards
me. I knew I couldn’t outrun it, so I lied down flat
on the ground, head first into the cloud.”
David LeClaire
Port Authority Police Officer

Who might react? Everyone! We all have strong emo-

tional reactions to a disaster. The good news is that these
reactions are natural and temporary in the majority of people.
Although traumatic events are rather common, most people
do not develop disorders after being exposed to a traumatic
event. In the United States about 61% of men and 51% of
women will experience at least one traumatic event during
their lifetimes. Nevertheless, of those exposed to a traumatic
event, only about an average of 14% to 24% develop chronic
Posttraumatic Stress Disorder (PTSD). For reasons that are
not fully understood, women are more likely, at a ratio of 2 to
1, to develop PTSD after being exposed to a traumatic event.
In addition, the likelihood of developing PTSD depends on
the nature and magnitude of the traumatic event, and one’s
degree of exposure. For example, a study of the Oklahoma
City bombing found that among those who directly experi-
enced the explosion, 34% developed PTSD. By contrast, in
the United States there is a lower probability of developing
PTSD from natural disasters including fires (4.5%) compared
How We React

to the probability of developing PTSD from any type of trau-

ma (14.3%).
In this chapter, we describe the natural reactions and
emotions that you and others might experience in relation to

77
disaster. We do this in four sections: 1) “How We React as
Individuals,” 2) “Our Feelings,” 3) “How Individuals with
Special Needs React,” and 4) “How We React as a Comm-
unity.” The general individual reactions are divided into
“Before,” “During and Immediately After,” and “Over Time.”
The community reactions are divided into four phases – hero-
ic, honeymoon, disillusionment, and reconstruction.
HOW WE REACT AS INDIVIDUALS
Before
Complacency: Between disasters we are usually compla-
cent. We attend to our ordinary routines without any
thoughts about the possibility of a disaster happening.
Although 9/11 shocked Americans out of their complacency,
human beings revert back over the course of time to being
unmindful about the potential for disasters. Therefore, even
the fears and energetic efforts generated by the trauma and
loss of 9/11 might eventually peter out with the passage of
time, the fading of memory, and the passing of those who
experienced it first-hand.
Anxiety: We become anxious when we are warned about
an impending disaster. When we are barraged with repeated
weather bulletins about a dangerous storm approaching our
area, our anxiety intensifies. The hectic buying of bottled
water and other supplies that quickly empties supermarket
shelves is the result of normal anxiety during the warning
phase of a disaster. If the storm proves not to be as terrible as
predicted, some individuals may be complacent when there
is a warning for the next potential storm.
On the one hand, Homeland Security Advisory System
alerts, which have announced elevated threat levels for a ter-
rorist attack, have raised our anxiety periodically. On the

78
other hand, we have become jaded or cynical because con-
stant alerts have never led to any calamity. Such alert systems
can be like the “little boy who cried wolf.” Many individuals
ignore fire alarms because they assume that most signals are
tests or false alarms. You should always investigate if there
might truly be a fire when any fire alarm sounds. It is best to
think about the Homeland Security Advisory System as a
reminder for us to be on the alert, rather than a means to
inform us of an imminent attack. With this point of view, we
may avoid both disregarding such alerts and becoming undu-
ly anxious.
During and Immediately After
Fight-Flight-Freeze: When faced with a threat to our
survival, we fight, flee, or freeze. These are inborn reactions
that we share with other mammals. An animal of one species
might turn on its attacker and fight. If it defeats its enemy, it
goes on living. An animal of another species might flee and,
thus, outrun its predator and survive. An animal of a third
species might freeze in place and blend into its surroundings
so that the deceived predator leaves to hunt elsewhere.
As human beings we retain the brain circuit that triggers
this fight-flight-freeze behavior. This behavior occurs natural-
ly and instinctively when we are threatened. It is merely a sur-
vival mechanism. Fighting is not necessarily heroic; fleeing
may not be a sign of weakness. Courage and cowardice are
judgments that we human beings make about these behav-
iors. When we are threatened, the best choice may be either
How We React

to flee (evacuate the area before the hurricane hits or evacu-

ate a burning building), to freeze (pretend to be dead while a
mass killer is stalking the building on a killing spree or stay in
an underground shelter until the tornado passes), or to fight

79
(attempt to put out a fire from a safe position or swim to safe-
ty when caught in flood waters). Although human beings
have the unique advantage of possessing the instinct for all of
these potential responses, our behavior can be guided by our
higher cognitive functions. In other words, we have the
instinctive reactions, yet we can also make decisions about
what we do.
But this can also backfire. We can acquire knowledge and
learn values that might oppose, for better or worse, our auto-
matic fight-flight-freeze reaction. Being told to stay put might
counteract our instinct to flee because we have learned as
part of our socialization process to obey rules. Preparedness
training that is based on best practices and evidenced-based
methods can teach us when we should override our learned
behaviors and react with our “gut.” Our capacity to unlearn
certain behaviors also makes it possible to reinforce other
behaviors that are actually contrary to our instinct for sur-
vival. Emergency first responders are trained to rush toward
the threat, placing themselves in harm’s way, in order to res-
cue victims and deal with the threat. Therefore, emergency
training, whether for the general public or for emergency per-
sonnel, needs to include teaching about when to hold back
versus when to rush in, and when to step back versus when
to continue to advance.
Adrenalin Rush: An outpouring of stress-response
chemicals, including noradrenalin in our brains and adrena-
lin in our bodies, is the biological basis for the fight or flight
response. Therefore, when faced with a threat, we feel an
“adrenalin rush” and experience a state of excitation. This
process prepares us to go into action and helps us endure.
Our pupils enlarge and heart rate increases. Our blood pres-
sure rises. Our hearts pump our blood more efficiently. Blood

80
flow increases to our brains but decreases to our guts, skin
and kidneys. Our muscles are stimulated. Our brains increase
the production of endorphins, our natural painkillers. The
adrenalin rush heightens our awareness, intensifies our
focus, and causes us to “look sharp, feel sharp, and be sharp.”
We are ready to go into action.
Action: Energized by adrenalin, we mobilize and do
what has to be done to meet the challenge of the threat.
Panic: We usually do not panic during a disaster. It is a
myth that panic is a typical and widespread reaction to disas-
ters. Nevertheless, we may panic – “lose our heads” – if we
think we are trapped. When we become panicked, our judg-
ment becomes impaired; we may attempt to secure safety
recklessly. The panic of a few people can be contagious, and
lead to pandemonium in a crowd. For example, incidents
have occurred where people frantically fleeing a fire in a pub-
lic building have packed up against exit doors and perished.
One solution to prevent panic is to institute changes that
reduce the chances of people becoming trapped, such as the
use of panic bars* for exit doors and the enactment of build-
ing codes that require exit doors to open outward.
Preparedness is another way to prevent panic. The anti-
dote for panic is “to keep one’s head” and to analyze the situ-
ation. However, during a rapidly growing threat, one does not
have the time to stop and slowly ponder what to do. Any
decision needs to be swift. Preparation gives us the edge to
perform well in the face of disaster and terrorism. With plan-
How We React

ning, training, and exercises, we can internalize a set of

actions that we can carry out automatically and quickly when
they are needed. For example, “Stop, Drop, Roll.” if you catch
*This is a bar that is placed horizontally across the middle of an exit door and
opens the door when pressure is aplied.

81
on fire. [See “Do You Know?” box – “Stop, Drop, and Roll” in
Chapter 4, p. 75.]
Acting in the Face of Conflicting Priorities: In the midst
of a disaster or terrorist attack, we may be faced with conflict-
ing priorities. The reality of the situation will not allow us to
serve both needs. We must choose between one or the other.
In some of these situations, we must act instantaneously in
order to save lives; in others, we may have more time to
think. Nevertheless, the consequences may be just as serious.
In the aftermath of a disaster, if we were forced by circum-
stances to make such choices, we may accept that we did the
best that we could, or we may become consumed with regret
and a haunting, irrational guilt. Conflicting priorities
include:
 Self-preservation versus self-sacrifice, that is, risking
one’s life to save another
 Sacrificing one life in order to save another (This choice
had to be made by at least one mother during the 2004
Asian tsunami. As the wave bore down on her she was
holding a child in each arm. She let go of one and
grabbed onto a tree in order to at least save the other.
The child that she let go was swept away. Amazingly,
both children survived.)
 Safety versus reuniting with loved ones, especially par-
ents reuniting with their children [See “Do you Know?”
– “Reunion vs. Safety and Security” – in this
chapter, p. 96.]
 Self-preservation versus privacy with regard to disrob-
ing in order to be decontaminated [See “Do You
Know?” – “Decontamination vs. Privacy” – Chapter
3, p. 43.]

82
  Self-interest versus concern for others
Decisions Related to Risk: During a disaster or act of
terrorism, we may be faced with making risk related deci-
sions. For example, is it safer to evacuate or shelter in place?
What are my chances of becoming infected now that I have
been told plague has been released? How do I protect my
family and myself? Some individuals might question
whether to trust authorities who are providing risk informa-
tion. Others may be skeptical about any official information
regarding risk. During emergency situations, there may not
be adequate time to assess all the information. Therefore, it is
very important that you learn what you should do in certain
emergency situations to mitigate risk and be safe before the
event occurs.
Spontaneous Leaders: Individuals who are not in any
position of leadership may take charge when faced with a life
or death emergency. For example, a secretary saved lives on
9/11 because she determined the route to safety and insisted
that the group she was with change their direction. They fol-
lowed her and survived. Another example, also on 9/11, was
of a businessman who led a group to safety while rescuing
individuals he encountered along the way who were too
numbed by emotional shock to move out of danger on their
own. There have been times during battle when an ordinary
soldier takes over his unit because its leaders have been crit-
ically wounded. The spontaneous leader may make the deci-
sion for a group about conflicting priorities.
How We React

Traumatic Stress: The adrenalin rush is sometimes a

mixed blessing. It may help us survive the situation but then
produces a powerful memory imprint that causes posttrau-
matic stress reactions. We replay the images – the sights, the

83
sounds – in our minds over and over again. We feel upset. We
can feel tense. We cannot fall or stay asleep. When we do fall
asleep, we have distressing dreams. However, many people
do recover from these initial reactions by making use of their
natural abilities to deal with stress. For example, they do not
avoid the reminders of the trauma. They talk anxiously about
the terrifying experience with family and friends. They
remain engaged. They look forward to the next day. They
continue to function despite sometimes having difficulty
concentrating or becoming irritable. After a brief time, the
intensity of these reactions lessens, and the reactions disap-
pear. This describes traumatic stress – a natural, short-term
reaction to a catastrophic event.
Distress: Distress is a natural negative reaction to stres-
sors of less magnitude, unlike traumatic stress, which is a
natural reaction to a threat to life or limb of self or others.
Stress is the non-specific response of our bodies to any
demand, that is, to a stressor. Emotionally, short-term dis-
tress is experienced as anxiety. If we experience distress over
a long-term, we feel helpless or become depressed. As stated
above, we can worry and feel tense when we are alerted to an
unfolding disaster. In addition, we feel distressed during a
prolonged threat or after a disaster when we are concerned
about how we will recover. The prolonged anthrax scare in
the fall of 2001, during which many people worried about
opening their mail and some sought prescriptions for Cipro,
was not a direct threat to the population at large but still
caused widespread distress. Individuals who have safely
avoided a disaster can feel distress because of damage to their
property, loss of their belongings, financial consequences,
the frustration of dealing with the bureaucracies of disaster
relief agencies, or even because of the difficulties of interact-

84
ing with strangers while residing at a shelter.

Over Time
Emotional Letdown: After the adrenalin rush ends and
we cease our flurry of activity, we may feel an emotional let-
down. While we were making last minute preparations before
impact or responding immediately to a disaster, we were
completely focused on crucial tasks. Afterwards, when the
excitement settles down, we have time to reflect. We may feel
sad and irritable when we are no longer engaged in action.
Disaster workers may experience an emotional letdown after
they have completed their tours of duty and have returned to
their usual activities.
Dishonest Behavior: Unfortunately, a few people take
advantage of a disaster to profit dishonestly. Some of them
price gouge and engage in deceptive business practices. For
example, they might overcharge for bottled water or blankets
that people desperately need, pose as insurance facilitators
for a fee, or jack up the cost for reconstruction. Therefore, “let
the buyer beware.” As a disaster survivor, be careful and pro-
tect yourself from those who are trying to cheat you. You
should report these individuals to the local authorities.
In the midst of chaos, some individuals loot or steal.
Homes that have been evacuated may be burglarized. People
may lie for profit or fame. Some individuals file fraudulent
claims for disaster relief. Others might falsely claim that they
were part of the rescue operation in order to be idolized as
How We React

heroes.
Burn-out vs. Rejuvenation: After repeated responses
to various disasters, emergency responders and disaster relief
workers can develop burn-out. Likewise, as survivors of a dis-

85
aster, we can experience burn-out when there is a long
response phase or prolonged recovery phase. As ordinary cit-
izens, we can feel burned out if the national threat level is
continuously on a high alert. Individuals and organizations
should take various steps regularly to rejuvenate themselves.
For example, there should be sufficient periods of scheduled
rest and relaxation for emergency workers during a pro-
longed operation. Survivors and their families and friends
should engage in leisure activity and recreation.
Resiliency: Resiliency is the capacity of being resilient,
which is from the Latin root resilire, “to jump back.” After
experiencing horrendous chaos and destruction, we rebound
and reconstruct our lives. Is resiliency inborn or something
we learn, or does it result from an interaction of our genes
and experience? Although science does not fully provide the
answer, it is widely believed that preparing for disasters can
foster resiliency. After a disaster, seeking out positive social
support can help us “bounce back.”

OUR FEELINGS
The following list of possible emotional responses is
incomplete. This representative sampling is intended to
show that there are a multitude of natural feelings that one
can experience in response to trauma and loss. You most like-
ly will not experience all these feelings. Likewise, you may
not feel any specific combination of emotions. You may not
feel your emotions in any particular sequence. Although we
can have similar emotional reactions and share our happi-
ness or grief, one’s feelings are a personal experience.
Whatever you feel is genuine and natural. It is all right to feel
anything that you feel. It is what you do based on your feel-
ings that makes the difference. You may use specific feelings

86
to motivate yourself to accomplish good goals.
As you go through a self-reflective process, you may
determine that the thoughts that led to certain feelings were
triggered by false assumptions or distorted thinking. For
example, after awhile you may realize that your anger was
misplaced, or there was no reason for you to feel guilty. After
the passage of time, your feelings can become much less
intense. It is a problem if you become frozen in one emotion-
al state instead of moving back and forth among a number of
feelings. For example, during the process of mourning, a per-
son does not feel sad all the time. We may feel happy as we
recall joyful memories of the person who has died. We may
even laugh because we remember a ridiculous moment that
we had shared with the deceased, but, at other times, we feel
sad again.
You may feel:
 angry (sometimes even rage) at:
 the individual(s) or organization who are responsible
for a man-made disaster
 the terrorists or other individuals who intentionally
caused the disaster
 the individual(s) or organization you blame for
causing the disaster but who are really not
responsible
 the government and/or disaster relief agencies
How We React

because you think they are ineffective

 those who ignored your warning(s)
 yourself because you did not prepare sufficiently
 yourself because a decision you made was wrong

87
  the deceased
 others who survived the disaster unharmed or
avoided the disaster completely
 those who try to help you
 God
 anxious because:
 of the latest terrorist alert
 of a warning for an impending emergency
 of directly experiencing a disaster
 of your concern for the safety of your family and
friends
 of your concern for your own safety
 you are uncertain about recovering
 of money problems caused by the disaster
 of your concern for the security of yourself and oth-
ers
 of thinking that it might happen again
 of watching scenes of the disaster on TV
 apathetic because:
 you think, what is the use of trying?
 it has happened before (for example, this is the third
flood in five years)
 the event is prolonged but no longer frightening
 demoralized because:

88
  you now doubt certain previously held views about
life – the world is good, the world is meaningful, and
you are worthy
 you question, why do bad things happen to good
people?
 despair when
 everything appears hopeless
 you feel you are all alone
 disgust upon:
 seeing the remains of the dead
 smelling foul odors
 seeing the accumulation of waste
 elated because:
 you have triumphed
 you feel intense self-satisfaction
 frightened because:
 your life is being threatened
 the lives of others are being threatened
 you think it will happen again, and you will become a
victim just like a relative, friend or even a stranger
with whom you identify
 you think you will become violent after experiencing
How We React

violence
 frustrated when:
 your personal recovery is slow
 reconstruction is slow

89
  obstacles are difficult to overcome
 happy because:
 you have counted your blessings
 you are grateful for what you still have
 grief :
 for the death of a family member or friend
 shared with your community or nation because of
mass casualties
 guilty because:
 you survived, but a family member, friend or
co- worker did not
 you think you failed to do enough, especially some-
thing that you think would have saved someone’s life
or kept someone from being injured
 you think you did something that caused someone
to die or to be physically injured
 you think you did or said something that wounded
someone emotionally
 you are angry
 helpless when:
 you do not have the means to help yourself
 you do not have the means to help others
 physical pain from an injury interferes with your
activity or function
 you feel that no matter what you do, nothing will
change

90
 horror upon:
 suddenly being threatened by death
 witnessing others being suddenly threatened by
death
 seeing others die
 seeing the remains of the dead
 hearing what happened
 watching scenes of the disaster on TV or seeing
photographs in the print media
 joy because:
 you have survived the “worst of it”
 others have survived the “worst of it”
 your home has survived the immediate impact of the
disaster
 numb (without emotion) because:
 you are reacting to the chaos
 you are reacting to the sudden death and devastation
 powerless because:
 you think you have no control over your life
 there are forces of nature you cannot control
 relief because:
How We React

 you and your loved ones survived

 you and your loved ones have endured over the long
term
 you realize it could have been worse

91
  sad because:
 you have lost your belongings, family mementos,
and photographs
 you have lost your home and/or job
 your life has drastically changed
 you think things will never be the same
 shame:
 for feeling vulnerable
 for feeling that you did not master the situation
 because you feel you should not have looked at the
dead or the people who were dying

HOW INDIVIDUALS WITH SPECIAL NEEDS REACT

In addition to the reactions and emotions mentioned
above, individuals in groups with special needs may exhibit
the following:
Children
There are two major ways that children react to a
disaster:
 Change in behavior: A child changes from his typical
and usual behavior. For example, an outgoing child
becomes passive and quiet.
 Regression: A child reverts to past behavior of an earli-
er stage of development. For example, a child who had
ceased sucking her thumb or bed-wetting reverts to
sucking her thumb or bed-wetting. [See table –
“Reactions of Children to Disaster” – in this
chapter, p. 100.]

92
 Previously Traumatized
Is trauma exposure immunizing – does it make us better
able to deal with the next trauma when it comes; or is it sen-
sitizing – does it “wear us down” so that we have even more
difficulty dealing with the next trauma? Scientific data
demonstrates that exposure to a trauma is sensitizing.
Therefore, individuals who have experienced previous trau-
mas – childhood abuse, combat, rape – even if they did not
develop a disorder at the time of exposure, are at risk for
developing disorders if they experience subsequent traumat-
ic events.
An individual with PTSD in remission is at risk of relaps-
ing when exposed to a current traumatic event. A person suf-
fering with active PTSD may experience a worsening of his
symptoms when exposed to another traumatic event.
However, we don’t know whether getting treatment for a dis-
order does, in fact, increase your resilience. Many profession-
als believe that it does, but the research hasn’t been conduct-
ed yet.
Seniors
In a disaster, seniors have many basic needs and reac-
tions similar to other populations. They also have strengths
and weaknesses that make them both more resilient and yet
more vulnerable. Their life experience has afforded them the
gift of survival, and with that comes better coping abilities.
However, frailty also comes with age, and this can bring on
How We React

fatigue and despair.

People with Serious Mental Illness
Many people with serious mental illnesses may be
resilient in the face of a disaster despite their illnesses; they

93
may rise to the occasion and perform well or even heroically.
Nevertheless, the stress of the situation may aggravate a pre-
existing disorder. Schizophrenia may cause a person to
become emotionless and lose self-motivation. Therefore, a
person with this disorder may appear disinterested and be
unable to pitch in. In addition, people with delusions may
interpret the disaster or terrorist attack in a way that incorpo-
rates it into their delusions. [See Chapter 6 – “Decide When to
Get Help” – p. 101.]
HOW WE REACT AS A COMMUNITY
The predominant post-disaster emotional states and
behaviors exhibited by groups or communities post-disaster
can be divided into four phases. The time frames can vary,
depending on whether there is a single event of relatively
short duration, a single event of relatively short duration fol-
lowed by a persistent threat, or a prolonged event. In addi-
tion, the duration of the phases can vary, depending on the
severity of the disaster.
These phases are:
 Heroic
Time Frame: from the moment of impact to the peri-
od immediately thereafter
Emotional State: excited and energized (strong and
direct)
Behavior: heroic actions to save oneself, rescue
others, and protect property
Social Resources: emergency workers, family,
neighbors

94
 Honeymoon
Time Frame: from about one week to three or four
months after the disaster
Emotional State:
 positive feeling of shared experience with others
who have lived through the catastrophe and sur-
vived the threat even though their loved ones
may have died and/or their possessions may
have been lost
 hope that they will receive substantial help
Behavior:
 joint efforts to recover the remains of the dead
 joint efforts to clean up the wreckage and recov-
er the belongings that can be salvaged
Social Resources: influx of official agencies that
promise help
 Disillusionment
Time Frame: from about two months to one or two
years
Emotional State:
 anger, bitterness, disappointment, frustration,
resentment
 feeling of loss, including the loss of “shared
community”
How We React

Behavior: survivors individually concentrate on build-

ing their own lives and solving their own
problems
Social Resources:

95
  various agencies fail to meet the survivors’s
expectations
 outside agencies leave
 some local groups do not continue
 Reconstruction
Time Frame: several years
Emotional State:
 positive: reaffirmation of self and community
 negative: intense emotional problems, especial-
ly if there is a delay in rebuilding
Behavior:
 survivors take responsibility for solving prob-
lems and rebuilding
 focus on construction, new plans and programs
Social Resources: individuals and groups who have
a long term investment in the community

DO YOU KNOW?
Reunion vs. Safety and Security
Do you know that one of the most powerful urges that
you will experience at the time of a disaster is the need
to be with your loved ones?
As family members and friends pursue their daily activi-
ties, they go their separate ways. When disaster strikes, we
may often not be with those we love. Children may be at
school. Adults may be at work. Retired seniors may be enjoy-
ing a hobby at a local center. A telephone company marketing
campaign that encouraged people to “reach out and touch

96
someone” was very successful because that is exactly what
people want to do under ordinary circumstances. In the
midst of chaos and terror, the urge to reach out is greatly mul-
tiplied. When threatened with danger or imminent death, we
yearn to be with those we love. When we fear for the lives of
our loved ones, we crave to connect with them and be con-
vinced that they are safe. During the chaos and destruction of
a disaster or terrorist attack, our instinct is to seek those we
love. As disaster mental health responders, we have wit-
nessed, time and again, this powerful force of human attach-
ment. In the aftermath of 9/11, people frantically sought to
find their missing relatives and friends.
Although the human bond is extremely strong, it may
not always be advisable or possible to act on the instinct to
reunite with loved ones. The need for safety and security may
oppose the desire to be with family and friends. Individuals
who attempt to reunite, no matter what the cost, may risk
their own lives and the lives of others. Individuals who insist
on being with their loved ones may interfere with emergency
workers, jeopardize the effectiveness of an emergency
response, and add to the chaos and the risks. In the midst of
a disaster, the distraught behavior of a family member may be
distressing for a survivor to witness. Studies have demon-
strated that children are more likely to suffer adverse reac-
tions if they observe their parents exhibiting uncontrolled
behavior. Although it is usually best for loved ones to unite
as soon as possible during a disaster, especially parents and
How We React

children, it may be necessary and, in some situations, better

to tolerate the separation. [See “You” under the “ABC’s of
Caring for Children” in Chapter 9, p. 179.]
Remaining separated is a real test of a person’s self-con-
trol. A recent study on human behavior in response to a

97
hypothetical dirty bomb terrorist scenario discovered that
40% of the people surveyed would not shelter in place as
long as needed (either not staying at all or leaving premature-
ly), even though sheltering in place is the recommended
method of protection for a dirty bomb. The two main reasons
these individuals would not shelter in place were: to care for
their children (33%) and to care for another relative (25%). Of
the people who said they would leave, 14% would stay if they
could communicate with those they care about, and 12%
would stay if they knew that the people they care about were
being well taken care of even though they could not commu-
nicate with them.
It is important that you have several ways of contacting
family members and friends during a disaster. It is essential
that you have a pre-arranged place to meet when you cannot
connect by telephone. [See Chapter 4 – “Prepare” – p. 52.]
Preparedness also includes knowing the school’s emergency
plan to evacuate and to shelter your child. Likewise, you
should know the emergency plan of the nursing home, reha-
bilitation center, or assisted living facility where your senior
relative resides. This is essential pre-disaster information
because you need to be assured that your child or other rela-
tive will be protected during a disaster, if you cannot get to
them immediately.
Traumatic Dreams
Do you know that your dreams can help you to heal
after psychic trauma?
Dreams are our thoughts while we are sleeping. They are
a natural process of our brains and minds. We always dream
when we sleep, but some people seldom recall their dreams
and others frequently do.

98
 There are various theories about the purpose of dreams.
Two major opposing views of dreams are that they are either
a random neurobiological process that deletes the “non-
sense” files or fragments of memory that accumulate in our
brains, or that they are a method to process information. The
former view would be analogous to our deleting all the
empty files with names like ~WRL3769.tmp that accumulate
in our computers. In this view dreams have no meaning. The
authors subscribe to the latter theory that dreams are a way to
process information. Thus, we may resolve unconscious con-
flicts, process new information, problem-solve, or even pro-
duce creative ideas while we dream. However, the meaning
of a dream is usually disguised. By analyzing the images in
our dreams, we can attempt to understand their meaning
and application to our life situation.
After experiencing a traumatic event, it is natural to expe-
rience distressing dreams about the trauma. Over time these
distressing dreams either just stop happening, or their tone
and images change from being frightening to becoming neu-
tral or even pleasant. In this case, the person has processed
the trauma. Nevertheless, some individuals will have persist-
ent nightmares. Various images related to the trauma will
replay night after night like a continuous loop. In this case,
the person is not processing the trauma, but is frozen in a
traumatic reaction. If distressing dreams haunt you after
being exposed to a traumatic event, talk with a mental health
professional.
How We React

99
 Children’s Reactions to Disaster
Pre-School Latency Preadolescent and Adolescent
Up to Five-Years-Old 6 through 11-Years-Old 12 through 17 Years-Old
 expressions of fear  emotion  emotion
 crying (whimpering, screaming,  anger  anger
calling for help)  irritability  irritability
 excessive clinging  sadness  sadness
 trembling and fearful immobility  behavior  behavior
 running toward adults  aggression (frequent fights with  aggression
 running aimlessly other children)  antisocial behavior (stealing,
 changed behaviors  disobedience vandalism)
 confusion  excessive clinging  confusion
 eating problems  refusal to socialize  isolation
 marked sensitivity to loud noises  body  sleep disturbances
 sadness  headaches –insomnia
 sleep disturbances  nausea –increased sleep

100
–insomnia (awakens during  upset stomach –nightmares
the night)  regressive behaviors  use of alcohol and/or drugs
–nightmares  bed-wetting  withdrawal
–unable to sleep alone or in  irrational fears, for example, about  body
the dark buildings collapsing  headaches
 speech difficulties  sleep disturbances  stomach pains
 weather fears–high winds, –insomnia  school related behaviors
lightning, rain –nightmares  absenteeism
 regressive behaviors –unable to sleep alone or in the dark  disruptive behavior
 asking to be dressed or fed  weather fears  poor academic performance
 bed-wetting  school related behaviors
 excessive whining or clinging  behavior problems
 fear of darkness, animals, being  distractibility
left alone, strangers, crowds  loss of concentration
 loss of bladder and/or bowel  loss of interest
control  poor academic performance
 6

When To Get Help

DECIDE WHEN TO GET HELP

YOU NEED HELP WHEN p. 103

Basic Needs p. 103
Financial Needs p. 103
Health Needs p. 103
Legal Matters p. 114
Social Needs p. 114
Spiritual Needs p. 115
Your Pets and/or Farm Animals p. 115
Your Property p. 116
Your Small Business p. 116

GROUPS WITH SPECIAL NEEDS p. 116

Children p. 117
Physically Disabled p. 117
Seniors p. 117
People with Serious Mental Illness p. 118

DO YOU KNOW?

Grief vs. Depression p. 118

Psychological Reactions to Nuclear,
Radiological, and Chemical Events p. 120

SYMPTOM CHECKLISTS p. 121

Acute Stress Disorder p. 122
Major Depressive Episode p. 123
Posttraumatic Stress Disorder p. 124
Suicide Risk p. 125

101
 DECIDE WHEN TO GET HELP
“No man is wise enough by himself.”
Titus Maccius Plautus
254-184 B.C.

“By speaking of our misfortunes we often relieve them.”

Pierre Corneille
1640

How do you know when to seek help? Making this deci-

sion is critical to your physical and mental health. This chap-
ter highlights the various reasons that you might need help
after a disaster. Later, in Chapter 7, we will present the many
resources which can provide you with help. In addition, in
Chapter 8, we will present ways to help yourself. Now you
should address the question – Why would someone need
help after a disaster?
In this chapter, we list numerous things that might hap-
pen to you and that would require you to seek help. These
misfortunes, symptoms, and illnesses could also happen to
family, friends, or neighbors. So everywhere “you” appears,
you may substitute “someone.” We also outline the situa-
tions that require help regarding property, pets or farm ani-
mals, and/or small businesses. We address how to recognize
when you or others may need to seek help. We do not include
every medical emergency – only those that are likely to be
caused by or occur in the midst of a disaster or terrorist
attack.
Do not hesitate to seek help. It takes courage to ask for
help. Doing so does not mean you are weak. It is always bet-
ter to ask for assistance, even if it later turns out that you do
not need it. Therefore, when in doubt, always ask for help.

102
 YOU NEED HELP WHEN

When To Get Help

Basic Needs
 During response phase, you have:
 no water
 no food
 no blanket and/or clothing
 no shelter
 During recovery phase, you have:
 no food
 no clothing
 no place to live
Financial Needs
 During response phase, you have:
 no cash
 During recovery phase, you have:
 no money for rent
 no funds to rebuild
 no job because of the disaster
 no property insurance
 no health insurance
Health Needs
 Your medication and/or healthcare devices for pre-
existing conditions were lost or destroyed.

103
  You have new health care needs, and you do not have
access to care.
 You have health equipment that operates on house
current and there is no electricity.
 You do not have health insurance or you had health
insurance with your job but lost your job because of
the disaster.
 You develop certain symptoms or disorders, such as:
General Medical
 Heart and Circulatory System
You may be having a heart attack (myocardial
infarction (MI):
 You should seek help:
 immediately, if you or others experience any of
the symptoms of a heart attack:
 men
–typical first symptom: severe aching, discom-
fort, pressure or pain in chest, arm, or below
breastbone (sternum)
–pain or discomfort radiating to the arm, back,
jaw, or neck
–apprehension and restlessness
–dizziness, nausea, sweating, or vomiting
–shortness of breath
–extreme weakness
–irregular or rapid heartbeat

104
  women

When To Get Help

–upper back pressure
–chest pain or pressure similar to men
–shortness of breath
–pressure in lower chest that could be mistak-
en for stomach problem
–unexplained fatigue
Receiving treatment within one to two hours of the
onset of the symptoms can be life-saving and prevent further
heart damage.
 You may be having a stroke (cerebrovascular accident
(CVA)):
 You should seek help:
 immediately, if you or others experience any of
the symptoms of a stroke (the type of symptoms
depend on where the “accident” occurs in the
blood vessels that supply the brain)
The symptoms occur suddenly and include:
 temporary blindness in one or both eyes
 confusion
 slurred speech
 spinning sensation
 double vision
 weakness and/or numbness of arms and/or
legs
 falling without loss of consciousness

105
  inability to express oneself (nonsense talking
or cannot use correct words)
 loss of consciousness
 Infections
 You may get an infection:
 from a disease outbreak
 from drinking contaminated water or eating
spoiled food after a disaster
 from a wound, especially if it is not treated
 from mold while living in a contaminated house
that was damaged by flood waters
 during a bioterrorism attack
 You should get help immediately, if you are exposed
to one of these conditions and develop any of the
following:
 fever
 upper respiratory symptoms (cough, congestion,
mucus)
 gastrointestinal symptoms (diarrhea, nausea,
vomiting, abdominal pain)
 painfulness, redness, swelling of a healing wound
 headaches with or without stiff neck
 skin rash
[See the tables in the Appendix – “Disease
Outbreaks: Causative Agent, Transmission,
Symptoms and Things to Do” – p. 188 and “Things
to Know for Bioterrorism” – p. 190.]

106
 Injuries

When To Get Help

 You may be injured during a disaster because of:
 electric shock
 fires
 flying debris (including broken glass)
 a fall
 being swept up in rushing flood waters
 the impact of an explosion
 being in a collapsing structure
 exposure to freezing temperatures (frostbite)
 lightning
 radiation burns
 You should seek help:
 immediately for any serious injury, including
burn injuries
 immediately for bleeding
 immediately for frostbite
 as soon as practicable for any injury other than a
minor scrape
 Lung Disorder
 You may develop difficulties with your lungs
because of:
 smoke from a fire
 fumes containing hazardous materials from an
industrial or transportation disaster

107
  breathing in dust from a collapsed building, espe-
cially if it contained asbestos
 toxins released during a terrorist attack
 infection
 You should seek help:
 immediately, if you have been contaminated by
hazardous materials
 if you develop persistent lung symptoms (cough
with or without phlegm, chest pain)
 Metabolic Disturbance
 You may develop a metabolic disturbance due to:
 dehydration (water reduction because of, for
example, not drinking enough in hot weather,
sweating, diarrhea, or vomiting)
 heat exhaustion
 heat stroke
 hypothermia
 You should seek help, for:
 heat stroke immediately – it is a medical emer-
gency
 hypothermia immediately
 Poisoning
 You may be poisoned by:
 carbon monoxide, for example, from using a gas
powered generator which is not vented properly
 hazardous materials – chemical or radiological –

108
 released during a disaster, especially industrial or

When To Get Help

transportation disasters
 a chemical agent released during a terrorist attack
 You should seek help:
 immediately for signs of carbon monoxide poi-
soning: headache, nausea, vomiting, weakness
[Note: evacuate an enclosed area immediately if
you and/or others suddenly develop these symp-
toms. If you stay, you will first become uncon-
scious and then die.]
 immediately, if you are exposed to a suspected or
actual hazardous material
[See table – “Things to Know for Chemical
Terrorism” – in the Appendix, p. 189.]
 Pre-existing Conditions
You may experience a worsening of a pre-existing
condition because:
 your usual health care services are not available
 your medication has been destroyed or lost
 you are not able to keep to your diet, for example, if
you are diabetic
 the stress of the experience worsens your condition
Mental Health
 You should seek professional help:
 immediately, if you or others experience:
 suicidal thoughts, urges, plans, or behavior
 violent thoughts or behavior

109
  an urge to hurt yourself
 confusion
 delusions and/or hallucinations
 as soon as possible if, after a few weeks have passed,
you or others experience:
 angry outbursts
 numbness, emotional distance or estrangement
 impaired functioning – at work, with family or
friends, or caring for yourself
 inability to concentrate
 intense, persistent anxiety
 memory impairment
 overwhelming stress
 persistent sadness
 persistent insomnia
 primarily one dominant emotional state without
the ability to switch between pleasant and
unpleasant feelings
 You should seek professional help for the following
disorders:
 Adjustment Disorder: This is a disorder that devel-
ops within three months of experiencing a stressful
life event and lasts no longer than six months after
the stressor has ended. The person experiences anxi-
ety, depressed mood, and/or conduct disturbances.
In addition, the individual either exhibits impaired
functioning or distress that is greater than what

110
 would usually be experienced relative to the life

When To Get Help

event. Exposure to a traumatic event can also trigger
this disorder in addition to stressful life events, such
as business failure, divorce, a general medical condi-
tion, or loss of employment.
 Delirium: This is a disorder in which an individual
experiences a sudden alteration in his awareness of
his surroundings, with an inability to focus or main-
tain his attention. He is disoriented, that is, he does
not know the date and time and where he is; he may
also experience hallucinations. Delirium could be
caused by a general medical condition such as an
infection, poisoning, or head injury. The poisoning
could occur when a person becomes contaminated
with a hazardous material.
 Dementia: The key feature of this disorder is deterio-
ration of previously acquired intellectual ability. This
primarily involves memory impairment but also
includes being unable to recognize things, carry out
learned behaviors, understand and use language,
and/or perform the mental tasks of planning, organiz-
ing, sequencing, and abstract thinking. This syn-
drome can be the result of a direct injury to the head
during a disaster.
 Dissociative disorder: This is a disorder in which a
person’s mind cannot integrate the mental functions
of consciousness, memory, identity, or perception of
the environment. For example, an individual would:
1. be unable to recall the traumatic event
2. experience being outside her body observing
herself, and/or

111
 3. feel detached from her environment as if her
surroundings were not real
 Generalized anxiety disorder: This is a disorder in
which a person experiences persistent worry, anxiety,
and tension. The person worries repeatedly about a
number of things despite reassurances. People who
know him may say, “Even if there was nothing to
worry about, he would find something to worry
about.”
 Major Depressive Episode: Major depressive
episodes can be triggered when a person experiences
adverse life events or traumatic events such as disas-
ters and terrorist attacks. Depression may be trig-
gered by the helplessness that people may experi-
ence, particularly during a prolonged hardship, such
as a difficult and lengthy recovery phase. Traumatic
loss, such as the traumatic death of a loved one dur-
ing a disaster or terrorist attack, may also lead to a
major depressive episode. [See “Do you know?” -
“Grief vs. Depression” - p. 118 and “Symptom
Checklists” - “Major Depressive Episode” - p. 123 in
this chapter.]
 Panic Disorder: In this disorder the individual expe-
riences recurrent panic attacks consisting of dread or
intense fear that quickly builds in intensity and is
accompanied by bodily symptoms, such as racing
heart, sweating, shortness of breath, nausea and
upset stomach, dizziness, or faintness. The individ-
ual usually fears that she might be having a heart
attack, losing control, or “going crazy.” After she
experiences the first attack, she worries that she

112
 might have another and may alter her usual behavior,

When To Get Help

for example, she may avoid places which she previ-
ously visited but that she now associates with the
attack.
 Phobia: In this disorder a person has an intense, irra-
tional fear of things or situations, with a desire to
avoid those things or situations. The individual
either avoids them or endures them with dread.
 Posttraumatic stress disorders: There are two
types:
 Acute stress disorder [See – “Acute Stress
Disorder” – in this chapter, p. 122.]
 Posttraumatic stress disorder: This is a disorder
in which characteristic symptoms develop after a
person is exposed to a traumatic event. During
the exposure, the person reacts with intense fear,
horror, and/or helplessness. The key feature of
the disorder is that a person reacts as if the origi-
nal threat is still present. He re-experiences the
trauma in thoughts, feelings, dreams, and bodily
symptoms. He avoids cues of the trauma and feels
numb. He has symptoms of increased arousal,
such as the inability to fall or stay asleep. [See –
“Posttraumatic Stress Disorder – in this
chapter, p. 124.]
 Psychoactive substance use disorders: An individ-
ual with one of these disorders either abuses or is
dependent on psychoactive substances. These
include alcohol, nicotine, illegal drugs such as
cocaine, hallucinogens, heroin and marihuana, and
those prescription medications that are potentially

113
 addictive. Individuals with these disorders may use
substances to numb their unpleasant emotions, cope
with trauma and loss, and/or tolerate physical pain.
 Psychosis: This a syndrome in which an individual is
unable to distinguish what is real. Delusions and /or
hallucinations are usually present. For a very few
individuals, extreme traumatic stress can precipitate
psychotic reactions.
(These are not all the types of mental disorders,
but only those that would likely be associated
with disaster and terrorism. Delirium and psy-
chosis always require immediate professional
attention.)
Legal Matters
 Your legal documents were destroyed.
 You need legal assistance applying for special disaster
funds.
 You think you might have a liability claim.
 There are pre-disaster legal matters that can affect you
as a beneficiary. For example:
 A loved one without a will died in the disaster.
 Your partner died in the disaster but your marriage
was not recognized or you were not married.
Social Needs
 During response phase, you:
 are separated from loved ones and need to be
reunited
 have no social support

114
 During recovery phase, you:

When To Get Help

 have no social support
 need new social activities because old ones are lost,
for example, a facility – senior center, local club – was
destroyed, or you had to relocate away from the
immediate area
 need to share your experiences with others
Spiritual Needs
 Before the disaster, you:
 want to use your spirituality or religion to prepare for
a disaster
 are not a spiritual or religious person, but at this time
of terrorism you wish to seek such a path
 Anytime after a disaster, you:
 are a spiritual or religious person invoking your
beliefs at a time of tragedy, trauma, and loss
 are a spiritual or religious person, but now are having
doubts because of a traumatic event
 were not a spiritual or religious person previously
until a trauma or loss triggered your need for faith
Your Pets or Farm Animals
 During response phase, your pets or farm animals:
 need to be rescued
 are physically injured
 are contaminated with hazardous material
 need uncontaminated water and/or food

115
  need shelter
 During recovery phase, your pets:
 demonstrate changed behavior such as fear, irritabili-
ty or not eating well
Your Property
 During response phase, you need:
 authorization and an official escort to enter your
damaged residence to claim your belongings
 During recovery phase, you need:
 a damage assessment
 to have your home cleared of debris and cleaned
 to have mold removed after water damage
 to repair or rebuild your damaged home
 to deal with the fact that your property has been con-
demned because of damage
 to apply for disaster relief funds or grants
Your Small Business
 During response or recovery phase, you need:
 same as “Your Property” [See above.]
 to set up a temporary location of operation
 to recover electronic business records

GROUPS WITH SPECIAL NEEDS

In addition to the needs, symptoms, and disorders list-
ed above, you should also seek help when the specific condi-
tions occur for each group listed below.

116
 Children

When To Get Help

You should consult a mental health professional when
your child has persistent reactions to a disaster, her reactions
intensify, or they interfere with her functioning. In addition,
even if your school-aged child has natural reactions, if these
cause problems for her or others at school, you should seek
guidance and work cooperatively with her teachers and other
school professionals. [See table – “Children’s Reactions to
Disaster” – in Chapter 5, p. 100.]
Physically Disabled
People with disabilities should have additional help
when they:
 need assistance to evacuate
 require repair or replacement of medical equipment
 need special transportation
 are faced with the destruction of their usual accessible
environment
Seniors
Seniors should have additional help when they:
 need assistance to evacuate
 have developed dehydration
 are suffering from heat stroke in hot weather, especially
if no air conditioning is available due to a power outage
 experience worsening of a pre-existing general medical
condition
 are faced with a disruption of medical and/or social
services

117
 People with Serious Mental Illness
People with serious mental illness should have additional
help when they:
 experience a worsening of their pre-existing mental
illness
 are faced with a disruption of access to care

“DO YOU KNOW?”

Grief vs. Depression
Do you know that there are certain warning symptoms
that grief is turning into depression?
Grieving is a natural process. As individuals, we mourn
when a loved one dies. As a community, we mourn collec-
tively when there is a public death. As a nation, we mourned
those killed in the terrorist attack in Oklahoma City on April
21, 1995, and the September 11, 2001 terrorist attacks on New
York City and Washington, DC. When a loved one dies, we
may take solace in religion, shared rituals, and spirituality.
When we grieve, we may seek out a relative or friend for sym-
pathy, talk to clergy, attend a self-help bereavement support
group, or even participate in counseling with a mental health
professional.
There are times, however, when a grieving person may
need treatment, including possible medication. One of these
times is when grief develops into clinical depression. Why is
this difference important? It is important because clinical
depression can lead to suicide. If suicidal thoughts are pres-
ent, one should always see a mental health professional.
How does one distinguish between grief and depres-

118
sion? For a variety of reasons, the length of the grieving

When To Get Help

process is not a good indicator. One person’s period of grief
might be shorter or longer than another’s. The length of the
mourning period can be culturally determined. How a per-
son died may alter the duration of one’s grief. For example,
grief due to traumatic loss – death from a traumatic event
such as a disaster – may last longer because the person died
suddenly, unexpectedly, violently, and perhaps early in life.
Some individuals may never stop grieving even though they
have continued to function and have gone on with their lives.
Three main factors distinguish grief from depression:
1) intensity, 2) variability, and 3) content.
1. Grieving individuals usually continue to function,
even if there are times when they have to force themselves to
do so. By contrast, clinical depression is gererally severe
enough to interfere with the ability to function to some
degree.
2. One’s mood usually switches back and forth during
the process of mourning. There are intense times of crying,
loneliness, and emptiness interwoven with times when one
is enjoying being with family and friends, or engaging in
some interest. During an episode of depression, an individ-
ual’s mood is usually persistently sad almost all day, every-
day.
3. Although guilt and hallucinations can be part of both
grief and clinical depression, their contents are usually differ-
ent. While grieving, a person may feel survivor guilt: “Why
didn’t I die instead?” or the guilt of not having done enough:
“It’s my fault. I should have tried harder to stop him from
going.” In depression, guilt usually takes the form of: “I did
something terribly wrong” and is often accompanied by feel-

119
ings of worthlessness: “I’m no good. I never do anything
right.” One can hallucinate during grief, that is, sense some-
thing that is not present or not really happening, and not be
“crazy.” This usually consists of seeing the deceased, espe-
cially when one is alone at night. In certain cultures, the
norm is seeing and communicating with the deceased. In
depression, the hallucination is usually a voice criticizing the
person. The voice may also tell a depressed individual to kill
herself.
Psychological Reactions to Nuclear,
Radiological, and Chemical Events
Do you know that most symptoms in reaction to a
nuclear, radiological, or chemical event are
psychological?
Here is what is known from three events:
Three Mile Island Nuclear Reactor Accident: On
March 28, 1979, damage occurred to the casing around the
radioactive core of reactor 2 (TMI-2) at the Three Mile Island
nuclear power plant near Harrisburg, Pennsylvania.
Although the incident occurred essentially over sixteen
hours, public alarm continued for several days because of
misinformation and misunderstanding. Two days after the
accident, the Nuclear Regulatory Commission recommend-
ed that the governor of Pennsylvania proceed with an evacu-
ation of the area. Although there had been a gaseous radioac-
tive release from the plant, levels of measured radioactivity in
the area were low. The maximum radiation dose to any indi-
vidual in the surrounding area would have been less than the
amount naturally received annually from background radia-
tion. Nevertheless, subsequent studies demonstrated that
people living within 20 miles of the TMI experienced sub-

120
stantial immediate psychological distress. An estimated 52%

When To Get Help

of those living within 20 miles fled the area during the acci-
dent. 26% of those studied were demoralized within one
month of the accident. Even five months after the incident,
the public in the area continued to mistrust authorities
regarding the safety of nuclear power.
Goiania, Brazil Radiological Event: On September 13,
1987, an abandoned radiotherapy device was broken open.
The radiation contaminated 249 people resulting in 4 deaths.
However, 113,000 people who were not contaminated feared
that they were and sought medical care. Some of these faint-
ed and experienced diarrhea and vomiting.
Terrorism in Tokyo Subway: On March 20, 1995, the
Aum Shinrikyo cult released sarin, a nerve gas, in the Toyko
subway. The attack killed twelve and resulted in 5,500 seek-
ing emergency care. Of those seeking help, 3,454 did not have
any signs of contamination but were anxious and highly
aroused.

121
 ACCUTE STRESS DISORDER
If during or after experiencing or witnessing a traumatic
event, any of the following symptoms occurred:
 I felt numb and detached or felt no emotional
response.

 I felt dazed and did not know where I was.

 I felt like things happening around me were

strange, mechanical, or not real.

 I felt that I was out of my body observing myself or

like I was in a dream.

 I was unable to recall what happened.

and after experiencing or witnessing the traumatic

event, any of the following symptoms have occurred:

 I persistently reexperience the trauma through:

1) recurrent images, thoughts, or nightmares
2) a sense of re-living the trauma, and/or
3) distress when exposed to reminders of the
trauma.

 I avoid feelings, thoughts, conversations, activities,

places, and/or people that remind me of the trau-
ma.

 I am very anxious or show symptoms of increased

arousal, for example, I have difficulty sleeping, feel
irritable, am unable to concentrate, am looking
around thinking something will happen, easily
jump or startle, and/or feel restless.

 I find it difficult to function with others, at work, or

in other important areas of my life, or I cannot do
some necessary task like seek disaster relief assis-
tance.
SEE A PROFESSIONAL FOR AN EVALUATION

122
 MAJOR DEPRESSIVE EPISODE

When To Get Help

If any of the following symptoms have occurred:
 I feel sad or empty almost all day every day, or oth-
ers tell me that I am depressed.

 My interest in all or almost all activities is markedly

diminished, or I no longer feel any pleasure in all or
almost all activities for most of the day for nearly
every day, or others tell me that I have lost interest.

 I have had a significant weight loss without dieting

or a weight gain (a loss or gain of more than 5% of
body weight in a month), or I have experienced a
decrease or increase in my appetite every day.

 I am unable to sleep, or I sleep more than usual

every day.

 I am agitated (pace back and forth) or sit without

much movement every day.

 I feel tired or have no energy nearly every day.

 I feel worthless or have excessive guilt nearly every

day.

 I have difficulty thinking or concentrating, or I have

difficulty making decisions nearly every day.

 One of the following:

I have recurrent thoughts of death.
I have recurrent thoughts about killing myself
although I do not have a specific plan.
I have tried to kill myself.
I have a specific plan to kill myself.

 I find it difficult to function with others, at work, or

in other important areas of my life.

SEE A PROFESSIONAL FOR AN EVALUATION

123
 POSTTRAUMATIC STRESS DISORDER
If any of the following symptoms have occurred and
persisted after the traumatic event that you have experi-
enced or witnessed:
 I am on the alert that something threatening
might happen.

 I am unable to remember some of the important

parts of the event.

 I easily jump or startle.

 I experience distressing recurrent and intrusive rec-

ollections of the event.

 I feel detached or estranged from others.

 I experience intense emotional distress when I am

reminded of the event.

 I feel irritable and/or have angry outbursts.

 I find myself acting or feeling as if the event is hap-

pening again.

 I have difficulty concentrating.

 I have difficulty falling asleep and/or staying asleep.

 I have physical reactions like a rapid heartbeat,

sweating, and/or trembling when I am reminded of
the event.

 I have recurrent distressing dreams about the

event.

 I make an effort to avoid or do avoid activities,

places, and/or people that arouse recollections of
the event.

124
 POSTTRAUMATIC STRESS DISORDER

When To Get Help

(continued)
 I make an effort to avoid or do avoid thinking, feel-
ing, and/or talking about the event.

 I think that somehow my future will be cut short.

 My interest or participation in previously enjoyed

activities has greatly diminished.

 My loving feelings for others are restricted.

SEE A PROFESSIONAL FOR AN EVALUATION

Adapted by permission of William H. Simon, George E.
Ehrlich and Arnold Sadwin from Napoli, JC “Mind/Body,
Body/Mind, Mind/Brain, and Post-Traumatic Stress
Disorder” in Conquering Chronic Pain: An Integrative
Approach to Treating Post-Traumatic Pain.

SUICIDE RISK
Do you know how to recognize if someone is at risk for
committing suicide?
 Talking about suicide (It is a myth that people who
talk about suicide don’t do it.)
 Anxiety and anguish
 Hopeless, helpless, and worthless
 Loss of interest
 Focused on death
 Signs of preparing for death
 suddenly happier or calmer because the per-
son has decided suicide is the solution
 placing one’s affairs in order
 giving belongings away
 contacting friends and relatives in a manner
that is not typical for person
ASSIST PERSON TO GET PROFESSIONAL HELP

125
 7 SEEK HELP

TYPES OF RESOURCES p. 128

Professional vs. Non-professional Help p. 128
Resources for Adults p. 129
Resources for Youth p. 129

RESOURCE DIRECTORY p. 130

Advocacy and Self-Help p. 130
Aviation Disasters p. 131
Children p. 131
Crime p. 132
Disaster Relief Organizations p. 132
Environment and Food p. 133
Health, Mental Health, and Public Health p. 133
Homeland Security p. 134
International p. 134
Military p. 134
Professional p. 135
State and Territory Offices of Emergency
Management (OEM) p. 136
Travel Safety p. 136
Weather p. 136

DO YOU KNOW?

Families of September 11 p. 137

National Air Disaster Alliance/Foundation p. 137
National Organization for
Victims Assistance (NOVA) p. 138
National Self-Help Clearinghouse p. 139
National Voluntary Organizations Active
in Disaster (NVOAD) p. 139
Peer Helpers p. 140

126
 SEEK HELP
“Ask, and it shall be given you;
seek, and you shall find;
knock, and it shall be opened unto you.”
New Testament, Matthew 7:7

Making the right choice about seeking help is a complex

and sometimes risky process. Before seeking help from oth-

Seek Help
ers, you need to consider how it might benefit you and how
it might harm you. For example, in some situations confid-
ing in a supervisor about your personal matters may adverse-
ly affect your job. Your internal conflicts and concerns may
be viewed as potentially damaging to your judgment and job
performance. Your decision to self-disclose any trauma-
induced emotional effects should be guided by your knowl-
edge of your employer’s management style, your relation-
ship, and your past history.
Regarding the decision to seek support from others,
some people assume that talking to a trusted co-worker who
has also been involved in the disaster will probably cause dis-
tress or traumatize that person. This is not necessarily true.
Don’t let this belief keep you from reaching out to that trust-
ed co-worker. In some cases, it might be beneficial to both of
you to share your experience of the disaster. You need to
weigh the risks and benefits to both you and the other per-
son. Determining the risks is not always easy, but you can use
your knowledge of a co-worker’s previous behavior, and his
vulnerabilities and strengths to guide you in your decision.
It may also be helpful to get an outside perspective by
talking with someone other than a trauma survivor. Don’t
assume someone who did not go through the disaster will

127
not be able to understand. Sharing ideas and feelings, and
getting objective feedback can be comforting and lead to new
insights. Family members, professionals, colleagues, co-
workers, members of the clergy, and trusted friends are
potential supportive resources you may consider.
The following is a list of possible individuals and organ-
izations that you may turn to after experiencing a crisis or dis-
aster. Once you realize you need help, you will also need to
decide whether to seek a professional or a non-professional
resource or agency.

TYPES OF RESOURCES
Professional vs. Non-Professional Help
 Why turn to professionals for help? Professionals
should:
 be better trained and skilled to deliver supportive
services
 be knowledgeable about diagnosing acute and
extreme reactions that require ongoing treatment
 be objective, neutral, and unlikely to be swayed by a
relationship with the survivor
 be able to deliver empathic support
 Why turn to non-professionals (relative, friend or co-
worker) for help? Non-professionals may:
 have personal knowledge of and a shared background
with the survivor, which can be helpful in knowing
how to offer the best support
 be more sympathetic to someone they know
 have been through the same crisis or trauma, and
thus may more effectively assist the survivor to adopt
a better functioning state of mind (It helps to share
experiences.)

128
  have a more positive influence over the survivor
because of a deeper relationship
Resources for Adults
 At Your Workplace:
 trained crisis and/or grief counselors on staff
 employee assistance programs (EAP)
 crisis and/or grief counselors who are members of
health insurance networks

Seek Help
 human resources department staff members
 trained peer helpers
 trusted co-workers who were affected by the crisis
 trusted co-workers who were not involved in the
crisis
 medical department for employees
 In Your Community:
 community based crisis counselors on the scene
 clergy who are trained in crisis and grief counseling
 local mental health professionals
 county or state crisis hotlines, usually in depart-
ments of mental health services
 local or county assault/rape crime agencies, usually
referred through county prosecutor’s office
 local psychotherapists specializing in stress disorders
and grief
 local emergency rooms
 self-help clearinghouses (self-help theme support
groups such as loss of family members, sexual/physi-
cal abuse, and widow/widower)
 your physician
Resources for Youth
 At Your School:

129
  guidance counselors
 student assistance counselors
 trained peer helpers
 school nurses
 school-based support teams (psychologists, social
workers, and mental health workers)
 school-based resource officers (police)
 In Your Community:
 trusted family members or friends
 self-help groups
 self-help books
 youth-oriented hotlines
 The Compassionate Friends [See listing in the
“Resource Directory” p. 131.]
 Rainbows groups (bereavement programs) [See list-
ing in the “Resource Directory” below.]
RESOURCE DIRECTORY
This resource guide is intended to support readers with a
wide variety of needs and issues. It is the result of careful
screening of numerous agencies and organizations. It is
divided by category for your convenience. Addresses and
phone numbers are included when available.
Advocacy and Self-Help
These sites offer disaster-related and subject-related self-help
groups, emotional and physical support, legal support, pre-
vention services, assistance, and educational information.
Many offer links to other sites.
Anxiety Disorders Association of American (ADAA) / 8730
Georgia Avenue, Suite 600, Silver Spring, MD 20910; (240)
485-1001. www.adaa.org
Families of September 11 [See p. 137.]
National Association of Students Against Violence
Everywhere (SAVE) / 322 Chapanoke Road, Suite 110,
Raleigh, NC 27603; (919) 661-7800.
Toll-free: (866) 343-SAVE (7283). www.nationalsave.org
National Self-Help Clearinghouse [See p. 139.]

130
Rainbows / 2100 Golf Road #370, Rolling Meadows, IL
60008; (847) 952-1770. Toll-free: (800) 266-3206; E-mail:
www.info@rainbows.org
SAVE (Suicide Awareness Voices of Education) / Hotline:
(800) 273-8255. www.save.org
The Compassionate Friends, Inc. / P. O. Box 3696 Oak Brook,
IL 60522; (630) 990-0010, FAX: (630) 990-0246. Toll-free:
(877)-969-0010. www.compassionatefriends.org
Trauma Anonymous / www.bein.com/trauma
Aviation Disasters
These resources offer financial, emotional. and legal support

Seek Help
to air crash victims and their families. Some offer links to
other sites.
Aircraft Casualty Emotional Support Services (ACCESS) /
1594 York Avenue, PMB 22 New York, NY 10028. Toll-free:
(877) 227-6435. www.accesshelp.org
National Air Disaster Alliance/Foundation (NADA/F)
[See p. 137.]
Children
These sites offer valuable resources for disaster preparedness
and prevention, coping with terrorism, and child traumatic
stress. They provide information about long term effects of
radiation and bio-terrorism, disease outbreak prevention,
and responses. Some have information regarding child care
services during disasters and crises. Others focus on educa-
tional and social needs of children. Their publications pro-
vide guidelines and suggestions for parents, schools, and
agencies to help children cope with disasters and crises.
Many offer links to other sites.
American Academy of Child and Adolescent Psychiatry
(AACAP) / 3615 Wisconsin Ave., N.W., Washington, DC
20016; (202) 966-7300. www.aacap.org
American Academy of Pediatrics / 141 Northwest Point
Boulevard, Elk Grove Village, IL 60007; (847) 434-4000.
www.aap.org
Apple Care Foundation / 41 West 57th Street, 4th Floor, New
York, NY 10019; (212) 688-0635.
www.applecarefoundation.org
Church of the Brethren, Emergency Response/Service
Ministries / 601 Main Street, P.O. Box 188, New Windsor, MD
21776. Toll-free: (800) 451-4407, ext. 7.

131
National Association of School Psychologists (NASP) / 4340
East West Highway, Suite 402, Bethesda, MD 20814; (301)
657-0270. www.nasponline.org
National Child Traumatic Stress Network (NCTSN) /
www.nctsnet.org
National Children’s Advocacy Center (NCAC) / Center, 210
Pratt Avenue, Huntsville, AL 35801; (256) 533-KIDS (5437).
www.nationalcac.org
Purdue University / West Lafayette, IN 47907 USA; (765) 494-
4600. Toll free: (888) EXT-INFO (398-4636).
www.ces.purdue.edu/terrorism
US Department of Education (DOE) / 400 Maryland Avenue,
SW, Washington, DC 20202. Toll-free: (800) USA-LEARN
(872-5327). www.ed.gov
Crime
The following sources offer legal, practical, physical, and
emotional support and treatment for crime victims. Many
offer links to other sites.
Federal Bureau of Investigation (FBI) / J. Edgar Hoover
Building, 935 Pennsylvania Ave, NW, Room 7350,
Washington, DC 20535; (202) 324-3000. www.fbi.gov
National Organization for Victims Assistance (NOVA) /
[See p. 138.]
The Office for Victims of Crime (OVC) / U.S. Department of
Justice, 810 Seventh Street NW, Eighth Floor, Washington,
DC 20531; (202) 307-5983. www.ovc.gov
The Office on Violence Against Women (OVW) / 810 7th
Street, NW, Washington, DC 20531; (202) 307-6026.
www.ojp.usdoj.gov/vawo
The Victims’ Assistance Legal Organization (VALOR) / 8180
Greensboro Drive, Suite 1070, McLean, VA 22102-3823;
(703) 748-0811. www.valor-national.org
Disaster Relief Organizations
The following sources offer medical, financial, safety, and
physical relief to victims of all disasters. Many offer links to
other sites.
American Red Cross / www.redcross.org
National Voluntary Organizations Active in Disaster (NVOAD)
/ [See p. 139.]
The Salvation Army / 615 Slaters Lane, P.O. Box 269,

132
Alexandria, VA 22313. www.salvationarmyusa.org

Environment and Food

The following sources offer environmentally related and food
related educational information on food safety, poison con-
trol procedures, and emergency response services. They pro-
vide bio-hazard alerts and resource quality regulation. They
also offer local, state, and national center listings, networks,
hotlines, and resources. Many offer links to other sites.
American Association of Poison Control Centers (AAPCC) /

Seek Help
3201 New Mexico Avenue, Suite 330, Washington, DC 20016;
(202) 362-7217. Poison help hotline: Toll-free: 800-222-1222.
www.aapcc.org
Department of Agriculture / www.foodsafety.gov
Department of Environmental Protection (EPA) / Ariel Rios
Building, 1200 Pennsylvania Avenue, N.W., Washington, DC
20460; (202) 272-0167. www.epa.gov
The Food Safety and Inspection Service (FSIS) / USDA Meat
and Poultry Hotline: (888) MP Hotline (674-6854).
www.fsis.usda.gov
Health, Mental Health, and Public Health
These sites contain valuable resources on public health
threats, homeland security, counter-terrorism, emergency
preparedness, and responses to environmentally related dis-
eases, bio-terrorism, and outbreaks. Some include valuable
information on and emergency responses to hazardous mate-
rials incidents. Programs for the homeless, mental health
information, hotlines, substance abuse prevention, and treat-
ment information programs, and referral sources are includ-
ed in some of these sites. Many offer links to other sites.
Academic Centers for Public Health Preparedness /
www.asph.org/acphp
Department of Health and Human Services (DHHS) / 200
Independence Avenue, S.W., Washington, DC 20201; (202)
619-0257. Toll-free: (877) 696-6775. www.hhs.gov
Centers for Disease Control and Prevention (CDC) / 600
Clifton Rd, Atlanta, GA 30333; (404) 639-3311. Toll-free:
(800) 311-3435. www.cdc.gov
Indian Health Service / The Reyes Building, 801 Thompson
Avenue, Ste. 400, Rockville, MD 20852; (301) 443-1083.
www.ihs.gov

133
National Institute of Mental Health / Office of
Communications, 6001 Executive Boulevard, Room 8184,
MSC 9663, Bethesda, MD 20892; (301) 443-4513. Toll-free:
(866) 615-6464. Anxiety Hotline: Toll-free: (888) 826-9438.
www.nimh.nih.gov
Substance Abuse and Mental Health Services Administration
(SAMHSA) / 1 Choke Cherry Road Room 8-1065 Rockville
MD 20857; (240) 276-2000. www.samhsa.gov
US Public Health Service / www.usphs.gov
Homeland Security
The Homeland Security Act of 2002 established the
Department of Homeland Security (DHS) to prevent terrorist
attacks within the United States; reduce the vulnerability of
the United States to terrorism, natural disasters, and other
emergencies; and minimize the damage and assist in the
recovery from terrorist attacks, natural disasters, and other
emergencies. The main office and two of divisions are below.
Department of Homeland Security (DHS) / Washington, DC
20528; (202) 282-8000. www.dhs.gov
Federal Emergency Management Agency (FEMA) / 500 C
Street, SW Washington, DC 20472; (202) 566-1600. Toll-free:
(800) 621-FEMA (3362). www.fema.gov
Readiness / (202) 282-8000. www.ready.gov
International
The following sources offer international relief and disaster
recovery, emergency management, reconstructive efforts,
and disease prevention initiatives outside the USA. Some
offer links to other sites.
The Disaster Preparedness and Emergency Response
Association (DERA) / P.O. Box 797, Longmont, CO 80502,
www.disasters.org
Office of Foreign Disaster Assistance (OFDA) / Information
Center, U.S. Agency for International Development, Ronald
Reagan Building, Washington, DC 20523; (202) 712-4810.
www.usaid.gov/index.html
World Health Organization (WHO) / Regional Office for the
Americas, 525, 23rd Street, N.W., Washington, DC 20037;
(202) 974-3000, Fax: (202) 974-3663. E-mail:
postmaster@paho.org www.who.int/en
Military
These sources offer national security, military, and anti-ter-

134
rorism services as well as protection and support to military
personnel and veterans.
Department of Defense (DOD) / 1000 Defense Pentagon,
Washington, DC 20301; (703) 545-6700.
www.defenselink.mil
US Veterans Administration / Secretary of Veterans Affairs,
Department of Veterans Affairs, 810 Vermont Ave NW,
Washington, DC 20420; Toll-free: (800) 827-1000.
www.va.gov
Professional
The professional associations below offer information that

Seek Help
serves the needs of the general public in dealing with crises,
disasters, terrorism, and traumatic events. Many list local
chapters and centers. Some offer information on mental
health issues, referral networks of therapists, and publica-
tions related to terrorism, disaster preparedness, disaster
response, and emotional wellness. Many offer links to other
sites
The American College of Emergency Physicians (ACEP) / 1125
Executive Circle, Irving, TX 75038, (972) 550-0911. Toll-free:
(800) 798-1822. www.acep.org
American Medical Association (AMA) / 515 N. State Street,
Chicago, IL 60610. Toll-free: (800) 621-8335. www.ama-
assn.org
American Psychiatric Association (APA) / 1000 Wilson
Boulevard, Suite 1825, Arlington, VA 22209; (703) 907-7300.
www.psych.org
American Psychological Association (APA) / 750 First Street,
NE, Washington, DC 20002; (202) 336-5500. Toll-free: (800)
374-2721. www.apa.org
International Critical Incident Stress Foundation, Inc. (ICISF)
/ 3290 Pine Orchard Lane, Suite 106 Ellicott City, MD 21042;
(410) 750-9600. www.icisf.org
International Society of Traumatic Stress Studies (ISTSS) / 60
Revere Drive, Suite 500, Northbrook, IL 60062; (847) 480-
9028. www.istss.org
National Association of Peer Programs /, PO Box 10627,
Gladstone, MO 64188. Toll-free: (877) 314-7337.
www.peerhelping.org [See p. 140.]
PTSD Alliance / Toll-free: (877) 507-PTSD (7873).
www.ptsdalliance.org

135
 State and Territory Offices of Emergency
Management (OEM)
There is an Office of Emergency Management (OEM) for each
state and territory. Visit the FEMA website: www.fema.gov
and obtain the name and contact information for your state
or territory OEM. Write this information here so that you will
have it handy.
Name:
Address:
Toll free number:
Local Number:
Website:
Travel Safety
These sources offer assistance to travelers by providing warn-
ings, advisories, safety information, and relief services. They
supply passport recovery assistance as well as legal and finan-
cial support to Americans in foreign countries. They help
family members in contacting relatives in disaster related sit-
uations. Some offer links to other sites.
The Office of American Services and Crisis Management
(ACS) and Bureau of Consular Affairs US Department of State,
2201 C Street NW, Washington, DC 20520. American travel-
ers’ hotline: (202) 647-5225. www.travel.state.gov
Weather
This source provides up-to-date information about weather
related warnings, alerts, and advisories.
National Oceanographic and Atmospheric Association
(NOAA) / US Department of Commerce, 14th Street &
Constitution Avenue, NW, Room 6217, Washington, DC
20230; (202) 482-6090. www.noaa.gov

136
 Families of September 11
Do you know there is an organization that helps victims of
terrorism?
Families of September 11, Inc. (FOS11) is a non-profit organi-
zation founded by families of those who died in the 9/11 terror-
ist attacks. Membership is open to the families of victims of 9/11
and the related anthrax attacks, as well as survivors and first
responders. Victims of other terrorist attacks and concerned
individuals who support their mission are invited to join as asso-
ciate members. FOS11 does not receive financial or other support
from any political parties, campaign organizations, or the like.
The group has two goals:

Seek Help
 to promote the interests of victims' families, survivors,
and others affected by 9/11 (They provide information
retrieval and dissemination, resource referral, research,
and online chat sessions. In addition, they focus on
such issues as school safety and curriculum, public
trauma, victims’ assistance, and children’s issues relat-
ed to terrorism and security.)
 to support public policies that respond to the threat of
terrorism; specifically, support for the 9/11 Commission
recommendations, development of appropriate agency
responses, legislation related to aviation, border, port,
and transportation security, and intelligence reform
To learn more about FOS11 visit the website:
www.familiesofseptember11.org or call: 212-575-1878
Reprinted and adapted by permission of Families of
September 11 from its website.

National Air Disaster Alliance/Foundation

The National Air Disaster Alliance/Foundation (NADA/F) is
a non-profit advocacy group that has helped write and pass leg-
islation to raise the standards of safety, security, and survivabili-
ty. It has lobbied for the interests of survivors and developed
many resources for support services. NADA/F has provided net-
working services for victims and developed a volunteer Family
Support Team (FST) to offer direct support for survivors and fami-
ly members.
They have identified some unique issues affecting victims of
aviation disaster:
 receiving insensitive, untimely, and sometimes erro-
neous information
 difficult and sometimes distant disaster site
 frustration in dealing with multiple agencies
 difficult and delayed forensics
 denied a traditional funeral

137
 National Air Disaster Alliance/Foundation
(continued)
 “stressful” family dynamics
 possible loss of multiple family members and/or friends
traveling together
 the need to know the cause of the disaster, and learning
that it was a preventable disaster
 crash becomes a potential platform for political, media,
and special interest agendas
As time progresses other difficult issues arise:
 lengthy, interrupted grieving process
 loss of privacy
 complex, long-term investigation and legal issues
 exhausting efforts to establish a memorial
 difficult to connect with other families from the disas-
ter, and the need to support each other and work on
common issues
 need for supportive assistance dealing with personal
and family life after returning home
To learn more about NADA/F, visit the website:
info@PlaneSafe.org. or call toll-free: 888-444-NADA
Reprinted and adapted by permission of NADA/F from its
website.

National Organization for Victims Assistance (NOVA)

Do you know that today there are thousands of programs to
help crime victims?
One of these is NOVA, a kind of umbrella group founded in
1975. It is the oldest national group of its kind in the worldwide
victims movement. NOVA’s mission is to promote rights and
services for victims of crime and crisis everywhere. NOVA is a
private non-profit 501(c)(3) organization of victim and witness
assistance programs and practitioners, criminal justice agencies
and professionals, mental health professionals, researchers, for-
mer victims and survivors, and others committed to the recogni-
tion and implementation of victim rights.
They have developed a model crisis response team (CRT) to
serve communities and individuals emotionally traumatized by
a disaster. NOVA offers training to professionals, clergy, public
safety professionals, and other community members through-
out the country so that they may volunteer to serve on these
CRT’s.
To learn more about NOVA, visit the website: www.tryno-
va.org or contact NOVA, 510 King Street Suite, 424 Alexandria,
VA 22314 Toll-free: 1-800-TRY-NOVA
Reprinted and adapted by permission of NOVA from its
website.

138
 National Self-Help Clearinghouse
Do you know there is a national organization that helps you
locate self-help groups?
The National Self-Help Clearinghouse is a not-for-profit
organization that was founded in 1976 to facilitate access to self-
help groups and increase the awareness of the importance of
mutual support. The clearinghouse provides a number of servic-
es:
Assists human services agencies to integrate self-help princi-
ples and practices into their service delivery
Conducts training activities for self-help group leaders and
for professional facilitators of support groups

Seek Help
Provides consultation to agencies to promote their capabili-
ties to encourage and sustain mutual support groups
Carries out research activities, including research about the
effectiveness of self-help, the character of the self-help process,
and relationships with the formal care-giving systems
Provides information about and referral to national self-help
support groups and regional self-help clearinghouses
 Some types of self-help groups are:
 Accident victim groups assist those who suffered from
accidents.
 Addiction support groups help individuals overcome
addictions.
 Loss of a child groups assist grieving parents to cope
with their loss.
 Suicide survivor groups assist family and friends of
those who committed suicide.
 Anxiety and panic attack support groups assist individu-
als with strategies that help.
 Trauma victim support groups offer assistance in a
socially empathic environment.
For information about where to find these groups, contact
your regional, state, or local self-help clearinghouse, or the
National Self-Help Clearinghouse at: www.selfhelpweb.org/
Graduate School and University Center of the City University of
New York, 365 5th Avenue, Suite 3300, New York, NY 10016,
(212) 817-1822
Reprinted and adapted by permission of National Self-Help
Clearinghouse from its directory and website.

National Voluntary Organizations Active in Disaster (NVOAD)

Do you know there is a national organization that encourages
communication, collaboration, cooperation, and coordination
among organizations that provide disaster response, relief,
and recovery?
In the wake of the devastation of Hurricane Camille along the
Gulf Coast in 1969, it became obvious that coordination and

139
 National Voluntary Organizations Active in Disaster (NVOAD)
(continued)
cooperation among disaster relief organizations would enhance
services to victims of disaster. On July 15, 1970, representatives
from the St. Vincent DePaul Society, National Catholic Disaster
Relief Services, Seventh Day Adventist Church, Southern Baptist
Convention, Mennonite Disaster Services, Christian Reformed
World Relief Committee, and American Red Cross signaled their
desire to work together in times of disaster by coming together in
Washington, DC where they initiated the process to form the
National Voluntary Organizations Active in Disaster (National
VOAD).
Since that first meeting and the incorporation of National
VOAD in 1975, the membership has grown to 40 members or
partners with more than half faith-based. The VOAD movement
continues to grow across the country with all states and territo-
ries having VOAD’s and county/parish/community VOAD’s
being formed every day.
National VOAD is a basis for voluntary organizations all over
the nation. When a disaster does strike, National VOAD assists
members and Friends of VOAD to share information and as a
result enhance the coordination among the voluntary organiza-
tions. It provides a forum for collaborative planning efforts by
many voluntary organizations responding to disaster. Member
organizations provide more effective services with less duplica-
tion by getting together before disasters strike. Once disasters
occur, National VOAD or an affiliated State/Territory or Local
VOAD encourages members and other voluntary agencies to con-
vene on site.
This cooperative effort has proven to be an extremely effec-
tive way for a wide variety of volunteers and organizations to work
together in a crisis.
They offer valuable links to their state members and to other
disaster-related sites.
To learn more about NVOAD, visit the website:
www.nvoad.org or contact NVOAD, PO Box 151973, Alexandria,
Virginia 22315; (703) 339-5596.
Reprinted and adapted by permission of NVOAD from its
website.

Peer Helpers
Do you know that there are trained peer helpers?
Many organizations and schools offer training courses to
their members to become peer helpers. These are non-profes-
sional human resources who serve as support agents and educa-
tors. They provide counseling, personal assistance, and a variety
of educational programs on such issues as health, prevention,
and disaster response. They are not psychotherapists or medical
professionals but are trained to know when and how to refer to
professionals.

140
 8 HELP YOURSELF

THINGS TO DO p. 143
Immediately (Response Phase) p. 143
Over Time (Recovery Phase) p. 145
Anytime after a Disaster p. 147

THINGS TO THINK ANYTIME

AFTER A DISASTER p. 148

FEAR MANAGEMENT p. 150

Help Yourself
DO YOU KNOW?

Crisis Counseling: Yes or No? p. 159

Relaxation Exercises p. 163

141
 HELP YOURSELF
“There’s only one corner of the universe you can be certain of
improving, and that’s your own self”
Aldous Leonard Huxley
1944

“Attitude” is vital to recovery. How you think about a sit-

uation will influence not only your emotional reactions but
also your physical reactions. Although a catastrophe would
be a shocking experience to you, it is important to put things
into perspective. When you have no control over what the
environment offers you, all you can do is change yourself and
react to the situation with as much flexibility as you can
muster. This is not easy, but most great leaders rise to the
occasion in adversity. Churchill said, “Move quickly through
a crisis.” Just imagine how your own hero or role model
might deal with a trauma such as yours. Modify how your
role model might react to fit your own style and values.
Some find that cultivating a sense of humor can do a lot
for their confidence. Others find it comforting to turn to their
spiritual side for support, through prayer, meditation, or the
power of positive thought. Above and beyond these personal
response styles, it is always important to draw strength from
others. Do not be afraid to ask for help from others. Your per-
sonal support system is critical to your survival. Social sup-
port is essential to maintaining one's healthy functioning
and recovery after a disaster.
The following section lists the most effective ways to
cope with the impact of a crisis or disaster. These responses
are listed in two categories: things to do and ways to think.
Choose the responses most natural and comfortable for you.

142
Most responses are effective anytime after a disaster.
However, there are some responses that are only relevant
soon after a disaster (Response Phase), and others that are
appropriate over time (Recovery Phase.)
THINGS TO DO
Immediately (Response Phase)
These things to do are more intended to meet your needs
soon after the disaster.
 Take Survival Action.
 Evacuate, when necessary.
 Rescue yourself.
 Shelter in place when appropriate.

Help Yourself
 Call 911.
 Receive emergency medical care.
[See “Do You Know?” – “Evacuation vs. Shelter in Place”
– in Chapter 3, p. 41. See Chapter 4 – “Do you Know?
boxes – “R.A.C.E.” – p. 73 and “Evacuating a Burning
Building” – p. 74.]
 Practice Safety.
 Move to a safe area away from danger. For example,
evacuate the building if on fire; stay away from
downed electrical wires; or after evacuating from a
collapsing building, move far enough away to avoid
being hit by falling debris.
 Watch out for danger during a disaster and avoid it.
 Look:
 up for falling power lines and other falling

143
 objects
 down for fire hoses, potholes, and debris
 sideways for rushing vehicles and people
including emergency workers
 ahead because someone or something might
be there in your way
 Listen:
 behind you for vehicles backing up
 above for falling debris
 Stay:
 outside any area marked by yellow police tape,
if you are a by-stander
 away from hazardous material (Hazmat) areas
 away from power lines (Don’t touch it even
with a ten foot wood pole. If you think the
object you have chosen to use will not con-
duct electricity, you are probably mistaken.)
 Take care of your basic needs.
 Maintain fluid intake and nourishment.
 Protect yourself and/or others from the elements by
seeking shelter.
 Keep warm.
 Take care of your mental health and social needs.
 Receive psychological first aid.
 Accept social support.

144
  Reunite with your friends and loved ones. [See “Do
You Know?” – “Reunion vs. Safety and Security” – in
Chapter 5, p. 96.]
 When you feel panicked or stressed out, take deep
breaths slowly from your belly.
 Imagine yourself in a calm, clear state of mind.
 Identify your first priority and focus on dealing with
that problem.
 Deal with things one at a time, hour-by-hour, and then
day-by-day.
 Reach out to available agencies to obtain immediate
resources to solve your problems and meet your needs,
for example, to obtain food, clothing, temporary shel-

Help Yourself
ter.
Over Time (Recovery Phase)
The following actions and strategies are intended to aid the
healing process in the aftermath of the disaster.
 Give yourself time to heal.
 Avoid certain types of major life decisions. For exam-
ple, if your house has burned down, you should focus
on the immediate response, such as contacting your
insurance carrier, rather than worry about where you
are going to live long-term and all the details of recon-
structing your life. These decisions can be dealt with
later.
 Reach out for agencies to get funds for your recovery,
for example, to repair your damaged house.
 Make a plan to solve the problem.

145
  What is your goal?
 What do you need to achieve it?
 Who can help you?
 What needs to be done first, second, third, etc?
 How will you know you have completed your goal?
 Get feedback to help you understand the meaning of
this event and how it affects your life.
 Fill your life with music and art. These creative gifts
from the masters provide “food for the soul,”
unmatched by other more basic activities.
 Take walks, exercise, or meditate to reflect on positive
aspects of your life.
 If you are religious, consider celebrating gratitude for
your blessings in prayer.
 Be kind to yourself. Give yourself breaks or quiet
moments. Reach out to loved ones and friends. Go to
the movies or do some light reading.
 Eat and drink pure foods and water. Avoid self-medica-
tion, alcohol, and drugs.
 Stay in touch with friends and family. Communicate
and reach out for support from others.
 Pets can be a great comfort to traumatized individuals.
Play with your pets or, if possible, adopt one. If you are
unable to have a pet, consider volunteering at an ani-
mal shelter.
 If possible, and if you have the strength, find some-
thing to laugh about each day. Sometimes a crisis or
catastrophe puts life’s priorities in perspective. Often

146
 this is the time to let go of emotional baggage from the
past and begin to forgive others.
 Try to help others. It is beneficial to your recovery to
give to others, when you have the strength to do so.
While reaching out to others, you will heal by con-
tributing to their lives.
 After time has passed, it becomes easier to focus on the
“big picture.” This is a good time to initiate some social
action – getting legislation passed, advocating for disas-
ter victims, establishing or joining an advocacy group,
etc. Some of the agencies engaged in social activism
which are listed as resources in Chapter 7 were started
by victims of tragic events.
Anytime after a Disaster

Help Yourself
These things to do are intended to be used anytime after a
disaster. They are general strategies.
 Get as much accurate information as possible from reli-
able sources such as emergency management person-
nel on the scene.
 Express feelings to someone whom you trust, such as a
crisis counselor.
 Explore your support systems and make plans to con-
tact relatives and trusted friends for comfort.
 Find and contact key agencies that can offer support.
These include the Red Cross, The Salvation Army,
FEMA and other agencies. [See Chapter 7 – “Seek Help”
– p. 126.]

147
  Use stress management techniques. [See “Do You
Know?” –“Relaxation Exercises” – in this
chapter, p. 163. ]
 Get sufficient rest whenever possible.
 Talk to others about what has happened.
 Engage in healthy behaviors. This enhances your
ability to cope with excessive stress.
 Exercise.
 Pursue relaxing leisure activities.
 Perform relaxation exercises.
 Avoid drugs and alcohol.
 Meditate.
 Use biofeedback.
 Consider seeking hypnotherapy.
 Change your physiology (face: from frown to smile;
posture: from rigid to relaxed, from bent to erect).

THINGS TO THINK ANYTIME AFTER A DISASTER

These are thoughts and attitudes that can help you to stay
calm, plan some recovery strategies, and keep your faith.
They are useful anytime after the event.
 It is okay for your thoughts to seem empty. It is also
natural to go into the “pretend it didn't happen mode"
to protect yourself from the event.
 In your mind, stay in the moment, but prepare for the
future.

148
 Challenge your negative beliefs. Replace such thoughts
as, ”I always have bad luck…, nothing will be better
from now on…, everything sucks,” with, “How could I
know that…, is there any real reason to think that…,
maybe things will change for the better.”
 Adjust your self-talk. Replace negative messages with
positive messages, for example, from, “No way! I’ll
never get through this,” to “I can do this…, it is okay to
feel scared, but I can take the edge off by breathing
deeply and taking a stress break.”
 Think of previous ordeals that you have successfully
overcome and use these as a “power base.” Imagine a
way you would like to get through this time of crisis. In
your mind’s eye, reactivate a previous ordeal that you

Help Yourself
have overcome. Think of what you did to get through
that crisis. Use similar strategies to deal with the cur-
rent situation.
 Tell yourself to relax and breathe low and deep.
 Remind yourself to practice stress management tech-
niques.
 As you imagine worst-case scenarios, try to think of
alternative outcomes, for example, “I can see my
friends…, I can get back into my routine…, I can enjoy
the little things in life.“
 Think of a positive role model, someone you admire in
your own life or in public life, and visualize this person
facing your disaster. Imagine what he might think to
deal with it more effectively. Based on your style and
personality, borrow and use his thinking strategies.

149
  Remember how things change over time. For example,
try to recall a previous crisis in your life and, as you
look back, remind yourself that now it seems less
catastrophic.
 If possible, imagine how you will look upon this event
in the future.
 Think of something positive to do to help yourself to
return to normal activities after the disaster has
subsided.
FEAR MANAGEMENT
“Nothing is so much to be feared as fear.”
Henry David Thoreau
1851

“The only thing we have to fear is fear itself.”

Franklin D. Roosevelt
1933

Since September 11, 2001, Americans have gained a

greater awareness of their vulnerability not only to terrorist
attacks but also to other disasters. As a global community, we
experience the ever-present worldwide threats of disasters.
Via the internet, we learn instantaneously what is happening
around our planet. We witness the suffering of others as the
media broadcasts live video of the latest catastrophe. In the
face of disaster and terrorism, we can allow fear to dominate
our lives, or we can control our fear.
Fear management is a method to control our fear. It
helps us cope with our anxiety during heightened Homeland
Security terrorist alerts and natural disaster warnings. This
method allows us to overcome our complacency, maintain
our vigilance, and be ready without becoming overwhelmed.

150
We offer you our FEAR NOT mnemonic to help you learn
and remember the basic strategies of fear management.

Focus on possible dangers.

Be vigilant. You actually increase your safety if you think
about dangers rather than if you live in denial. Nevertheless,
being mindful of what might happen does not mean that you
have to replay the worse case scenario over and over in your
mind. Balance is important. Avoid the extremes. Terence
advised, “Moderation in all things.”

Examine the environment.

Scan around you. Think and behave like security and
safety experts. For example, when a security expert walks
through a parking garage, she notes the locations of the exits,

Help Yourself
stairwells, and the alarm buttons. When a safety expert stays
in a hotel he locates the fire exits. In addition, he notes how
far the nearest exit is from his room and what route he needs
to take from his room to the exit. By performing similar
actions, you key your mind on the safe harbors.
Assess risk.
How likely is it that something will happen? In the
beginning of Chapter 1, we asked several questions to help
you assess risk. By knowing the frequency of various events,
you can place your fears about what might happen into a
proper perspective. People usually dread that a “big one” will
occur, but do not give much thought to the many dangerous
things that happen on a daily basis and that can be prevent-
ed. Although you should prepare for terrorist attacks, you
should also focus on the more common traumatic occur-
rences. For example, most people do not worry about driving.
However, driving is dangerous. Motor vehicle accidents hap-

151
pen frequently. As a society, we have benefited when we have
reduced everyday trauma and its consequences. For example,
by the increased use of seatbelts, motor vehicle accident
injuries and fatalities have greatly decreased. In addition, we
can reduce the number of accidents by driving safely.
R estructure your thoughts.
“I have a new philosophy: I’m only going to
dread one day at a time.”
Charles Schulz, Charlie Brown in “Peanuts”

As human beings, we often make faulty assumptions

and process information in ways that work against us when
we try to manage our fear. Nevertheless, by being aware of
these possible pitfalls in our thinking, we can restructure our
thoughts to our advantage. What are these assumptions and
thought processes, and how can they be corrected? We pres-
ent a list of things to do or think. We also provide descrip-
tions of the false assumptions or unproductive thought
processes that are corrected by following the strategies
below.
 Trust your intuition.
We think too much. Sometimes it is good to ponder an
idea or thoroughly analyze a situation; sometimes is it better
to act on intuition. Our intuition is the best tool that we have
to alert ourselves to potential danger. Nevertheless, we are
capable of talking ourselves out of our hunches and “reason-
ing” away our concerns. In certain situations, “thinking too
much” can be dangerous. You may see that something is out
of place, notice an apparent contradiction, sense that some-
thing is “just not right,” or feel uneasy “in your gut.” These
are situations when it is best to “lose your mind and come to

152
your senses!” Check out your suspicion on your own, if it is
safe to do so, or notify the proper authorities.
A few months after 9/11, one of the authors noticed a
canvas bag sitting on a stoop as he was about to enter a local
high school. Without touching the bag, he peered into its
open top and was able to read handwritten notes on “bomb
making.” He immediately notified the police officer inside
the school. Although it turned out that the bag belonged to a
student taking a class on terrorism and this “suspicious pack-
age” was not dangerous, it was better to be safe than sorry if
it really had contained an undiscovered bomb that caused
massive destruction.
 Emphasize the positive.
We dwell on the negative. Some individuals even “cata-

Help Yourself
strophize,” that is, constantly imagine the worse case sce-
nario. There is no question that bad things happen.
Nevertheless, many good things also happen and you can
lessen your fears if you focus on, engage in, and enjoy these
good things.
 Avoid jumping to conclusions.
We misuse logic. It seems as if our brains are hardwired
to automatically think of explanations for what occurs
around us. Just because an event precedes another event, we
often assume that the first event caused the second. Even
without any proof, we act on false cause-and-effect assump-
tions. When combined with negative thinking, this logical
fallacy can generate enormous worry. For example, if we were
to see a van speeding down the street and then hear an explo-
sion, we might assume that the occupants of the van were
responsible for the explosion. Our negative thinking might
lead us to conclude that terrorists were in the van and, thus,

153
the explosion was an attack. We would become very fright-
ened. Later, we might learn that the explosion was accidental
and unrelated to the van. Therefore, it is better to challenge
your assumptions rather then jump to conclusions.
 Place statistics in perspective.
We are poor natural statisticians. We often go about our
daily routines with an attitude that “nothing will ever hap-
pen to us.” However, after a traumatic event does happen, we
go to the other extreme and fear that we are in constant jeop-
ardy of a recurrence. This fear is particularly pronounced if
we were impacted directly by the traumatic event. Once we
have experienced a trauma, we may even develop an “atten-
tional bias,” that is, sensitivity towards trauma-like stimuli.
Therefore, we sense imminent danger when there is no real
threat.
You should keep in mind that statistics demonstrate
that events have a particular probability of occurring, and the
fact that a person has experienced an event does not mean
that she will experience the event again. “Lightning doesn’t
strike twice” is a saying that expresses the low probability of
a person repeatedly experiencing an event, although Roy C.
Sullivan is on record for having been struck by lightning
seven times. The good news is that he is the “exception that
proves the rule,” and lived to tell of each and every experi-
ence. Obviously, if you continue to live in a place that is at
risk for certain disasters, such as hurricanes in Florida, then
you will be more likely to have repeated encounters with hur-
ricanes over your lifetime.
In addition to this all-or-none error, we often misunder-
stand probability in general. For example, each of the events
listed in Chapter 1 has a 100% chance of happening at some

154
time in the future. How frequently it might happen and how
many people might be involved are entirely different statis-
tics. Shortly after 9/11, a terrorism expert stated that there
would be a 100% chance of another terrorist attack. At that
time, some people interpreted this to mean that another
attack was imminent and that they would definitely be vic-
tims. To place the “100%” figure in perspective, it is worth-
while using a lottery analogy. On the one hand, the chance of
someone winning a lottery is 100%. The amount of the jack-
pot may build up over several weeks because there have been
no winners. But as people continue to play, someone eventu-
ally wins. On the other hand, the chance of a specific person
winning a lottery could be as high as one in about 135 million.
 Learn from history.

Help Yourself
We assume that whatever is unknown and seems uncon-
trollable is more dangerous, even though intrinsically it is not.
For example, tobacco smoking is very familiar and can be con-
trolled; terrorism is viewed as unknown and uncontrollable.
Nevertheless, smoking tobacco is more deadly. In the United
States, international terrorist incidents from 1991 to 2000
caused, on average, one fatality every 260 days, but a tobacco
related death occurred every 1.3 minutes. Remind yourself
that terrorism is not new. It has been around in an organized
form for at least several hundred years, perhaps starting when
one group of people catapulted plague infected corpses into
the midst of another group. Reading the quotations in this
guide may also help you gain a healthy perspective. These
quotes can reduce your fears by providing a connection to
the past. For example, President Roosevelt’s 1933 admonish-
ment at the beginning of this section reminds you that for-
mer generations faced and conquered similar daunting cir-
cumstances with resiliency.

155
  Remind yourself that you can be safe without
controlling everything.
We assume that what we cannot control will be a threat to
us. In this case, you should remind yourself that many natu-
ral events take place beyond our control but are harmless. In
fact, many occurrences outside our control are actually bene-
ficial.
 Work on what you can control.
We worry about what we cannot control. If you are con-
cerned about “control,” it helps to separate “good” worry
from “bad” worry. “Good” worry motivates. When we engage
in “good” worry, we take action that will benefit us. For exam-
ple, worrying that you might fail an examination motivates
you to study so that you increase your chances of passing it.
“Bad” worry is dwelling on something that your worry will
not change. It wastes your time. Apply Reinhold Niebuhr’s
serenity prayer – “God, give us grace to accept with serenity
the things that cannot be changed, courage to change the
things that should be changed, and the wisdom to distin-
guish the one from the other.” Therefore, why not spend
your energy changing what is under your control?
 Think that maybe “size does not matter.”
We think that size alone defines the characteristics of
something. In other words, we assume that if something is
bigger, it is totally different from something smaller. After
9/11, it did not calm the fears of Americans for us to hear pun-
dits say: “Nothing like this has ever happened before.” “This
is a whole new ballgame.” It was the immensity of 9/11 that
made it appear entirely different. When confronted with
something so massive, our previous successes in overcoming
disasters on a smaller scale may do little to reassure us. It

156
appears to be totally “unknown,” and the “lessons learned”
from battling other disasters do not seem to apply. If you are
in this state of mind, you should particularly look at Chapter
3 “Learn What to Expect” and Chapter 5 “Learn How We
React.” Although disasters produce chaos, they follow cer-
tain patterns. Our collective emotional reactions, and the
principles of disaster response and recovery are the same no
matter what the size of the disaster. Finally, if you are not
convinced by this “size does not make a difference” argu-
ment and are still frightened, all you need to do is look back
in history. The attack on Pearl Harbor on December 7, 1941,
although different from 9/11, was equally sudden, massive,
and devastating.
 Focus on the universal aspects of your experiences.

Help Yourself
We think that what we experience is unique. In many
ways, that is true. Nevertheless, there is a commonality about
trauma and tragedy that we can all experience and share. If
you focus only on the uniqueness, you feel alone and differ-
ent. This increases your fear. Express your fears to others,
share your experiences, and gain support.

Natural protection: Accept that fear is protective.

Fear is not bad. We admit that our mnemonic might be
misleading in this respect. We do not believe it is safe or
healthy to live without fear. Fear and also anxiety are instinc-
tive emotions that protect and even motivate us. However,
there are optimal levels of fear and anxiety. Too little can
leave us unprepared. Too much can interfere with our func-
tioning. Humor and faith can counteract excessive fear and
can be protective in the face of disaster and terrorism.

Observe particular principles.

157
 By practicing two sets of principles – prevention and pre-
paredness, safety and security – you can become proactive
and lessen your fear. This guide provides you with many spe-
cific strategies that you can use in order to put these princi-
ples into action

Threat alarm: Use how your mind/brain works to your

advantage.
Knowing how something works dispels the mystery; we
are reassured. We can either think of our minds/brains as
“black boxes,” the contents of which are unknowable, or we
can learn what scientists have discovered about how they
work. We can use what we know about the psychobiology of
fear and anxiety to better control our feelings. For example, it
is comforting to know that our brains contain a threat alarm
or fear circuit that protects us from life threatening danger.
Joseph LeDoux, a neuroscientist, identified the amygdala,
two small almond-shaped areas on each side of the brain, as
the key components in this fear circuit which also processes
sensory input and produces the startle response and fight-
flight-freeze behavior. The amygdala monitors our environ-
ment for danger. If you step off the curb just as a truck is
speeding down the street, this system senses the danger and
causes you to automatically jump back in a matter of millisec-
onds without any conscious thought. However, there is a
downside to possessing this threat alarm system. It works
well only in regard to direct threats. In addition, it can condi-
tion us to fear non-threatening stimuli. But we have another
brain function – thought – that we can use to modify our con-
ditioned fear. A key player in this function is the medial pre-
frontal cortex that interacts with the amygdala and modu-
lates its activity. Therefore, our thinking can relieve our fear.

158
Thought restructuring strategies, like those above, work to
control and lessen fear.

DO YOU KNOW?
Crisis Counseling: Yes or No?
Do you know that you may need to decide whether to
participate in crisis counseling?
During the aftermath of a disaster or terrorist incident
that affected you, someone may likely approach and offer you
crisis counseling. Since your participation in any type of psy-
chological counseling is voluntary, you need to decide
whether to participate. What do you need to know in order to
make an informed decision?

Help Yourself
Crisis Counseling and Crisis Intervention
Crisis counseling is an umbrella term used for any type of
psychological intervention during a crisis or after a disaster.
These interventions are not treatments or therapies although
they may facilitate healing. Crisis intervention is a specific
method that developed out of the work of two psychiatrists –
Erich Lindemann, M.D., who studied the survivors of the
tragic 1942 Cocoanut Grove nightclub fire in Boston, and
Gerald Caplan, M.D., who worked primarily with families in
crisis. The dual goals of this method are: 1) to reduce the
impact of the stressful event, and 2) to help individuals not
only solve the present problems but also enhance their abili-
ty to cope with future adversities.
Psychological Debriefing
Psychological debriefing (PD) is a one-time structured
activity to process trauma by talking about the experience.

159
The purpose of this activity is also to provide information
about traumatic stress and stress management. The debrief-
ing is usually done as a group activity that is directed by facil-
itators. It takes place ideally between 24 and 72 hours after a
traumatic event, but can be performed within weeks of such
an incident. There are different versions of PD.
There is an ongoing debate in the field of disaster mental
health about the use of PD. The International Critical
Incident Stress Foundation supports the use of a particular
type of PD called Critical Incident Stress Debriefing (CISD),
which is the most widely used method. Other experts in the
field warn against using CISD or any PD method because PD
may be harmful.
What is CISD? In 1983, Jeffrey Mitchell, Ph.D. designed a
group PD method consisting of a seven phase process to be
used by emergency personnel – emergency medical techni-
cians, firefighters, paramedics and police – after a critical inci-
dent, for example, being confronted with a fatality while per-
forming their duties.
Initially, experts had hoped that PD would prevent the
development of posttraumatic stress disorder (PTSD) after
exposure to a traumatic event. Presently, there is no scientif-
ic evidence that any intervention – either psychosocial or
medication – shortly after a traumatic experience prevents
the development of PTSD. Nevertheless, research studies of
PD demonstrate that most of the individuals who have partic-
ipated in psychological debriefings have been satisfied and
found them useful. Recently, a few studies have demonstrat-
ed that individuals who were highly aroused at the time of
the PD actually fared worse than other highly aroused indi-
viduals who received no intervention. In response to this

160
data, ICISF has emphasized that CISD is not meant to stand
alone as a one-time intervention. It should be part of an
entire program called Critical Incident Stress Management
(CISM) that has multiple components.
Over the years, the use of CISD has spread widely as a one-
time intervention. It was originally developed for members of
pre-existing groups, such as people who work together. In
addition, these co-workers likely experienced the traumatic
event together. Now CISD is also used inappropriately for
individuals who do not comprise a pre-existing group but are
put together for a PD only because they have been involved
in the same disaster. For example, strangers should not be
together in a PD just because by chance they came to the
same evacuation center. In addition, the trained PEER coun-

Help Yourself
selors who conduct this intervention are required to work
with and be supervised by mental health professionals.
Although the ICISF officially sanctions CISM teams to per-
form interventions for emergency personnel, there are free-
lance teams which respond to aid disaster victims, but which
are not comprised of mental health professionals and do not
have proper supervision. We recommend that you avoid
interventions conducted by these unofficial teams.
What should you ask?
There is some important information that you should
find out. If the person in charge does not provide this infor-
mation, you should raise some questions.
First, when you are directed to participate in a “debrief-
ing” you should ask, “What is the purpose of the meeting?” It
might not be a PD but a briefing, that is, a way to provide the
available facts of a disaster to those who need to know. For
example, an airline will hold periodic briefings with the rela-

161
tives of the passengers after a commercial aviation disaster.
The meeting might also be an educational forum to provide
information about available resources and the procedures for
obtaining aid. For example, the staff at a family assistance
center might hold such an educational meeting.
Second, if you are offered any type of crisis counseling,
including a PD, you should ask: “Who is sponsoring it?”
“Who will conduct it?” “What training do the leaders have?”
“What are their credentials?” “What is the expected result?”
“Are there any potential adverse effects?” “How will confi-
dentiality be maintained?” After receiving the answers to
these questions, you can make your decision whether to par-
ticipate. If you have any doubt, avoid participation.
Psychological First Aid
There is a consensus developing among disaster mental
health experts that psychological first aid is the preferred psy-
chological intervention in the immediate aftermath of a dis-
aster or terrorist incident. This method emphasizes protec-
tion and support. It is used to lessen the psychological injury
and reduce the physiological reaction to a traumatic event. It
consists of protecting the survivor from further harm, reduc-
ing the emotional and bodily arousal triggered by the trauma,
mobilizing support for those who are most distressed, keep-
ing families together or facilitating reunion with loved ones,
providing information, and fostering communication and
education. This method differs greatly from crisis interven-
tion and PD, because it does not require the survivor to talk
about the traumatic event.

162
 Relaxation Exercises
Do you know there are a variety of relaxation techniques that
will help you control your stress in the face of a disaster or
trauma?
Here is an example:
Benson’s Relaxation Technique
The relaxation response is a physical state of deep rest that
changes the physical and emotional responses to stress (e.g.,
decrease in heart rate, blood pressure, and muscle tension). If
practiced regularly, it can have lasting effects when encounter-
ing stress throughout the day and can improve health. Regular
elicitation of the relaxation response (RR) has been scientifi-
cally proven to be an effective treatment for a wide range of
stress-related disorders. In fact, to the extent that any disease
is caused or made worse by stress, the relaxation response can
help. Elicitation of the relaxation response is not difficult.
There are two essential steps to eliciting the RR:
Repetition of a word, sound, phrase, prayer, or muscular
activity.
Passive disregard of everyday thoughts that inevitably
come to mind, and then return to your repetition.

Help Yourself
The following is the generic technique taught at the
Mind/Body Medical Institute:
1. Pick a focus word, short phrase, or prayer that is firmly
rooted in your belief system, such as "one", "peace", "The
Lord is my shepherd", "Hail Mary full of grace”, or
"shalom".
2. Sit quietly in a comfortable position.
3. Close your eyes.
4. Relax your muscles, progressing from your feet to your
calves, thighs, abdomen, shoulders, head, and neck.
5. Breathe slowly and naturally, and as you do, say your
focus word, sound, phrase, or prayer silently to yourself as
you exhale.
6. Assume a passive attitude. Don't worry about how well
you're doing. When other thoughts come to mind, simply
say to yourself, "Oh well", and gently return to your
repetition.
7. Continue for ten to 20 minutes.
8. Do not stand immediately. Continue sitting quietly for a
minute or so, allowing other thoughts to return. Then
open your eyes and sit for another minute before rising.
Practice the technique once or twice daily. Good times to do so
are before breakfast and before dinner.
Benson’s Relaxation Technique reprinted by permission of
the Mind/Body Medical Institute. www.mbmi.org 9
HELP

163
OTHER
9 HELP OTHERS

THINGS TO DO p. 165
Immediately (Response Phase) p. 165
Over Time (Recovery Phase) p. 167
Anytime after a Disaster p. 167

THINGS TO SAY AND AVOID SAYING

ANYTIME AFTER A DISASTER p. 169
Things to Avoid Saying
(Not Helpful or May Be Harmful) p. 169
Things to Say p. 171

GROUPS WITH SPECIAL NEEDS p. 171

ABC’s of Caring for Children p. 171
Accommodating the Physically Disabled p. 179
Caring for Seniors p. 180
Collaborating with People with
Serious Mental Illness p. 1181

SELF-CARE WHILE YOU HELP OTHERS p. 181

DO YOU KNOW?

Donations for Disaster Relief and Recovery p. 182

Volunteering: Helpful or Dangerous? p. 183

164
 HELP OTHERS
“What do we live for if not to make the
world less difficult for each other?"
George Eliot
circa 1871

Your support of others offers hope and helps them

develop resiliency. Whether they are friends, relatives, co-
workers, or strangers, your help is important to their emo-
tional well-being. Research suggests social support during
the exposure to or during the recovery from a traumatic event
may reduce the possibility of an individual developing
Posttraumatic Stress Disorder. Your greatest gifts to others
sometimes go unrecognized until time has passed. After
their recovery, they may remember you as a comforting and
supportive figure. And, you will also find that giving to oth-
ers will promote your own learning and healing.
Below are the most effective ways of responding to oth-
ers. These responses are listed in three categories: 1) “Things
to Do, 2) “Things to Say and Avoid Saying”, and 3) “Groups Help Others
with Special Needs.” Choose the responses most natural and
comfortable for you. Most responses are effective anytime
after a disaster. However, there are some responses that are
only relevant soon after a disaster in the Response Phase and
others that are appropriate over time in the Recovery Phase.
In addition, this section includes “Self-Care While You
Help Others.”
THINGS TO DO
Immediately (Response Phase)
These things to do are more intended to assist another indi-

165
vidual with safety issues and to reach out to meet the per-
son’s needs soon after the disaster.
 Take survival action.
 Lead others out during an evacuation.
 Rescue, if possible.
 Attend to those who need assistance, without
endangering yourself.
 individuals who have collapsed
 individuals who have signs of acute distress
 individuals who are injured
 Assess
 vital signs (breathing and pulse)
 for injuries
 Administer
 CPR, if individual is unresponsive and in pul
monary arrest or cardio-pulmonary arrest,
if certified
 First Aid, if certified
 Get emergency medical or surgical treatment for those
in need.
 Address psychological needs.
 Scan the area for emotionally distressed individuals
who may need help.
 Respond to distressed individuals and offer to help.
 If survivors appear very distraught, move them away
from others, if possible, while talking calmly with
them.
 Help move emotionally distressed victims who are
immobilized to safety.
 Help others to tolerate sheltering in place, when
sheltering in place is necessary.

166
  While offering emotional support, observe for and
inquire about any medical warning signals such as
shortness of breath, dizziness, or chest pain. If neces-
sary, seek medical assistance.
 When possible, reinforce the fact that safety is being
secured.
 Upon request, seek information about the condition
of loved ones or friends.
Over Time (Recovery Phase)
After time has passed, these recovery actions help others
return to their normal routines. As someone taking a sup-
portive role, you should encourage survivors to engage in
the following self-care activities.
 Maintain routines.
 Organize memorial events, share meals, and build
monuments.
 Read self-help books on coping with disasters and
crises.
 Take stock periodically by rating stress level, sleep, job
or school functioning, and relationships. Use a 1-10 Help Others
scale to determine any of these areas that need further
attention.
 Periodically review recovery plans.
Anytime after a Disaster
These things to do are intended to assist others anytime
after a disaster. They are general helping skills.
 Arrange for health and mental health care needs.
 Do not administer any medical procedures that require
training and certification unless you possess those
qualifications.

167
 Provide whatever accurate information you have in
answering the individual’s questions.
 If someone is reacting emotionally, tell him that it is
normal to be upset, and if he were not upset, you
would be very concerned about the way he was coping.
 Empathize and re-assure.
 Listen actively by making eye contact and tuning in to
the other person’s physical and mental state.
 Use the person’s name when you speak to her.
 Encourage the person to express feelings.
 Be non-judgmental.
 Be supportive but avoid enabling.
 Honor different cultures and beliefs.
 Be sensitive to the ways various cultures might react to
a situation. Resist promoting your way of reacting as
the only way.
 Find out about the victim’s support systems and
encourage him to contact relatives and trusted friends
for comfort.
 Assist the victim to contact key agencies that can offer
support. These include the Red Cross, The Salvation
Army, FEMA and other agencies. [See Chapter 7 – “Seek
Help” – p. 104.]
 Encourage the victim to tolerate uncertainty in the
immediate future.
 If you are trained in stress management techniques and
the victim is willing, you may instruct and coach him
to perform a relaxation exercise. [See “Do You Know?”
box – “Relaxation Exercises” – in Chapter 8, p. 163.]

168
  Silent support, often called witnessing, is a powerful
way to connect with people, and is more effective than
hollow conversation.
 Listen, listen, listen!
THINGS TO SAY AND AVOID SAYING
ANYTIME AFTER A DISASTER
“Speaking without thinking is shooting without aiming.”
Anonymous

The words you say in the midst of crisis situations are

especially powerful. The right ones can help a survivor
acquire the most effective emotional state to cope with a trau-
matic situation. The wrong words can completely undermine
a person’s ability to cope. The ways of using words described
below are intended to strengthen individuals and assist
them to cope with trauma.
Most of all, how you deliver your verbal responses is crit-
ical to the way they impact others. Your message is only effec-
tive if your receiver defines it as such. Establish rapport.
Show concern and be gentle. Your sincerity and authenticity
are essential to the well-being of those you reach. Remember
Help Others
that the impact of your message is defined by the way others
respond. Nevertheless, do not expect all victims to embrace
your attempts to reach out. Many victims may be too upset to
listen.
Things to Avoid Saying (Not Helpful or May Be Harmful)
This section appears first because there are a number of
verbal responses that can intensify trauma and anxiety in
those facing critical incidents. It is important to use good
judgment and resist the urge to rush in and “fix the prob-
lem.’’ That is why we are identifying some of the responses

169
that can be ineffective or damaging to the victims you
address. We present some things that many people often say
and the reasons not to say them.
 “I understand.”– Only the person having the experi-
ence can truly understand it from their own perspec-
tive.
 “You’re lucky you survived.” – A person who has been
traumatized or who has lost a loved one does not feel
very lucky.
 “The good die young.”– It all depends on your beliefs
about the spiritual realm. It is hard to match your
beliefs with another’s, so don’t try.
 “The angels took your loved one to heaven.” – The per-
son might have a different belief and such a remark
could backfire and spur anger. It is better to check first
with the person to determine his beliefs or attitudes
towards religion.
 “It could be worse.” – The person will not believe this
after enduring such a traumatic event.
 “Let me tell you what happened to me.” – At this criti-
cal time the victim is not interested in hearing the
helper’s trauma story.
 “You need to get on with your life” – The person is not
able to even think of the future. He needs to stay in the
moment and process what has happened. By suggest-
ing that he move on, you may rob the survivor of the
necessary steps in the process of grieving or recovering
from the trauma.
 “You think this is bad. I’ve been through worse.” – The
person will feel you are competing with him in a
“biggest victim/worse disaster contest.”

170
 Things to Say
This section identifies some responses which can make
others feel more comfortable or process the event in con-
structive ways.
 “What can I do to make you more comfortable? – An
obvious way to present yourself as someone who cares.
 “I can only imagine how horrible this must be for
you.”– This approach validates that you are not trying
to second guess the person’s exact feelings. It gives the
person room to deal with the situation in his best way.
 “This wasn’t your fault.” – Many victims feel guilty that
they have survived and others did not (survivor guilt).
They think they should have done something to save
other people. “If only I had…..” This response lets
them know that they are not responsible. It may help
to reduce their guilt. (Note: This applies only to people
who have not actually caused or contributed to the
negative event.)
 “You are safe now.”– Say this only if she is really out of
danger. Help Others
 “Things may never be the same, but they can improve
with time” – This helps to put things into perspective
and gives someone hope for the future. It can also start
the healing process.
 “Believe it or not, I might understand. Something like
this happened to me.” – There is an appropriate time
and a proper way to let the victim know that he is not
alone, that is, others have had similar experiences.
GROUPS WITH SPECIAL NEEDS
ABC’s of Caring for Children

171
 Age Appropriate: Children respond differently at dif-
ferent ages. What is appropriate for a toddler would certainly
not be appropriate for an adolescent. Therefore, you should
individualize your responses to each child according to her
age. An adolescent may cope by being involved with her peer
group – for example, scouts, candy-stripers, etc. – but a
younger child would obviously not have these support sys-
tems and will need your individual attention. Talk at her
level. Avoid technical terms a young child would not under-
stand. Do not use very simple words with teenagers since
they may view this as patronizing and possibly even insult-
ing.
Balance: A key principle of stress management, and for
living one’s life in general, is balance. Extremes can be dis-
tressful and even dangerous. Everything in moderation is a
good rule. For example, you do not have to eliminate your
child’s TV watching. It is okay for an older child or adolescent
to watch TV news or other programs about the disaster.
However, put some limit on the amount of time your child
spends watching these programs. Watch the TV news with
him, discuss it, and then engage him in other activities.
Care for Yourself: Several studies have demonstrated
that a child’s distress level frequently mirrors her parents’.
Therefore, caring for yourself is the first and foremost way of
helping your child. [See Chapter 8 – “Help Yourself” – p. 141.]
By getting your distress under control, you serve as a role
model for your child. Your behavior shapes your child’s
behavior.
Dreams: Teach your child that dreams are not mysteri-
ous. You should say, “It is only a dream. It is not real, but it
can mean something to you.” There is even a study that

172
demonstrates that individuals may be able to control and
change the content of their dreams. Talk with your child
about his dreams, if he feels comfortable about revealing
them to you. An older child can study his dreams and learn
their personal meaning. This can help him put the ordeal
into perspective.
Emotion and Empathy: Feelings are okay. They are nat-
ural. Feelings are genuine. Although what we might feel may
be out of proportion to a particular situation, it is still how we
feel. You may not agree with how your child feels about what
has happened because you feel differently about it. Although
you may not agree with your child’s feelings, you can
empathize, by imagining her point of view. Be sure to respect
her feelings. Do not attempt to talk her out of her feelings.
Facilitate: As an adult, you have abilities that your child
might not have. Therefore, a major role for you is to facilitate
what is necessary for your child to cope. For example, if your
young child expresses the need to raise funds for the disaster
victims, make it a project for both of you so that you may
guide him. If your adolescent wishes to volunteer his servic-
es, call a co-worker whom you know volunteers for a disaster
Help Others

relief organization, and arrange for your child to meet with

him.
Gifts: A gift is doing something special without needing
to be asked. Even though you regularly give to your children,
this is an especially significant time to give. Your gift might
be to go on that day trip you were planning together but have
been too busy to do. Your gift could be doing what she really
likes, even if you do not enjoy it. For example, see a children’s
movie.
Hugging and Holding: These need no explanation.

173
 Individualize: “One size does not fit all.” Each child
may need something different because of his personality and
temperament. There is more than one way to react and cope
with tragedy and trauma. One child may cope best by main-
taining some solitude; another child by being socially
involved.
Join Together: Spend more time with your child. Doing
family activities, especially at a time of tragedy and trauma, is
very supportive and reassuring.
Kindness: Show your kindness to others, especially
those in need among your neighbors. Children learn by
example. This is the time to be especially kind.
Love: The lyrics of the Beatles song state, “All you need
is love, love, love is all you need.” Demonstrate and express
your love for your children.
Meaning: There are two “meanings” in regard to expe-
riencing trauma. The first is the specific meaning the trauma
takes on for the individual. This is usually the answer she
seeks to such questions as, “Why me?” or “Why did this hap-
pen?” “What can I learn from this to improve my life?” There
is a larger meaning that has to do with one’s life viewpoint
and beliefs. This meaning exists before one is exposed to the
trauma and shapes how one answers the questions previous-
ly stated. This meaning involves one’s culture and religion. It
relates to spirituality. When faced with tragedy and trauma,
affirming the family’s shared values or religious beliefs pro-
vides comfort and hope.
Normal Reactions: Most reactions are natural and tem-
porary. A very young child may regress, that is, go back to for-
mer behavior. For example, a toddler may return to thumb-
sucking or lose bladder and/or bowel control after having

174
been toilet trained. A latency age child (6 through 11 years)
may bed-wet or cling excessively. Avoid over-reacting to or
punishing your child for these behaviors. Give your child
extra attention and care. Help him to regain his most appro-
priate behavior. An adolescent, for example, may withdraw or
become irritable. Show him you care by helping him “weath-
er the storm.”
“Normalization” is the act of reassuring another that his
behavior, thoughts, or feelings are natural or normal reac-
tions to a situation. For example, to “normalize” your 16-year-
old’s reactions, you might say, “ I can see why you’re out of
synch, but please don’t take it out on me.” For your 10-year-
old, you might offer, “It’s okay to be sad. I’m sad too.”
Observe: Watch your child’s behavior to reassure your-
self that she is having a normal reaction to a traumatic event,
or to detect warning signs of difficulty. Intense and/or per-
sistent reactions should be professionally evaluated.
Intervene and get help if there is use of alcohol or drugs. If
you have any question or concern about your child’s reac-
tion, consult an appropriate health or mental health
professional.
Help Others

Process and Play: Reacting to and recovering from a

disaster is a process. Do not expect everything to immediate-
ly return to “normal.” Play, for a younger child, is a way to
process his experience and relieve tension. It also helps a
child gain mastery over an otherwise overwhelming event.
For example, in reacting to the attack on the World Trade
Center, a young child may have needed to repeatedly build
two tall towers out of blocks, only to angrily “knock them
down.” Allow your child to process the disaster. Such behav-
ior may make you uneasy, but do not stop it, although you

175
need to intervene if his behavior becomes genuinely destruc-
tive.
Questions and Respect: Encourage your child to ask
questions. Do not bar questions or change the topic when
she asks a question. You may also ask questions, but do not
interrogate your child. Make yourself available. Listen, listen,
listen! This allows your child to express her thoughts and
feelings, and process her experience. Remember to use the
principle of “balance.” There is a time to ask questions, a time
to encourage your child to talk about her experience, and a
time to respect her silence.
Routine and Ritual: Children need structure and sup-
port. Therefore, maintain your regular routines and sched-
ules as much as possible. Try to continue to observe your
family rituals, such as birthday celebrations, annual barbe-
cues, or religious observances.
Safety and Security: A major task for you is to keep your
child safe and secure. [Follow the safety and security proce-
dures in Chapter 3 – “Prevent” – p. 29.]
Talking, Truth and Timing: Talk to children truthfully.
You may wish to use the opportunity of a disaster to teach
your child some truths about life. Parents are protectors of
their children. When a child is young, you can hold his hand
to prevent him from running into danger. When he is older,
you cannot constantly guard him or physically rescue him
from every threat. You can only hope that he will use what
you have taught him to protect himself.
We often automatically utter statements that might not
be true. For example, “Everything will be all right” is a lie
unless you are positive that it will. “There is nothing to worry
about” is a lie if there is something to worry about. Children

176
can often sense that there is something wrong or that you are
upset. They just might not know what is wrong or what is
upsetting you. Therefore, it will only distress your child if
you falsely reassure her. In addition, she will likely learn from
another source what you have withheld. Isn’t it better to have
her learn the truth from you, so that you can be emotionally
supportive and give her guidance?
You can be informative and truthful without “letting it
all hang out.” You do not have to blurt out all the horrible
details. You can often say things in a way that is reassuring
and hopeful.
Timing is important. For example, a good method to
convey “bad news” to anyone is to do it in small doses over
time, if possible. This allows the person to adjust rather than
to be shocked. How do you know when it might be a good
time to give your child information? Your child’s asking you
a question is one indication of the correct time. Nevertheless,
it is best that you only answer the question he is asking so
that you do not overwhelm him with too much information.
You may ask questions to clarify what your child is really
seeking. Remember to give age-appropriate answers.
Help Others

Express your feelings if you are comfortable doing so.

Hearing that “mommy and daddy are sad” but seeing that
they are still functioning sets an excellent example. Such
behavior is normalizing. Talking truthfully to your child also
gives her an opportunity to express her thoughts and feel-
ings.
Understand: To take care of children, it helps if you
understand them, that is, be thoroughly familiar with their
makeup, with “what makes them tick.” Learn the normal
behavior that children exhibit at various stages of develop-

177
ment. Learn the natural responses children might have to
trauma. [See the table – “Children’s Reactions To Disasters” – in
Chapter 5, p. 100.]
Know your child’s individual characteristics. What is he
usually like? How does he behave when he is ill? What moti-
vates him? What are his interests? Is he a quiet person or a
talker? Etc., Etc., Etc. You can use this knowledge to help
your child prior to, during, and in the aftermath of a disaster.
Validate: In interpersonal relations there are two types
of validating. The first type is a process of testing if your
assumptions are correct. If you make an assumption about
what a person might be feeling or thinking, you should con-
firm your hunch. You can do this by saying, “You look wor-
ried to me. Are you?” or “If this happened to me, I would be
thinking . . . . Is this what you are thinking?” The second type
of validation is the act of acknowledging what another person
is feeling. If what your child is feeling is obvious, you might
say, for example, “I hear how sad you are,” or “You are angry.”
You may use both of these types of validation to help your
child.
Work: Freud’s definition of psychological health is the
ability “to love and to work.” Work is basic to our emotional
well-being. Unless it is not possible, you should set an exam-
ple by continuing to go to work. Work does not only mean
performing at a job. For example, you can also work on a
home project with your child.
eXercise: Physical activity breaks the tension. Regular
exercise promotes a “sound mind in a sound body,” because
exercise benefits our brains as well as our bodies. Exercise is
an activity that you and your child can do together.

178
 You: Yes, you! You are vital to your child’s well-being.
Therefore, take care of yourself. Didn’t we say this already?
Yes! We did. We said, “Care for yourself.” But, it is so impor-
tant, we are saying it again.
An important ingredient for good parenting is tolerating
your emotional turmoil – especially anxiety – for the sake of
your child. For example, you may have to tolerate being sep-
arated from your child while she is at school or an evacuation
center during a disaster. Although being reunited with your
child will relieve your anxiety, your child will become dis-
tressed upon seeing you in a severely agitated state.
Therefore, it would better if you take some time and avoid
rushing to her side until you get your own distress and
aroused behavior under control.
Zebras: Zebras? Yes! Zebras! Think of Disney cartoons
with appealing animals. How do they make you feel?
Sometimes it helps to be silly, especially with younger chil-
dren. It breaks the tension.
Accommodating the Physically Disabled
The physically disabled often will have special needs Help Others
after a disaster. The devastation produced by the disaster
may impede the mobility of an individual who was previous-
ly getting around his community. The need for services will
vary according to an individual’s degree of disability. You
may need to take a more active role to move a physically dis-
abled person to safety, and to arrange for assistance. For
someone who is homebound, you will need to make home
visits. If an individual’s usual services are disrupted – for
example, meals-on-wheels – you will need to arrange for an
alternate way to supply his basic needs. Seek medical help
when necessary.

179
 Facilities that have barriers should not be used for evac-
uation centers or shelters. Unfortunately, during emergency
conditions, there may be no choice but to use such facilities.
Therefore, you could be very helpful by assisting someone
who is physically disabled and has been relocated to a facility
with barriers.
In addition, if an individual’s disability was caused by a
previous trauma, the present disaster might trigger traumat-
ic memories. Be mindful of his psychological state.
Caring for Seniors
In a disaster, seniors have many basic needs and reac-
tions similar to other populations. They also have strengths
and weaknesses that make them both more resilient and yet
more vulnerable. Their life experience has afforded them the
gift of survival, and with that comes better coping abilities.
However, frailty also comes with age, and this can bring on
fatigue and despair.
If you find yourself in a care-giving role to a senior, there
are some simple ways to give assistance.
The Four R’s for Assisting Seniors
Reaching out: Initiate contact, and do a safety check.
Make sure the person is physically safe and has any necessary
medications. Make the person comfortable and find out if
she has sufficient food and shelter. Assist with the recovery
of physical possessions. Arrange contact with family, medical
back-up, caregiver, and/or a support facility.
Rapport: Establish rapport. Show concern and be
gentle.

180
 Reassurance: Show support and confidence in the per-
son’s ability to handle difficult situations. Let the person
know that you will be there for him.
Referral: Refer the individual to appropriate special
agencies for recovery of possessions, financial and emotional
support, and other emergency assistance. [See Chapter 7 –
“Seek Help” – for information about relief agencies, p. 132.]
Collaborating with People with Serious Mental Illness
Work with the individual and her case manager at her
community mental health center or with her private mental
health professional as a preventive measure, even if there is
no change in the individual’s condition, or she was not
impacted directly by the disaster.
SELF-CARE WHILE YOU HELP OTHERS
You can become a disaster victim emotionally just by
helping disaster survivors, even if you were not directly
impacted by the disaster. Just listening to a disaster victim’s
tragic and horrible story may cause you distress. Stress can
cause you to burn out. Therefore, taking care of yourself is
essential while you help others. Below are tips on how you
Help Others

may care for yourself. [In addition, study Chapter 8 – “Help

Yourself” – p. 141.]
 Know your limitations.
 Stay within your limits.
 Recognize when you are hearing information that is
overwhelming to you.
 Pull back when things are becoming overwhelming.
 Recognize when you are getting “in over your head.”
 Pull back before you get “in over your head.”

181
  Ask for help from your friends and relatives, when deal-
ing with others in crisis.
 Use exercise and frequent breaks to relieve your own
stress.
 Share your experiences as a helper by talking with oth-
ers who are assisting disaster survivors.
 Accept that your reactions of stress, fatigue, or fearful-
ness are natural and valid.
 Seek professional help, if needed.
Donations for Disaster Relief and Recovery
Do you know the best way to donate to help disaster
victims?
Chaos rules after a disaster. Getting the right supplies to
the right place to help the right people is a logistical chal-
lenge. Your approach to offering donations has a critical
impact on the lives of others. Under ordinary conditions,
delivering materiel requires a well-organized system and an
intact transportation network. However, disasters leave dev-
astation in their wake. Roads may be washed out. Debris may
block transportation routes. Bridges may no longer exist.
Airport runways may be damaged and unusable. Comm-
unication networks may be destroyed. Delivery of donated
goods, therefore, becomes problematic, if not impossible. If
you donate goods, they need to be inspected, inventoried,
and warehoused. Outdated, malfunctioning, or damaged
items need to be discarded. Perishable items need to be
refrigerated. You may donate shoes, but the need may be for
coats; you may donate coats, but the victims may have no
shoes. Donating goods can get in the way of disaster relief
efforts. Donate goods only if specifically requested.

182
 It is much better for disaster relief organizations to
receive donations of money. Money is easy to store. It does-
n’t spoil. It can be wired across the globe to be used at appro-
priate locations nearest to the disaster. It can pay for supplies,
as they are needed and in the quantities that are needed, after
damage and needs assessments are done. It can be allocated
for a variety of resources – water, food, clothing, bedding,
medical supplies, shelter, construction materials, labor, etc.
Money provides flexibility to address changing conditions.
You can arrange to make a donation by contacting one of
the disaster relief organizations. You can go directly to an
organization’s website, link to many organizations via the
NVOAD website, or call an organization via its toll-free num-
ber. When there is a major disaster, newspapers list the disas-
ter relief organizations that are seeking donations. You may
wish to donate money periodically instead of doing so only
when a major disaster occurs. These charitable organizations
have ongoing needs and help countless victims of disasters
which are not on a scale to merit widespread media coverage.
[See – “Resource Directory”– in Chapter 7, p. 130.]
Volunteering: Helpful or Dangerous?
Help Others

Do you know that numerous well-meaning individuals,

who often are untrained, inexperienced, and/or unaffiliat-
ed with any disaster organization, show up at the scene of
a disaster to lend a hand?
There is an old saying that may well apply to the act of vol-
unteering: “The road to Hell is filled with good intentions.”
In response to 9/11, thousands of people volunteered for the
first time to work with the American Red Cross. Other agen-
cies were also flooded with new volunteers. Such individuals
who just show up at the time of disaster are called “conver-

183
gent” volunteers (FEMA’s term) or “spontaneous” volun-
teers (the term used by the Red Cross). If you have ever been
a convergent volunteer who has provided service, we applaud
you for helping. Nevertheless, we prefer that compassionate
and caring people become trained and affiliated volunteers.
Training and affiliation better provide for the well-being of
the volunteer, efficient emergency efforts, and most impor-
tantly, the maximum possible benefit for the victims.
When people just show up at a disaster, they often
become part of the problem instead of part of the solution.
The individuals in charge of the emergency response or
recovery efforts most likely do not know you. They do not
know your background or what you are capable of doing. This
is not the time for a job interview. The trained responders
would rather focus their skills and energies on aiding the vic-
tims. They should not be spending time and effort on train-
ing convergent volunteers. Therefore, the quickest and most
effective way of dealing with convergent volunteers is for
police to bar them from the scene. If you are barred, your
good intentions will be in vain, and your talents will be wast-
ed.
The solution to the convergent volunteer problem is pre-
paredness. The best way to reduce the number of sponta-
neous volunteers is for you to join an organization today and
be trained as soon as possible. Join the American Red Cross,
The Salvation Army or any other disaster relief organization.
Volunteer for your local Office of Emergency Management
(OEM). Become a member of a volunteer ambulance corps or
fire department. Join an OEM Community Emergency
Response Team (CERT). These organizations will train you
so that you can perform a vital role in disaster mitigation, pre-
paredness, response, and recovery.

184
 10 DO 1 to 9
“All’s Well That Ends Well”
William Shakespeare
1602-04
At the beginning, we stated that the 10 things that you
should do are: l) determine the types and frequencies of the
disasters that might happen, especially in your community,
2) learn what to expect when a disaster strikes, 3) prevent dis-
asters or lessen their impact, 4) prepare for disasters, 5) learn
the human reactions to disaster, 6) decide when you need to
seek help, 7) find out where to get help, 8) help yourself, 9)
help others, and 10) convince yourself that doing the first
nine things are essential for your survival and the survival of
others.
We advise you to place into practice what you have
learned from Chapters 1 through 9. In other words, imple-
ment the principles stated in each chapter title. In order to
motivate yourself to do the other nine things, ask yourself,
“Why do them?” Then, review the benefits. We have started a
list for you, identifying the reasons why it makes sense to
internalize the contents of this guide and to practice its prin-
ciples and techniques. We encourage you to complete this
list with some of your personal reasons.

LIST OF REASONS
Doing the 9 things is important because:
 Your survival may depend on it.

Do 1 to 9

The survival of your family, friends, or neighbors may

depend on it.
 You can learn how to become a psychological survivor
and not just a victim.
 You may strengthen your resilience.

185
 Your psychological well-being depends on knowing
practical things to do.
 Knowledge is power.
 You will put the threats into perspective.
 Knowing what to expect can reduce the degree of trau-
matic stress and distress.
 “An ounce of prevention is worth a pound of cure.”
 Being prepared is vital.
 Planning is an important part of preparedness.
 Educating yourself is the pathway to knowledge.
 Practical things to do will be easily remembered in the
heat of the moment.
 Rehearsing real life situations is the best way to learn
and increase your skills.
 Knowing that your reactions are natural is reassuring.
 Distinguishing between natural reactions and disor-
ders is essential.
 You need references to find valuable resources.
 Self-help is an element of resiliency.
 Knowing how to manage your fear helps you to react
effectively, recover more rapidly, and regain self-confi-
dence.
 Helping others can be fulfilling.
 If you are going to help others, you need to know how
to do it.
 Learning the “ABC’s of Caring for Children” helps you
care for your children
 Caring for your children helps them adjust and cope
with adversity.
 Caring for individuals with special needs can be
gratifying
 Self-care is necessary when you help others.
YOUR REASONS

186
 Things to Do for Any Disaster
Phase Definition
Mitigation Mitigation means to
make less (Latin, mitigare,
to soften), hence to pre-
vent injuries, death,
property damage, and
economic loss, or to min-
imize the severity of the
impact of a disaster when
these effects cannot be
prevented.
Preparedness Preparedness is the state
of readiness.
It consists of three tasks –
planning, training and
exercise.
Warning
Response The actions that are taken
from the time the disas-
ter strikes to when the
threat has ended.
Recovery The process of returning
to pre-disaster function-
ing and restoring the pre-
disaster environment, or
adapting to a new balance
in functioning and a new
way of living.
187
What To Do
Appendix
Live safely.
Practice safety in your home, at work,
in school, while traveling, and in the
use of electricity, hazardous materials
(including combustibles), and
firearms.
Eliminate hazardous conditions.
Be alert for potential disasters.
Prevent the event from happening, or
Reduce the impact of the event.
Plan: Have an Emergency Plan,
Disaster Supplies Kit, Evacuation Kit,
First Aid Kit, and Vehicle Kit.
Train: Educate yourself and teach
others (for example, your family)
what to do for each type of disaster.
Learn First Aid and CPR.
Exercise: Practice your emergency
plan. Hold drills that include per-
forming evacuation procedures.
Listen for disaster alerts.
Follow directives from authorities.
Warn others.
Take pre-disaster action
Take action that is specific for type of
disaster.
Look for dangerous conditions.
Maintain safety.
Call for help (911).
Rescue victims, if possible.
Perform CPR, if trained.
Administer first-aid, if trained.
Help self and family and then neigh-
bors.
Monitor media broadcasts for updat-
ed information.
Care for basic needs (clothing, food,
shelter, water).
Care for mental health.
Receive immediate aid from disaster
relief and government agencies.
Assess the degree of damage and/or
loss.
Draw upon your strengths.
Ask for ongoing support from disaster
relief and government agencies.
Obtain resources necessary for recov-
ery.
Repair damage.
Care for general and mental health.
Engage in mutual support with oth-
ers.
Learn from the experience to better
mitigate, prepare, respond, and recov-
er in the future (“lessons-learned”).
 Disease Outbreaks: Causative Agent, Transmission, Symptoms, and Things to Do
Disease Agent Symptoms Things to Do (Interventions)
AIDS human immuno-defi- rapid weight loss  dry cough, recurring fever or Prevention:
ciency virus (HIV) profuse night sweats  profound and unexplained Practice responsible sexual
Transmitted: fatigue  swollen lymph glands in the armpits, behavior.
sexual contact, blood- groin, or neck  diarrhea that lasts for more than a Take precautions in high risk occu-
to-blood, and mother week  white spots or unusual blemishes on the pations. For example, healthcare
to child during birth tongue, in the mouth, or in the throat  pneumo- workers should use gloves when in
and breast feeding nia  red, brown, pink, or purplish blotches on or contact with patients, especially if
under the skin or inside the mouth, nose, or eyelids using needles.
 memory loss  depression  neurological Treatment: antiretroviral agents
symptoms

Flu influenza viruses fever (usually high)  headache  fatigue (can be Prevention: Receive annual flu vac-
Transmitted: extreme)  cough  sore throat  runny or cine especially if in high risk group
from person to person stuffy nose  body aches  chills  diarrhea and (chronic illness, weakened
by coughing and vomiting ( more common in children) immune system, > 65 years old,

188
sneezing or touching children 6 to 23 months, caregivers
virus to mouth/nose of children < 6 months old, preg-
nant woman, age 6 months to 18
years on long-term aspirin therapy,
nursing home residents and
healthcare workers).
Wash hands.
Treatment: only for symptoms

West virus West Nile Fever: fever  headache  fatigue  Prevention: Use mosquito repel-
Nile Transmitted: body aches  (occasional) skin rash on the trunk of lant.
Virus mosquito bite the body  swollen lymph glands OR severe disease Mosquito proof your home.
West Nile encephalitis, meningitis or poliomyelitis: Treatment: only for symptoms
headache  high fever  neck stiffness  stupor
 disorientation  coma  tremors  convul-
sions  muscle weakness  paralysis
 Things to Know for Chemical Terrorism
Agent Symptoms Onset of Symptoms Interventions
Blister Agents fluid-filled skin blisters, itchy and slow (immediate to 2 For all:
burning skin, eye pain, respiratory days)
tract irritation, pain, maybe nausea Move away from source if inhaled.
and vomiting Go to high place if inhaled. (Agents in gas
form are heavier than air.)

Decontaminate:
Blood Agents rapid breathing, headache, very rapid Remove clothing.
drowsiness, loss of consciousness, Wash skin.
respiratory failure, cardiac arrest Seek immediate emergency medical care.

For Blister agents: Blot to remove, if in liquid

form. Avoid rubbing skin.

189
Lung Toxins small dose: mild cough, difficulty rapid
breathing, chest discomfort,
burning eyes, nose and throat
moderate dose: same plus eyes tear
high dose: severe difficulty
breathing, severe cough,
wheezing

Nerve Gases small dose: pupils dilate, runny rapid

nose, slight breathing difficulty
moderate dose:
same but greater breathing
difficulty
large dose:
same plus loss of consciousness,
seizures, paralysis and interrup-
tion of breathing

Appendix
 Things to Know for Bioterrorism
Person to Onset of
Agent Person Symptoms Interventions
Symptoms
Transmission
Anthrax No flu-like [See table p. 156] but no runny nose, < 1 week; may be pro- –antibiotics
Inhalation fever increases, severe breathing difficulty longed (up to 2 (Avoid moving around
develops, skin becomes blue, then shock and months) to limit spreading
coma anthrax spores.)
Botulism No starts with dry mouth and muscle weakness 12-80 hours for inhala- –antitoxin
of the head (double vision, droopy eyelids, tion (Seek immediate emer-
difficulty speaking and swallowing), then gency medical treat-
paralysis of entire body; respiratory failure ment.)
(death in 24-72 hours if untreated)
Pneumonic High fever, headache, weakness, and rapidly devel- 1-6 days –antibiotics within 24
Plague oping, severe pneumonia (chest pain, cough- hours of symptom
ing up phlegm and blood, difficulty breath- onset
ing) (Use N95 mask near

190
infected individuals.)
Tularemia No sudden fever, chills, headache, diarrhea, 3-5 days, but can be as –antibiotics
muscle aches, joint pain, dry cough, progres- long as 14 days
sive weakness; ulcer lesions of skin and
mouth occur if direct contact; severe pneu-
monia, if inhaled
Smallpox High initial: high fever, head and body aches, averages 12-14 days but –immediate vaccination
(sometimes) vomiting, skin rash beginning can range 7-17 days –isolation and infection
as small red spots, then becoming pustules precautions
(small, round bumps) that form crusts and
scab, and fall off leaving scars
Viral Moderate severe fever, fatigue, dizziness, muscle 2-21 days; varies among –no established
Hemorrhagic aches, loss of strength, exhaustion, bleeding viruses treatment
Fevers under skin, internally, and from mouth, –isolation and infection
eyes, ears precautions
 LEARN MORE ABOUT IT
All Hazards
Borofka, Michael. Emergency Survival Guide: You Can Survive
Anything. Carmel, CA: Ventana Gear, 1994.
Kelly, Kate. Living Safe in an Unsafe World: The Complete Guide to
Family Preparedness. New York, NY: New American Library,
2000.
Mason, Victoria. A Practical Guide to Survival: What to Do Before,
During and After Disasters in the Home. MasonPublications,
1987.
Piven, Joshua, and David Borgenicht. The Worst Case Scenario
Survival Handbook. San Francisco, CA: Chronicle Books,
1999.
Business Emergency Planning
Childs, Donna and Stefan Pietrich. Contingency Planning and
Disaster Recovery: A Small Business Guide. Hoboken, NJ: John
Wiley & Sons, Inc., 2002.
Mitroff, Ian. Why Some Companies Emerge Stronger and Better
from a Crisis. New York, NY: American Management
Association, 2005.
Wallace, Michael and Webber, Lawrence. The Disaster Recovery
Handbook: A Step-by-Step Plan to Ensure Business Continuity and
Protect Vital Operations, Facilities, and Assets. New York, NY:
AMACOM, 2004.
Fear Management
de Becker, Gavin. Fear Less: Real Truth about Risk, Safety, and
Security in a Time of Terrorism. New York, NY: Little, Brown
and Company, 2002.
de Becker, Gavin. The Gift of Fear: Survival Signals That Protect Us
from Violence. New York, NY: Little, Brown and Company,
2005, hardcover; New York: Dell Publishing, 1998, paper-
back.
Food Preparedness
Mason, Rosalie. Beginners Guide to Family Preparedness: Food
Storage, Back to Basics, Survival Facts. Bountiful, UT:
Horizon Publishers & Distributors, 1977.
Spigarelli, Jack A. Crisis Preparedness Handbook: A Complete
Guide to Home Storage and Physical Survival. Alpine, UT:
Cross-Current Publishing, 2002.

191
 Health and Healing
Allen, Jon G. Coping With Trauma: Hope Through Understanding.
2nd Edition. Arlington, VA: American Psychiatric
Publishing, Inc., 2005.
Benson, Herbert, M.D. Timeless Healing: The Power and Biology
of Belief. New York, NY: Simon & Schuster, 1997.
Borysenko, Joan. Minding the Body, Mending the Mind. New
York, NY: Bantam, 1993.
Davis, Martha, Matthew McKay, and Patrick Fanning.
Thoughts and Feelings: Taking Control of Your Moods and Your
Life. Oakland, CA: New Harbinger Publications, Inc., 1997.
Epstein, Robert. The Big Book of Stress Relief Games. New York,
NY: McGraw-Hill, 2000.
Frankl, Viktor E., M.D. Man's Search for Meaning. New York,
NY: Pocket Books, 1984.
Mc Williams, Mary Beth. The PTSD Workbook: Simple, Effective
Techniques for Overcoming Traumatic Stress Symptoms.
Oakland, CA: New Harbinger Publications, Inc., 2002.
Mc Williams, Peter. You Can’t Afford the Luxury of a Negative
Thought. Los Angeles, CA: Prelude Press, 1995.
Rush-Presbyterian-St. Luke's Medical Center. Medical
Encyclopedia. Chicago, IL: World Book, Inc., 1991.
Seligman, Martin E.P., Ph.D. Learned Optimism. New York, NY:
Simon & Schuster, 1990.
Simon, William H., George E. Ehrlich, and Arnold Sadwin
(eds). Conquering Chronic Pain After Injury: An Integrative
Approach to Treating Post-Traumatic Pain. New York:
Avery/Penguin Putnam Inc., 2002.
Natural Disasters
Junchaya, Kellye A. They Laughed at Noah: Preparing for Natural
Disasters. Clifton, NJ: Medcap, 1999.
Nwanna, Gladson I. Natural Disasters and Other Emergencies,
What You Should Know: A Family Planning and Survival Guide.
Somerville, MA: Frontline Publishers, 2004.
Ropeik, David and George Gray. Risk: A Practical Guide for
Deciding What’s Really Safe and What’s Really Dangerous in
the World Around You. New York, NY: Houghton Mifflin
Company, 2002.
Resiliency
Bridges, William. The Way of Transition: Embracing Life’s Most
Difficult Moments. Philadelphia, PA: Perseus Publishing,
2001.

192
Brooks, Robert and Sam Goldstein. The Power of Resilience:
Achieving Balance, Confident and Personal Strength in Your
Life. New York, NY: McGraw-Hill, 2003.
Flach, Frederic. Resilience: Discovering a New Strength in Times of
Stress. Long Island City, NY: Hatherleigh Press, 2002.
Shatte, Andrew and Karen Reivich. The Resilience Factor: 7
Essential Skills for Overcoming Life’s Inevitable Obstacles. New
York, NY: Broadway, 2002.
Risk Assessment
Lee, Laura. 100 Most Dangerous Things in Everyday Life and What
You Can Do About Them. New York, NY: Broadway Books,
2004.
Safety and Security
Aviv, Juval. The Complete Terrorism Survival Guide: How to Travel,
Work and Live in Safety. Huntington, NY: Juris Publishing,
Inc., 2003.
Glover, Jim. Street Smarts, Firearms, and Personal Security: Jim
Glover’s Guide to Staying Alive and Avoiding Crime in the Real
World. Boulder, CO: Paladin Press, 2000.
Kehayan, V. Alex and Tindall, Judith. Bicycle Safety Peer
Program. Gladstone, MO: National Association of Peer
Programs, 2004.
Rawls, Neal and Sue Kovach. Be Alert, Be Aware, Have a Plan: the
Complete Guide to Personal Security. Guilford, CT: Globe
Pequot Press, 2002.
Terrorism
Acquista, Angelo. The Survival Guide: What to Do in a Biological,
Chemical, or Nuclear Emergency. New York, NY: Random
House Trade Paperbacks, 2003.
Beahm, George W. Straight Talk About Terrorism: Protecting Your
Home and Family from Nuclear, Biological, and Chemical
Attacks. Dulles, VA: Brassey’s, Inc., 2003.
Volunteers
Canfield, Jack, Mark Hansen, Arline Oberst, John Boal, and
Tom Lagana. Chicken Soup for the Volunteer’s Soul. Deerfield
Beach, FL: Health Communications, 2002.

193
 ACKNOWLEDGMENTS

We gratefully acknowledge our debt to those who have

preceded us in the fields of disaster mental health and emer-
gency management, and to our colleagues currently con-
tributing to the understanding and care of the survivors of
disasters. In emergency management, a basic principle is “do
not reinvent the wheel.” We have demonstrated our accept-
ance of this principle by not only giving you the benefit of our
experience and knowledge, but also bringing together in this
handy guide the collective wisdom of many other disaster
survival experts.
We applaud all emergency responders and disaster relief
workers for their dedication and sacrifices. We give tribute to
those who responded to the terrorist attacks on September
11, 2001. We especially thank the emergency responders and
disaster mental health workers with whom we personally
trained and worked and who have taught us so much. We
thank the members of the Fort Lee, NJ Community Crisis
Response Team, the Crisis Response Team of the Fort Lee
Office of Emergency Management, the Crisis Counselor
Team of Englewood Hospital and Medical Center in
Englewood, NJ, the Disaster Preparedness Committee and
the Disaster Response Network of the New Jersey Psychiatric
Association, the New Jersey Disaster Mental Health Services
of the American Red Cross, and the New Jersey Emergency
Management Association.
To all those on whom we have relied to help us make
this an informative book that addresses people’s concerns in
the face of disaster and terrorism, we are indebted. We
acknowledge the helpful insights of our informal focus
groups for our cover design – the gang at Breaking News
Network (Rob and Steve Gessmann and their staff - Chris
Casale and Brian Duddy) Dr. Napoli’s colleagues at
Englewood Hospital and Medical Center (Drs. Chertoff,
Freidman, Ciora, Schumeister and Phylliss Capiaghi, RN, Gail
Lundy RN, and Craig Hilton, MSW) and our families. We are
also grateful for the views and advice of Michael Bartolomei,
Joe Bruncati, David Duncan, Bob and Debbie Doerig, Ross
Fieldson, Richard Formica, Nicholas Gee, Dr. Ray Handbury,

194
Mark Hatton, Dr. Jill Kedersha McClay, Ann Martini, Dr. Fran
Michaels, Joseph Mitchell, Andrew Pollock, Dr. Jakob
Steinberg, Kevin Stroh, Michael Stroh, Dr. Judy Tindall, Dr.
Margaret Tompsett, Rev. Jim Warnke, and Dr. Peter Wolf.
We thank Randall Marshall, M.D. and Stuart Weiss, M.D.
for reviewing aspects of our book, checking our accuracy and
providing their expert advice. We are grateful to our reviewers
– Diana Brown, Joe Licata and Dr. Barbara Varenhorst for their
generous praise.
We especially thank our outstanding editor Loretta
Napoli for constantly challenging our thoughts and for work-
ing so hard on this project. We thank our wonderful publish-
ers Bradley and Cathy Winch of Personhood Press, who col-
laborated with us every step of the way to bring our book to
press, Peter Forster, who imparted his savvy business advice,
Christine Scharch of Tupelo Art, our talented graphic design-
er who is a delight to work with, and Erin Scanlon, our indis-
pensable and efficient research assistant.
Most importantly we are grateful to our respective fami-
lies for their love, support and advice – Alex’s wife, Carolyn,
and son, Cary, and Joe’s wife, Loretta, daughters, Gina and
Laura, and son-in-law, Nick.

195
 ABOUT THE AUTHORS
Drs. Kehayan and Napoli, Co-Directors of Resiliency
LLC, a partnership for crisis and disaster consultation and
training, have collaborated for many years in the fields of dis-
aster mental health and emergency management. They have
designed and taught courses on disaster mental health for
various audiences including mental health professionals and
peer leaders. They have participated in the planning and exe-
cution of numerous disaster exercises. Individually, they
have responded to many crises and disasters. Together, most
notably as volunteer Fort Lee Office of Emergency
Management crisis counselors, they aided employees of the
Port Authority of New York and New Jersey, and officers of
the Port Authority Police Department in the aftermath of
9/11.
V. Alex Kehayan, Ed.D.
 Author of three other books: SAGE, Partners for Change,
and Peer-Led Bicycle Safety Program
 Co-Founder of the Community Crisis Response Team of
Fort Lee, NJ
 Director of Edu-Psych, Inc., a training and consultation
network, Ridgewood, NJ
 National Association of Peer Programs Scholar of the
Year Award for his lifetime achievements
 Private practice specializing in anxiety, Ridgewood, NJ
Joseph C. Napoli, M.D., DFAPA
 American Psychiatric Association Bruno Lima Award for
his outstanding contributions to the care and under-
standing of the victims of disaster
 Assistant Clinical Professor of Psychiatry, College of
Physicians and Surgeons of Columbia University
 Chairperson, Disaster Preparedness Committee, New
Jersey Psychiatric Association
 Distinguished Fellow, American Psychiatric Association
 Former volunteer firefighter
 Private practice specializing in posttraumatic stress
disorders, Fort Lee, NJ

196