Engaging in rescue and recovery efforts in the wake of terrorist acts is inevitably stressful for rescue workers. The long hours, breadth of needs and demands, ambiguous roles, and exposure to human suffering can adversely affect even the most experienced professional. While the work is personally rewarding and challenging, it also has the potential for affecting workers in harmful ways. Too often, the stress experienced by rescue workers is addressed as an afterthought. With a little effort, however, steps can be taken to minimize the effects of stress.

Stress prevention and management should be addressed in two critical contexts: the organization and the individual. Adopting a preventive perspective allows both workers and organizations to anticipate stressors and shape responses, rather than simply reacting to a crisis when it occurs. Suggestions for organizational and individual stress prevention and management approaches are presented below:

Organizational Approaches for Stress Prevention and Management

1. Provide effective management structure and leadership. Elements include:

* Clear chain of command and reporting relationships.
* Available and accessible supervisors.
* Disaster orientation for all workers.
* Shifts of no longer than 12 hours, followed by 12 hours off.
* Briefings at the beginning of shifts as workers enter the operation.
* Necessary supplies (e.g., paper, forms, pens, educational materials, etc.).
* Communication tools (e.g., cell phones, radios, etc.).

2. Define clear purpose and goals.

3. Define clear intervention goals and strategies appropriate to assignment setting.

4. Define roles by function.

5. Orient and train staff with written role descriptions for each assignment setting. When setting is under the jurisdiction of another agency (e.g., Red Cross, FEMA), inform workers of each agency's role, contact people, and expectations.

6. Nurture team support.

7. Create a buddy system to support and monitor stress reactions. Promote a positive atmosphere of support and tolerance with frequent praise.

8. Develop a plan for stress management. For example:

* Assess workers' functioning regularly.

* Rotate workers between low-, mid-, and high-stress tasks.

* Encourage breaks and time away from assignment.

* Educate about signs and symptoms of worker stress and coping strategies.

* Provide individual and group defusing and debriefing.

* Develop an exit plan for workers leaving the operation, including a debriefing, reentry information, opportunity to critique, and formal recognition for service.

Individual Approaches for Stress Prevention and Management

1. Manage workload.

* Set priority levels for tasks with a realistic work plan.

* Delegate existing workloads so workers are not attempting disaster response in addition to their usual jobs.

2. Balance lifestyle.

* Get physical exercise and stretch muscles when possible.

* Eat nutritiously and avoid excessive junk food, caffeine, alcohol, or tobacco.

* Get adequate sleep and rest, especially on longer assignments.

* Maintain contact and connection with primary social supports.

3. Apply stress reduction techniques.

* Reduce physical tension by taking deep breaths, calming self through meditation, walking mindfully, etc.

* Use time off for exercise, reading, listening to music, taking a bath, talking to family, or getting a special meal to recharge batteries.

* Talk about emotions and reactions with coworkers during appropriate times.

4. Practice self-awareness.

* Recognize and heed early warning signs for stress reactions.

* Accept that one may not be able to self-assess problematic stress reactions.

* Avoid over identification with survivors'/victims' grief and trauma, which may interfere with discussing painful material.

* Understand differences between professional helping relationships and friendships.

* Examine personal prejudices and cultural stereotypes.

* Be mindful that vicarious traumatization or compassion fatigue may develop.

* Recognize when a personal disaster experience or loss interferes with effectiveness.

* Additional resources can be found here: www.mentalhealth.samhsa.gov/cmhs/EmergencyServices/links.asp