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Swissair Flight 111 Disaster Response Impacts: Lessons Learned From the Voices of Disaster Volunteers

Authors:
  • Wilfrid Laurier University and Balsillie School of International Affairs

Abstract

This qualitative research study provides insight into the specific experiences, trauma, and needs of disaster volunteers as an understudied and marginalized sector of response and recovery personnel. Based on a qualitative analysis of in-depth interviews, the authors present the tasks, exposures, impacts, and search for meaning of the Swissair Flight 111 disaster volunteers who were exposed to human remains during response and recovery efforts. The article is structured to amplify the voices of volunteers to reveal the specificity of disaster fieldwork and resultant multilevel impacts critical to understanding and responding to contemporary disasters. The article concludes with a discussion of the need for clinical and operational policies and protocols that acknowledge the risk and impact of volunteer exposure to human remains and serve to protect the well-being of future volunteer disaster response and recovery workers.
Swissair Flight 111 Disaster Response Impacts:
Lessons Learned From the Voices of Disaster
Volunteers
Terry L. Mitchell, PhD, CPsych
William Walters, MSW
Sherry Stewart, PhD
This qualitative research study provides insight into the specific experiences, trauma, and
needs of disaster volunteers as an understudied and marginalized sector of response and
recovery personnel. Based on a qualitative analysis of in-depth interviews, the authors
present the tasks, exposures, impacts, and search for meaning of the Swissair Flight 111
disaster volunteers who were exposed to human remains during response and recovery
efforts. The article is structured to amplify the voices of volunteers to reveal the specificity of
disaster fieldwork and resultant multilevel impacts critical to understanding and
responding to contemporary disasters. The article concludes with a discussion of the need
for clinical and operational policies and protocols that acknowledge the risk and impact of
volunteer exposure to human remains and serve to protect the well-being of future
volunteer disaster response and recovery workers. [Brief Treatment and Crisis Intervention
6:154–170 (2006)]
KEY WORDS: disaster, volunteers, human remains, PTSD, qualitative research, Swissair Flight
111, Nova Scotia.
Exposure to disasters is known to have both
short- and long-term cognitive, emotional,
physiological, and behavioral consequences
(Chu, 1998; Fullerton & Ursano, 1997; Schnurr
& Green, 2004). Despite a growing body of lit-
erature about the traumatic nature of events
such as disasters and increased knowledge
about their adverse impacts, inadequate atten-
tion has been given to the experience and well-
being of disaster rescue workers and volunteer
responders. Response workers often experience
trauma in relation to the cognitive and sensory
assaults of disaster response work, while at-
tempting to process and integrate what they are
seeing, hearing, touching, and smelling around
them (Fullerton & Ursano, 1997). The range and
magnitude of stress responses vary significantly
among those involved in disaster response oper-
ations chiefly in relation to the individual’s role
in the response efforts. There is, however, a well-
established link between human remains ex-
posure and the development of posttraumatic
stress disorder (PTSD) (Leffler & Dembert,
From the Department of Psychology, Wilfrid Laurier
University (Mitchell), the Canadian Red Cross, Indonesia
(Walters), and the Departments of Psychiatry and
Psychology, Dalhousie University (Stewart).
Contact author: Terry L. Mitchell, Assistant Professor,
Faculty of Science, Department of Psychology, Rm. 2018,
Wilfrid Laurier University, Waterloo, Ontario N2L 3C5,
Canada. E-mail: tmitchel@wlu.ca.
doi:10.1093/brief-treatment/mhj011
Advance Access publication April 7, 2006
ªThe Author 2006. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:
journals.permissions@oxfordjournals.org.
154
1998; Ursano, 1990). Despite the known risks of
disaster exposure, in particular human remains
exposure, there is a dearth of research
investigating the experiences of and impact of
this type of exposure on volunteer disaster
workers. On reexamining the voices of the Swis-
sair Flight 111 (SA111) disaster volunteers who
wereexposedtohumanremains, we learn impor-
tant details about volunteer experiences and
impacts and begin to address a critical gap in
the literature that describes the phenomeno-
logical nature of experience and exposure, as
well as short- and long-term impacts on vol-
unteer disaster workers.
This article extends from and further explains
the initial findings of a larger mixed-method
study in which the initial analyses of volunteer
responses (n¼13) to standardized question-
naires indicated that 71% of the volunteers
that were exposed to human remains were suf-
fering from likely PTSD according to scores
on a self-report measure (Mitchell, Stewart,
Griffin, & Loba, 2004). The first analysis of
the community-level health utilization data
from this study (three years prior as compared
with 3 years postdisaster) also identified com-
munity residents as potential secondary victims
with the report of certain disease categories sig-
nificantly increasing in this region following
the disaster, that is, respiratory, neurological,
Cardiovascular Disease, mental health, gastroin-
testinal, and endocrinological/immunological
diseases (Weerasinghe, Stewart, Mitchell, &
Russell, 2003). Also, our earlier work on
coping-related drinking (Stewart, Mitchell,
Wright, & Loba, 2004) demonstrates the nega-
tive impact of volunteer exposure. The present
article involves further analysis of interview
transcripts of the seven response volunteers
from the original sample who were involved
in the recovery of human remains in the after-
math of the Swissair disaster. In this secondary
analysis, we consider the response and recovery
experiences of a much understudied group of
disaster response workersindividuals who
have endured human remains exposure in their
role as disaster response and recovery volun-
teers. As very little is known about this group
of disaster workers, we seek to contribute to
increased understanding and insight into the
experiences and needs of disaster volunteers
by listening to first-hand field accounts and
by amplifying the voices of the volunteers
themselves. Drawing upon in-depth qualitative
interviews, we analyze qualitative data to de-
scribe the field experiences, impacts, and cop-
ing strategies of volunteer recovery workers
involved in the SA111 disaster who were ex-
posed to human remains. Despite the small num-
ber of interview participants in this subsample
of recovery volunteers, we are able to provide
otherwise rare accounts of recovery volunteer
experiences with reflections on their specific
tasks, exposures, and impacts. Working with
very rich data (Denzin, 1989) and detailed
first-person accounts, we represent the voices
of disaster response workers whose role was
to recover human remains. Given the known
mental and physical health impacts of human
remains exposure and the long-term social, re-
lational, occupational, and health impacts of
posttraumatic stress, we portray the specific
experiences and responses of volunteer disaster
recovery workers. We conclude the article with
a call for further research on volunteer impact,
treatment models, and protocols to inform vol-
unteer involvement in disaster response and
recovery efforts.
Methods
In 1999, an interdisciplinary research team,
working in partnership with a community
advisory group, studied volunteer- and
community-level impacts of the SA111 dis-
aster. The Community Advisory Group in-
volved 12 community members from various
disciplines included three clergy, three mental
Swissair Flight 111 Disaster Response Impacts
Brief Treatment and Crisis Intervention / 6:2 May 2006 155
health professionals, a community fire chief, a
community volunteer, an Emergency Measures
Coordinator, a Ground Search and Rescue
Captain, and two elected civic leaders from
the impacted communities. Utilizing an ecolog-
ical perspective (Bronfenbrenner, 1979) and
a mixed-method methodology (Tashakkori &
Teddlie, 1998), the team of researchers studied
trauma exposure, stress responses, and resil-
ience in the aftermath of the disaster.
The research team received ethical approval
from a university research ethics board to con-
duct a research study to determine both individ-
ual- and community-level impacts of the crash
of SA111. All interview participants were pro-
vided with a letter of information, and all signed
a consent form that indicated the voluntary na-
ture of the interview process. All participants
were also given a resource sheet with informa-
tion about possible negative health responses
that can be associated with exposure to disasters
with contact information for counseling and
support services in their area of residence.
Utilizing a naturalistic paradigm (Hammersley
& Atkinson, 1983) and a participatory action
research methodology (Green et al., 1995), the
team of researchers studied the nature and me-
chanics of exposure, trauma, stress responses,
and resilience during and in the aftermath of
the disaster. Such an approach allowed for a
wholistic evaluation of the subjective realities
of people who experienced the response efforts
and the aftermath of the SA111 disaster.
The data for this article are derived from
a subset of the qualitative data (7 of 13 volun-
teer interviews). The initial study involved
volunteer respondents who were categorized
as instrumental and recovery volunteers. In-
strumental volunteers were individuals who
provided logistical support such as food, cloth-
ing, and transportation to response and recov-
ery workers both professional and volunteer.
The recovery volunteers were those who were
actively involved in the recovery of airplane
debris and human remains. For the purpose
of this article, we selected the recovery
volunteer transcripts as an intensity sample
(‘‘Information-rich cases that manifest the
phenomenon of interest intensely but not ex-
tremely’’) of volunteers (Patton, 1990, p. 171).
The disaster response volunteer data selected
for this article (n¼7) were collected over a pe-
riod of 9 months between July 2001 and April
2002, approximately 3 years after the SA111 di-
saster. Volunteer interviews were open-ended,
semistructured, and lasted for approximately
1.5–2 hr. The interview guide invited partic-
ipants to tell their stories in relation to their
personal experiences the night of the crash,
their role in response and recovery efforts,
and the impacts of such work on themselves.
Interviews were audiotape recorded and tran-
scribed, and the transcripts were checked
against the original tapes. All identifying data
were removed to ensure participant anonymity.
(All names used in the representation of find-
ings in this article are assigned pseudonyms.)
Each of the seven volunteers (two women and
five men) included in this article participated in
the collection and cataloging of human remains,
personal effects, and airplane debris. Partici-
pants worked in the field between 7 and 35
days. Further participant demographic infor-
mation is not reported due to the small sample
size, in order to better protect the confidential-
ity of research participants.
Data Analysis
In February 2004, the disaster recovery volun-
teer transcripts were reanalyzed using the
coding procedure of Strauss and Corbin (1998).
Transcripts were coded using a three-phase
process of open, axial, and selective coding
derived from a grounded theory approach to
data analysis (Strauss & Corbin, 1998). In the
initial phase of the data analysis process, a se-
ries of broad categories with subthemes were
MITCHELL ET AL.
156 Brief Treatment and Crisis Intervention / 6:2 May 2006
developed: impacts and processing experience
(meaning, hope, respect, and honor), commit-
ment and determination (positive and negative
coping), impacts (social, relational, occupa-
tional, PTSD symptoms: physical, behavioral,
cognitive, and emotional), communication (co-
worker, family, community, and confidential-
ity), positive implications of involvement,
traumatic incidents (direct and secondary),
work environment (recognition, information
sharing, role, changes in the nature of role over
time, coordination, policy/protocol, duration,
intensity: emotional and physical), interven-
tions and supports (in field and external), and
coping (positive-active coping, negative).
Based on the open-coding process and the
preliminary placement of codes into purposeful
groupings, subsequent categories were derived
and existing categories refined, leading to the
process of axial coding. During the axial-coding
process, the relationship between all previous
codes and coding categories was explored and
the connections between all data were further
considered and collapsed to reach a data synthe-
sis revealing a narrative of key constructs: the
task, the exposure, the impact, and the mean-
ing. This analysis of a largely underinvestiga-
ted phenomenon intentionally privileges the
voice of the disaster recovery volunteers versus
the interpretive voice of the researchers. How-
ever, the narrative constructed from volunteer
voices in this article has consciously been
employed by the authors to share insights, to
increase understanding, and to inform policy
recommendations for future involvement of
volunteers in disaster response efforts.
Rigor
Lincoln and Guba (1985) describe ‘‘trustworthi-
ness’’ as having collected data that are to be
found credible. They argue that the basic issue
in relation to trustworthiness is to demonstrate
that the findings of an inquiry are worth paying
attention to. In establishing trustworthiness,
Lincoln and Guba outline several key issues
to be attended to while carrying out research:
credibility, dependability, confirmability, and
transferability.
In the execution of this research initiative,
several strategies were employed to ensure that
the findings were trustworthy. To establish cre-
dibility, four key techniques were employed:
prolonged engagement, persistent observation,
constant comparison, and member checks. De-
pendability and confirmability were assured
via an extensive audit trail that outlines the
chronology of community and research events
as well as details of each stage of the data anal-
ysis process. The first two authors indepen-
dently coded and analyzed the volunteer data
and conferred on interpretation before axial
coding and checked back with the original
transcripts during the writing up of the article
to confirm and to seek negative cases of emer-
gent interpretations/representations of the data.
Transferability speaks to the degree to which
the findings apply to other similar situations
as determined by the reader of the article. In or-
der for such a determination to be made, there
needs to be ‘‘thick data’’ (Denzin, 1989). In the
context of this study, transcribed interviews
provided a wealth of ‘‘thick data’’ detailing very
consistent accounts of the recovery workers
experiences. While working with a small sample
(n¼7), we believe that the information yielded
from the voices of these individuals, especially
in relation to being exposed to human remains,
is highly transferable and applicable on a much
broader level, beyond the confines of this study.
Findings
The Task
To give specific contextual information to the
reader and to highlight the profound nature
Swissair Flight 111 Disaster Response Impacts
Brief Treatment and Crisis Intervention / 6:2 May 2006 157
of the volunteers’ experiences, we provide an
extended quote derived from the transcript
of one of the recovery volunteers as a for-
ward to the findings on the volunteers’ field
experiences.
I’ll Do It For Them Because They Can’t
About the fifth day, by that time getting
worn down [pause] I was starting to wonder,
I needed some, some attainable goal. Some
reason for what I’m doing. Why am I doing
this to myself? I needed something to keep
going. To try and dig that strength out. Be-
cause I was starting to tire down, I was start-
ing to get tired out. And ah, near a point that I
hadn’t been before. So I was in kind of an un-
tested territory with myself as far as my resil-
ience was concerned. And I wasn’t sure
where my mind or where my body was going
to go from here if I kept going. And even then
I (was) suspecting that you’re okay now but if
even if you stop at this point, is there going
be a ... a period of time where the effects are
still accumulative or whatever when, when it
stops physically, is it going to continue emo-
tionally or whatever? The toll. And I needed
something to cling to because usually, when
you’re out on a search, you have the energy
to keep going no matter how tired you
are because you think, if I just keep going,
you might find the person alive and if you
don’t at least, ah know you, work hard be-
cause you want to be able to find them even
if they are dead, to say that the families have
somebody and they’re not laying out there in
the woods somewhere for two or three years
for some hunter to come across or, or not get
them back at all and I can understand that
being very important. And that’s what hit
me. Coming back in transport one day, we
were coming back in the camp and there were
some family members out by the water and it
just struck me then. You know, there it is
right there. [pause] That’s ...[long pause,
gets emotional] That’s why I’m doing it. I’ll
do it for them because they can’t [pause]
nor should they be expected to [pause] do
what I’m doing. Ah, so I’ll do my best and
I’ll make sure that my guys have the oppor-
tunity to do the best and we’ll get everything
that we can.
When SA111 crashed into the Atlantic on Sep-
tember 2, 1998, at 10:31 p.m., many residents
of the surrounding area were already at home
in bed. Fishers and volunteer firefighters re-
sponded as they always had to marine disasters
and readily went to the shore, launching their
boats to assist. Individuals initially presumed
that they went out to sea to rescue survivors
of the crash. In reality, however, response
and rescue workers were faced with the pro-
found realization that all 229 passengers and
board personnel had perished in the disaster.
Responders were confronted with an extraordi-
nary and horrific watery debris field.
... the confusion and the eeriness of the
night, um was sort of like a messed up paint-
ing when on acid. It was black. It was rainy,
miserable. The waves were pretty high. The
sea was coming over the bow. The Hercules
dropping para-flares which wouldn’t make it
thought the clouds completely and it would
give this weird glow to the whole area.
It was just a surreal night ... it was sort of
like one of Dante’s levels of hell.
Bert who was with me was starting to get
very panicky because of what we heard on
the radio. There was a lot of fishermen losing
control on the radio and the final straw was
when he heard one fisherman talking about
how he had found a pair of legs because he
thought it was hose and he was pulling it
up and these female legs floated to the surface
and he lost it. And then when Bert heard that,
he said, George we’ve got to go. I can’t deal
with this.
MITCHELL ET AL.
158 Brief Treatment and Crisis Intervention / 6:2 May 2006
It was beyond my experience to see humans
in that condition. Ah, I think what struck me
apart from the gruesome and the grotesque-
ness of it was the fragility of the human body
that ah, something that can walk and talk and
do things can be reduced to this in a flash and
there’s nothing you can do about it. It is that
fragile. It can be extinguished that quickly
and torn asunder that easily.
Despite the surreal and grotesque nature of the
debris field left by the tragedy and the emo-
tional and physical demands of the rescue
efforts, on the first night an untold number
of community volunteers stayed out in the
darkness searching for people to save.
... I felt that it was necessary to stay out
there as long as possible just in case.
You know, your logic dictates everyone was
dead and there wasn’t a chance of survival.
We didn’t know that that night.
After the first night, as ground search and
rescue teams started to be organized and
deployed in an organized manner, volunteers
were asked to follow a strict protocol for col-
lecting, bagging, and tagging human remains,
personal effects, and airplane debris. All items
needed to be securely wrapped and identified.
The volunteers took their roles seriously and
worked with a high degree of respect, profes-
sionalism, and care as illustrated in the follow-
ing quotes from three volunteer response
workers.
Well, [pause] we ‘‘bagged and tagged it’’ as
they say, it got picked up and brought back
[pause]. There was a routine for plane stuff. It
went into one bag and [pause] body parts, or
alleged body parts, went into another. We
would have just been talking about tissue
here eh. Something that is so undefined that
you know, unless I was a doctor or something
wouldn’t know. You know, it could have
been jellyfish .. . So I mean we were aware
that we might be dealing with tissue from
a person, okay?, but we didn’t know. So
we did what we were supposed to do and
we came back in
... you made sure that (you covered) the area
that was cast for you to do that there was no
rush job. You had to do a very thorough job
that you were set out to do. Your task had to
be very efficient or else.
... we’d stop around noon and take half an
hour and because, at least the way I felt, that
an half an hour was enough because we were
searching and we didn’t know what we could
find or what we would come in contact with.
Maybe a person was still alive or something,
so we didn’t want to take an hour.
The task shifted from rescue to recovery with
the daunting role for both workers and volun-
teers of salvaging parts of the devastated air-
craft, recovery of human remains, and
cataloging of personal effects. The daily events
of volunteers involved long hours, in extreme
settings. Groups of three were taken by boat or
helicopter to one of over 300 small islands
within St. Margaret’s Bay and Mahone Bay,
Nova Scotia.
Within a few hours actually we knew that
there was gonna be no survivors. When
the reports were coming back in on what
was being found, there was absolutely no
way that anybody survived it. So we knew
that. So there was a real general sadness over
the support camp we’d set up, but everyone
was still very dedicated. ‘‘Well okay then,
here’s what we have to do. We have to go
out and we have to bring these things back.’’
But it was ... it was hard.
Volunteers worked in remote areas under all
types of weather conditions. While individuals
Swissair Flight 111 Disaster Response Impacts
Brief Treatment and Crisis Intervention / 6:2 May 2006 159
worked together in teams, they were asked not
to speak with one another about what they
were finding. The task was physically demand-
ing with individuals working long hours, some-
times weeks on end without rest.
One recovery volunteer spent 34 days in the
field and some volunteers, particularly in the
first two weeks, were working from six in the
morning to midnight.
When I left, when I left (for) the crash site, it
was dark. When I arrived on shore it was
light and when I went home it was light, it
was a new day. It was totally, it was like
a bad dream or a nightmare and when I went
to sleep, I kind of, it wasn’t that I forgot about
it, but I left it behind me. It wasn’t a, [pause]
it was very surreal.
Although it was evident for most response
workers very early in the operation that the
probability of finding survivors following the
total devastation of the aircraft was remote, vol-
unteers worked conscientiously and continued
to be motivated by the hope that there might be
someone to rescue.
It’s not a job, it’s a task that you’re asked to
do and you volunteer to do it and ah, there’s
always the hope, the hope is, the hope is re-
ally what keeps you going. It’s not something
that you can give up on, the hope. Because if
you give up on hope, you really have noth-
ing, you know. There’s nothing to work with
or nothing to accomplish so hope is a wonder-
ful thing to keep you, you know, striding
ahead.
Exposure and Impact
In this section, we present the impact findings
in the subcategories of behavioral, emotional,
cognitive, and physiological impact. (Although
the Diagnostic and Statistical Manual of Mental
Disorders lists only three symptom categories,
our finding of four symptom clusters has been
corroborated by earlier work by Stewart, Con-
rod, Pihl, & Dongier [1999].) The profound na-
ture of the multiple exposures and the related
physiological, cognitive, behavioral, and emo-
tional impacts are revealed in the following
vivid quote from one recovery volunteer. This
quote indicates the profound intersection of
exposures and impacts and contextualizes the
volunteer’s experience as a preface to the struc-
tured presentation of findings.
The Experience Was So Intense
The experience was so intense. The sensory
input was so high, the emotional level so high
that when it started to wane, when it started
to decline, Ah, you found yourself missing
that adrenaline I guess. The sensory excite-
ment. The whole intensity of it. It was ah, a re-
al depressing feeling came over you that this
isn’t like it was the first couple of days now,
you know, the smell of the jet fuel is starting
to disappear. The pieces of the plane are be-
ing battered and worn and becoming soggy.
The human remains are beginning to decay
and ah, that’s what I was getting mad at. I
was angry. I wanted fresh debris. I wanted
it to be like it was the first couple of days.
I wanted a fresh crash, damn it. [laughs]
was the sort of mindset that I had. I want
a new crash. I want it back the way it was ...
Why was it? Um, it was easier then. It was
more, if you could possibly fathom that it
was more. Um, it was cleaner. It was newer.
Um, to deal with ah, fresh human remains in
my mind is much more preferable to deal with
than decaying remains .... It’s, it’s a much
different experience to, um, collect parts of
a person that have been very recently torn
apart, than it is to pick through, um, stuff
that’s ah, that smells offensive, that looks,
ah, I would compare um, the first human re-
mains would be ah, grotesques and unsettling
MITCHELL ET AL.
160 Brief Treatment and Crisis Intervention / 6:2 May 2006
where as later on, they became offensive ...
Um, it smelled bad. It looked, rotten. It was
rotten. It was getting old. And that’s what
was bothering me. The same with the plane
parts and everything else. The freshness of
it was going away and it was just, it was
something peculiar that I just, I noticed, and
it struck me. I actually laughed after when
I realized, hey buddy, you know you’re tell-
ing off debris here. [laughs] ... This isn’t re-
ally going to change anything. It just struck
me as kind of funny that I was actually doing
that. That, that had happened .... And ah,
using a few expletives then I realized you’re
angry at the debris is what I was angry at and
I was actually angry at the debris. It was, I
was ah, talking to myself but complaining
to the debris, animating it. That ah, I wasn’t
happy. I was ah, telling the debris off. In a
way. Like you’d talk to yourself if you were
going to anticipate a confrontation with some-
body or if you had an issue with a person and
you were sort of rehearsing ah, how you
would ah, address that confrontation. Going
through various scenarios. Ah, you know, im-
provising kind of. And I, I was telling the de-
bris off. I was angry at the debris and I when I
realized what I was doing, I ah, oop, hee
ho ... Pull over to the side and put a pink
flag out the window. Help needed here. ...
Due to the nature, intensity, context, and du-
ration of the volunteers’ fieldwork, volunteers
had multiple types of exposure and various
levels of impact. The biggest challenge for
many volunteers was to come to terms with the
distinction between their original expectations
and their actual role in the disaster response
efforts. Most, if not all, individuals volunteered
to rescue survivors of the crash. That is the
traditional role of coastal people and the
designated role of ground search and rescue
volunteers. The SA111 response efforts chal-
lenged this expectation and called upon volun-
teers to assist in the unfamiliar role of
recovering human remains rather than rescuing
survivors.
It was hard because you know we’re used
to, like I said, we go out and we hope to find
the person alive and well maybe hypother-
mic, or whatever right, and we bring them
home. And even when we do find someone
who’s deceased we bring the body back to
the family.
I don’t think it was so much the bodies but
the fact that we went out there to do a job,
to provide first aid, to provide medical ser-
vice to help people and how can you help
body parts? You can’t. And I think that, that
was the hardest part for them.
Because really our team, I mean, we’re
a search and rescue team and what we were
doing was search and recovery. So ... Um, I
never realized what a big world of difference
there was in the two until then.
The volunteers were also exposed to sleep
deprivation and physical and emotional ex-
haustion over extended periods of time from
1 week to over 1 month. Recovery volunteers
were exposed to massive loss of life, grieving
family members, repeated exposure, and threat
of exposure to dismembered human remains,
personal effects, as well as intense international
media coverage.
I didn’t sleep really the first five or six days.
Maybe an hour or so but I’d wake up and it
would be two or three in the morning and I
figure I might as well go back down and get
ready to go out back in the field. After ...
[pause] After about the fifth day, um then
it started getting [pause] I started wearing
from fatigue and a, as well as, the nature of
the operation. Ah, there was ... there were
a lot of factors involved. Part of it was fatigue.
Just the physical demands traveling that
Swissair Flight 111 Disaster Response Impacts
Brief Treatment and Crisis Intervention / 6:2 May 2006 161
much shoreline and being up that much com-
pounded by the, the ah the nature of the ma-
terial being recovered and as well ah, one of
the more difficult aspects would be the ah ...
seeing the families.
And we all sat together and we cried, oh we
cried. Because when they handed out the pam-
phletsandithad all the namesonit.Itwaswhen
you looked at it, you realized, that there were
whole families. You know, there would be six,
seven names all the same. It was like, ‘‘Oh my
god, that was that whole family, gone.’’
Yeah.I thinkthat’swhat reallybroughtithome.
Even more than the day we saw the human
remains, was seeing the families come. That,
those were people. They’re not just pieces of
people that you put into a bag.They were peo-
ple. They had lives, they had families....
I lived, I won’t say I slept but I ate and lived
Swiss Air all the time I was down there. So in
the evening when I did come home, I’d turn
on the news and just find out. It just went
along with it. I just saturated myself in it.
It might have been a good thing or a bad
thing. It’s just the way ... It felt like what
I wanted so that’s what I did.
Due to the nature of the volunteer response
workers’ task and multiple levels of exposure
while in the field, volunteers experienced a
variety of impacts. The trauma effects were im-
mediate for some behaviorally, emotionally,
cognitively, and/or physiologically.
Behavioral: ‘‘I washed my clothes five
times.’’ Volunteer respondents reflected on
and discussed the various ways in which they
had modified or changed their lives during
and following the disaster efforts. Volunteers
responded in various ways that resulted in indi-
viduals being in the field for various periods of
time and exposure.
So, they realized that there was something
wrong. That the members were not showing
up the next day. Some of them would go
home and some of them would stay there.
They wouldn’t go home at all.
Volunteers reported various behavioral out-
comes, which included excessive washing, iso-
lating themselves, and not talking with anyone
about the recovery experience or responses to
the experience. For three volunteers, these be-
havioral responses contributed to marital prob-
lems, and for some, their behavioral responses
also contributed to difficulties at their place of
employment.
I washed my clothes five times now and I can
still smell people on them.
I stayed in the woods ... I just built a little
lean-to you know and got under there and if
it rained, I would sleep under one of the
buses. I had a sleeping bag. I go in the woods
and sleep all the time anyway. Sometimes I
go for four or five days in the woods and
wouldn’t come out .. .. I want to be alone
all the time. I don’t want nobody around with
me. ... I want to be alone and I’m by myself, I
can cope with things better that way.
Roy actually sold the boat that I was out in
that night.
It slowed me down and it made me frus-
trated and it made me angry. And my work
suffered.
Silence was a common behavioral response, a re-
sponse that was promoted in the field but
which was carried back to the volunteers’
homes and communities further isolating and
putting volunteers at risk.
Nobody ever indicated that they had found
anything [pause] like body parts. And they
probably did. Some did. Some had to have.
But nobody talked about it.
I never talked with anyone who was out
there.
MITCHELL ET AL.
162 Brief Treatment and Crisis Intervention / 6:2 May 2006
Emotional: ‘‘I reached a point of satura-
tion.’’ The emotional impacts were very signif-
icant for the recovery volunteers with clear
reports of cognitive posttraumatic symptoms,
intrusive thoughts, flooding, and dissociation.
The exposure to human remains in particular
required a type of emotional disengagement
that resulted variously in intense emotional
release or conversely emotional numbing.
Ah, there was, there was a point that I reached
which was an interesting experience. That I
reached a point of saturation. Where if so-
meone had slaughtered ten children in front
of me, it wouldn’t have, it wouldn’t have
raised my heart rate. I would simply look at
it and I, I couldn’t go any further than I
had gone emotionally. There was no more.
There wasn’t another level. I had reached
the limit that I could endure and I think it
was just psychologically protective. That it
was to me, the analogy I would use is like
a sponge. And I didn’t know how much more
I could take and then I reached a point where
the sponge was full and the rest just washes
off. For me, other people might break or what-
ever. Um, luckily, I didn’t. I don’t think I did.
... young recruits that were down on the
shore and actually picking up body parts
and some of them got into trouble. You know,
reality just suffocated them I think.
I felt kind of stifled over the whole time and
it, and I didn’t really understand it because I
hadn’t been anything, through anything
quite on that scale.
Cognitive: ‘‘What the hell is wrong with
me?’’ The thoughts of volunteers were also af-
fected as they attempted to cognitively and
emotionally process the mass casualty and the
challenging and grotesque nature of the recov-
ery work. As the physical and emotional im-
pacts of exhaustion, sadness, fear, and anger
were felt, individuals struggled to understand
their experiences and their responses.
You know it’s like a tunnel. You went into it
and you came out the other end. [pause] and
while you were in there, it was dark.
Volunteers were confronted with exposures
and responses that were both equally foreign
to them. Realizing that they were being affected
on multiple levels, volunteers began to ques-
tion their personal emotional, physiological,
and cognitive responses wondering what was
happening to them.
You just kept thinking, ‘‘What is wrong with
me?’’ I’d get up in the morning and I’d be
like, ‘‘Oh, why am I so fuzzy, why can’t I,
what’s wrong with me?’’ That’s what I con-
stantly thought.
But it was hard to feel that tired all the time. It
really was. And kind of a shock. Because you
constantly thought, ‘‘what the hell is wrong
with me?’’
I mean there was a long period of time. You
know, the crash is always in your head and
you thought about it constantly ....
Physiological: ‘‘The body tells you.’’ The
volunteers also spoke of tremendous exhaus-
tion, of various physical responses, early signs
of somatization significant enough to require
time off work.
The body tells you ... You may be silent,
even your brain may be silent but your body
will not be silent for long. I’ve found that out.
It’s a different kind of tired. [laughs]. You feel
like you’ve been sucked dry.
Delayed Responses: ‘‘The first year after-
wards, I, I took a bit of a decline.’’ The
volunteers reflected on how the SA111
Swissair Flight 111 Disaster Response Impacts
Brief Treatment and Crisis Intervention / 6:2 May 2006 163
response and recovery involvement had af-
fected them over time. Volunteers identified
sleep problems, for some increased smoking
and/or drinking, as well as relational, employ-
ment, emotional, and behavioral impacts, in-
cluding a fear of flying. In particular, people
identified an enduring exhaustion, the pres-
ence of depressed affect, and difficulty in relat-
ing to those who were not involved in the
response efforts. For at least three of the partic-
ipants, these impacts also contributed to the
dissolution of their marriages.
The fatigue’s been very slow to go. Um, prob-
ably the worst thing of all was the over-
whelming fatigue. Um, I just don’t have
the energy I used to. You know, it’s slowly
coming back but that was the longest effect.
And I mean the depression, you know, I
guess that’s all just part and parcel of feeling
depressed. Um, what ... post traumatic
stress ... whatever right.
Finding Meaning in Disaster, Death, and
Devastation
Volunteers struggled with the massive loss of
life and their inability to rescue any survivors
from the disaster.
We didn’t save anybody. Why should we go
there to get thanks by these people because
really at the end of the day, [we didn’t] do
anything to help them.
Another volunteer stated
Hazen said to me that he felt like we failed.
And I’m like, I feel that way too.
Finding meaning in such devastation caused
constant struggle with their role and their sense
of contribution or failure. Ultimately, as de-
scribed in the recovery volunteer’s quote be-
low, volunteers gained significant meaning and
strength from various sources, including their
interaction with grieving family members.
I Didn’t Feel Like I Failed Anymore
At the anniversary, we talked to a lot more.
And I know, they kept telling us, ‘‘We
couldn’t believe all you did for us.’’ Every
day that they were out there, they saw all
of these people in orange combing here and
combing there. Going out on boats to here,
going out on helicopters to here. She said,
‘‘Every day, there was just more of you
and more of you and more of you. She says
I couldn’t believe that all of these people
would drop everything they were doing
and would come help us. And you helped
us so much. We’ll never be able to thank
you.’’ I had all of the same theme kind of
thing. People telling us over and over, ‘‘I
can’t believe what you did for us.’’ I thought,
they don’t think we failed. So then, I felt a lot
better about it and so did some of the other
people on the team that I had talked to who
had the same feeling. They said, "Yeah, after
that, I didn’t feel like I failed anymore. Be-
cause they don’t think I failed anymore.
In light of the reality of the situation and the
catastrophic nature of the event, although ex-
periencing a range of adverse impacts, each
individual employed various strategies to aid
them in finding meaning in their disaster
response efforts. Although many response
workers felt a sense of failure in light of their
valiant effort during the relief and recovery
process but their inability to rescue any crash
victims, interactions with the family members
often helped to put their sense of disappoint-
ment and failure into perspective. Many re-
covery volunteers were then able to see how
truly grateful these individuals were for the
effort they had exerted. Such contact with vic-
tims’ family members often served to validate
the recovery workers’ experience and to aid
MITCHELL ET AL.
164 Brief Treatment and Crisis Intervention / 6:2 May 2006
in putting closure to their own emotional
distress.
One key theme that readily appeared in the
data was the abrupt realization of the fragility
of the human body and delicate nature of
human existence. Such realizations led many
people to question their own mortality and
the degree of control they have over their own
destiny and existence.
I don’t think you ever really make sense of it.
It’s just um, [pause] that whole notion, it kind
of made me think a little bit more. It made me
rethink life and rethink death and um, kind
of concluded that we really don’t have con-
trol and I guess, I guess that’s the way it’s
supposed to be. You know, it’s just the
way it happens and unfortunately, as it is,
that’s the way things work.
Religion, faith, and an increased understand-
ing of the human spirit also became a source of
comfort for many response workers and often-
times served as a means to help the volunteers
to give meaning to the disaster and their per-
sonal experiences. Turning to one’s faith aided
many in helping them find meaning and
answers to how and why such things can hap-
pen. Many people resolved themselves to the
notion that there are no simple answers and that
such occurrences are beyond human control.
Ah, my faith is, I won’t say very strong, it’s
unshakeable. I have rock solid faith. Um, I’m
not ah, I’m beyond the point where I would
ask the typical question, why would God al-
low something like this to happen?, because
my personal belief is that ah, there is a univer-
sal consciousness of some kind or another. I
think it’s far beyond human intellect to com-
prehend the nature of that. I leave that in the
realm of the unknowable, the infinite. ...
The fact, you know, was that maybe it could
be your mother, your father, your brother,
your sister you know, or a child of yours,
you know. So from day to day you kind of
would go about your work and do the best
you could and sometimes you would get a lit-
tle strength from your buddy next to you
whether he was on your right or the left.
You know. But it was always sad. There
was never any jokes or anything passed on
and I’ve never noticed people humming
hymns more than on those searches.
Weighing their experiences overall, the volun-
teers did not seem to regret their involve-
ment in the recovery efforts. Nonetheless, most
expressed the wish to move on from the disas-
ter, and the hope that they would not be met
with this type of life challenge again. Yet, some
said that they would volunteer again, if needed.
... it was quite an experience and I hope to
God that it never happens again ....
Discussion
As with previous sections, our discussion
begins with the words of a volunteer who re-
counts his/her experience while working in
the field. The volunteer details the careful,
methodical, and respectful manner in which
the response worker carried out his role.
The volunteer passionately and compassion-
ately describes his exposure to personal effects
and shares his reflections on the profound psy-
chological impact of such an experience.
It Was Like The Whole Universe Just
Closed Right In On Me
And ah, I was taking the clothing and the
clothing would get tangled all wrapped up
in seaweed and everything so you would have
pull everything apart. And, I, I thought it
was a t-shirt that was my initial impression
when I was trying to get this particular, well
they’re all knotted and twisted and tangled
Swissair Flight 111 Disaster Response Impacts
Brief Treatment and Crisis Intervention / 6:2 May 2006 165
from rolling in it and stuff. [sighs] And I ah, I
opened it up, I cleaned everything off and
folded it up to put it in the bag and ah,
a lot of times, rung it out if it were saturated
for, just for the weight problems. I took it out
and finally got it untangled and it was just ah,
it was just a little jumper [baby’s clothing
item]. That might be blocked out a bit, actu-
ally it’s kind of weird. I can’t really picture it
right now. Um, but I do, I do remember that
the ... it was like, the whole, it was like in
a movie or something that you see zoom in
on one spot like from outer space‘‘vomp’’
[participant imitates sound]. Right in on that
one spot on the planet. It was like the whole
universe just closed right in on me and right
in on that. And I was holding it up and I, oh
shit. It just, it just stopped me. I was just dead
in the water. And, I thought, you poor little
bastard. And that’s when it hit me. Yup. No
sweat. If I could ah, little guy, I’d trade places
with ya. [participant emotional]
When reflecting on the voices of the response
volunteers and their lived reality during their
involvement with the SA111 disaster, we are
humbled by the fact that the data so eloquently
and succinctly reveal more than we could
offer from an interpretive authorial voice.
We are committed to honoring and amplifying
the voices of volunteers in this text to describe
the experiences of disaster response volunteers
and the interplay between their task, exposure
in the field, and the resultant impacts they suf-
fered. Volunteer voices have clearly described
the profound nature of their experience as re-
sponse workers, and they have articulated the
various impacts of their involvement with the
SA111 recovery efforts. Having honored this
voice, we now transition to a discussion of these
graphic experiences in relation to contempo-
rary understandings of exposure to traumatic
events with an emphasis on posttraumatic
stress as a probable outcome.
The crash of SA111 off the coastal of a rural
area of Nova Scotia in September 1998 pre-
sented a unique disaster response experience
for local response personnel, many of whom
were members of the surrounding communities
and served in a volunteer capacity. In such
areas, where there are limited paid emergency
and disaster response personnel, members of
the local community often serve in an auxiliary
role as volunteer firefighters and members of
the ground search and rescue teams. Although
often well-versed in their respective fields and
accustomed to responding to incidents such as
auto accidents and searching for missing per-
sons, they were ill-prepared for the magnitude
of the SA111 response due the catastrophic na-
ture of the crash, the total annihilation of the
aircraft, and the disembodiment of all 229 pas-
sengers and crew. In this case, what appeared to
be a routine search as local volunteers manned
their boats and headed out to sea to assist sur-
vivors, turned into a salvage mission of the
most grotesque nature.
The volunteers worked for up to 34 days on
shoreline recovery work and performed a piv-
otal role in the response efforts, working on
a daily basis combing the beaches collecting
forensic evidence for investigative and victim
identification purposes. As the findings chroni-
cled, the nature and duration of these activi-
ties had a vast impact on the response workers
due to multiple, repeated, and prolonged expo-
sures to dismembered and decomposing human
remains, personal effects such as children’s
clothing, fragmented components of the air-
craftmost not exceeding the surface area of
a dinner plateongoing interaction with griev-
ing family members, and the relentless presence
of the international media.
Existing research indicates that various ad-
verse psychological and emotional impacts
have been identified in disaster-affected popu-
lations (Bowman, 1997; Browne & Neal, 2001;
Coarsey-Rader, 1995; Davis, 2003; Freedman
MITCHELL ET AL.
166 Brief Treatment and Crisis Intervention / 6:2 May 2006
et al., 2002; Fullerton, McCarroll, Ursano, &
Wright, 1992; Herman, 1997; Litz, Gray, Bryant,
& Adler, 2002; Sprang, 2002; Stephens, 1997;
Suar, Mandal, & Khuntia, 2002; Wright &
Bartone, 1994). The fourth edition of the
Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV; American Psychiatric
Association [APA], 1994) defines a traumatic
event as an occurrence in which a person
has experienced, witnessed, or was confronted
with an event or events that involved actual
or threatened death, serious injury, or a threat
to the physical integrity of self or others and
the person’s response involved intense fear,
helplessness, or horror. PTSD is an extreme
response to a traumatic event characterized
by specific clusters of symptoms experienced
following the event (APA, 1994, DSM-IV).
The PTSD symptom cluster can be formulated
into three broad categories: reexperiencing/
intrusion (nightmares, flashbacks, intrusive
thoughts, or images), avoidance/numbing
(detachment, restricted effect, avoidance of
reminder, thoughts, and activities), and hy-
perarousal (hypervigilance, decreased concen-
tration, increased startle response, insomnia,
irritability); in order for a diagnosis of PTSD
to be made, these symptoms must last for 30
days or more and result in significant social
or occupational distress (APA, 1994, DSM-
IV). However, a diagnosis of acute stress disor-
der, while bearing many similarities to PTSD in
its symptom cluster structure, can be made as
soon as symptoms have persisted for 2 days,
theoretically allowing for more prompt diagno-
sis and earlier intervention (Mitchell & Everly,
1997).
Although the majority of response workers
are highly trained professionals within their re-
spective fields (such as paramedics, medical
practitioners, members of search and rescue
units, police officers, and firefighters), this
study focused on the experiences of volunteer
response workers who had various degrees of
training and experience in emergency re-
sponse. The SA111 disaster was a catastrophic
event beyond the range of normal emergency
response efforts. When placed in such situa-
tions, in addition to being presented with chal-
lenges regarding their familiarity with their
assumed role, workers may be exposed to grave
human tragedy and hardships that may con-
tribute to the psychological impact of their
work (DeWolfe, 2000). In such situations, re-
sponse workers are often traumatized through
their senses as they struggle to process and in-
tegrate what they are seeing, hearing, touching,
and smelling around them (Fullerton & Ursano,
1997). In the SA111 disaster, the volunteers
were exposed for an extended period of time
to human remains, and this exposure had a
variety of behavioral, cognitive, emotional, and
physiological impacts. In a study conducted
by Fullerton et al. (1992), professional rescue
workers who were involved in a mass casualty
disaster suffered adverse effects. The rescue
workers complained of intrusive images and
smells following exposure to the deaths of vic-
tims, and some reported difficulties in sleeping,
nightmares, and images of the dead during the
night. Fullerton et al. also identified that re-
sponse workers felt helplessness and guilt at
not being able to do more to help the victims.
The recovery volunteers in the present SA111
study similarly suffered negative impacts from
their exposure to a mass casualty disaster com-
pounded by the emerging reality that there was
complete devastation of the aircraft and no sur-
vivors. The distress was heightened by the
inconceivable devastation of the airplane and
unimaginable disembodiment of humans that
resulted in the recovery of human remains ver-
sus intact human bodies. In a study by Coarsey-
Rader (1995), the psychological and emotional
effects of investigating the fatal air crash of
USAir Flight 1016, which claimed the lives of
38 passengers when it crashed on July 2,
1994, revealed that persons who work with
Swissair Flight 111 Disaster Response Impacts
Brief Treatment and Crisis Intervention / 6:2 May 2006 167
affected populations and who are exposed to
grotesque elements often become secondary
victims. Due to the implosion of the SA111
aircraft and the difficulty and duration of the
response efforts, the degree of distress for
SA111 disaster volunteers was affected by both
extremes in duration and intensity of exposure.
The SA111 response volunteers felt helpless at
not being able to rescue survivors or to provide
intact corpses to grieving families. We concur
with Coarsey-Rader that such exposures can
produce secondary disaster victims.
Limitations
Although we have established the strengths of
the data and the compelling importance of the
volunteer voice, we also acknowledge that this
article is subject to several critical limitations.
We are working with data from a small group
of volunteers who agreed to participate in
the research and who may not necessarily be
characteristic of the majority of volunteers.
The research participants may be more or less
traumatized. However, we suspect that those
who suffered the greatest long-term distress
after the disaster would not have participated
in this study given the avoidance of trauma
reminders characteristic of those with PTSD
(APA, 1994, DSM-IV) and that the volunteer
effects discussed here are a conservative por-
trait of PTSD impact on the SA111 recovery
volunteers. The data are all first-person
accounts that were gathered retrospectively,
approximately 3 years after the disaster oc-
curred. The data are therefore subject to recall
biases. Finally, this paper was based on a sec-
ondary analysis of the original data completed 6
years after the disaster occurred. Given this
time lag, it is possible that the findings may
not accurately reflect contemporary volunteer
disaster experiences. However, we believe that
the in-depth first-person accounts gathered in
this study provide critical information that has
not been reported previously in the literature.
Conclusion
It is evident in the findings of this qualitative
study that volunteer responders were exposed
to multiple tragic deaths and the shock of the
loss of ‘‘physical integrity’’ of the SA111 crash
victims due to the profound physical impact
of the crash. We learned that the volunteers’
selfless, dedicated service resulted in varying
degrees of feelings of helplessness and horror
as they engaged in their volunteer recovery
task. Volunteer interview transcripts revealed
the characteristic cluster of PTSD responses
of reexperiencing, avoidance, numbing, and
hyperarousal. Volunteers described immediate,
short-term, and long-term impacts with nega-
tive personal, social, and occupational out-
comes. Volunteer responders were grossly
impacted by the nature and duration of their
tasks and the cumulative effect of their multiple
exposures. The Swissair response volunteer ac-
tivities involved multiple exposures including
identification with victims through personal
clothing and effects, exposure to grotesquely
fragmented and decomposing human remains,
and direct contact with hundreds of grieving
family members. Further, ongoing international
media coverage of the response efforts served to
compound the distress of the SA111 volunteers.
It is important, however, to acknowledge that
some volunteers gained meaning and strength
from their interaction with family members
and their ability to contribute at a time of need.
The personal contact contributed greatly to the
volunteers’ ability to complete their task with
respect and dignity for human remains, honor
for the lives of the deceased passengers, and
service to their grieving families. The ability
of volunteers to give meaning to their disaster
experiences appears to have contributed to
MITCHELL ET AL.
168 Brief Treatment and Crisis Intervention / 6:2 May 2006
adaptive coping as found by Meichenbaum
(1994).
Further research is required to investigate
short- and long-term impacts, with attention
to volunteer needs in the field for communica-
tion, support, and debriefing. The development
of treatment vehicles and modalities must also
be considered for short- and long-term follow-
up of volunteers who serve in disaster response
efforts. Given the profound impact of human
remains exposure and the long-term personal
social and occupational costs of PTSD, it is rec-
ommended that emergency and disaster organ-
izations develop specific policies and protocols
for volunteer involvement, support, treatment,
and follow-up, in particular when responders
are exposed to human remains.
Acknowledgments
We wish to acknowledge the interdisciplinary team
of researchers from the Department of Community
Health and Epidemiology and the Psychology
Department of Dalhousie University that
collaborated in this study, in particular,
coinvestigator Dr. Swarna Weerasinghe and
research coordinator Kara Griffin. We also recognize
the essential role of the Community Advisory Group
that guided all phases of the study and the
important contributions of the volunteers
themselves without whom this research could not
have been conducted. It is with great respect that we
acknowledge the contributions of the volunteer
responders to the disaster efforts and to this study.
Without the participation of these individuals this
article could not have been written. Finally, we
acknowledge the generous funding of the Social
Sciences and Humanities Research Council of
Canada. Conflict of Interest: None declared.
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MITCHELL ET AL.
170 Brief Treatment and Crisis Intervention / 6:2 May 2006
... of living in a large scale disaster response site with intensive military and international media presence [1,2]. ...
... We carried out gender-stratified analyses, bearing in mind that men are more involved in disaster recovery and rescue operations following any type of disaster, while women are more involved in receiving grieving family members [1,2]. Our literature review indicated significant gender differences in reported health outcomes among men and women [26,27]. ...
... The disaster-affected (study) community is comprised of "event victims"-those who experienced the direct effects of the disaster, "contact victims" -those who lived in the disaster area but did not experience direct effects; "peripheral victims" -those who did not live in the community but nonetheless had strong ties with the affected community; and finally "entry victims"-those who came to the area to help [35]. Combining the above classification and the qualitative work of the present research team, [1,2,3,6] we classify the disaster community as "event victims" and "contact victims" since the latter were subject to secondary exposure and lived in the disaster area. The levels and types of exposure of the study community are described elsewhere [1]. ...
Article
Full-text available
Citation: Weerasinghe S, Stewart SH, Mitchell TL (2016) Longitudinal follow up of health outcomes of the 1998 Swissair 111 crash. J Epidemiol Public Health Rev 2(1): doi http://dx.
... 6 Burnout in disaster relief work Our review of the literature suggested that volunteers assisting disaster victims in disaster relief work, exposed themselves to an environment that is stressful, such as earthquakes, floods and hurricanes. The common stressors encountered by volunteers in disaster relief works are extreme emotional reactions from victims and devastation of property, 1 contact with dead body and injury, 1,7,8 exposure to mass violence, health and safety issues, 9 and unsanitary condition. 10 The researcher would like to add the following to the list of common stressors: having to witness the extreme poverty experienced by victims during a recovery period. ...
Article
Full-text available
Purpose Malaysian disaster relief volunteers have a long and proud history of providing relief missions within and outside the country. Despite of a plethora of researches into the various areas of disaster relief, there has been a little scholarly activity looking into the experiences of the medical volunteers worldwide and even less research on the experiences of the relief volunteers in Malaysia. Therefore, the purpose of this study is to identify the effect of disaster relief works on volunteers in Malaysia. Methods This is a non-experimental cross-sectional design study, which was conducted using survey questionnaire to examine the incidence of burnout, posttraumatic stress disorder (PTSD) symptoms and the quality of life (QOL) among the disaster relief volunteers. And the study also examined the socio-demographic variables of the participants. In addition, the association between the sociodemographic variable and the preferred coping strategies was also investigated through self-reporting checklist. Results The findings of this study revealed that 90.9% volunteers (n = 312) experienced some levels of recurring stress throughout their lives, which led to burnout. Also, 96.8% (n = 332) of the participants were categorized as having at least some symptoms of PTSD. However, self-reporting QOL measurements indicated that the participants are, in general, satisfied with their lives. Significant associations between the incidence of burnout, incidence of PTSD and QOL were identified. Both positive coping measures and behavioral or avoidant coping measures were also identified. Furthermore, a number of socio-demographic factors were also seen to interact significantly with burnout, PTSD and QOL. Conclusion This study provides some insights into the psychological challenges of disaster relief volunteers in Malaysia, and this impact can last a long time after the volunteers return to their hometowns. Several recommendations including practice development, policy and research were discussed in the study.
... 6 Burnout in disaster relief work Our review of the literature suggested that volunteers assisting disaster victims in disaster relief work, exposed themselves to an environment that is stressful, such as earthquakes, floods and hurricanes. The common stressors encountered by volunteers in disaster relief works are extreme emotional reactions from victims and devastation of property, 1 contact with dead body and injury, 1,7,8 exposure to mass violence, health and safety issues, 9 and unsanitary condition. 10 The researcher would like to add the following to the list of common stressors: having to witness the extreme poverty experienced by victims during a recovery period. ...
Preprint
Disaster, whether natural or man-made, is an unpredictable event that occurs worldwide and may cause untold damage to the environment and its occupants. In the aftermath, deployment of volunteer workers into disaster zone is a necessary part of the effort to provide relief to disaster victims. Hence, the objective of this study is to explore the experiences of disaster relief volunteers in Malaysia who has served in disaster relief efforts. Ten participants from among doctors and nurses who have worked as disaster relief volunteers were purposively selected for qualitative in-depth interviews. The data gathered during the interviews were analyzed using thematic analysis. Five main themes emerged in the data analysis process, namely, Limited Resources, Reactions, Support, Preparation and Gratification. The theme reveals the challenges faced by the participants and the toll taken on their psychological, emotional, and physical wellbeing. It also reveals the factors that could lessen the toll. In conclusion, we find it imperative for volunteer organizations, employers, and health bodies alike to recognize the need revealed in this study in order to provide the necessary support to prevent the possible damaging effect of disaster relief works on volunteers.
Article
Full-text available
Background and objective: Emotional, behavioural and cognitive consequences of an air disaster on the direct and indirect victims and rescuers have not been investigated thoroughly, particularly due to the rarity of this type of event. Therefore exploring residual stress disorders in people involved in rescuing is worth undertaking. The aim of this study is to investigate persistence of stress disorders on the voluntary rescuers involved in the tragedy after the crash of the ATR 72 flight in water near Palermo (Italy), which occurred on August 6th, 2005. There were 16 deaths, 3 people missing and 23 survivors of the crash. Method: We analysed peritraumatic reactions associated to the disaster in a sample of 103 voluntary rescuers after one year from the event. The sample was divided into two groups: Directly Exposed (DE) and Indirectly Exposed (IE). In particular, we examined specific risk factors "pre-disaster" (age, gender and other socio-demographic characteristics) and we estimated frequency of intrusive or avoidance symptoms, trait anxiety, arousal level, depression level and perceived social support. These were related to how much exposed and involved the rescuers were in the event. Results: The sample was composed by 60.2% male and 39.8% female. There were no significant differences between men and women as regards age, level of education and employment status (Table I). Psychological assessment shows statistically significant differences between the two groups. In particular, the DE group presents higher level of stress, anxiety and arousal than the IE group. There were no significant differences in mean scores and variance of depression (Table II). Conclusion: Two main findings emerged: a) despite the absence of influence of the risk factors identified by the scientific literature, it is still possible to observe significant levels of stress disorders 1 year after the event; b) high exposure levels lead to increased psychological problems such as anxiety, avoidance and somatic pain, however depression was not significantly present in neither of the two groups. Further studies are needed to clarify the psychological impact of traumatic events on rescue volunteers in order to improve the management of emergency situations.
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Although psychological debriefing (PD) represents the most common form of early intervention for recently traumatized people, there is little evidence supporting its continued use with individuals who experience severe trauma. This review identifies the core issues in early intervention that need to be addressed in resolving the debate over PD. It critiques the available evidence for PD and the early provision of cognitive-behavioral therapy (CBT). Based on available evidence, we propose that psychological first aid is an appropriate initial intervention, but that it does not serve a therapeutic or preventive function. When feasible, initial screening is required so that preventive interventions can be used for those individuals who may have difficulty recovering on their own. Evidence-based CBT approaches are indicated for people who are at risk of developing posttraumatic psychopathology. Guidelines for managing acutely traumatized people are suggested and standards are proposed to direct future research that may advance our understanding of the role of early intervention in facilitating adaptation to trauma.
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To understand the way children develop, Bronfenbrenner believes that it is necessary to observe their behavior in natural settings, while they are interacting with familiar adults over prolonged periods of time. His book offers an important blueprint for constructing a new and ecologically valid psychology of development.