Former Social Work Director at Oklahoma City Hospital Says Rescue Workers Are Among Disasters' "Victims"

BUFFALO, N.Y. -- While the nation stared aghast at television screens and listened in horror to radio reports of the Sept. 11 attack on the World Trade Center and the Pentagon, a University at Buffalo professor listened to events unfold with a gut-wrenching familiarity.

Deborah Waldrop, Ph.D., UB assistant professor of social work, was social work director at Oklahoma City's St. Anthony Hospital on April 19, 1995, when a truck bomb exploded in front of the Alfred P. Murrah Federal Building. Located roughly five blocks from the disaster, St. Anthony was on the front line of rescue efforts.

She learned first-hand the impact such a tragedy has on rescue workers responding to the crisis.

While a great deal of attention is paid to the victims of calamitous tragedies and their families, the rescue workers -- firefighters, police, ambulance crews, emergency personnel, hospital staff and others -- also are victims. Witnesses to nearly unimaginable horrors, those involved in the rescue efforts often need help to deal with what they have seen and experienced, Waldrop said.

In the first days of a crisis, she noted, rescue workers operate on the autopilot of adrenaline and the desire to help. But as search efforts wear on, she added, people working at the scene experience an emotional and physical toll.

"Critical-incident stress reactions don't happen right away. At first, the rescue workers are just trying to get through the disaster," Waldrop said. "But what they see is horrendous. They see severed limbs and broken bodies. You can't just walk away from that."

As rescue efforts stretch into days and weeks, workers begin to experience physical and emotional reactions, she said.

Symptoms may be physical (nausea, fatigue, headaches, profuse sweating), cognitive (confusion, nightmares, hypervigilance, poor concentration), emotional (fear, guilt, depression, agitation) and/or behavioral (withdrawal, restlessness, pacing, appetite changes).

"They may lay down at night and see the images of the tragedy replaying in their heads. That's a normal reaction to an abnormal event," Waldrop emphasized, "but they feel like they're going out of their minds."

Perhaps the most important thing rescue workers can do to cope, she said, is talk.

"It's really important for them to talk about what's going on -- what has happened, how they're feeling, what symptoms they may be experiencing," Waldrop said.

"Saying it out loud makes it real. These folks need the mutual support, the knowledge that they're not alone, they're not abnormal and they're not losing their minds."

Stress reactions don't happen in a straight line, either. Rescue workers may be needed for months, and tend to experience emotional peaks and valleys as rescue efforts continue.

"It's like a reverberation -- waves of emotions are going to go through rescuers and their families," she said.

It's important to remember that reactions to the tragedy are going to vary among individuals, she said.

"How people deal with the trauma depends on their past history, as well as how close they were to the scene when the tragedy happened, what role they played in the rescue efforts and how sustained their efforts were," Waldrop said. "Not everyone will react the same."

Members of the mental health community will need to be vigilant about subtle symptoms rescue workers may be showing that indicate deeper problems.

"Tragedies like this can push trauma buttons for people with past problems," she said. Mental health professionals need to keep an eye out for people who may be losing touch with reality and exhibiting symptoms such as hallucinations or self-destructive behaviors.

Debriefings -- closed-door, confidential sessions where trained leaders help guide rescue workers through what they've experienced, encouraging them to verbalize and process what's happened -- are vital to the well-being of people who have to face the horror of the rescue efforts day after day.

Debriefing isn't therapy, Waldrop stressed.

"It's people who were in a similar situation coming together to talk and process what they've just experienced," she said.

Following the Oklahoma City bombing, Waldrop was part of a team that developed a crisis-intervention plan used to help more than 1,600 hospital employees and other involved in the

day-to-day care of bombing victims deal with their experiences. It is important to her personally, she said, to teach people how to deal with the aftermath of disaster.

"I realized that if there's some way I can help people deal with their reactions to this kind of event, then terrorists won't win. For me it was important to make good come from bad," Waldrop said.