You could say that I am a bit of an expert on disasters and their consequences. As the medical director of one of the country’s 28 Urban Search and Rescue (USAR) teams for 20 years, I was deployed across the country to help deal with disasters, both natural and d man-made, beginning with 9/11 (21 years ago today), Hurricane Katrina, and as recently as 2021, the collapse of the Surfside condo in Miami, Florida.
Whether my team and I are sorting through rubble looking for survivors or in a boat rescuing victims from rising waters, our mission is the same: to help those in need. That’s what my team and I do.
Climate change leading to multiply by five in the number of weather-related disasters over the past 50 years, the need for disaster-related trauma care will only increase. Experts are projecting increasing numbers intense tropical cyclones (category 4-5 hurricanes) with higher maximum wind speeds, which can cause deaths, devastate communities and displace thousands of people.
Crisis response efforts immediately after disasters – by the Red Cross and other organizations – have become much more effective over the past decade, but even that is not enough. Recognizing the mental health issues that are occurring alongside the other effects of climate change on people around the world is only the first step in creating short- and long-term care plans for people with struggling with disaster-related trauma.
We must prepare for the possibility that climate change-related disasters will cause a corresponding mental health crisis.
A coordinated initial response
As the USAR Team Physician, I am responsible not only for the physical well-being of my teammates, but also for their mental well-being. We must also help victims in both directions, in the initial response as well as in the aftermath.
The first step in helping victims in a crisis is being able to recognize that there may be a problem. Obviously, if someone has just been rescued from a collapsed building or cut from their attic after 2 days of flooding, one can assume that they might need some help. But, in any disaster, there is collateral damage, including those who may have been nearby, loved ones at home or friends watching on TV.
It is important to recognize potential problems and begin to resolve them. I like to make eye contact and study the person’s facial expressions while looking for signs that might be of concern. I am also looking for physical symptoms.
Sometimes extreme emotional stress and trauma immediately after a disaster can manifest as symptoms such as dizziness, shortness of breath, heart palpitations or even body aches, in which case those affected may need medical attention. I do this with my fellow first responders and with the victims and families I meet.
It is also important to find effective ways to normalize grief and trauma, both for victims and first responders. It can be as simple as asking, “How are you?” to get the person to open up about how they feel. Or it may require more professional interventions from a doctor or counselor.
But for many people, the trauma doesn’t just go away – weeks or months later, some experience depression or other acute symptoms due to feelings of loss, guilt, economic ruin or other troubling circumstances. .
Despite the fact that I have been responding to disasters for so long, as an individual I can’t do much and I only have resources. Most responses to disasters – natural or man-made – are local, local and isolated.
It’s sometimes difficult with a disaster like the Surfside collapse, because it’s so localized when literally three blocks away, life in Miami unfolds as if one of the biggest disasters of recent times doesn’t happen. did not produce in the street. But with the possibility of more natural disasters occurring due to climate change, we need a more intentional and coordinated approach to helping people – both victims and first responders. The national suicide prevention hotline 988 is an excellent example of a nationwide omnipresent resource.
Longer term support
The problem with our current disaster response is that while the efforts that immediately follow are robust and “in your face”, over time those efforts naturally fade. In the long term, as people struggle to understand what happened and attention to the disaster in which they were involved diminishes, this is when acute issues can arise and the need therapy may be more important.
The classic symptoms of post-traumatic stress disorder — negative thoughts and moods, easy fear, disturbing dreams, and relationship problems — often don’t go away quickly or on their own.
Yet there are never enough clinical resources available. In the USA, 77% of counties suffer from a serious shortage of mental health professionals, and this shortage could worsen in the coming years. Fortunately, the pandemic has brought increased attention and normalization to the importance of recognizing and addressing mental health issues.
In the years and decades to come, as climate change continues to cause disasters such as floods, hurricanes, droughts and wildfires, the need for long-term crisis response for people affected will only get worse. More national attention and focus is needed to make resources available to victims and first responders involved in disasters, including to alleviate the shortage of mental health care providers.
We have largely met the need for natural disaster response on day one and week one. Now we need more awareness of the long term effects of this trauma and the resources we need to provide.
Chris Valerian, DO, MMM, is the chief medical officer Surprise Health, a leading EAP and digital health company. He is board certified in family medicine and has worked in emergency departments for many years. Valerian is also an EMT, Emergency Tactical Care Instructor, Certified Medical Diver, Black Belt, and Triathlete.