In a previous section, disaster management was covered in much detail. Of importance was the formula:
(VULNERABILITY+ HAZARD) / CAPACITY = MAGNITUDE of DISASTER
As a reminder: The severity of the impact of an occurrence is relative to the strength of the hazard, the vulnerability of the recipients, and the capacity to avoid the hazard or deal with its consequences.
Occupational therapists should be involved in all stages of planning and preparation at local, provincial and national level for disaster management as well as post-disaster rehabilitation.
Practitioners should be equally responsive to psychological and psychiatric conditions as they are to physical disorders. A special focus is needed on the early detection of severe psychological distress and psychiatric phenomena. Occupational therapists’ education prepares them to be a major contributor to this refocusing of attention. Intra-professional support is essential.
For vulnerable groups such as children, women and the elderly as well as individuals with previous disabilities and newly acquired conditions, meaningful occupation in daily personal and community activities can have therapeutic outcomes during disaster recovery. In all approaches to Disaster Prevention and Recovery, gender roles must be sensitively addressed and strategies developed to enhance equality in opportunity and resource allocations.
A major task in disaster preparedness and response management for occupational therapists (and others working in health care) lies also in long term strategies in collaboration with key stakeholders. The potential benefits of the involvement of occupational therapists in disaster preparedness and response management are numerous and are related to immediate post disaster response as well as building longer term national capacity and self-reliance in disaster affected countries, and beyond.
Of importance here is the fact that disaster management is one of many hazards identified, assessed and prepared for. As such, the preparations must complement the hazard mitigation strategies (engineering, administration and protection).
Occupational therapy’s role in disaster relief
When disaster occurs, society becomes disabled, limiting its members’ ability to perform normal activities. Occupational therapy practitioners have the opportunity to become a part of the solution to a disaster’s disabling effects by playing a role in the three stages of emergency situations: preparedness, response, and recovery.
Occupational therapy’s role in preparedness
A community can prepare for disasters by creating emergency plans that enable an effective disaster response. Occupational therapy practitioners can participate in this planning by lending their expertise in areas such as designing special needs shelters and training staff and volunteers on assisting persons with disabilities during a crisis.
A lack of planning results in a lack of resources to adequately address the needs of disaster victims. Reviewing problems that emerged from previous disaster responses can aid planners and occupational therapy practitioners in avoiding similar mistakes. For example, “the food served to people on special diets [because of conditions such as diabetes] was often difficult to obtain in shelters. Reaching the bathroom and bathing people with mobility limitations was a challenge,” said Susanne Pickering, MPH, MS, OTR/L, CHES, CAPT, U.S. Public Health Services, Centres for Disease Control and Prevention (CDC) in Atlanta. Pickering was deployed during the first few years of the Kosovo refugee airlift to Fort Dix, New Jersey, in 1999; to the World Trade Centre site in 2001; and to hurricane relief efforts in Florida in 2004.
To participate in this stage, occupational therapy practitioners need to get involved with local agencies to make community contacts up front. They can demonstrate to emergency planners that they can help them properly respond to the community’s entire population, including those with disabilities, and jumpstart the recovery process. Getting involved before a disaster will ensure that practitioners are called upon if the need arises.
At evacuation shelters, people with disabilities require ramps wide enough to accommodate wheelchairs and the right to enter a shelter with a service animal. “OTs can educate managers that this is an ADA [Americans with Disabilities Act] right and that this person needs to have this dog to stay independent,” said Frank Pascarelli, MS, OTR/L, NMSE, CPI, subject matter expert for the Strategic National Stockpile with the CDC. People with disabilities will become completely dependent and require more staff attention if planners fail to accommodate them in the planning stage.
Occupational therapy’s role in response
Immediately following a disaster, occupational therapy practitioners’ participation in the response can include managing special needs shelters, facilitating support groups to decrease anxiety, and providing supportive mental health to victims, first responders, and military personnel.
“As occupational therapists we are so versatile that we can see a complete picture. We don many hats and are excellent at evaluation, problem solving, and implementation of plans,” said Laura Grogan, OTR, LCDR, of the U.S. Public Health Service.
A major part of the response is helping victims to regain control after an uncontrollable event. When everything is chaotic, being able to function in a productive and meaningful manner helps bring normalcy back. Whether it is fixing damaged mailboxes or cleaning up playgrounds for children to resume play, these acts empower victims to take control and reengage in their occupation of living.
“You start helping the person figure out what is important,” says Pascarelli. “Every day, you work with that person on trying to rebuild their life in a small, incremental way. It puts control back in their life, and they take control because they’re doing it, and they’re part of the solution.”
Occupational therapy’s role in recovery
Following the disaster response, occupational therapy practitioners’ contributions to the final stage of emergency situations, the recovery effort, involve repairing and rebuilding disrupted activities and routines. Victims of disasters need to develop coping skills to deal with the effects of their experiences. By engaging in occupation, disaster survivors can restructure their routines to cope with stress and anxiety.
“When we’re talking about occupational therapy’s role, there is a point that needs to be made about the body’s physical reaction to stress,” says Charles Christiansen, EdD, OTR, OT(C), FAOTA, executive director of the American Occupational Therapy Foundation. “Research shows that if we normalize routines and lifestyles, we can, in fact, have a measurable positive impact on reducing the negative consequences of stressors [on the body]. Because the immune system is involved, this positive benefit serves a preventative role in helping the person to resist infection and chronic disease that occurs with the wear and tear of stressful situations on tissues and organs.”
By participating in all three stages of emergency situations, occupational therapy practitioners can carve out a niche for themselves to help restore order and aid those affected. Yet an often-overlooked aspect of disaster responders is the toll this role takes on one’s self. Working long days, meeting people who have lost everything, and being mentally and physically challenged can lead to exhaustion.
“If you see a fellow team member in distress, as an occupational therapist you can help augment their needs, and if they need services beyond your capacity you can facilitate getting services for them,” says Grogan. Practitioners also need to remember to help each other, and to ask for help when they need it.
Occupational therapy’s role in disasters
More practitioners should be encouraged to get training in disaster response, says Marjorie Scaffa, PhD, OTR/L, FAOTA, and a contributing author of AOTA’s concept paper on the role of occupational therapy in disaster relief (AOTA, 2006). “It’s a specialized area and does require some additional knowledge. There is a whole skill set that we don’t have in terms of crisis intervention that I would like to see practitioners pursue to become more proficient in that.”
One way to access additional knowledge, Pascarelli notes, is through Web sites like www.fema.gov, which can help occupational therapy practitioners be better prepared to volunteer during disaster situations—like learning the terminology used during disaster response and reading about common stress reactions to disaster. Practitioners need to have an understanding of the hierarchical structure of organisations and agencies involved in planning and response and can do so by affiliating with local and national organisations like the American Red Cross or mental health crisis services.
Ultimately, practitioners can help victims of disasters in all stages of emergency situations by creating realistic goals, “empowering them to regain their independence and move from being a victim to a survivor,” says Pascarelli.