Trauma Training for the CT State Animal Response Team (CTSART): Mitigating The Emotional Impact of Emergencies

Story and Photos by Paula Antolini
View more photos here: picturesbypaula.com

We are all aware that first responders and citizens alike have experienced extensive trauma situations, especially in light of the tragedies of the Boston Marathon bombing, the Sandy Hook Elementary shooting, the 9/11 World Trade Center disaster, and more.

Whether the trauma situation involves people, animals or both, the human reactions are similar.  High stress produces both physiological and mental reactions.  There is a need to know how to handle these reactions and take preventative methods to be better prepared in case of future disasters.  First responders can do a better job to help in crisis situations if they know their body's response mechanisms, so they can help others and also themselves too, when on overload.   

On Saturday, April 20th, 2013, The Connecticut State Animal Response Team (CTSART), Region 5, sponsored a regional training opportunity for emergency management directors and animal control officers for all towns in CT Region 5. The event was organized by CT Region 5 Team Leader Dr. Donna Cobelli, of Ridgefield, CT, and took place from 8:30 a.m. to 12:30 p.m. at the Watertown Firehouse in Watertown, CT.

In the continuing preparatory training, CTSART Region 5 emergency management officials from eight towns along with CTSART Region 5 volunteers, participated in training regarding trauma in emergency situations. The aim of the meeting was also to provide animal shelter starter kits to all towns that have not yet received these supplies, and teach them how to set up a small emergency animal shelter.

FIRST PRESENTATION

The topic covered was "Mitigating The Emotional Impact of Emergencies/Tragedies for Emergency Responders."  Cathy Burns, a licensed clinical social worker and board certified diplomat (LCSW, BCD) from Danbury, CT, gave the presentation.

Definition and Types of Brain Imprinting

Any trauma is bad. "What we see is that people oftentimes have a harder time, a more distressing reaction, when the trauma involves children, elderly, animals or people you know," Burns said.

Burns reviewed the concept of "brain imprinting" and she defined this as "what our brains do….It's a normal response to an abnormal situation."  It is the way we learn the characteristics of a stimulus and it is then imprinted on the brain. 

Regarding a trauma situation, Burns said, "At first it's kind of a feeling of shock, then you can kick into action, it's what our bodies need and want to do.  Learning occurs instantaneously.  That image comes in, gets locked in the brain, and it stays there," Burns said.  "Just because you have emergency training it does not mean that a trauma situation will not affect you. The human brain does not give you a pass, it's how it functions." 

There are ways to monitor this brain imprinting during an emergency. First, know that brain imprinting can come in positive or negative forms.

Burns said positive brain imprinting can be as simple as seeing a chocolate milkshake and knowing it is good because you already have that imprint.  Positive imprinting also gives us a source from which to draw upon during crisis, such as our emergency training drills or other information we have learned in training, she said. 

"Negative forms or 'trauma imprinting' comes into our brain, we store it in our brain, and it sets off a physiological chain reaction, releasing adrenalin and allowing us to take action," Burns said.  She gave examples of the Newtown 12/14 tragedy and the recent Boston bombing as events that are now imprinted in our brains. 

This can cause us to feel something, or not, depending on our past brain imprinting.  Either way, it is normal for what you are experiencing at the moment, based on your personal brain imprinting, and that's okay, as long as you realize the cues as to why you are feeling or not feeling anything.  Be aware of the cue that your normal response may be a little bit off.

How Trauma is Stored in the Brain

"Traumatic imprinting is stored in a different place in the brain, it has more of an effect and we have to be aware of that because it keeps us in a heightened state of arousal," Burns said.  It gives us the "flight or fight" response in order to help people.

Trauma is either stored in the sensory experiential part of the brain called the thalamus, or the cognitive part of the brain.

"The imprint can remain frozen in your body for a long period of time," Burns said.  Trauma response can be a decrease in future emotional response to situations or it can come back as repeated nightmares or irrational or exaggerated behavior.  

"The male and female brain are different," Burns said.  She explained that women have an emotional center on both sides of the brain, men do not.  "Oftentimes the female brain, because of that connection--with the emotion on both sides--can be a little more prone to crying," she said.  There is good news about that crying however, the production of those tears simultaneously triggers the production of happy chemicals to level things out, she said.  "Tears and crying are actually another attempt for our bodies to recalibrate….and level off." 

How Trauma Affects Us
 
When you are in the midst of seriously traumatic situations you can have a shut down for an extended period of time.

"One of the situations that arises for folks who are consistently exposed to traumas emergencies and tragedies is that that heightened state of arousal becomes so imprinted in the brain that in order to feel anything you need more of those situations," Burns said.  "So that means that in order to feel alive, and actually feel good, and feel calm, you need to be in a crisis. And in everyday life you end up not feeling anything."

Burns mentioned that this was an issue she saw in a lot of 9/11 first responders that she treated.  They couldn't go home because they couldn't feel anything.  There's a feeling of wanting to go back to the trauma scene just so they can feel something, she said.

Burns said that first responders "will likely try to override stress and fatigue with dedication and commitment and they may deny the need for rest and recovery time."

The heightened state of arousal also calls to more arousal and first responders may not be able to put themselves to bed at night, or they may stay up and sit at the computer or watch TV or do something else to keep the brain stimulated, she said.  "Your brain will not feel anything normal so it will keep looking for ways to recalibrate. Thats the good news.  The brain  is very resilient…and it wants to bounce back…and it can do that."   

Burns said, "No one that responds to a mass casualty situation is unaffected. Just to know that, is part of the step in dealing with your well-being during the situation as well as after it."  She said that even though emotions shut down for a period of time, and you might feel that you are unaffected and doing pretty well at the time, you might be in shock and "the crash is going to come" eventually.

"Whether it is immediate or further down the line, the imprinting is there,' Burns said.

Preventative Measures First Responders Can Do To Handle Trauma

It is the job of the first responders to monitor their own well-being during crisis situations.  This means a constantly being aware of your physical and emotional condition, and accepting assessment of your condition from other responders too.   Many times first responders think they are fine but others can tell they are not.  So have an awareness of physical body sensations and mental condition.  "Rely on the input of others," Burns said.

Observe your surroundings.  Just by being there you are helping the trauma victims. "We are pack animals, it makes a difference that somebody is with us when there's something bad happening," Burns said. 

Look around at the other helpers. See this as a positive point. "If we have a negative experience, if there's a co-occurring positive experience, it can help mitigate some of the effects of that negative experience…let yourself see other helpers," Burns said.
      
Recognize that when you are in an emergency situation you end up having a bond with people that you are there with.  Also know that it is important to connect with other people.

Focus on your strengths.  "Just showing up is your greatest strength, Burns said.  "I hear it all the time…somebody showed up," she said.  Then you have all your own individual strengths, for whatever training you had, that you bring onto the scene. "It is going to help you out, remind yourself of what you are able to do," Burns said. "You are going to draw on those things when you need to."

"Set small goals…don't try to take on the world," Burns said. Reconnect with people, get back into your own world and a routine so you can recover.  And again, take input from others to let you low how you are doing.

First responders must limit their time on the scene. It may be difficult to step out of the scene when they want to stay there, when there are people in need, or they feel they have something to offer.   Having awareness of self preservation is necessary and will actually allow them to be more helpful in the overall picture, Burns said.

"Rotate from a more intense to a less intense part of the scene," Burns suggested.  Take breaks, and step away from the triggers that cause high arousal.  Let it drop down a little, let your brain recalibrate, she said.  Know your limits.

Monitor self care…eat, hydrate.  This goes hand in hand with knowing your limits, which is sometimes hard to judge when you are in the middle of a disaster situation.  Allow yourself to take cues.  "This is where the 'Chain of Command' training kicks in.  You read the manuals, you did the training, you know what is supposed to happen, you have brain imprinting for that.  Rely on that for cues," Burns said.

You also have your own individual strengths for whatever training you bring to the scene.  "Remind yourself of what you are able to do, you are creating that imprinting for yourself as well, then you are going to be able to draw on those things when you need to," Burns said..  
 
Professional Therapy Restores Well-being for Trauma Victims

"When we're taking about serious trauma, it sometimes needs the help of some therapeutic interventions to get you back….and that's when we talk about seeking professional help. We start off with figuring out whats going on for you, and then our job is to assist your brain in recalibrating.  That's what we do." Burns said.

Part of what is done in therapy is to try and make the connection between the part of the brain where trauma is stored, and make a shift. "The good news is, just as the environment can create that traumatic imprinting, we also can get rid of it with some very very effective therapeutic techniques. We can get these images that are stuck in that sensory experiential part of the brain, and we can get them to shift just into the cognitive part of the brain," Burns stated.

Also talk about your feelings, Burns said.  "The starting point is to get you to connect with other people, be in the presence of other people, start to feel your own body, get that awareness of yourself back, and that can help undo that imprinting that shuts down that thalamus."

The Aftermath

Burns spoke about treating a Vietnam veteran who had been dealing with triggers and flashbacks soon after he returned.  "He didn't want to have them, he couldn't will them away…this is rational thinking up here that trauma is stored back here and there's a disconnect between the two.  She helped him to undo that imprinting and shift it to the cognitive part of the brain. Burns said, "I will never forget this man sitting on my couch, tears coming out of his eyes, and him saying to me, 'thank you, you gave me my life back.'  I didn't really give him his life back, the trauma therapy gave him his life back."

"That's the point, we can undo traumatic imprinting, but part of the key is for all of you to be aware when you are present to it, it's going in there…your bodies automatically have a reaction to it."

*****

SECOND PRESENTATION and HANDS ON EXERCISE

The second presentation and demonstration included "How to Set Up a Simple, Small Scale, Co-located Emergency Animal Shelter."

Dr. Donna Cobelli, a veterinarian practicing small animal medicine and surgery in Ridgefield, CT and CTSART Team Leader, Region 5, along with CTSART volunteers, guided teams in setting up a mock emergency animal shelter with several crates and other supplies, then following up with the dismantling too.

The presentation included the following information: knowing your animal shelter locations, knowing where your supplies are, knowing who to call and how to contact volunteers, pre-planning and activating your teams early, and learning how to set up and run an animal shelter.

Possible animal shelter locations were discussed, as well as shelter requirements, starter kit supplies, and admit/discharge forms.

There was a question and answer period after the presentation and it was followed by a hands-on set up of a mock animal shelter.  Dr. Cobelli supervised and CTSART volunteers showed how to assemble and dismantle crates and how to set up supplies and forms as emergency management officials participated in the task. 

The emphasis of the meeting was to provide training to individual towns for animal emergency preparedness. It was also an opportunity to meet local CTSART volunteers, who are available for support during animal sheltering emergencies.

The training was open to emergency management directors, animal control officers and any additional interested town/city employees of the 43 municipalities within Region 5. 

Saturday's training exercise replicated the where 17 towns participated.

For more information email ctsartr5@yahoo.com or visit:
CTSART: http://www.ctsart.org
CTSART Region 5 map: http://www.ctsart.org/regions/
CERT: http://www.citizencorps.gov/cert/

For more information, call Cathy Burns LCSW, BCD at (203) 730-2246
For more information, call Dr. Donna Cobelli DVM at (203) 438-8878