Edited Version of April 12, 2000 Transcript
EIIP Virtual Forum Presentation
"The American Red Cross Disaster Mental Health Role in
Aviation Disasters and Beyond."
American Red Cross (ARC)
Moderator - EIIP Technical Projects Coordinator
The original unedited transcript of the April 12, 2000 online Virtual Forum presentation is available on the EIIP Virtual Forum (http://www.emforum.org). The following version of the transcript has been edited for easier reading and comprehension. Typos were corrected, date/time/names attributed by the software to each were deleted but content of discussions, questions, and responses are as stated by each participant. Answers from the speakers to questions by the audience are grouped beneath the appropriate question to facilitate meaning.
Amy Sebring: Welcome to the EIIP Virtual Forum!
For the benefit of any first-timers, when you see a blue web address, you can click on it and the referenced Web page should appear in a browser window. After the first one, the browser window may not automatically come to the top, so you may need to bring it forward by clicking on a button at the status bar at the bottom of your screen.
We will start with a presentation, and then follow with a Q&A session for your questions and comments. Right before we begin the Q&A portion we will review the procedure.
Please do NOT send direct messages to the speaker or moderator as it makes it difficult for us to follow the discussion.
Background information for today's session may be found at <http://www.emforum.org/vforum/000412.htm>.
Today we are observing National Volunteer Week in the Virtual Forum. This event is sponsored by the Points of Light Foundation, and is an opportunity to celebrate volunteers in this country. There is a link to the celebration page from today's background page, and a brief article in this month's newsletter, which you can access from our home page. I doubt there has ever been an attempt to quantify the value of the time donated by volunteers in disasters, nor to include any such figure in the true cost of disasters. My guess is that it would be a very big number indeed.
At the end of today's session we will take a few moments to recognize our own EIIP volunteers, and hope you will join us then in expressing our appreciation.
But first, we are pleased to have Jane Morgan with us today, representing the American Red Cross (ARC), an organization that could not achieve its goals without the many volunteers that donate their time.
Jane is a registered nurse and has worked for the Red Cross for twenty years. During that time she has provided leadership in the development and implementation of the ARC Disaster Mental Health Services program. In 1998, Jane was awarded an honorary Doctorate of Humane Letters from the University of South Dakota in recognition for her leadership in the disaster mental health field and in January 2000 she received the Florence Nightingale Medal from the International Red Cross and Red Crescent Societies. Please see the background page for Jane's complete bio. Today her topic is "The American Red Cross Disaster Mental Health Role in Aviation Disasters and Beyond."
Welcome, Jane. We are honored to have you with us today.
Jane Morgan: Thanks, Amy. Hopefully, I'll push any ignore buttons and stay up with everyone.
The fall of 1989 tested the ARC as it had never been tested before with Hurricane Hugo and the Loma Prieta Earthquake in San Francisco. Large numbers of disaster workers were needed for extended periods of time to meet the disaster related needs of hundreds of thousands of people in the Caribbean, the Carolinas and in California.
Workers experienced high levels of stress as they worked to alleviate suffering. Following the operations, a national task force made up of psychiatrists, psychologists, social workers and nurses was formed to determine if an internal disaster mental health program was needed. Additionally, the ARC initiated an extensive post operational survey of clients and workers to determine if the provided services were effective and how workers were impacted by these catastrophic disasters.
Survey results supported the task force findings and the development of the ARC DMHS program began. Guidelines clarifying the scope and limitations, standard operational procedures, introductory training and agreements with professional associations were developed.
Key points are that services are short term, limited to crisis intervention and based on the premise that most of the people affected by disasters are not mentally ill but experiencing normal reactions to an abnormal occurrence.
Supportive services are also provided for disaster workers. In fact, this was the original priority in the development of our program. One way to be sure that quality services are consistently provided to those affected by disaster is to ensure that our workers are ok themselves.
More than 2,500 licensed mental health professionals are now trained and available to go on assignment away from their own communities. An additional 7,000 have completed ARC DMHS training and provide DMHS in their own jurisdictions. Slides 3 & 4 show the associations we have agreements with and how the numbers break down by discipline.
More than 1,200 ARC chapters work across the country with local mental health authorities and other local providers to coordinate and collaborate to ensure the availability of DMHS for disasters ranging from single family fires to large floods, earthquakes and hurricanes.
Response to Aviation Disasters
1995 was not a good year for air travel in the United States. In May, the ValuJet disaster occurred in Florida and again in July another tragedy occurred when TWA Fight 800 crashed into the Atlantic Ocean off the coast of New York. Prior to ValuJet, family members from earlier aviation disasters had started lobbying for a more quality, consistent approach to providing assistance to survivors and family members. This included changing the involvement of the affected airline.
These two tragic events ensured that Congress would be responsive. Hearings were held resulting in the passing of the Aviation Disaster Family Assistance Act of 1996. The Act named the National Transportation Safety Board (NTSB) as the federal agency in charge of developing a plan for and leading a coordinated response to future aviation disasters.
It is important to note that the Act does not impact the immediate response at the crash site, which remains the responsibility of the local community.
The Act also required the NTSB to name a non-profit humanitarian organization with experience in post trauma communication with families be named as the lead organization for providing mental health services.
Many of those testifying mentioned the ARC as an organization that should be involved in responding to aviation disasters. Slide 5 shows the responsibilities of the designated organization identified in the Act.
NTSB named the ARC as that designated organization. They then developed the Federal Response Plan for Aviation Disasters and divided responsibilities into seven Victim Support Tasks (VST). Slide 6 shows the seven VSTs and the responsible agency or organization.
The plan expands ARC's role to include 10 primary responsibilities. One of the most important is the coordination of all individuals or organizations that would offer support to the family members.
It is essential that the numbers of people with access to family members be limited so that they are not suffocated by well-intentioned helpers. These disasters cause such strong emotional reactions among the general public that finding helpers is never the problem; controlling and limiting them becomes the issue.
The only way this can occur is to require that all helpers come through one screening, scheduling location that is away from all service delivery sites. This ensures that those helping are qualified to provide the services they are offering and equally important, that they are prepared for what they will experience.
Responding to mass casualty events is particularly difficult for workers and they must be appropriately prepared and given an option to not work the response without any stigma being attached to their decision.
Services provided by the ARC or under their umbrella by other organizations include feeding, health services, mental health services, spiritual support and childcare.
The ARC is also tasked with coordinating an interfaith memorial service. Usually one large service is held within a few days of the disaster. An additional service may be necessary several months later if there is a need for burial of unidentified remains.
A tremendous amount of work has occurred over the last three years to develop training programs within ARC, the airlines and NTSB to develop a coordinated response to aviation disasters.
There have been six disasters since the Act was passed. They are identified in Slide 7.
The comfort levels and knowledge of the responding organizations grow each time. All involved parties continue to work to increase their abilities to work together and be better prepared to assist those affected by these tragic events.
I think I'll stop here and we'll be able to go into more detail depending on what your areas of interest and questions are.
Amy Sebring: Thank you very much, Jane. Let's turn to our audience now. Audience, please enter a question mark (?) to indicate you wish to be recognized, compose your comment or question, but wait for recognition before hitting the enter key or clicking on Send. We now invite your questions/comments.
Roger Kershaw: Does the support from ARC go to the emergency workers, as well as the families?
Jane Morgan: The law itself doesn't refer to workers, however, the plan does. ARC will check with responding agencies, see what resources are in place, what resources they have, are they meeting the needs, and can they maintain for the long haul. If so, we make them aware that we are available if needed but encourage things already in place to function as planned.
Avagene Moore: Jane, is training available in this area for local level folks? If so, how would someone go about getting it or requesting training?
Jane Morgan: There's not a lot available as of this point. NTSB is meeting with a lot of communities, airports, EMAs, etc., and discussing needs. ARC has developed a video with a plan for chapters to facilitate meetings in communities for addressing family needs. The video has scenarios that can be used for a table top.
Rick Tobin: Critical Incident Stress applications are under scrutiny now, including reports that question its use. Does ARC have a position on the efficacy of CIS debriefings for staff serving those in these scenarios?
Jane Morgan: We are continuing to review the material as it is made available. Our program utilizes preparedness --- prepare workers for what to expect, make them aware of what resources are available during assignment, be available during assignment, conduct a debriefing prior to departure and have mental health workers follow up when they return home. So it is an ongoing process.
Sue Meservey: What if a worker is okay and can meet the needs of the family, etc., then a month or a week or two later this worker develops a problem, since that worker can now reflect on what happened, etc.?
Jane Morgan: That's a very good point --- especially with these kinds of disasters. Would the worker be able to seek help? We send a reminder to all chapters who send workers to multi-casualty incidents as to the unique aspects, and difficult and traumatic aspects of these disasters that a reaction later is not unlikely. We ask the home chapters to stay in touch and chapters can always get support from DMHS at NHQ if they need it.
Jim Cook: I know all disasters are difficult to work. What was the situation like in Nova Scotia (being outside the U.S.?) Were you able to function as well as if you were in the U.S.?
Jane Morgan: That was very different and really shouldn't be included in that slide. ARC national societies must be invited by the affected county's society before providing services in their jurisdiction. The Act it self only applies to disasters on US soil so it did not apply. The NYC chapter staffed a family reception site for families at JFK. All families traveled from there to Nova Scotia. We worked with the Canadian RC in providing guidance to them and at their request, sent some DMHS workers up there to support and debrief their workers.
Jack Williamson: Does the plan identify a process to screen or make some determinations as to what services are needed in a major disaster like a hurricane and, if so, how is it implemented?
Jane Morgan: Chapters are a part of the local community and state preparedness activities so they are part of that general assessment. We also have a hurricane watch program that we are very involved in the preparedness part right now. Chapters and states assess their resources, people, equipment etc., and determine what their anticipated support needs would be should they receive a threat and/or a hit. We then support them and plan ahead at the national level to meet those needs.
Chip Hines: I know that in a number of disasters, massage therapists have volunteered to help both workers and victims. As a budding massage therapist myself, I know the value that is offered by these services. But I've also heard that because of the high level of stress, and the potential for emotional release during massage, it is important that this work be done in close association with mental health care professionals. Do you know if this has been researched and if there is a policy or approach that deals with this issue?
Jane Morgan: We have had quite a few discussions with the American Association of Massage Therapists, particularly with their emergency group. Those discussions have fallen off lately. We recognize the value it can add but need to work some logistical, risk management kinds of issues.
Rick Tobin: What liabilities did the ARC take on, or get relief from, when it took on this role, since the door for litigation in such cases seems to touch everyone? In fact, does ARC have any role in screening lawyers from hounding the families?
Jane Morgan: OOH - a favorite topic. Our liability is no different than it would be for any type of disaster. The Act itself prohibits lawyers from soliciting families for 30 days following an incident. That doesn't prevent families from getting help but does prevent the hounding. In fact, this piece of the Act has been tested, lawyers were prosecuted and fined in one incident. So it is working. On the other hand, we are working with the ABA, Young Lawyers Division to seek a couple of volunteers to come on site and answer questions for families, but not seek clients.
Sheena Vivian: Peggy's Cove was mentioned. After that disaster were there any discussions with Canadian authorities to put a similar set of protocols in place for Canadian air disasters?
Jane Morgan: There have been before and after. We have met with the International Association of Airlines and discussed this issue. NTSB has had multiple requests and is going to France this month to meet with another international group to discuss this on a national level.
John Roberts: I would like to request information about the possibility of joining an air team. Could you give me some help concerning how to proceed from here or did I miss something?
Jane Morgan: The Aviation Incident Response (AIR )Team is an ARC quick response leadership team to respond to aviation disasters. Team members are on call a month at a time and must be available to travel within 4 hours of notification. This team becomes the leadership for the ARC part of the response, blending with the immediate response of the chapter. AIR Team members must be coordinator or above in DSHR (the ARC personnel inventory tracking system) to apply. They need to let their function lead know of their interest. Anyone needing more details can contact me directly.
Amy Sebring: Jane in the aircraft or other disasters where you have dealt directly with families, have you gotten a positive response? And is there a provision for follow up later on as with workers?
Jane Morgan: We have gotten a very positive response. The first aviation disaster I responded to was in New Orleans in 1982 with quite a few in between. There is a tremendous difference in the services provided now, the trust that is established quickly between the families and responding organizations and individuals. I was on Egypt Air and Alaska Airlines and I have seen very little accusatory, negative actions. This includes towards the airline. The NTSB, airline and ARC work very closely as a team and I think this is making it much easier for the families. As families depart or just begin to return to normal activities. They are given 800#s from the airline, NTSB and ARC for further assistance so they are not cut off once the immediate response is over.
Jack Williamson: Does the NTSB, ARC, FBI and others have the opportunity to meet, discuss and practice procedures on a regular basis to ensure the best possible response or is it a learn as you go process?
Jane Morgan: Some of all of above. The airline is different every time, but we are all trying to take each other's training, and get to know the key players as much as possible.
An after action report is required by NTSB after each event with issues and recommendations. We've come a long way with talking and working together, but there is still room for improvement in this area.
Jack Williamson: How are recommendations adopted and formally implemented?
Jane Morgan: Most of the exercises that are community-based tend to stop at the tarmac and don't involve the family side much. So everyone is working on this point and developing more opportunities for practice.
Amy Sebring: Jane, can you briefly tell Jack about how report recommendations are adopted?
Jane Morgan: One issue is providing identification for families. Airlines are supposed to do this, but so far none of them have been able to do this. We have had to do this at every incident that makes our identifying of workers more difficult. We've submitted recommendation on this and NTSB has developed an interim system and is disseminating info to airlines reminding them of this responsibility, so pretty informally so far.
Ray Pena: The Badger Chapter Red Cross here in Madison is working closely with us, the Dane County Regional Airport and airlines to prepare for these events. These connections make a big difference --- we know each other, have established good relationships (including during exercises) that will be crucial during an incident.
Jane Morgan: That's an excellent comment --- you can't overstress knowing each other in peacetime building those relationships. During the heat of battle is not the time to do this.
Amy Sebring: Jane, are you willing to put up your contact info?
Jane Morgan: I can be reached at <firstname.lastname@example.org> or (703) 206-8635.
Another valuable contact is Dusty Bowenkamp who is the current DMHS Associate and the lead for aviation planning. Dusty is <email@example.com> or (703) 206-8615.
Amy Sebring: Thank you very much for being with us today, Jane. This is an important topic we have wanted to address for some time, and we hope that the session today will contribute toward a broader understanding and appreciation.
Please, stand by a moment if you can while we take care of some EIIP business. First, Avagene, can you tell us what's on for next week, please?
Avagene Moore: Thanks, Amy. Jane, I enjoyed your presentation and appreciate your time and effort. This topic is of interest --- 47 people logged in for the session. Good number! Thank you for being here today, Jane.
Next week, Wednesday April 19, 12 Noon EDT, we continue our Hazard Series with a Virtual Classroom presentation on Dam Safety, with Don Bathurst, FEMA Dam Safety Program. We hope you will mark your calendar and make time for this discussion. That's all for now, Amy.
Amy Sebring: Thank you, Ava. Next we would like to acknowledge three new pledges! Thank you to Walker Gonzalez, Kellyann Meloche, and Jessica Basch.
<//bell http://www.emforum.org/pledge.wav> !!!
Now we would like to "celebrate" our EIIP volunteers. Please hold your applause until we have introduced them all.
First, Isabel McCurdy has been volunteering her time for over two years. She has attended almost every session, and you have seen her in the lobby where she serves as greeter. Every week she also takes the raw text transcript and helps us turn it into a more readable format. In recognition of her loyal service we are pleased to present her with this certificate: <http://www.emforum.org/eiip/isabel.htm>.
Isabel McCurdy: Thank you, Amy and Avagene!
Amy Sebring: Second, we met Lori Wieber who assisted us with pulling off the first WEBEX exercise! This past year, she has been assisting us with the editing of our monthly newsletter, Emergency Partner Postings. In recognition of her valued service we are pleased to present her with this certificate: <http://www.emforum.org/eiip/lori.htm>.
Last, but not least, Dawn Wiese has joined us this year as a student intern from the University of Tennessee at Chattanooga. She has been assisting us with work involved in setting up and running the EIIP as a non-profit corporation. In recognition of her valued service we are pleased to present her with this certificate: <http://www.emforum.org/eiip/dawn.htm>.
Ava, would you like to add a few words?
Avagene Moore: Yes, Amy, thank you. The EIIP has been most fortunate to find volunteers to help us. Every bit of effort contributes to our overall success. We have had several student interns over the past 2 ½ years. On behalf of the EIIP, we are personally indebted to each of them and especially Isabel, Lori, and Dawn who are currently working with us. Bottom line, whether you work as a volunteer or work with and rely heavily upon volunteers, it is a sincere pleasure to honor and celebrate volunteers this week. Our thanks to all volunteers! May the spirit of volunteerism always abound!
Back to you, Amy.
Amy Sebring: Now, will you please join us in thanking our guest today, Jane Morgan, and all our volunteers.
Daryl Spiewak: Here! Here! Thanks for all your support and volunteer efforts on the EIIP.
Amy Sebring: <clap, clap, clap>!
David Crews: Congratulations Isabel, Lori and Dawn! Thanks for your dedication and fine work!
Avagene Moore: <<applause, applause, applause>> Thanks Jane! Good show!
Amy Sebring: Thanks to all our participants today. We will adjourn the session for now, but you are invited to remain for open discussion. You no longer need to use question marks.
Jane Morgan: Thank you, it was a lot of fun.