For more than 60 years, the Centers for Disease Control and Prevention (CDC) has responded to a broad spectrum of natural and human-caused disasters, including food- and waterborne illnesses, disease outbreaks, chronic health challenges, terrorism incidents, hurricanes, and earthquakes. Until recently, the highly educated professionals who deploy to hot spots around the world received little training on how to deal with the potential mental and emotional effects of the stressors to which they might be exposed.
One example is the 9.0-magnitude earthquake under the Indian Ocean on December 26, 2004. It generated destructive shockwaves and a tsunami that resulted in more than 150,000 people being killed or identified as missing, and made millions of people in 11 countries homeless.
In the aftermath of the tsunami, because of widespread injuries and the potential for disease outbreak, CDC deployed a few dozen people to Thailand and Indonesia. While these individuals were experts in their respective fields, they ran into challenges, such as seeing grieving parents mourning their losses or being inundated with the sights and smells of hundreds of disaster victims' remains stored in blue body bags piled on dry ice. Direct exposure to this level of destruction is an experience that most U.S. citizens never face.
CDC has an increasing number of individuals involved in numerous emergency responses, which puts them at risk of experiencing significant negative outcomes. Based on those facts, it made sense to conclude that if CDC's workers were physically, mentally, or emotionally impaired by what they were exposed to, their capacity to perform their job duties would be negatively affected.
+ Health, safety, and resiliency planning
Realizing that more needed to be done to better prepare these emergency responders, behavioral science experts at CDC reviewed stressors that CDC emergency responders could encounter. Postdeployment interviews were conducted with staff to collect information about what they saw and heard in the field. This led to the inclusion of information in predeployment briefings about physiological, cognitive, and emotional signs of stress; available support; and the importance of self-care.
In addition to providing briefings, CDC's responder resiliency leaders connected with CDC's employee assistance plan to ensure that resources were available to any CDC worker seeking professional guidance regarding their deployment. Collaboration with CDC's Humanitarian Assistance Team and its continuity of operations planning and outreach efforts also was initiated.
Project leadership in the Office of Safety, Health and Environment (OSHE) reached out to other agencies that put their workforces into potentially dangerous environments to benchmark best practices related to protecting workforce well-being. This enabled CDC to build on the knowledge and expertise of other federal organizations. The groups that shared information included the Bureau of Alcohol, Tobacco, Firearms and Explosives; Federal Bureau of Investigation; National Aeronautics and Space Administration; U.S. Environmental Protection Agency; U.S. Army; U.S. Coast Guard; and U.S. Marine Corps.
Despite numerous variations in training content between agencies, two common elements emerged: inclusion of a psychological model that provided a foundation on which training could be built and inclusion of a peer support component. These findings and a review of behavioral health research lead to selection of a model called Psychological First Aid (PFA), developed by The National Child Traumatic Stress Network and the National Center for Post-Traumatic Stress Disorder.
+ Factors affecting training design
Those findings, plus the following four core assumptions, influenced the design of this training:
1. An individual placed in the field with his deployed team members (such as a medic in a military unit) following training to assess and address his physical and emotional health, safety, and resiliency had merit. …