Monday Morning Crisis Quarterback

Rikers Island circled in blue on evacuation map from NY Times

As Hurricane Irene churned its way up the East Coast last week, New York City Mayor Michael Bloomberg ordered the evacuation of coastal areas of the city. 300,000 people were ordered out of their homes (although a fair number didn't leave).

In the middle of this unusual situation, someone asked a very interesting question. What about Rikers Island? For those of you who don't watch Law & Order reruns, Rikers is the principal correctional facility for New York City. It currently houses about 12,000 prisoners. As the name suggests, it's on an island, and it's smack dab in the middle of the zone that was evacuated ahead of the hurricane.

But Rikers Island was not evacuated for Irene. We can argue about whether it -- or anywhere else in New York City -- really needed to be. But it turns out that Rikers has no evacuation plan. Let me reiterate that, because it really is striking. There is no plan in place to evacuate Rikers Island under any circumstance. Not a hurricane, tornado, flood, fire, earthquake, riot or anything else. If someone brings a bomb into the visitor's room and they can't diffuse it, too bad. If the whole island catches fire, oh, well.

I know that concern about the welfare of criminals is not a politically popular stance, and maybe that's why they haven't figured this out. But there are some other things to consider. First of all, Rikers houses people temporarily awaiting transfer to other facilities, those serving less than a year in jail and those awaiting trial who cannot make bail or are being held without bail. This is not, overall, the place you find the most hardened criminals of New York. What's more, a sizable number of them have never been convicted of a crime. They are accused and poor, but presumed innocent.

What's more, in order to maintain the prisoners at Rikers, there is a sizable staff of guards, cleaning crew, cooks, medical personnel and others who make the place run. Those people aren't even accused of crimes. They're just doing their jobs. And as long as there are prisoners on Rikers Island, they have to be there.

The public school where I was Principal has not one but two different evacuation locations plus a variety of plans based on the hazard. We have to practice evacuating the building, as does every school in the country. If your business doesn't know how to evacuate its personnel and its customers in the event of a disaster, I'd call that negligent. But a facility with about 20,000 people in it, all told, has no plan.

I'm sure evacuating Rikers would be a nightmare. It is possible that even if they had a plan, implementing it for Irene would not have been worth it. Fine. But not having a plan at all isn't just stupid, it's criminal. I don't know which is more horrifying -- that there is no plan, or that nobody thought it was a problem until now.

Someone is sending letters to Washington, D.C. schools with white powder in them. The letters, which also contain the typewritten message, "AL AQEDA-FBI [sic]," have arrived at at least 28 schools thus far, and four more letters have been intercepted. Authorities say that the substance inside them is not hazardous, although they haven't said what it is.

If you do a Google News search for "white powder schools" you will find numerous incidents over the last decade, plus a bunch involving various organizations, institutions, and even Dancing With the Stars. Apparently, something similar even happened in Washington schools last October.

Am I the only one who remembers a time when it would have been the furthest thing from someone's mind to try to scare people with cornstarch? Before the anthrax attacks of 2001, this just wasn't on anyone's radar screen -- not even the lunatic fringe. Since then, it seems like almost an epidemic.

In 2001, schools in Western Pennsylvania (and perhaps elsewhere -- I just happened to work in Western PA at the time) had to scramble over "white powders." A local supplier of science curriculum had a 5th grade science explorations unit which many districts used which asked students to identify various "mystery powders," all of them white. All of a sudden, this didn't seem like a good idea, and replacement units had to be created or purchased.

As far as I can tell from the news coverage of the latest incident, the level of panic occurring at the schools involved is extremely low. It looks like people opened the letters and notified the authorities, who took it seriously and came out to the schools. I'm not seeing reports of school personnel becoming hysterical or evacuating buildings. I'm not seeing any reaction from kids, which seems to indicate that most of them didn't know about it. One school did notice the letter before it came inside and left it outside -- that seems cautious without being a complete overreaction.

The thing is, if we panic every time someone does this, then the bozos who are doing it get what they want. This encourages future bozos to do the same thing. Would it be safer to evacuate every building where this happens? Maybe, maybe not. We may be at the point where the chances of someone getting hurt in the evacuation -- tripping, stepping on something, getting hit by lightning, being a crime victim, getting hit by a car -- are actually greater than the chances of someone getting hurt by a mystery powder in a letter.

You might be surprised to know that the same logic often applies to bomb threats in schools. Many schools do not routinely evacuate if they receive a bomb threat. They wait for the advice of the police and fire departments regarding the specific threat. That's because if you know you can disrupt school -- any school, but particularly your own school -- by phoning in a bomb threat, then this becomes a very attractive thing for kids to do to get out of exams and such. Add to this the risk that someone will phone in a bomb threat and then wait for everyone to start coming outside and do something to them there, and evacuating is not always the thing to do. It depends on the situation.

Often times parents, in particular, don't want to hear that not evacuating is the best thing. Our knee-jerk reaction is that we should evacuate kids if there is any risk or threat. The thing is, that may not be in the best of interests of the kids. If we actually did that, we could well spend every day going in and out of school buildings. Schools have to evaluate relative risk, just as parents do at home. We don't get everyone outside when our dirty ovens start to smoke at home, or every time we hear a funny noise in the night. In loco parentis means that schools must act with the same care that parents would at home, not that they must jump every time someone says "boo." It would be a lot easier, however, if people didn't think it was a good idea to say "boo" in the first place.

The attention of most of the country continues to be across the Pacific in Japan. The loss of life is horrific. The material damage is enormous. The fear regarding the radiation in Fukushima is mounting.

Now is not the time for a psychological crisis intervention in Japan. The situation is still unfolding, and there are still significant basic physical and safety needs to be met. The best that can be done from a mental health standpoint in Japan right now is managing people's fear. Both the Prime Minister and the Emperor appear, from this vantage point, to be doing a pretty good job at exercising resilient leadership. The consistent emphasis on coming together and getting through this is good practice.

What about folks in the U.S.? Is there anything we can or should be doing for people here? I think there is.

First of all, everyone in the world needs some decent information about the radiation risk. With the exception of nuclear scientists, most of us have very little understanding of how much radiation is too much, how the current accident will affect people in Japan and whether it will affect anyone anywhere else at all. The news media is doing a somewhat better job of bringing in experts to explain this to us, but I think it would help if they acknowledged that none of us like hearing that there's any radiation at all, and that the biggest impact here is from fear, not nuclear byproducts.

People here who have family and close friends in Japan, particularly in the area where the quake and tsunami were, need something a little more. I think you could further separate that group into two -- those who come from Japan and have roots there, and those who don't trace their roots to Japan but have family studying or visiting there. Last Friday was ghastly for both of these groups, and it would not be surprising if they're feeling the affects even now, presuming that they now know how their loved ones fared in the quake.

For those who come from Japan, this incident is not, in some ways, over. The pictures the rest of us see and think are horrible are more personal. They may have lost homes or other special places. They may not be ready, yet, to process through their feelings and try to put them away.

For those who had family visiting or living in Japan but are not themselves Japanese, the incident is largely over and they are probably ready for some intervention. It would be totally understandable if they are having some issues with feeling irritable, having trouble concentrating, not sleeping well or having intrusive thoughts about the quake and the agonizing wait to hear from loved ones. They need to know they're normal -- it's the situation that isn't.

Then there is that group that is somewhere in a no man's land in between. They are from Japan, every picture is personal, the situation is ongoing, and they also experienced the traumatic death of someone they love. For them, some understanding and moral support is in order until the dust can settle a little more and they can start to come to terms with all of this.

I wrote yesterday about my son's friend, Taro. When I wrote, I wasn't sure which category Taro fell into. Late yesterday we confirmed that he is in this last category. He lost his grandmother and his home. The only bright side, perhaps, is that young children don't really understand death and loss as permanent things. But his family does, like so many other families in Japan, here and elsewhere. The latest estimate I've heard is 10,000 dead. That's a lot of people in limbo, waiting for this to be over so they can grieve.

Depending on where you live, the earthquake and tsunami in Japan may or may not seem like something that can happen to you.  Here in Michigan, our chances of an 8.9 earthquake are pretty low. Even a tsunami on Lake Michigan wouldn't reach my house. But a nuclear reactor accident? Before today I didn't even know where the nearest nuclear power plant to my house was (it's about 40 miles). Floods, tornadoes, hurricanes, blizzards, chemical spills . . . there are a lot of reasons why you might, someday, need to either evacuate your house or shelter in place.

FEMA has been on us for years to get ready. Most of us aren't. At a recent meeting of CISM providers, the FEMA director asked for a show of hands of how many people had an emergency bag for evacuations.  Less than half of us raised our hands. Then he asked how many had a plan for evacuating their family. In a room of 800 people, I was one of two.

Make no mistake about it. When the time comes to leave your house, you will not necessarily have any time to get ready. Depending on what the disaster is, you might have a day and you might have less than 5 minutes. That's not the time to be thinking about this for the first time.

So, let's get practical. Here is a list of things you can do, roughly in order of the ease of doing them. This list is not exhaustive, nor does it take into consideration every possible catastrophe that could befall you. But it's a start. Find something on this list you haven't done yet, and do it.

• Talk.  Seriously. Have a conversation with the other people in your house and make the following decisions:
• Where would you meet in the event of an evacuation at a time you weren't together. Pick someplace out of the immediate area.
  
• Where would you meet if that place was also evacuating.
• Who are two people outside your area who you will call in an emergency if you can't reach each other, so they can relay messages to the others when they call.
• If you have children and you have to evacuate during the school day, who is responsible for picking them up (if possible -- they may have to go with school personnel, keep in mind).
• If your children are home alone, where should they go? Who is a safe person who is nearby who can help them?
  
• Find out what the official evacuation route or procedure is, if there is one, for the catastrophe most likely to happen in your area.
• Educate yourself about that catastrophe. Find out what the dos and don'ts of surviving it are. Do this even if you think you already know. Conventional wisdom may well be wrong.
  
• Make sure you have a battery operated radio and a flashlight, and that everyone in the house knows how to use them. Also make sure everyone in the house knows where in the house is safest in the event of an earthquake or tornado, if applicable.
• Make a list of the medications everyone in the house takes, both so you can grab them on your way out and so you can tell people at the shelter if you don't have your meds.
• Make sure you keep 3 days worth of food in your house at all times. It doesn't have to be 3 days of great food, but don't let your cupboards get bare.
• Stock up on clean water. You should have one gallon per person per day for 3 days. If you have a chest freezer, you can stick a gallon or two in the freezer, which will also save electricity.
• Create a bag with the things you would need if absolutely everything else in the world were destroyed. This probably includes medications, vital documents, a first aide kit, and at least a little non-perishable food. Put a list in the bag of anything that isn't in there that you need to remember (e.g. your child's asthma nebulizer).

Not only will these steps help you stay safe, they will help you stay sane. In the event of an emergency, you want to be able to devote as much of your energy as possible to doing what needs to be done and not add to the crisis with your panic at not knowing what that is. Being prepared makes people resilient. That won't make a major disaster fun, but it will make it doable.

Over 2,400 people in Santa Cruz County, California, have now been evacuated due to the Lockheed Wildfire which began burning earlier this week. With all these people in crisis, you might wonder what the CISM response looks like right now. And if you think of CISM as mostly being one-to-one and small group work, then the answer is: not much.

But that's not completely accurate. CISM includes a large number of components, but I would predict that right now there are only two that are generally and widely appropriate: the Crisis Management Briefing (CMB) and the Demobilization. Both of these, however, are large group interventions.

Demobilization is a strategy used mostly for first responders in large scale operations, which this certainly is. In a demobilization in this instance, as firefighters come off the line following their first shift, they come to some predetermined location where there is food and drink, possibly shower facilities and/or cots. A member of the CISM team spends maybe 10 minutes with them while they eat. They share any new information about the fire and give them some self-care tips and information about what they can expect emotionally in the days ahead, gives them a handout about common stress reactions and about self-care, and then sends them off either to rest or to go home, depending on how the rotation is working.

CMBs may be being used for evacuated residents and/or first responders prior to subsequent shifts. In this intervention, some person in authority (a representative from the fire department or the governor's office, for example) gives the latest information about the fire, what is currently being done, and what the plans are moving forward, and a member of the CISM team does some education about critical incident stress and how to take care of yourself.

What you'll notice in both instances that all the CISM team is doing is "information push." Disaster victims and responders are not really being given an opportunity to process their thoughts and feelings with the team. The reason for this is simple -- the incident isn't over. To draw an analogy, it would be like trying to stitch up a dog bite in someone who is still being chased by a dog. They can't possibly hold still and cooperate in their care because their mind is on outrunning the dog, and they're going to be pretty mad at you if you try to stitch them up instead of at least cheering them on in the outrunning of the dog.

I can't say categorically that nowhere in any shelter is anybody getting any individual or small group help. Folks who had to be rescued from a burning building, for example, may need some support for that portion of the incident and they may be ready to talk about it. But maybe not. Most folks are still worried about whether their home will be there when they get back, whether their pets made it, trying to find loved ones and a more permanent place to stay, etc. And crisis responders ought to be helping them with those things.

Sometimes after mass disasters and major incidents people don't ever get the help they need because it takes so long for an incident to end or the ending is not very clear. For example, many rescue and recovery workers at Ground Zero got some support at the scene but never did a Critical Incident Stress Debriefing (CISD) because there was no agreed upon time when they were done. The CISM teams that supported them on site also didn't always get Post Action Staff Support (PASS) because it never felt like they were done. After Katrina, by the time New Orleans residents were settled enough to get CISM help, they were scattered all over the country. Planning to support victims of long-lasting disasters is a great challenge for crisis responders. I know my colleagues in Santa Cruz are up to the job.