POST-DISASTER INTERVENTION PROGRAM

THE MASSACHUSETTS BLIZZARD OF 1978

 

                                                                                                                                                             R.E.Cohen MD

 

EVENT

 

The most severe blizzard to strike the Boston Metropolitan Area in over 109 years began on the afternoon of February 6, l978.

 

Before it ended, the storm set state records for most snow accumulation in a 24 hour period at 23 inches.  The snow raised the area’s total seasonal snowfall to 68.5 inches, the most in 30 years.  It also was identified as the 10th worst disaster in U.S history.

 

The storm lasted 33½ hours, during which wind gusts of 69 miles per hour were recorded in Boston and 92 miles per hour on Cape Cod.  The high tides in the next few days were recorded at more than 16 feet above normal level.  This elevation resulted in severe flooding, damaging the state’s coastal communities.

 

Blizzard Impact

 

The disaster killed 28 individuals and caused over 2,250 injuries and over 450 hospitalizations statewide as a direct result of the blizzard.  Over 2000 homes were destroyed, while 35,000 homes were damaged which required over 30,000 individuals to be evacuated from their neighborhoods.  On the highways, over 3,000 cars were stranded and a large number of individuals were trapped in their cars for over 36 hours.  Shelters were used by as many as 20,000 individuals who were fed and cared for over the next several weeks.

 

Mental Health Planning

 

Mental Health professionals employed by the State Community Mental Health Center in Boston became aware of the need for assistance and mobilized themselves rapidly, taking turns to assist and participate in the emergency efforts. They developed a survey protocol by visiting the school shelters in the community, where they found citizens manifesting signs of stress and difficulty coping with their new situation. In one of the schools, a first-aid setting had been developed by a group of health professionals.  The mental health team and myself had previously worked with them in community projects, so we were able to rapidly establish responsibilities and collaborative relations aimed at developing an approach to assist the survivors of this event.

 

The Red Cross also was present and was aware of the mental health needs of survivors, which facilitated the triage methods we put into practice.  The physical setting had been divided into different areas of group activity, for example living quarters for families, quiet areas for adult relaxation, administrative areas for resource allocations, and settings for medical assistance.  The National Guard and State/local officials, who rapidly mobilized many resources to assist the families who had lost their homes and needed transitional shelters, directed these shelters. 

 

FIRST-AID ASSISTANCE

 

The types of problems for which the mental health professionals were called to assist by the emergency caregivers ranged from problems of uncontrollable crying, emotional/functional maladaptive behavior, fear of miscarriage, drug/alcohol withdrawal symptoms and former mental patients who had no access to their medication.  As documented by emergency health professionals, two major areas of support were crucial to assist them in helping their patients:  1) specialized professionals who could directly take over the medical problems that had strong emotional and deviant behavior components; and 2) their awareness that they could not be saddled with having to take responsibility for problems they could not handle and which demanded a large amount of time to solve.  The use of time and energy within the first-aid model was the single most useful cooperation appreciated by the 2 groups - medical and Red Cross.  The flow of individuals from the “living” settings to the specialized “health-mental health” setting was the operative structure.  Professionals from the three units moved through each others’ units and worked with the survivors in the shelter.  If any member of the groups identified a need for further service, they would escort the individual to the area where the needed services were “housed”.   Many first-aid interventions were given sitting on a cot or even on the floor of the high school gym.  This fluid, rapid, and  effective approach allowed the staff to work in a task-focus manner including additional volunteers that joined us a few days later.

 

It was evident that during the assistance activities provided by a small number of multidisciplinary professionals aiming to service a large population, the ratio of individuals to survivor needs was imbalanced.

At the present time little is known of the time and number of mental health professionals needed to assist large number of survivors of a catastrophic disaster.  This important component needs to be researched so as to develop planning operations and be able to set up rapid mobilization ready to assist the survivors.  One of the most valuable lessons from this experience was that development of previous relations the professionals involved in the disaster allowed us to mobilize ourselves at the same time as the State Emergency Assistance personnel.  We were able to demonstrate our usefulness and ability to assist survivors in many areas of maladaptive coping and painful expressions of “normal reactions to abnormal circumstances”.

 

This perception of the non-mental health workers who relied on our expertise remained for the duration of the post-disaster phases of the recuperation and reconstruction periods.

 

TEAM OPERATIONS-First component

 

The rapid deployment and entry by mental health workers into the shelter setting started without a prior organizational plan or logistics appraisal to develop a division of tasks.

 

As the immensity of demands for different activities emerged, there was a need to allot the scheduling of time and staff so as to have continuous attendance by mental health personnel.  Decisions had to be made to plan prospectively for use of resources in parallel with the emergency assistance agencies’ planning structures.  Issues of  1) logistics; 2) amount of hours/staff; 3) communication links with government liaison staff; 4) dealing with the media; and 5)  determining volunteers’ certification credentials used many hours to administer. 

 

The first week could be described as a “first aid mental health intervention”, with the immediate objective to orient, offer support and try to return survivors to a semblance of self-organized and coping behavior capability.  The survivors had to adapt to new routines, lack of privacy, and spartan settings while living in the stressful environment of shared intimacy during daily activities with hundreds of other stressed survivors.

 

Planning for continuing mental health assistance had to anticipate the change of shelter living organizational programs of the government.  The “shelters” closed within a couple of weeks and individuals were moved to hotels and motels while others found places with friends and relatives.  Parallel to the availability of living in the shelters, the survivors were able to go to the Federal Disaster Centers (FEMA) being organized to systematically assist the distressed and weary populations to offer and rapidly process physical and economic resources.  Within this federal setting the mental health-crisis counseling intervention made its official appearance.  This assistance was sanctioned by the Disaster Relief Act Amendment of 1974, Section 413 (Pl 93-288) that states “the President is authorized (through NIMH) to provide professional counseling services, including financial assistance to state or local agencies or private mental health organizations.  They will provide such services or training for disaster workers to victims of major disasters in order to relieve mental health problems caused or aggravated by such major disasters or their aftermath.” The funding for mental health counseling was granted to the state after a grant documenting needs and the appropriate budget was submitted to the funding agencies.  This generally meant that for six weeks the manpower needed to assist immediately the survivors had to be obtained from the state budget. 

 

Due to the above facts, the professionals that manned the program during the first three weeks were all state employees and other volunteers who suspended their usual full time jobs and moved into the disaster area. The professionals divided their responsibilities within different settings, setting their priorities and choosing assignments to meet selected objectives.  One group manned the Federal Disaster Center.  In this setting there were different needs necessitating a variety of skill and activities.  An important outcome was the agreement forged between the Red Cross staff and us. The agreement provided that a mental health professional would be available to the Red Cross staff on a continuous basis.  The R.C. worker assisted individuals who had lost all their belongings and were asking for immediate help to obtain clothing, housing, food and furniture.  When a worker became concerned about the behavior or emotions about an individual, they would call one of us to join them at their “working” table and participate in evaluating the level of emotional distress.  If the mental health professional felt that further time should be spent with the survivor, they would be invited to move over to another area of the Center and continue the conversation. This continued throughout three weeks and proved to be an essential and collaborative activity.

 

The activity was reported as being helpful to the operations and objectives of both groups by all workers.  Another of our activities was to offer consultation and assistance to all the federal and state emergency staff that manned the many tables and desks.  We had the ability to notice or single out individuals who appeared distressed, approach them while they were waiting to be assisted, and informally ascertain their interest in talking to us simply by asking “how are you feeling”?

 

We also developed an educational program by presenting to different groups of workers the type of knowledge that would help them relate to survivors.  We tried to assist and inform the emergency workers to understand the dynamics of the survivor’s situation and efforts to cope with the tragic outcome of their loss. We underscored the need to develop a supportive, empathetic, but not paternalistic, approach while at the same time paying attention to the workers’ own fatigue, sadness and over-identification with the survivor’s plight,

 

TEMPORARY HOUSING PROGRAMS—Second component

 

Several weeks post-disaster, the survivors were moved from the shelters into motels and hotels.  In this setting we became aware that the survivors needed recreational/occupational activities.  They seemed to have too many unoccupied hours and the adolescent population was getting into mischievous problems.  Many of them were exhibiting high levels of stress and frustration manifested by acting out behavior and uncontrollable out-bursts of emotion with little provocation.  As we looked further into what was fueling these emotions, we realized we had thought housing them in a comfortable hotel setting would be appropriate, not realizing that the hotel staff was unable to deal with the needs of this displaced traumatized multi-generational population. Offering consultation to the federal planners who were responsible for housing programs ameliorated this situation.

 

We organized meetings with the hotel management who needed constant support due to the fact that this was a novel and difficult situation.

It became aggravated by minor destructive activities of adolescent survivors and complaints presented by anxious and irritated adults.  Constant and varied activities to support these disparate groups thrown together by fate were helpful in ameliorating the suffering of the survivors, and was a challenging experience for our team.

 

Our concern for the child population led us to develop support groups for children and their parents.  The objectives of the children’s programs were to develop a preventive structure to organize activities that would give the children a sense of security and constructive discharge of energy.  Because of the road conditions following the disaster, the hotels were isolated and it was extremely difficult to transport individuals out of the hotels.  Occasionally, we could rent buses to take the children to program activities using public pools, gyms, and recreational settings.  A team of educators was brought to the hotels and they were very helpful in developing both recreational and educational programs during the daytime.  Offering them regular counseling sessions plus medical or psychological help assisted the parents. The sheltering and housing needs for individuals who have lost their homes can either benefit or obstruct emotional recovery depending on how it is handled.

 

In two of the hotels where our program and services for intervention were put rapidly into operations, the close collaboration with the Red Cross and the teams assisting the physical, recreational and practical needs continued to show alliance benefits.

 

FINAL COMPONENT—COMMUNITY BASED

 

Agencies started making plans to close their operations within a few weeks after the blizzard. This necessitated a shift in the planning of the mental health assistance format. Families began to find more permanent housing or were able to obtain vouchers for rent.  The Federal Disaster Center closed but kept several satellite offices in the most affected communities.  The Department of Mental Health continued managing the grant that we obtained to maintain services to the citizens in their communities.  Analyzing our early activity and experiences, we were able to conceptualize and identify the services we wanted to provide to the community.  The objectives were:

·        Screening and diagnostic services

·        Crisis counseling

·        Further outreach approaches to find survivors

·        Consultation to non-mental service agencies

·        Training caregivers

·        Education and information to the public

 

CONCLUSION

 

We believe that the “volunteer” experience in the first month allowed us to focus on the specific needs of the survivors and permitted us to select the best services for this population. The factors that allowed for a rapid collaboration included prior joint work in community programs, the availability of capable professionals and students in the Boston area, and the supportive and positive efforts of local legislators in obtaining resources. The experience of working together during the “Blizzard of ‘78” offered the opportunity of developing an efficient service in this newly evolving field of post-disaster civil emergencies.