PSYCHOLOGICAL RESPONSES TO WILDERNESS ACCIDENTS - Medicine for Mountaineering and Other Wilderness Activities - page 34

Overload may come on suddenly, particularly after a major disaster that produces many
casualties with mutilating injuries, or it may come on insidiously from the accumulated
stressofaseriesoflessdistressingaccidents.Arescuer'ssusceptibilitytooverload,termed
rescue trauma threshold , may change from day to day as the result of events or circum-
stances entirely unrelated to the rescue, such as poor health, family problems, or insuffi-
cient sleep.
Sources of Rescue Stress
The many causes of rescue stress are interrelated, but they can be categorized as overt
andcovert. Overt sourcesofstressareimmediately related totheaccident. Sightsorsmells
at the scene may assail the senses. The person to be rescued may be dead or may die dur-
ing the rescue. Rescue equipment may be inadequate. The available personnel may be in-
sufficient in number or lacking in knowledge and ability, resulting in great demands being
placed on a few people. Wilderness accident casualties frequently must be evacuated over
miles of difficult and dangerous terrain, often at night, which requires hours of exhausting
labor. (For example, rescues require an average of twelve hours in the White Mountains of
New England; they can require days in more remote areas when helicopters are not avail-
able.)
Covert sources of stress include fatigue or illness that may weaken rescuers. They may
be preoccupied with financial, legal, or family problems. The attitude of other participants
canbestressful.Rescuerswithhighexpectationsofsuccessatthestartofanoperationmay
be frustrated by the death of one or more of the people involved in the accident, by their or
their coworkers' fallibility, or by lack of appreciation for their work, including inaccurate,
critical, or even censorious reports in the media.
Anothersourceofstressistheenforcedinactivity aportionoftherescueteamexperien-
cesafterarrivingatanaccidentscene.Manystretcherbearersarerequiredtocarryaloaded
litter through difficult terrain, but only a few can administer medical treatment. While the
rest wait, their energy and enthusiasm ebb. Some sink so low they need to have their mor-
ale boosted byothers if they are to participate enthusiastically in evacuating the individual.
The stress of this middle period in a rescue is often overlooked and appears to result from
feeling unneeded, from fatigue, and sometimes from newness of the rescue experience.
Normal Reactions to Stress
Totally normal reactions to stress may be immediate or delayed. Immediate reactions
that occur among rescuers at the accident site include anxiety and apprehension, doubts
about their abilities, or hopelessness and despair, which are often mixed with denial or
splitting. Some rescuers experience cognitive difficulties, forgetting where they put things
and finding decisions hard to make. All these reactions are normal.