PSYCHOLOGICAL RESPONSES TO WILDERNESS ACCIDENTS - Medicine for Mountaineering and Other Wilderness Activities - page 35

Rescuers in all types of incidents report nausea, a pounding sensation in their hearts,
muscle tremors, cramps, profuse sweating, chills, headaches, and muffled hearing. These
symptoms tend to dissipate within one to three days, but if the underlying emotions are not
recognizedandallowedtosurfacewithinareasonablyshortperiodoftime,theyeventually
worktheirwayintorescuers'dailylivesandcancripplethememotionally,cognitively,and
physically.
Delayed stress reactions appear hours to weeks—sometimes months to years—after an
accident and may be directed inward or outward. Inward reactions include depression,
apathy,orfeelingsofguiltfornothelpingorforfurtherinjuringtheindividual.Nightmares,
insomnia, or occasional visual flashbacks or physical symptoms such as headache, loss of
appetite,ornauseamaybeexperienced.Outwardreactionstypicallyincludeirritability,ex-
plosiveness, and in some cases anger with others who contributed to the stress of the incid-
ent, particularly with the press for inaccurate or distorted reporting. Like immediate stress
reactions, these delayed reactions are entirely normal.
Preventing Adverse Stress Reactions
Rescuers, whether amateurs or professionals, must be emotionally prepared for the
worst casualties—the mutilated, dying, or dead—and for the worst situations. Watching
helplessly while individuals involved inaccidents diebecause theyareinaccessible, equip-
mentisinadequate,ortheyjustdonotrespondtothebestpossiblemedicalcareisadevast-
ating experience. In preparing for the worst, participants must be aware of their limitations
and must balance their expectations with reality.
Rescuersmustbepreparedtoserveunderleaderswhodonothavetimeforexplanations
or who are not aware of the needs of their crew members. They must expect sparse recog-
nitionandabundantcriticism, andtheyshouldnotbesurprisedwhenrescueworkturnsout
to be 90 percent drudgery and 10 percent terror.
Despite training and experience, rescuers must withdraw from situations they find par-
ticularly stressful, such as accidents that involve family or friends, injuries to children who
are similar to their own children, and some specific injuries. The leader and associates, as
well as rescuers, must respect such sensitivity.
Rescuers must realize that stress overload is virtually inevitable, regardless of training
and experience, if sharing it with others does not relieve accumulated emotional stress. To
ensure the emotional health of rescuers, established preventive or therapeutic measures are
essential. The following is one example:
Withintwenty-fourhoursafterarescue,team members shouldengageinvigorousexer-
cise to relieve tension and achieve greater muscular relaxation.
Withintwenty-fourtoseventy-twohoursafterastressfulrescue,amandatoryemotional
debriefing should be held for the entire team. (Making such sessions routine instead of
mandatory reduces the obligatory aspect of participation.) Effective sessions require an