PSYCHOLOGICAL RESPONSES TO WILDERNESS ACCIDENTS - Medicine for Mountaineering and Other Wilderness Activities - page 36

hour or more and promote expression and sharing of emotional reactions to the res-
cue—specifically the pain, sadness, terror,guilt, orfeelings ofhelplessness experienced by
each in different ways. These emotions must be expressed and accepted without shame or
embarrassment. The participants must share their humanity and support each other.
After debriefing, rescuers must eat and rest well, rounding out the recovery of the entire
organism.
Onlyafterphysicalandemotionalrecoveryhasbeenensuredshouldtherescueteamcri-
tique the rescue objectively, learning from successes as well as mistakes, and plan for the
future.
The debriefing session must be entirely nonjudgmental. There can be noright orwrong,
correct or incorrect, as long as emotions did not interfere with the rescue. To ensure abso-
lute confidentiality, no records should be kept.
Although some groupscanmanage this process quite well bythemselves, particularly if
they have gone through it a number of times, such exercises frequently are more effective
when guided by someone experienced in stress management and not directly involved in
the rescue. Completely resolving the stress may require more than one meeting, but all
meetings should be conducted as close to the event as possible, preferably within three
days. Delays of a week or more increase the risk of converting early, tenuous emotional
reactions into entrenched, chronic disorders. The debriefing must be conducted without al-
cohol or other drugs; to maximize the benefits, the minds of all must be fully functional.
POSTTRAUMATIC STRESS DISORDER
If rescuers do not work through their normal reactions, they risk developing a more severe
abnormality, posttraumatic stress disorder (PTSD). This condition has been repeatedly de-
scribed and, depending on its origin, has been given widely varying names that include
shell shock and combat fatigue. The term posttraumatic stress disorder unites these con-
ditions under one label. This condition has been recognized with surprising frequency in
veterans of the Iraq War.
The following are the features of PTSD:
1. The individual has undergone a recognizable stressful experience that would evoke sig-
nificant symptoms of distress in almost everyone.
2. The individual reexperiences the event in one or more ways:
Recurrent and intrusive recollections
Recurrent dreams of the event
Sudden acting or feeling as if the traumatic event were recurring due to the stimulus
of an environment or thought associated with the event
3. The individual has numbed responsiveness to or reduced involvement with the external
world that began some time after the event and is manifested by one or more of the fol-
lowing: