Crisis or Challenge: At the Scene of an Attack

CHAPTER SEVEN:
AT THE SCENE OF AN ATTACK

The market is crowded with the usual shoppers on a Thursday afternoon. All you're thinking about is getting back to the office before your boss notices you've been gone for an hour. Then all hell breaks loose. Only someone who has gone through such an experience can understand what it is like. "I thought I was on a movie set," testified a bystander. "Everything seemed unreal."

Those of us who have had the first-hand experience of a terror attack or any other disaster are often left with the feeling that we could have done more - even though at the time we were surrounded by smoke, our ears were ringing, and the sights and sounds we experienced were straight from hell.

It is the first few minutes after a disaster that are the most confusing, and yet the most important. Your natural initial reaction in such a situation is to freeze. Your senses cannot absorb what is happening, yet you want to at least try to help. However, the only way you will be able to function under these circumstances is by planning ahead so that you have the tools to work amidst chaos.

I will not discuss the first-aid needs of a terror emergency. A medic certainly knows what to do far better then I. Rather, I will deal with how those who are able can support and help others. Before I start however, several caveats are in order:

Do not expect to be able to help others if you yourself are physically hurt or in shock.
Attempts to help the injured and the families and friends who are with them must not interfere with the work of the medical personnel who are treating and evacuating the wounded, or the security people who are trying to make sure there is no further danger.

Know Your Limitations

Most terrorist attacks or disasters last seconds, or minutes at the most. The aftermath, however, may continue for many hours - or even days. You are not superman. Nor have you been trained in emergency rescue techniques. Don't expect to be able to do the work of a professional.

Whether you are a professional or someone who just happens to be at the scene and wants to help, you must be aware of your limitations.

Roni works at a Magen David Adom station in the Talpiot section of Jerusalem. Late one evening he got an emergency call. The floor of a wedding hall had collapsed and dozens of people were injured or buried beneath the rubble. Roni rushed to the site. He tried to stabilize the injured and help remove the debris in order to find those buried underneath. After 10 hours his supervisor told him to go home. Roni became angry and irrational, "How can I leave when there is so much to do? I need to be here! I am not tired!" Harsh words were exchanged.

Rescue workers - whether volunteer or professional - often demonstrate irrational behavior and lack of concern for their personal safety. Roni's supervisor was experienced enough to insist that Roni get a few hours sleep before returning. He also insisted that each worker drink plenty of water as well as take a break every few hours to rest and eat a sandwich or a fruit.

No one can be at the scene of a disaster and not be affected. Anger and grief are natural reactions, and even though you seem okay and able to be of help, you will experience - albeit as a delayed reaction - many of the same symptoms you have witnessed in others.

Be Prepared

Those of us who have been in the army remember the dry runs during training. They all served one purpose: to enable the soldier to function when it's "for real," when the noise and the smells are almost overpowering and ones mind goes numb. The same principle works with a terror attack: it is important to know what to expect in a crisis, so that you know what to do if you are ever faced with it. Be aware of your own strengths and mentally mobilize them to the fullest.

What Should I Expect?

Sights and Sounds

There is nothing that can prepare you for the actual experience. Most people who have been through it remember more than anything else, the smells and the noise, which often made them feel physically sick. The sight of a child's shoe or a body part may linger hauntingly in the mind far longer then the general sight of the chaos that followed the disaster. Nevertheless, once the adrenalin kicks in most people find that they become numb and can concentrate only on what has to be done.

Pandemonium

A parent may call hysterically for his children and refuse to leave the scene or be taken to the hospital without knowing where they are. The same may happen with a husband and wife, siblings, or friends. If a loved one is nearby, an injured person will want to stay close to him. This presents a dilemma. The immediate goal of the medical and security personnel is to clear the area in as short a time as possible. Most security personnel will not give victims much of a choice, even if there isn't any imminent danger.

The length and intensity of reactions of victims of terror are also are affected by:

The presences of other stress in their lives
This may range from university exams to a crisis in a personal relationship or medical difficulties.
Aggressive media
It is not unusual for TV reporters to literally push their cameras into the faces of victims lying in a hospital bed and ask them for either their eyewitness account or, worse still, their expert political opinions.
Separation from family
It may take a while until the family is notified. In the case of someone who doesn't have close relatives living nearby - which is particularly common among new immigrants - it may take hours or even longer.
Pain and Rehabilitation
The injured person may be in severe pain. We often forget that a "medium" injury may mean the loss of limb. Rehabilitation may take months, causing the total collapse of normal family life .
Financial repercussions
While the injured receive some help from the government, they may unable to continue in their same occupations (for instance, an artist or an electrician, who loses the use of even one hand). If the victim had a small business he may lose much of his income. Even if he eventually return to their former employment, the financial losses can be staggering.
Ability to cope
Everyone's ability to cope differs. Someone who has trouble coping with the curve balls life tosses will naturally have more difficulty and need more help and time to recover.

What Can I Do to Help (Even if I Don't Have Any Experience)

The most valuable tool you can carry is a pen and paper!

Call for Help.

Hopefully - and in all probability - security and medical help will soon be at the scene. If there is no danger of another attack or dangerous after-effects of the first attack (fire spreading, walls collapsing, another bomb going off, etc.), then your job is to try and provide as much help in as short a time as possible. In most cases the emergency services will have already been notified, but it is a good idea to have a list of emergency numbers (police, hospitals, etc.) in your wallet.

First Aid.

Even if you have no training you can offer assistance to those who do - if that doesn't interfere with them. Often EMTs (Emergency Medical Technicians) will need someone to hold a bandage or press on a wound. They may need help carrying the injured.

Phone Home.

People who aren't badly injured may be confused, but they should be able to respond to direct questions. Many people will say something like, "My God, if my mother sees this on TV she'll have a heart attack!" Ask, "Whom can I call to let them know you are all right?" Often this will have a calming effect. They'll have one less thing to worry about.

As with dealing with the bereaved, your question should not be, "Do you need any help?" Rather, it should be, "Tell me what I can do to help you" If you do not get a coherent response you could make specific suggestions such as, "Should I call someone?"

Find Out Whom They Were With.

Write down as much personal information as you can get from the people you talk to (address, phone number, name of people to contact) as well as information about friends or relatives they were with (names, ages, descriptions of the people and the clothing they were wearing), and give this information to the security personnel. It may be crucial in order to find out who's still missing. (In a recent attack on a bus, one father complained bitterly that it took three hours to discover that his daughter had been hurt, and to learn to which hospital she had been taken.)

Offer Support.

People at the site may become disoriented, particularly the elderly. Walk over to them and offer to help them find a place to sit away from the scene of the attack. Ask if they were there when it happened. Lead the conversation with a statement like, "It must have been horrible." Usually that will be enough for them to get started telling you about what they witnessed. Although they will probably repeat what they saw hundreds of times to relatives and friends in the weeks to come, talking to you will release the initial pressure.

Encourage Them to Check into the Hospital.

Everyone at the scene of an attack will be in some state of shock even if they do not have any physical symptoms. It is important that a professional treat them as soon as possible.

In Israel, the Bituah Leumi (the National Insurance Institute) gets a list of victims of attacks from the hospitals and tries to hold follow-up sessions for them. Because victims who didn't go to the hospital to be treated or checked out aren't on that list, they can have problems later on getting government help if they develop Post Traumatic Stress Disorder symptoms.

Reactions

In cases of acute trauma, reactions are similar to those that accompany any sudden loss. These reactions may quickly follow one after the other - as if they were tumbling over each other. On the other hand some people are initially asymptomatic with reactions not coming to the fore for days and even weeks. Then they witness something ( maybe a similar event on TV) triggering the reactions.

Those who have been badly hurt will probably be in shock and remain so for a while. Their need is for immediate medical attention. If they are conscious they may ask about friends or loved ones. Do your best to assure them that you will try to help get them this information. Unless the information that you have is positive do not under any circumstances be the one to break bad news. First let them concentrate on recovering.

Those who were lightly hurt or who weren't injured but witnessed what happened will probably have the first two - if not all three - of the following reactions:

Shock

Shock, is what happens when one of your systems is suddenly overloaded: Blood pressure drops and the heart rate increases. The body can go into shock if someone falls into freezing water or is involved in a car accident. In many ways the human mind and body work in the same way as a circuit breaker; when there is an overload a circuit breaker simply shuts down the circuit. While the mind and body don't really shut down, they have mechanisms that produce a similar effect.

Treatment for physical shock usually consists of keeping the victim warm and still. For this purpose, a blanket is usually placed over him. Shock to the psychological system has similar physiologically symptoms. The heart rate and blood pressure go up. The mind needs time to adjust to the situation, which it cannot do at this time. When someone is in shock they may appear dazed and have trouble concentrating. People who witness a terror attack often suffer emotional shock, and need to be seen by a medical professional. If you encounter someone in shock, try to stay with him until he receives medical attention.

Denial

Denial, like shock, is a mechanism that gives the mind a chance to adjust to circumstances. The definition of denial is refusal to accept a particular fact or situation. Denying an emotional situation shields you from its full impact. It is like a veil or Novocain for the mind. The amount of time a person remains in shock or denial - it may be minutes or hours - depends on a combination of factors. In most cases medical help will have already arrived by then.

Guilt

The third stage kicks in once we realize what really happened. It can go in two directions:

1. Why did I freeze? Why didn't I help those who were hurt?

Yishai was at a bus stop in Hadera when a car bomb went off. Although he suffered no physical injuries, he became morose afterwards and wanted to drop out of school. When asked to write down a list of adjectives describing himself, he wrote, "Cowardly, worthless, etc." Yishai kept reviewing the event again and again in his mind. He felt that he should have done something to help those who were hurt. "You imagine you would be a hero, tearing off your shirt to bind someone's wound" he said. 'I just froze. All I did was sit on the sidewalk with my head in my hands." Shackled by guilt for what he perceived as cowardly behavior, he was not able to get past what happened. His sense of self-worth plummeted.

Those of us who have actually witnessed an attack understand how natural it is to be paralyzed by naked terror and shock. Yet Yishai's feeling of guilt was real and he had difficulty acknowledging that he himself was in shock and incapable of helping others. He needed help as much as anyone else. He will need time to internalize that fact.

2. Why am I alive?

Anyone who has experienced a car accident in which others were hurt knows the feeling of survivor guilt even if no one was killed. If you came out of it relatively unharmed, you are relieved, but that relief is tinged with guilt. "Every time I think how lucky I was, I feel as if I am thinking something negative or even evil" said Sarah. " And I cannot control these thoughts. Is there something wrong with me? Am I selfish to think only about myself?"

These feelings are part of what is known as post-traumatic stress disorder. What should you do about it? See a social worker or psychologist - the sooner the better. These feelings must be discussed and worked out as close to the time of the trauma as possible.

Minimizing the After-Effects

How can you minimize the effects of having been at the scene? First of all, it may be hard but you have to talk about your experience. Remember that what you did was the best you were able to do under the circumstances and you can't be held responsible for not being able to help - or save - everyone.

As strange as it may seem, attending the funerals or memorial services or paying a shiva call for some of those killed will provide a measure of comfort and closure.

If you were at the scene and were able to help someone, it is important to visit him as soon as possible. The bond that was created through this intense experience is an invaluable tool in the healing process for both of you. (Don't forget - just by being there, you also underwent a trauma.) Even if the person died, visiting the family will have special meaning. Bereaved families usually want to find out details about the last minutes of their loved one's life. You are in a unique position to provide them with that information, and to reassure them that he didn't die alone.

Roni (remember him?) decided to attend the shivas for some of the victims he'd tried to help. He was able to assure their families that they did not suffer. In one case he was holding the hand of an older women and comforting her when she died. Knowing that their mother did not die alone was of great comfort to her husband and children.

A colleague related a similar story: "The daughter of a friend was killed during a bombing several years ago. A man who came to visit during the shiva told her that he had held the child when she died. He told her that she had been killed almost instantaneously and did not suffer. It helped my friend a lot."

Finally, as noted before with general stress and trauma, try to return to your normal routine as soon as you can,. If you don't already have some exercise regimen, this is a good time to begin.

CHAPTER SEVEN: AT THE SCENE OF AN ATTACK