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Volume 2004-2

The Australasian Journal of Disaster
and Trauma Studies
ISSN:  1174-4707
Volume : 2004-2

Douglas Paton, School of Psychology, University of Tasmania, Locked Bag 1342, Launceston, Tasmania 7250, Australia.. Email: Douglas.Paton@utas.edu.au

Volume : 2004-2

Douglas Paton

School of Psychology,
University of Tasmania
Launceston, Tasmania

Managing Traumatic Stress in Complex Emergencies:
Demographic, organizational and cultural influences

As this edition of the Journal goes to press, acts of civil unrest, war and terrorism continue to provide reminders of the plight of civilians caught up in these events and the attendant risk they face for developing acute stress disorder and posttraumatic stress disorder. The impact of such events is particularly traumatic for children who experience the direct effects of continued threat, injury and the death of family members and friends. Their risk status may, however, be influenced by actions executed in attempts to mitigate these problems through, for example, evacuation.

In their article, Shacham and Lahad, in a study based upon Lahad’s Integrative Model of Coping and Resiliency, examined 102 children in real time during shelling and evacuation in Israel. Their findings reiterate the importance of conceptualizing traumatic stress reactions within an ecological framework that incorporates key elements of their social environment (Harvey, 1996; Paton, Violanti & Smith, 2003). Shacham and Lahad concluded that children evacuated without their families reported more emotional and cognitive stress reactions. Their finding that children prefer to stay with their families, even under shelling, provides additional insights into the importance of this ecological context within a stress management strategy. Their findings also reiterate a need to accommodate gender differences and age when conceptualizing traumatic stress processes.

The scale of many natural disasters and acts of terrorism can result in potentially substantial numbers of victims experiencing both physical injuries and acute and more significant traumatic stress reactions. Lahad and Rogel illustrate the growing need to reconcile physical and psychological treatment needs in those victimized by such events. They do so by pointing out that until the mid-80s, the ratio of people admitted to emergency rooms with physical injuries to those with emotional reactions was 1:3, but, in Israel, since the 9/11 attacks, the ratio has risen to 1:10 and in some cases 1:12. Recognizing the priority for treating physical injuries, Lahad and Rogel outline an approach to the contingent management of the accompanying acute stress reactions within hospital emergency rooms. They discuss this issue in regard to organisational policy, admission procedures, and treatment protocols. Their discussion also signals the importance of a comprehensive approach to managing emergencies, through integrated emergency management (Paton, 2003).

Despite the increased interest in the mental health issues associated with dealing with terrorist and other events that result form human action, natural disasters continue to create their own research and intervention needs. In response to a recognized difficulty in regard to predicting when and where these events can occur, attention has focused on promoting resilience. That is, a capacity to continue to function even in the face of significant disruption by hazard activity using the available resources (Paton, 2000b; Paton, Violanti & Smith, 2003). A key element of a resilience strategy is promoting the availability of resources by encouraging preparedness. Being prepared minimises the risk of injury and damage, and facilitates a capability for coping with the temporary disruption associated with hazard activity. A positive relationship between preparedness and mental health increases the importance of this activity within a traumatic stress management strategy (Benight et al., 1999; Hobfall, 1989; Sattler et al., 2002). It could be used, for example, to anticipate the potential distribution of acute stress reactions, and to plan service delivery within the post-disaster environment.

Because it represents a significant predictor of the capacity to adapt to unforeseen circumstances, it is important to develop strategies to promote the adoption and maintenance of hazard preparedness measures and activities. Consistent with the development of more ecological approaches to conceptualizing traumatic stress reactions, an issue that is becoming increasingly important concerns how cultural factors influence preparedness. In their paper, Kasapolu and Ecevit, discuss how the cultural values of materialism and traditionalism influence preparedness. They examine this issue in the context of the 1999 Marmara earthquake in Turkey, and discuss how polices designed to encourage preparedness should accommodate cultural issues. The insights offered by this study have implications have implications for work undertaken in multicultural societies such as Australia and New Zealand.


Benight, C. C., Ironson, G., Klebe, K., Carver, C. S., Wynings, C., Burnett, K., Greenwood, D., Baum, A., & Schneiderman, N. (1999). Conservation of resources and coping self-efficacy predicting distress following a natural disaster: A causal model analysis where the environment meets the mind. Anxiety, Stress and Coping: An International Journal, 12, 107-126.

Harvey, M. (1996). An ecological view of psychological trauma and trauma recovery. Journal of Traumatic Stress, 9, 3-23.

Hobfall, S.E. (1989). Conservation of resources: a new attempt at conceptualising Stress. American Psychologist, 44, 513-524.

Paton, D. (2000) Emergency Planning: Integrating community development, community resilience and hazard mitigation. Journal of the American Society of Professional Emergency Managers, 7, 109-118.

Paton, D. (2003) Stress in Disaster Response: A risk management approach. Disaster Prevention and Management, 12, 203-209.

Paton, D., Violanti, J.M. & Smith, L.M. (2003) Promoting Capabilities to Manage posttraumatic stress: Perspectives on resilience. Springfield, Ill., Charles C. Thomas.

Sattler, D. N., Preston, A. J., Kaiser, C. F., Oliviera,V. E., Valdez, J., & Schlueter, S. (2002). Hurricane Georges: A cross-national study examining preparedness, resource loss, and psychological distress in the US Virgin Islands, Puerto Rico, Dominican Republic, and the United States. Journal of Traumatic Stress, 15, 339-350.



Douglas Paton © 2004. The author assigns to the Australasian Journal of Disaster and Trauma Studies at Massey University a non-exclusive licence to use this document for personal use and in courses of instruction provided that the article is used in full and this copyright statement is reproduced. The authors also grant a non-exclusive licence to Massey University to publish this document in full on the World Wide Web and for the document to be published on mirrors on the World Wide Web. Any other usage is prohibited without the express permission of the author.

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