See Disaster Triage Part One. So, you've assigned every victim to the appropriate triage area. Now what? Triage doesn't end until the disaster is over and each victim has been treated by medical personnel or transferred to a medical facility. Even if you’ve assigned every victim to their appropriate triage category, their categories may change based on their conditions. Your helpers for each group should continue to evaluate each victim’s condition and watch for changes—both physical and emotional. After a disaster, survivors—and even rescuers—may experience emotional and psychological changes that you need to watch for so you can give them the treatment they need. The purpose of this article is to help you understand what physical and emotional changes victims might go through after you've sorted them into triage categories.

Re-assess Victims’ Physical Injuries

Constant re-assessment of each victim’s condition is crucial—they should be monitored frequently and carefully. Many times, when the disaster situation begins to calm down and the victim’s adrenalin and pain decreases, they may realize that something else is wrong. It is possible that because of an injured extremity that is causing so much pain, the victim may not know that they have other injuries. It is easy for those treating them to become focused on an obvious injury—the bone sticking out or the deformity of their extremity—and fail to notice that they may have internal injuries or other problems. These other injuries or problems may cause their condition to deteriorate—sometimes gradually, and other times rapidly—which is why continual monitoring and feedback is essential. If a patient’s condition changes, they need to be moved to the appropriate category as soon as possible and given the appropriate treatments.

Watch for and Address Emotional Changes (Disaster Psychology)

Survivors and rescuers will go through several different phases immediately after a disaster. 1) Impact phase. During this phase survivors generally do not panic and may, in fact, show no emotion at all. For those of us who have not been in a disaster, it’s likely we’ve seen it on news reports. People who have just gone through a traumatic experience seem to be unexpectedly calm and focused. 2) Inventory phase. This phase immediately follows the event, and involves survivors assessing damage and trying to locate other survivors. During this phase, routine social ties tend to be discarded in favor of the more functional relationships required for initial response activities such as search and rescue. This is where you would begin to look for appropriate triage areas; as victims are discovered, they will start gathering or be brought for help. During this phase, everyone seems to be focused on helping others and not worrying about their belongings or other things. 3) Rescue phase. During this phase, as emergency responders start to arrive, survivors are willing to take direction from these individuals without protest. Survivors are likely to be very helpful and compliant during the rescue phase. 4) Recovery phase. Survivors appear to pull together against emergency services personnel. Survivors may express anger or blame to the rescuers as they transition to this phase. They will often express anger for taking so long to arrive with help, or they may be upset because loved ones or friends have succumbed to their injuries, and they blame rescue workers for not doing enough. This is a natural response during a disaster and can be very difficult not only for victims, but for emergency workers who were completely overwhelmed during the disaster. As you provide physical and emotional support, be careful about what you say and do. Things that you should avoid saying include:

• “I understand.” In most situations we cannot understand unless we have had the exact same experiences as they have. We don’t know what has happened previously in their life and so it is very difficult for us to really understand. We are enduring the same disaster, but things that have happened before lead each of us to be in a different place.
• “Don’t feel bad.” The survivor has a right to feel bad and we will all feel differently.
• “You’re strong” or “You’ll get through this.” Many survivors do not feel strong and question if they will recover from the loss.
• “Don’t cry.” It’s okay to cry. Each of us will come to that point at some time, some sooner than others. Let them cry and be there to support them.
• “It’s God’s will.” With a person you do not know, giving religious meaning to an event may actually insult or anger the person.
• “It could be worse,” “At least you still have…” or “Everything will be okay.” It is up to each individual to decide whether things could be worse or if everything can be okay.

Many times, if we use some of the responses above, we could actually elicit a strong negative response or distance the victim from us, rather than provide comfort. It’s okay to apologize if you say or something that angers them. It’s human nature to try and offer words of encouragement, or try and help somehow by giving advice. The best thing you can do is be there for a survivor. Many times all they need is a shoulder to lean on, someone to cry with, or someone who will listen as they express their feelings.

We can prepare

There are some that will go their entire lives without experience a major disaster. Some will go through many. The one thing we call all do is prepare for the types of disasters that are likely to happen where we live. Many cities or counties offer C.E.R.T. training. This program is universal and people in one part of the country are generally taught the same things as those in another. First Aid, light Search and Rescue, Disaster Triage, and many other things are taught in these classes to help community members prepare for whatever might happen. There may also be other types of disaster training in different areas of the country. Check with your local city or county associations to see what is available near you. Take the opportunity to participate in these classes so you are prepared for whatever might happen, whether it is small or a large-scale disaster. They will help you prepare your own home and family, and you’ll also be ready to help in a disaster triage situation.