Make a place for chaplains in your disaster prep plan
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October 1, 2009
In the Hospital Incident Command System (HICS), there is not a specific job action sheet for chaplains. But the position is referenced in several places, and chaplains become valuable players when disasters hit.
For example, chaplains help the mental health unit ease patient and staff member stress brought on by disaster trauma—as Julie Greig, Dominican Sister and hospital chaplain at Ben Taub General Hospital in Houston did during Hurricane Ike in 2008.
“I was in the emergency center just walking around, and there was a doctor there and a television was on. He looked at it and said, ‘Oh look, my house is burning!’ ” Greig says. “As they were showing different things, he was watching his beach house burn ... You just have to listen to them. Sometimes they want prayer, but mostly they just need someone to listen.”
Grieg, who has 50 years on the job, and colleague Todd Duckett, director of spiritual care at Harris County (TX) Hospital District, are part of the response team at their hospitals and the overarching Texas Medical Center network of 47 area facilities. That includes counseling patients enduring trauma on a daily basis to full-scale emergency responses.
In their facilities’ response plans, Grieg and Duckett are classified as “E-1” or essential: They are required to be present at the facility—sometimes up to three consecutive days during a response—and privy to official briefings ahead of time when possible. Duckett has gone through training for the National Incident Management System.
At times Grieg and Duckett take on administrative duties, but more often they act as a resource for patients, workers, and their families.
“[When] you have an employee that has two children at home 30 miles away, and she won’t be able to go home to them for three or four days, that creates a high-anxiety feeling,” Duckett says. “Pastoral care can help reduce their anxiety.”
That, in turn, can tie directly into safety. For example, many needlestick injuries occur when nurses are thinking about something else and having difficulty concentrating, Duckett says. Reducing their stress can help make the environment safer for employees and patients alike.
Fit chaplains into your hierarchy
Accounting for chaplains in your response plan, training, and exercises will help make your facility better prepared for disasters, says Marge McFarlane, PhD, MS, CHSP, principal at Superior Performance, LLC, in Eau Claire, WI. Such efforts can also help meet The Joint Commission’s requirements for emergency management.
“The key point is that all duties in emergency preparedness remain with the incident commander until delegated,” McFarlane says. An incident commander can delegate roles to chaplains in the mental health support unit and/or the employee health unit under the logistics chief.
Establishing those roles within the HICS hierarchy will better equip responders, patients, and visitors to deal with bad, scary, or uncertain news that abounds in disaster scenarios.
Set these prime responsibilities
Looking at the HICS organizational chart, McFarlane says chaplains can report to the mental health unit leader under the operations chief—or even serve as the mental health unit leader—and be assigned the following tasks on their job action sheets as customized to a hospital’s response:
- In the immediate period following a disaster (i.e., within the first two hours), chaplains can help provide mental health guidance and recommendations to the medical care branch director in operations based on response needs and potential triggers of psychological effects (e.g., trauma exposure, perceived risk to staff members and family, restrictions on movement, resource limitations, or information unavailability)
- In the intermediate period (i.e., within two to 12 hours), chaplains can coordinate with the logistics section chief on the availability of mental health staff members needed to deliver psychological support and intervention and participate in development of risk communication about mental health concerns
- In the extended period (beyond 12 hours), chaplains are suited to take on the following tasks:
- Provide resources for mental health recovery and education to children and families
- Observe staff members, volunteers, and patients for signs of stress and inappropriate behavior
- Ensure employee rest periods and relief
- Continue to meet the mental health needs of patients and families
- Respond to signs of worker stress and inappropriate behavior
- Report mental health needs of staff members to employee health in the logistics section under HICS
Provide mental first aid during recovery
During the recovery period, chaplains can ensure that the needs of staff members and their families are met for any extended periods, McFarlane says. “These could be the key tasks that would go on the job action sheet for a chaplain,” she says. “Those would be the things then that you could connect into a training session. You could make this happen with very little extra effort based on the resources you have out there.” (For more details, see “Tips for using chaplains more effectively in disaster preparation” below.)
The training might include what McFarlane calls “psychological first aid,” in which mental health providers give pointers to help disaster victims meet basic needs and promote safety.
The training should also emphasize that during a disaster, chaplains must tend to their own needs for rest and nutrition, too, because that will make them more effective during extended periods. This can be a tough notion to enforce, as a chaplain’s natural instinct is to administer counseling and never stop until the work is done.
And don’t forget to plan for the disaster aftermath, assigning chaplains an active role in reducing stress during a community’s recovery, starting with what HICS and The Joint Commission call periodic “stress debriefings” (see standard EM.02.02.07, element of performance 5).
“What you do after the initial disaster is really where chaplains can provide the most critical part in helping employees deal with the aftermath,” Duckett says.
Set religious aspects aside
The word “chaplain” to most people implies some sort of spiritual advisor. Chaplains certainly qualify to handle those duties. However, beyond spiritual matters, chaplains can fill needs that other staff members can’t during an emergency response.
“What we’re trained to do is to look beyond the words the person is speaking [and instead] be attentive to what’s going on,” Greig says.
Tips for using chaplains more effectively in disaster preparation
Use the following ideas to bolster chaplain roles in your emergency operations plan:
- Tap chaplains for duty. Even if your hospital doesn’t have a full-time chaplain on staff and instead uses a rotating roster of local volunteer ministers, they are likely ready and willing to be enlisted for your emergency operations plan. In one community surrounding his previous hospital employer, a network of pastors actually reached out to the hospital and sought out roles in the response plan, says Todd Duckett, director of spiritual care at Harris County (TX) Hospital District.
- Enlist chaplains in clinical pastoral training. The Association for Clinical Pastoral Education (www.acpe.edu) offers resources about multicultural competency and substance abuse issues. The group even publishes a standards manual, which dovetails with the crisis management training most pastors have already undergone.
- Create your own training. If the previous idea isn’t feasible, two training aids for chaplains are available for free download: Psychological First Aid for First Responders, published by the U.S. Substance Abuse and Mental Health Services Administration, and Psychological First Aid: Field Operations Guide for Community Religious Professionals, published by the National Child Traumatic Stress Network. You can easily find both documents on Google.
- Assign chaplains to waiting areas. After Hurricane Ike passed in 2008, one of the busiest periods was helping out backed-up waiting areas as patients came in for treatment, says Julie Greig, Dominican Sister and hospital chaplain at Ben Taub General Hospital in Houston. Greig not only had opportunities to listen to victims’ stories and provide counseling when requested, but she also took pressure off other employees so they could more efficiently administer clinical care.
- Plan support groups for disaster aftermath. After Ike, Greig says, the hospital’s mental health services staff and chaplains teamed up to form support groups for employees struggling with hurricane-related losses.
- Make sure chaplains have their own peer support network. Besides rest, chaplains need an outlet to discuss the stress of emergency response they will be experiencing. Set this up in advance of a disaster.