Swissair Flight 111 Disaster Response Impacts: Lessons Learned From the Voices of Disaster Volunteers

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Swissair Flight 111 Disaster Response Impacts:
          Lessons Learned From the Voices of Disaster
          Volunteers

                Terry L. Mitchell, PhD, CPsych
                William Walters, MSW
                Sherry Stewart, PhD

          This qualitative research study provides insight into the specific experiences, trauma, and
          needs of disaster volunteers as an understudied and marginalized sector of response and
          recovery personnel. Based on a qualitative analysis of in-depth interviews, the authors
          present the tasks, exposures, impacts, and search for meaning of the Swissair Flight 111
          disaster volunteers who were exposed to human remains during response and recovery
          efforts. The article is structured to amplify the voices of volunteers to reveal the specificity of
          disaster fieldwork and resultant multilevel impacts critical to understanding and
          responding to contemporary disasters. The article concludes with a discussion of the need
          for clinical and operational policies and protocols that acknowledge the risk and impact of
          volunteer exposure to human remains and serve to protect the well-being of future
          volunteer disaster response and recovery workers. [Brief Treatment and Crisis Intervention
          6:154–170 (2006)]

            KEY WORDS: disaster, volunteers, human remains, PTSD, qualitative research, Swissair Flight
          111, Nova Scotia.

Exposure to disasters is known to have both                   about their adverse impacts, inadequate atten-
short- and long-term cognitive, emotional,                    tion has been given to the experience and well-
physiological, and behavioral consequences                    being of disaster rescue workers and volunteer
(Chu, 1998; Fullerton & Ursano, 1997; Schnurr                 responders. Response workers often experience
& Green, 2004). Despite a growing body of lit-                trauma in relation to the cognitive and sensory
erature about the traumatic nature of events                  assaults of disaster response work, while at-
such as disasters and increased knowledge                     tempting to process and integrate what they are
                                                              seeing, hearing, touching, and smelling around
From the Department of Psychology, Wilfrid Laurier            them (Fullerton & Ursano, 1997). The range and
University (Mitchell), the Canadian Red Cross, Indonesia      magnitude of stress responses vary significantly
(Walters), and the Departments of Psychiatry and
                                                              among those involved in disaster response oper-
Psychology, Dalhousie University (Stewart).
  Contact author: Terry L. Mitchell, Assistant Professor,     ations chiefly in relation to the individual’s role
Faculty of Science, Department of Psychology, Rm. 2018,       in the response efforts. There is, however, a well-
Wilfrid Laurier University, Waterloo, Ontario N2L 3C5,
Canada. E-mail: tmitchel@wlu.ca.                              established link between human remains ex-
doi:10.1093/brief-treatment/mhj011                            posure and the development of posttraumatic
Advance Access publication April 7, 2006                      stress disorder (PTSD) (Leffler & Dembert,
ª The Author 2006. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:
journals.permissions@oxfordjournals.org.

154
Swissair Flight 111 Disaster Response Impacts

1998; Ursano, 1990). Despite the known risks of      disaster response workers—individuals who
disaster exposure, in particular human remains       have endured human remains exposure in their
exposure, there is a dearth of research              role as disaster response and recovery volun-
investigating the experiences of and impact of       teers. As very little is known about this group
this type of exposure on volunteer disaster          of disaster workers, we seek to contribute to
workers. On reexamining the voices of the Swis-      increased understanding and insight into the
sair Flight 111 (SA111) disaster volunteers who      experiences and needs of disaster volunteers
were exposed to human remains, we learn impor-       by listening to first-hand field accounts and
tant details about volunteer experiences and         by amplifying the voices of the volunteers
impacts and begin to address a critical gap in       themselves. Drawing upon in-depth qualitative
the literature that describes the phenomeno-         interviews, we analyze qualitative data to de-
logical nature of experience and exposure, as        scribe the field experiences, impacts, and cop-
well as short- and long-term impacts on vol-         ing strategies of volunteer recovery workers
unteer disaster workers.                             involved in the SA111 disaster who were ex-
  This article extends from and further explains     posed to human remains. Despite the small num-
the initial findings of a larger mixed-method        ber of interview participants in this subsample
study in which the initial analyses of volunteer     of recovery volunteers, we are able to provide
responses (n ¼ 13) to standardized question-         otherwise rare accounts of recovery volunteer
naires indicated that 71% of the volunteers          experiences with reflections on their specific
that were exposed to human remains were suf-         tasks, exposures, and impacts. Working with
fering from likely PTSD according to scores          very rich data (Denzin, 1989) and detailed
on a self-report measure (Mitchell, Stewart,         first-person accounts, we represent the voices
Griffin, & Loba, 2004). The first analysis of        of disaster response workers whose role was
the community-level health utilization data          to recover human remains. Given the known
from this study (three years prior as compared       mental and physical health impacts of human
with 3 years postdisaster) also identified com-      remains exposure and the long-term social, re-
munity residents as potential secondary victims      lational, occupational, and health impacts of
with the report of certain disease categories sig-   posttraumatic stress, we portray the specific
nificantly increasing in this region following       experiences and responses of volunteer disaster
the disaster, that is, respiratory, neurological,    recovery workers. We conclude the article with
Cardiovascular Disease, mental health, gastroin-     a call for further research on volunteer impact,
testinal, and endocrinological/immunological         treatment models, and protocols to inform vol-
diseases (Weerasinghe, Stewart, Mitchell, &          unteer involvement in disaster response and
Russell, 2003). Also, our earlier work on            recovery efforts.
coping-related drinking (Stewart, Mitchell,
Wright, & Loba, 2004) demonstrates the nega-         Methods
tive impact of volunteer exposure. The present
article involves further analysis of interview       In 1999, an interdisciplinary research team,
transcripts of the seven response volunteers         working in partnership with a community
from the original sample who were involved           advisory group, studied volunteer- and
in the recovery of human remains in the after-       community-level impacts of the SA111 dis-
math of the Swissair disaster. In this secondary     aster. The Community Advisory Group in-
analysis, we consider the response and recovery      volved 12 community members from various
experiences of a much understudied group of          disciplines included three clergy, three mental

                                     Brief Treatment and Crisis Intervention / 6:2 May 2006      155
MITCHELL ET AL.

     health professionals, a community fire chief, a      debris and human remains. For the purpose
     community volunteer, an Emergency Measures           of this article, we selected the recovery
     Coordinator, a Ground Search and Rescue              volunteer transcripts as an intensity sample
     Captain, and two elected civic leaders from          (‘‘Information-rich cases that manifest the
     the impacted communities. Utilizing an ecolog-       phenomenon of interest intensely but not ex-
     ical perspective (Bronfenbrenner, 1979) and          tremely’’) of volunteers (Patton, 1990, p. 171).
     a mixed-method methodology (Tashakkori &             The disaster response volunteer data selected
     Teddlie, 1998), the team of researchers studied      for this article (n ¼ 7) were collected over a pe-
     trauma exposure, stress responses, and resil-        riod of 9 months between July 2001 and April
     ience in the aftermath of the disaster.              2002, approximately 3 years after the SA111 di-
       The research team received ethical approval        saster. Volunteer interviews were open-ended,
     from a university research ethics board to con-      semistructured, and lasted for approximately
     duct a research study to determine both individ-     1.5–2 hr. The interview guide invited partic-
     ual- and community-level impacts of the crash        ipants to tell their stories in relation to their
     of SA111. All interview participants were pro-       personal experiences the night of the crash,
     vided with a letter of information, and all signed   their role in response and recovery efforts,
     a consent form that indicated the voluntary na-      and the impacts of such work on themselves.
     ture of the interview process. All participants      Interviews were audiotape recorded and tran-
     were also given a resource sheet with informa-       scribed, and the transcripts were checked
     tion about possible negative health responses        against the original tapes. All identifying data
     that can be associated with exposure to disasters    were removed to ensure participant anonymity.
     with contact information for counseling and          (All names used in the representation of find-
     support services in their area of residence.         ings in this article are assigned pseudonyms.)
       Utilizing a naturalistic paradigm (Hammersley         Each of the seven volunteers (two women and
     & Atkinson, 1983) and a participatory action         five men) included in this article participated in
     research methodology (Green et al., 1995), the       the collection and cataloging of human remains,
     team of researchers studied the nature and me-       personal effects, and airplane debris. Partici-
     chanics of exposure, trauma, stress responses,       pants worked in the field between 7 and 35
     and resilience during and in the aftermath of        days. Further participant demographic infor-
     the disaster. Such an approach allowed for a         mation is not reported due to the small sample
     wholistic evaluation of the subjective realities     size, in order to better protect the confidential-
     of people who experienced the response efforts       ity of research participants.
     and the aftermath of the SA111 disaster.
       The data for this article are derived from         Data Analysis
     a subset of the qualitative data (7 of 13 volun-
     teer interviews). The initial study involved         In February 2004, the disaster recovery volun-
     volunteer respondents who were categorized           teer transcripts were reanalyzed using the
     as instrumental and recovery volunteers. In-         coding procedure of Strauss and Corbin (1998).
     strumental volunteers were individuals who           Transcripts were coded using a three-phase
     provided logistical support such as food, cloth-     process of open, axial, and selective coding
     ing, and transportation to response and recov-       derived from a grounded theory approach to
     ery workers both professional and volunteer.         data analysis (Strauss & Corbin, 1998). In the
     The recovery volunteers were those who were          initial phase of the data analysis process, a se-
     actively involved in the recovery of airplane        ries of broad categories with subthemes were

     156   Brief Treatment and Crisis Intervention / 6:2 May 2006
Swissair Flight 111 Disaster Response Impacts

developed: impacts and processing experience        attention to. In establishing trustworthiness,
(meaning, hope, respect, and honor), commit-        Lincoln and Guba outline several key issues
ment and determination (positive and negative       to be attended to while carrying out research:
coping), impacts (social, relational, occupa-       credibility, dependability, confirmability, and
tional, PTSD symptoms: physical, behavioral,        transferability.
cognitive, and emotional), communication (co-          In the execution of this research initiative,
worker, family, community, and confidential-        several strategies were employed to ensure that
ity), positive implications of involvement,         the findings were trustworthy. To establish cre-
traumatic incidents (direct and secondary),         dibility, four key techniques were employed:
work environment (recognition, information          prolonged engagement, persistent observation,
sharing, role, changes in the nature of role over   constant comparison, and member checks. De-
time, coordination, policy/protocol, duration,      pendability and confirmability were assured
intensity: emotional and physical), interven-       via an extensive audit trail that outlines the
tions and supports (in field and external), and     chronology of community and research events
coping (positive-active coping, negative).          as well as details of each stage of the data anal-
  Based on the open-coding process and the          ysis process. The first two authors indepen-
preliminary placement of codes into purposeful      dently coded and analyzed the volunteer data
groupings, subsequent categories were derived       and conferred on interpretation before axial
and existing categories refined, leading to the     coding and checked back with the original
process of axial coding. During the axial-coding    transcripts during the writing up of the article
process, the relationship between all previous      to confirm and to seek negative cases of emer-
codes and coding categories was explored and        gent interpretations/representations of the data.
the connections between all data were further       Transferability speaks to the degree to which
considered and collapsed to reach a data synthe-    the findings apply to other similar situations
sis revealing a narrative of key constructs: the    as determined by the reader of the article. In or-
task, the exposure, the impact, and the mean-       der for such a determination to be made, there
ing. This analysis of a largely underinvestiga-     needs to be ‘‘thick data’’ (Denzin, 1989). In the
ted phenomenon intentionally privileges the         context of this study, transcribed interviews
voice of the disaster recovery volunteers versus    provided a wealth of ‘‘thick data’’ detailing very
the interpretive voice of the researchers. How-     consistent accounts of the recovery workers
ever, the narrative constructed from volunteer      experiences. While working with a small sample
voices in this article has consciously been         (n ¼ 7), we believe that the information yielded
employed by the authors to share insights, to       from the voices of these individuals, especially
increase understanding, and to inform policy        in relation to being exposed to human remains,
recommendations for future involvement of           is highly transferable and applicable on a much
volunteers in disaster response efforts.            broader level, beyond the confines of this study.

Rigor
                                                    Findings
Lincoln and Guba (1985) describe ‘‘trustworthi-
ness’’ as having collected data that are to be
                                                    The Task
found credible. They argue that the basic issue
in relation to trustworthiness is to demonstrate    To give specific contextual information to the
that the findings of an inquiry are worth paying    reader and to highlight the profound nature

                                    Brief Treatment and Crisis Intervention / 6:2 May 2006       157
MITCHELL ET AL.

     of the volunteers’ experiences, we provide an           gets emotional] That’s why I’m doing it. I’ll
     extended quote derived from the transcript              do it for them because they can’t [pause]
     of one of the recovery volunteers as a for-             nor should they be expected to [pause] do
     ward to the findings on the volunteers’ field           what I’m doing. Ah, so I’ll do my best and
     experiences.                                            I’ll make sure that my guys have the oppor-
                                                             tunity to do the best and we’ll get everything
       I’ll Do It For Them Because They Can’t                that we can.
       About the fifth day, by that time getting
       worn down [pause] I was starting to wonder,         When SA111 crashed into the Atlantic on Sep-
       I needed some, some attainable goal. Some           tember 2, 1998, at 10:31 p.m., many residents
       reason for what I’m doing. Why am I doing           of the surrounding area were already at home
       this to myself? I needed something to keep          in bed. Fishers and volunteer firefighters re-
       going. To try and dig that strength out. Be-        sponded as they always had to marine disasters
       cause I was starting to tire down, I was start-     and readily went to the shore, launching their
       ing to get tired out. And ah, near a point that I   boats to assist. Individuals initially presumed
       hadn’t been before. So I was in kind of an un-      that they went out to sea to rescue survivors
       tested territory with myself as far as my resil-    of the crash. In reality, however, response
       ience was concerned. And I wasn’t sure              and rescue workers were faced with the pro-
       where my mind or where my body was going            found realization that all 229 passengers and
       to go from here if I kept going. And even then      board personnel had perished in the disaster.
       I (was) suspecting that you’re okay now but if      Responders were confronted with an extraordi-
       even if you stop at this point, is there going      nary and horrific watery debris field.
       be a . . . a period of time where the effects are
       still accumulative or whatever when, when it           . . . the confusion and the eeriness of the
       stops physically, is it going to continue emo-        night, um was sort of like a messed up paint-
       tionally or whatever? The toll. And I needed          ing when on acid. It was black. It was rainy,
       something to cling to because usually, when           miserable. The waves were pretty high. The
       you’re out on a search, you have the energy           sea was coming over the bow. The Hercules
       to keep going no matter how tired you                 dropping para-flares which wouldn’t make it
       are because you think, if I just keep going,          thought the clouds completely and it would
       you might find the person alive and if you            give this weird glow to the whole area.
       don’t at least, ah know you, work hard be-            It was just a surreal night . . . it was sort of
       cause you want to be able to find them even           like one of Dante’s levels of hell.
       if they are dead, to say that the families have       Bert who was with me was starting to get
       somebody and they’re not laying out there in          very panicky because of what we heard on
       the woods somewhere for two or three years            the radio. There was a lot of fishermen losing
       for some hunter to come across or, or not get         control on the radio and the final straw was
       them back at all and I can understand that            when he heard one fisherman talking about
       being very important. And that’s what hit             how he had found a pair of legs because he
       me. Coming back in transport one day, we              thought it was hose and he was pulling it
       were coming back in the camp and there were           up and these female legs floated to the surface
       some family members out by the water and it           and he lost it. And then when Bert heard that,
       just struck me then. You know, there it is            he said, George we’ve got to go. I can’t deal
       right there. [pause] That’s . . . [long pause,        with this.

     158   Brief Treatment and Crisis Intervention / 6:2 May 2006
Swissair Flight 111 Disaster Response Impacts

  It was beyond my experience to see humans            wouldn’t know. You know, it could have
  in that condition. Ah, I think what struck me        been jellyfish . . . So I mean we were aware
  apart from the gruesome and the grotesque-           that we might be dealing with tissue from
  ness of it was the fragility of the human body       a person, okay?, but we didn’t know. So
  that ah, something that can walk and talk and        we did what we were supposed to do and
  do things can be reduced to this in a flash and      we came back in
  there’s nothing you can do about it. It is that       . . . you made sure that (you covered) the area
  fragile. It can be extinguished that quickly         that was cast for you to do that there was no
  and torn asunder that easily.                        rush job. You had to do a very thorough job
                                                       that you were set out to do. Your task had to
Despite the surreal and grotesque nature of the        be very efficient or else.
debris field left by the tragedy and the emo-           . . . we’d stop around noon and take half an
tional and physical demands of the rescue              hour and because, at least the way I felt, that
efforts, on the first night an untold number           an half an hour was enough because we were
of community volunteers stayed out in the              searching and we didn’t know what we could
darkness searching for people to save.                 find or what we would come in contact with.
                                                       Maybe a person was still alive or something,
   . . . I felt that it was necessary to stay out      so we didn’t want to take an hour.
  there as long as possible just in case.
  You know, your logic dictates everyone was           The task shifted from rescue to recovery with
  dead and there wasn’t a chance of survival.        the daunting role for both workers and volun-
  We didn’t know that that night.                    teers of salvaging parts of the devastated air-
                                                     craft, recovery of human remains, and
  After the first night, as ground search and        cataloging of personal effects. The daily events
rescue teams started to be organized and             of volunteers involved long hours, in extreme
deployed in an organized manner, volunteers          settings. Groups of three were taken by boat or
were asked to follow a strict protocol for col-      helicopter to one of over 300 small islands
lecting, bagging, and tagging human remains,         within St. Margaret’s Bay and Mahone Bay,
personal effects, and airplane debris. All items     Nova Scotia.
needed to be securely wrapped and identified.
The volunteers took their roles seriously and          Within a few hours actually we knew that
worked with a high degree of respect, profes-          there was gonna be no survivors. When
sionalism, and care as illustrated in the follow-      the reports were coming back in on what
ing quotes from three volunteer response               was being found, there was absolutely no
workers.                                               way that anybody survived it. So we knew
                                                       that. So there was a real general sadness over
  Well, [pause] we ‘‘bagged and tagged it’’ as         the support camp we’d set up, but everyone
  they say, it got picked up and brought back          was still very dedicated. ‘‘Well okay then,
  [pause]. There was a routine for plane stuff. It     here’s what we have to do. We have to go
  went into one bag and [pause] body parts, or         out and we have to bring these things back.’’
  alleged body parts, went into another. We            But it was . . . it was hard.
  would have just been talking about tissue
  here eh. Something that is so undefined that       Volunteers worked in remote areas under all
  you know, unless I was a doctor or something       types of weather conditions. While individuals

                                     Brief Treatment and Crisis Intervention / 6:2 May 2006       159
MITCHELL ET AL.

     worked together in teams, they were asked not          Disorders lists only three symptom categories,
     to speak with one another about what they              our finding of four symptom clusters has been
     were finding. The task was physically demand-          corroborated by earlier work by Stewart, Con-
     ing with individuals working long hours, some-         rod, Pihl, & Dongier [1999].) The profound na-
     times weeks on end without rest.                       ture of the multiple exposures and the related
                                                            physiological, cognitive, behavioral, and emo-
       One recovery volunteer spent 34 days in the          tional impacts are revealed in the following
       field and some volunteers, particularly in the       vivid quote from one recovery volunteer. This
       first two weeks, were working from six in the        quote indicates the profound intersection of
       morning to midnight.                                 exposures and impacts and contextualizes the
       When I left, when I left (for) the crash site, it    volunteer’s experience as a preface to the struc-
       was dark. When I arrived on shore it was             tured presentation of findings.
       light and when I went home it was light, it
       was a new day. It was totally, it was like             The Experience Was So Intense
       a bad dream or a nightmare and when I went             The experience was so intense. The sensory
       to sleep, I kind of, it wasn’t that I forgot about     input was so high, the emotional level so high
       it, but I left it behind me. It wasn’t a, [pause]      that when it started to wane, when it started
       it was very surreal.                                   to decline, Ah, you found yourself missing
                                                              that adrenaline I guess. The sensory excite-
       Although it was evident for most response              ment. The whole intensity of it. It was ah, a re-
     workers very early in the operation that the             al depressing feeling came over you that this
     probability of finding survivors following the           isn’t like it was the first couple of days now,
     total devastation of the aircraft was remote, vol-       you know, the smell of the jet fuel is starting
     unteers worked conscientiously and continued             to disappear. The pieces of the plane are be-
     to be motivated by the hope that there might be          ing battered and worn and becoming soggy.
     someone to rescue.                                       The human remains are beginning to decay
                                                              and ah, that’s what I was getting mad at. I
       It’s not a job, it’s a task that you’re asked to
                                                              was angry. I wanted fresh debris. I wanted
       do and you volunteer to do it and ah, there’s
                                                              it to be like it was the first couple of days.
       always the hope, the hope is, the hope is re-
                                                              I wanted a fresh crash, damn it. [laughs]
       ally what keeps you going. It’s not something
                                                              was the sort of mindset that I had. I want
       that you can give up on, the hope. Because if
                                                              a new crash. I want it back the way it was . . .
       you give up on hope, you really have noth-
                                                              Why was it? Um, it was easier then. It was
       ing, you know. There’s nothing to work with
                                                              more, if you could possibly fathom that it
       or nothing to accomplish so hope is a wonder-
                                                              was more. Um, it was cleaner. It was newer.
       ful thing to keep you, you know, striding
                                                              Um, to deal with ah, fresh human remains in
       ahead.
                                                              my mind is much more preferable to deal with
                                                              than decaying remains . . . . It’s, it’s a much
                                                              different experience to, um, collect parts of
     Exposure and Impact
                                                              a person that have been very recently torn
     In this section, we present the impact findings          apart, than it is to pick through, um, stuff
     in the subcategories of behavioral, emotional,           that’s ah, that smells offensive, that looks,
     cognitive, and physiological impact. (Although           ah, I would compare um, the first human re-
     the Diagnostic and Statistical Manual of Mental          mains would be ah, grotesques and unsettling

     160    Brief Treatment and Crisis Intervention / 6:2 May 2006
Swissair Flight 111 Disaster Response Impacts

  where as later on, they became offensive . . .       teers to assist in the unfamiliar role of
  Um, it smelled bad. It looked, rotten. It was        recovering human remains rather than rescuing
  rotten. It was getting old. And that’s what          survivors.
  was bothering me. The same with the plane
  parts and everything else. The freshness of            It was hard because you know we’re used
  it was going away and it was just, it was              to, like I said, we go out and we hope to find
  something peculiar that I just, I noticed, and         the person alive and well maybe hypother-
  it struck me. I actually laughed after when            mic, or whatever right, and we bring them
  I realized, hey buddy, you know you’re tell-           home. And even when we do find someone
  ing off debris here. [laughs] . . . This isn’t re-     who’s deceased we bring the body back to
  ally going to change anything. It just struck          the family.
  me as kind of funny that I was actually doing          I don’t think it was so much the bodies but
  that. That, that had happened . . . . And ah,          the fact that we went out there to do a job,
  using a few expletives then I realized you’re          to provide first aid, to provide medical ser-
  angry at the debris is what I was angry at and         vice to help people and how can you help
  I was actually angry at the debris. It was, I          body parts? You can’t. And I think that, that
  was ah, talking to myself but complaining              was the hardest part for them.
  to the debris, animating it. That ah, I wasn’t         Because really our team, I mean, we’re
  happy. I was ah, telling the debris off. In a          a search and rescue team and what we were
  way. Like you’d talk to yourself if you were           doing was search and recovery. So . . . Um, I
  going to anticipate a confrontation with some-         never realized what a big world of difference
  body or if you had an issue with a person and          there was in the two until then.
  you were sort of rehearsing ah, how you
  would ah, address that confrontation. Going            The volunteers were also exposed to sleep
  through various scenarios. Ah, you know, im-         deprivation and physical and emotional ex-
  provising kind of. And I, I was telling the de-      haustion over extended periods of time from
  bris off. I was angry at the debris and I when I     1 week to over 1 month. Recovery volunteers
  realized what I was doing, I ah, oop, hee            were exposed to massive loss of life, grieving
  ho . . . Pull over to the side and put a pink        family members, repeated exposure, and threat
  flag out the window. Help needed here. . . .         of exposure to dismembered human remains,
                                                       personal effects, as well as intense international
  Due to the nature, intensity, context, and du-       media coverage.
ration of the volunteers’ fieldwork, volunteers
had multiple types of exposure and various               I didn’t sleep really the first five or six days.
levels of impact. The biggest challenge for              Maybe an hour or so but I’d wake up and it
many volunteers was to come to terms with the            would be two or three in the morning and I
distinction between their original expectations          figure I might as well go back down and get
and their actual role in the disaster response           ready to go out back in the field. After . . .
efforts. Most, if not all, individuals volunteered       [pause] After about the fifth day, um then
to rescue survivors of the crash. That is the            it started getting [pause] I started wearing
traditional role of coastal people and the               from fatigue and a, as well as, the nature of
designated role of ground search and rescue              the operation. Ah, there was . . . there were
volunteers. The SA111 response efforts chal-             a lot of factors involved. Part of it was fatigue.
lenged this expectation and called upon volun-           Just the physical demands traveling that

                                      Brief Treatment and Crisis Intervention / 6:2 May 2006          161
MITCHELL ET AL.

       much shoreline and being up that much com-             up the next day. Some of them would go
       pounded by the, the ah the nature of the ma-           home and some of them would stay there.
       terial being recovered and as well ah, one of          They wouldn’t go home at all.
       the more difficult aspects would be the ah . . .
       seeing the families.                                 Volunteers reported various behavioral out-
       And we all sat together and we cried, oh we          comes, which included excessive washing, iso-
       cried. Because when they handed out the pam-         lating themselves, and not talking with anyone
       phlets and it had all the names on it. It was when   about the recovery experience or responses to
       you looked at it, you realized, that there were      the experience. For three volunteers, these be-
       whole families. You know, there would be six,        havioral responses contributed to marital prob-
       seven names all the same. It was like, ‘‘Oh my       lems, and for some, their behavioral responses
       god, that was that whole family, gone.’’             also contributed to difficulties at their place of
       Yeah.Ithinkthat’swhatreallybroughtithome.            employment.
       Even more than the day we saw the human
       remains, was seeing the families come. That,           I washed my clothes five times now and I can
       those were people. They’re not just pieces of          still smell people on them.
       people that you put into a bag. They were peo-         I stayed in the woods . . . I just built a little
       ple. They had lives, they had families. . . .          lean-to you know and got under there and if
       I lived, I won’t say I slept but I ate and lived       it rained, I would sleep under one of the
       Swiss Air all the time I was down there. So in         buses. I had a sleeping bag. I go in the woods
       the evening when I did come home, I’d turn             and sleep all the time anyway. Sometimes I
       on the news and just find out. It just went            go for four or five days in the woods and
       along with it. I just saturated myself in it.          wouldn’t come out . . . . I want to be alone
       It might have been a good thing or a bad               all the time. I don’t want nobody around with
       thing. It’s just the way . . . It felt like what       me. . . . I want to be alone and I’m by myself, I
       I wanted so that’s what I did.                         can cope with things better that way.
                                                              Roy actually sold the boat that I was out in
       Due to the nature of the volunteer response
                                                              that night.
     workers’ task and multiple levels of exposure
                                                              It slowed me down and it made me frus-
     while in the field, volunteers experienced a
                                                              trated and it made me angry. And my work
     variety of impacts. The trauma effects were im-
                                                              suffered.
     mediate for some behaviorally, emotionally,
     cognitively, and/or physiologically.
                                                            Silence was a common behavioral response, a re-
     Behavioral: ‘‘I washed my clothes five                 sponse that was promoted in the field but
     times.’’ Volunteer respondents reflected on            which was carried back to the volunteers’
     and discussed the various ways in which they           homes and communities further isolating and
     had modified or changed their lives during             putting volunteers at risk.
     and following the disaster efforts. Volunteers
     responded in various ways that resulted in indi-         Nobody ever indicated that they had found
     viduals being in the field for various periods of        anything [pause] like body parts. And they
     time and exposure.                                       probably did. Some did. Some had to have.
                                                              But nobody talked about it.
       So, they realized that there was something             I never talked with anyone who was out
       wrong. That the members were not showing               there.

     162    Brief Treatment and Crisis Intervention / 6:2 May 2006
Swissair Flight 111 Disaster Response Impacts

Emotional: ‘‘I reached a point of satura-             were felt, individuals struggled to understand
tion.’’ The emotional impacts were very signif-       their experiences and their responses.
icant for the recovery volunteers with clear
reports of cognitive posttraumatic symptoms,            You know it’s like a tunnel. You went into it
intrusive thoughts, flooding, and dissociation.         and you came out the other end. [pause] and
The exposure to human remains in particular             while you were in there, it was dark.
required a type of emotional disengagement
that resulted variously in intense emotional          Volunteers were confronted with exposures
release or conversely emotional numbing.              and responses that were both equally foreign
                                                      to them. Realizing that they were being affected
  Ah, there was, there was a point that I reached     on multiple levels, volunteers began to ques-
  which was an interesting experience. That I         tion their personal emotional, physiological,
  reached a point of saturation. Where if so-         and cognitive responses wondering what was
  meone had slaughtered ten children in front         happening to them.
  of me, it wouldn’t have, it wouldn’t have
  raised my heart rate. I would simply look at          You just kept thinking, ‘‘What is wrong with
  it and I, I couldn’t go any further than I            me?’’ I’d get up in the morning and I’d be
  had gone emotionally. There was no more.              like, ‘‘Oh, why am I so fuzzy, why can’t I,
  There wasn’t another level. I had reached             what’s wrong with me?’’ That’s what I con-
  the limit that I could endure and I think it          stantly thought.
  was just psychologically protective. That it          But it was hard to feel that tired all the time. It
  was to me, the analogy I would use is like            really was. And kind of a shock. Because you
  a sponge. And I didn’t know how much more             constantly thought, ‘‘what the hell is wrong
  I could take and then I reached a point where         with me?’’
  the sponge was full and the rest just washes          I mean there was a long period of time. You
  off. For me, other people might break or what-        know, the crash is always in your head and
  ever. Um, luckily, I didn’t. I don’t think I did.     you thought about it constantly . . . .
   . . . young recruits that were down on the
  shore and actually picking up body parts
                                                      Physiological: ‘‘The body tells you.’’ The
  and some of them got into trouble. You know,
                                                      volunteers also spoke of tremendous exhaus-
  reality just suffocated them I think.
                                                      tion, of various physical responses, early signs
  I felt kind of stifled over the whole time and
                                                      of somatization significant enough to require
  it, and I didn’t really understand it because I
                                                      time off work.
  hadn’t been anything, through anything
  quite on that scale.                                  The body tells you . . . You may be silent,
                                                        even your brain may be silent but your body
                                                        will not be silent for long. I’ve found that out.
Cognitive: ‘‘What the hell is wrong with                It’s a different kind of tired. [laughs]. You feel
me?’’ The thoughts of volunteers were also af-          like you’ve been sucked dry.
fected as they attempted to cognitively and
emotionally process the mass casualty and the
challenging and grotesque nature of the recov-        Delayed Responses: ‘‘The first year after-
ery work. As the physical and emotional im-           wards, I, I took a bit of a decline.’’ The
pacts of exhaustion, sadness, fear, and anger         volunteers reflected on how the SA111

                                     Brief Treatment and Crisis Intervention / 6:2 May 2006           163
MITCHELL ET AL.

     response and recovery involvement had af-             strength from various sources, including their
     fected them over time. Volunteers identified          interaction with grieving family members.
     sleep problems, for some increased smoking
     and/or drinking, as well as relational, employ-         I Didn’t Feel Like I Failed Anymore
     ment, emotional, and behavioral impacts, in-            At the anniversary, we talked to a lot more.
     cluding a fear of flying. In particular, people         And I know, they kept telling us, ‘‘We
     identified an enduring exhaustion, the pres-            couldn’t believe all you did for us.’’ Every
     ence of depressed affect, and difficulty in relat-      day that they were out there, they saw all
     ing to those who were not involved in the               of these people in orange combing here and
     response efforts. For at least three of the partic-     combing there. Going out on boats to here,
     ipants, these impacts also contributed to the           going out on helicopters to here. She said,
     dissolution of their marriages.                         ‘‘Every day, there was just more of you
                                                             and more of you and more of you. She says
       The fatigue’s been very slow to go. Um, prob-         I couldn’t believe that all of these people
       ably the worst thing of all was the over-             would drop everything they were doing
       whelming fatigue. Um, I just don’t have               and would come help us. And you helped
       the energy I used to. You know, it’s slowly           us so much. We’ll never be able to thank
       coming back but that was the longest effect.          you.’’ I had all of the same theme kind of
       And I mean the depression, you know, I                thing. People telling us over and over, ‘‘I
       guess that’s all just part and parcel of feeling      can’t believe what you did for us.’’ I thought,
       depressed. Um, what . . . post traumatic              they don’t think we failed. So then, I felt a lot
       stress . . . whatever right.                          better about it and so did some of the other
                                                             people on the team that I had talked to who
                                                             had the same feeling. They said, "Yeah, after
     Finding Meaning in Disaster, Death, and
                                                             that, I didn’t feel like I failed anymore. Be-
     Devastation
                                                             cause they don’t think I failed anymore.
     Volunteers struggled with the massive loss of
     life and their inability to rescue any survivors      In light of the reality of the situation and the
     from the disaster.                                    catastrophic nature of the event, although ex-
                                                           periencing a range of adverse impacts, each
       We didn’t save anybody. Why should we go            individual employed various strategies to aid
       there to get thanks by these people because         them in finding meaning in their disaster
       really at the end of the day, [we didn’t] do        response efforts. Although many response
       anything to help them.                              workers felt a sense of failure in light of their
                                                           valiant effort during the relief and recovery
       Another volunteer stated—
                                                           process but their inability to rescue any crash
       Hazen said to me that he felt like we failed.       victims, interactions with the family members
       And I’m like, I feel that way too.                  often helped to put their sense of disappoint-
                                                           ment and failure into perspective. Many re-
     Finding meaning in such devastation caused            covery volunteers were then able to see how
     constant struggle with their role and their sense     truly grateful these individuals were for the
     of contribution or failure. Ultimately, as de-        effort they had exerted. Such contact with vic-
     scribed in the recovery volunteer’s quote be-         tims’ family members often served to validate
     low, volunteers gained significant meaning and        the recovery workers’ experience and to aid

     164    Brief Treatment and Crisis Intervention / 6:2 May 2006
Swissair Flight 111 Disaster Response Impacts

in putting closure to their own emotional               your sister you know, or a child of yours,
distress.                                               you know. So from day to day you kind of
  One key theme that readily appeared in the            would go about your work and do the best
data was the abrupt realization of the fragility        you could and sometimes you would get a lit-
of the human body and delicate nature of                tle strength from your buddy next to you
human existence. Such realizations led many             whether he was on your right or the left.
people to question their own mortality and              You know. But it was always sad. There
the degree of control they have over their own          was never any jokes or anything passed on
destiny and existence.                                  and I’ve never noticed people humming
                                                        hymns more than on those searches.
  I don’t think you ever really make sense of it.
  It’s just um, [pause] that whole notion, it kind    Weighing their experiences overall, the volun-
  of made me think a little bit more. It made me      teers did not seem to regret their involve-
  rethink life and rethink death and um, kind         ment in the recovery efforts. Nonetheless, most
  of concluded that we really don’t have con-         expressed the wish to move on from the disas-
  trol and I guess, I guess that’s the way it’s       ter, and the hope that they would not be met
  supposed to be. You know, it’s just the             with this type of life challenge again. Yet, some
  way it happens and unfortunately, as it is,         said that they would volunteer again, if needed.
  that’s the way things work.
                                                        . . . it was quite an experience and I hope to
  Religion, faith, and an increased understand-         God that it never happens again . . . .
ing of the human spirit also became a source of
comfort for many response workers and often-          Discussion
times served as a means to help the volunteers
to give meaning to the disaster and their per-        As with previous sections, our discussion
sonal experiences. Turning to one’s faith aided       begins with the words of a volunteer who re-
many in helping them find meaning and                 counts his/her experience while working in
answers to how and why such things can hap-           the field. The volunteer details the careful,
pen. Many people resolved themselves to the           methodical, and respectful manner in which
notion that there are no simple answers and that      the response worker carried out his role.
such occurrences are beyond human control.              The volunteer passionately and compassion-
                                                      ately describes his exposure to personal effects
  Ah, my faith is, I won’t say very strong, it’s      and shares his reflections on the profound psy-
  unshakeable. I have rock solid faith. Um, I’m       chological impact of such an experience.
  not ah, I’m beyond the point where I would
  ask the typical question, why would God al-           It Was Like The Whole Universe Just
  low something like this to happen?, because           Closed Right In On Me
  my personal belief is that ah, there is a univer-     And ah, I was taking the clothing and the
  sal consciousness of some kind or another. I          clothing would get tangled all wrapped up
  think it’s far beyond human intellect to com-         in seaweed and everything so you would have
  prehend the nature of that. I leave that in the       pull everything apart. And, I, I thought it
  realm of the unknowable, the infinite. . . .          was a t-shirt that was my initial impression
  The fact, you know, was that maybe it could           when I was trying to get this particular, well
  be your mother, your father, your brother,            they’re all knotted and twisted and tangled

                                     Brief Treatment and Crisis Intervention / 6:2 May 2006       165
MITCHELL ET AL.

       from rolling in it and stuff. [sighs] And I ah, I      The crash of SA111 off the coastal of a rural
       opened it up, I cleaned everything off and           area of Nova Scotia in September 1998 pre-
       folded it up to put it in the bag and ah,            sented a unique disaster response experience
       a lot of times, rung it out if it were saturated     for local response personnel, many of whom
       for, just for the weight problems. I took it out     were members of the surrounding communities
       and finally got it untangled and it was just ah,     and served in a volunteer capacity. In such
       it was just a little jumper [baby’s clothing         areas, where there are limited paid emergency
       item]. That might be blocked out a bit, actu-        and disaster response personnel, members of
       ally it’s kind of weird. I can’t really picture it   the local community often serve in an auxiliary
       right now. Um, but I do, I do remember that          role as volunteer firefighters and members of
       the . . . it was like, the whole, it was like in     the ground search and rescue teams. Although
       a movie or something that you see zoom in            often well-versed in their respective fields and
       on one spot like from outer space—‘‘vomp’’           accustomed to responding to incidents such as
       [participant imitates sound]. Right in on that       auto accidents and searching for missing per-
       one spot on the planet. It was like the whole        sons, they were ill-prepared for the magnitude
       universe just closed right in on me and right        of the SA111 response due the catastrophic na-
       in on that. And I was holding it up and I, oh        ture of the crash, the total annihilation of the
       shit. It just, it just stopped me. I was just dead   aircraft, and the disembodiment of all 229 pas-
       in the water. And, I thought, you poor little        sengers and crew. In this case, what appeared to
       bastard. And that’s when it hit me. Yup. No          be a routine search as local volunteers manned
       sweat. If I could ah, little guy, I’d trade places   their boats and headed out to sea to assist sur-
       with ya. [participant emotional]                     vivors, turned into a salvage mission of the
                                                            most grotesque nature.
     When reflecting on the voices of the response            The volunteers worked for up to 34 days on
     volunteers and their lived reality during their        shoreline recovery work and performed a piv-
     involvement with the SA111 disaster, we are            otal role in the response efforts, working on
     humbled by the fact that the data so eloquently        a daily basis combing the beaches collecting
     and succinctly reveal more than we could               forensic evidence for investigative and victim
     offer from an interpretive authorial voice.            identification purposes. As the findings chroni-
     We are committed to honoring and amplifying            cled, the nature and duration of these activi-
     the voices of volunteers in this text to describe      ties had a vast impact on the response workers
     the experiences of disaster response volunteers        due to multiple, repeated, and prolonged expo-
     and the interplay between their task, exposure         sures to dismembered and decomposing human
     in the field, and the resultant impacts they suf-      remains, personal effects such as children’s
     fered. Volunteer voices have clearly described         clothing, fragmented components of the air-
     the profound nature of their experience as re-         craft—most not exceeding the surface area of
     sponse workers, and they have articulated the          a dinner plate—ongoing interaction with griev-
     various impacts of their involvement with the          ing family members, and the relentless presence
     SA111 recovery efforts. Having honored this            of the international media.
     voice, we now transition to a discussion of these        Existing research indicates that various ad-
     graphic experiences in relation to contempo-           verse psychological and emotional impacts
     rary understandings of exposure to traumatic           have been identified in disaster-affected popu-
     events with an emphasis on posttraumatic               lations (Bowman, 1997; Browne & Neal, 2001;
     stress as a probable outcome.                          Coarsey-Rader, 1995; Davis, 2003; Freedman

     166    Brief Treatment and Crisis Intervention / 6:2 May 2006
Swissair Flight 111 Disaster Response Impacts

et al., 2002; Fullerton, McCarroll, Ursano, &       training and experience in emergency re-
Wright, 1992; Herman, 1997; Litz, Gray, Bryant,     sponse. The SA111 disaster was a catastrophic
& Adler, 2002; Sprang, 2002; Stephens, 1997;        event beyond the range of normal emergency
Suar, Mandal, & Khuntia, 2002; Wright &             response efforts. When placed in such situa-
Bartone, 1994). The fourth edition of the           tions, in addition to being presented with chal-
Diagnostic and Statistical Manual of Mental         lenges regarding their familiarity with their
Disorders (DSM-IV; American Psychiatric             assumed role, workers may be exposed to grave
Association [APA], 1994) defines a traumatic        human tragedy and hardships that may con-
event as an occurrence in which a person            tribute to the psychological impact of their
has experienced, witnessed, or was confronted       work (DeWolfe, 2000). In such situations, re-
with an event or events that involved actual        sponse workers are often traumatized through
or threatened death, serious injury, or a threat    their senses as they struggle to process and in-
to the physical integrity of self or others and     tegrate what they are seeing, hearing, touching,
the person’s response involved intense fear,        and smelling around them (Fullerton & Ursano,
helplessness, or horror. PTSD is an extreme         1997). In the SA111 disaster, the volunteers
response to a traumatic event characterized         were exposed for an extended period of time
by specific clusters of symptoms experienced        to human remains, and this exposure had a
following the event (APA, 1994, DSM-IV).            variety of behavioral, cognitive, emotional, and
The PTSD symptom cluster can be formulated          physiological impacts. In a study conducted
into three broad categories: reexperiencing/        by Fullerton et al. (1992), professional rescue
intrusion (nightmares, flashbacks, intrusive        workers who were involved in a mass casualty
thoughts, or images), avoidance/numbing             disaster suffered adverse effects. The rescue
(detachment, restricted effect, avoidance of        workers complained of intrusive images and
reminder, thoughts, and activities), and hy-        smells following exposure to the deaths of vic-
perarousal (hypervigilance, decreased concen-       tims, and some reported difficulties in sleeping,
tration, increased startle response, insomnia,      nightmares, and images of the dead during the
irritability); in order for a diagnosis of PTSD     night. Fullerton et al. also identified that re-
to be made, these symptoms must last for 30         sponse workers felt helplessness and guilt at
days or more and result in significant social       not being able to do more to help the victims.
or occupational distress (APA, 1994, DSM-           The recovery volunteers in the present SA111
IV). However, a diagnosis of acute stress disor-    study similarly suffered negative impacts from
der, while bearing many similarities to PTSD in     their exposure to a mass casualty disaster com-
its symptom cluster structure, can be made as       pounded by the emerging reality that there was
soon as symptoms have persisted for 2 days,         complete devastation of the aircraft and no sur-
theoretically allowing for more prompt diagno-      vivors. The distress was heightened by the
sis and earlier intervention (Mitchell & Everly,    inconceivable devastation of the airplane and
1997).                                              unimaginable disembodiment of humans that
   Although the majority of response workers        resulted in the recovery of human remains ver-
are highly trained professionals within their re-   sus intact human bodies. In a study by Coarsey-
spective fields (such as paramedics, medical        Rader (1995), the psychological and emotional
practitioners, members of search and rescue         effects of investigating the fatal air crash of
units, police officers, and firefighters), this     USAir Flight 1016, which claimed the lives of
study focused on the experiences of volunteer       38 passengers when it crashed on July 2,
response workers who had various degrees of         1994, revealed that persons who work with

                                    Brief Treatment and Crisis Intervention / 6:2 May 2006      167
MITCHELL ET AL.

     affected populations and who are exposed to           this study provide critical information that has
     grotesque elements often become secondary             not been reported previously in the literature.
     victims. Due to the implosion of the SA111
     aircraft and the difficulty and duration of the
     response efforts, the degree of distress for          Conclusion
     SA111 disaster volunteers was affected by both
     extremes in duration and intensity of exposure.       It is evident in the findings of this qualitative
     The SA111 response volunteers felt helpless at        study that volunteer responders were exposed
     not being able to rescue survivors or to provide      to multiple tragic deaths and the shock of the
     intact corpses to grieving families. We concur        loss of ‘‘physical integrity’’ of the SA111 crash
     with Coarsey-Rader that such exposures can            victims due to the profound physical impact
     produce secondary disaster victims.                   of the crash. We learned that the volunteers’
                                                           selfless, dedicated service resulted in varying
                                                           degrees of feelings of helplessness and horror
     Limitations                                           as they engaged in their volunteer recovery
                                                           task. Volunteer interview transcripts revealed
     Although we have established the strengths of         the characteristic cluster of PTSD responses
     the data and the compelling importance of the         of reexperiencing, avoidance, numbing, and
     volunteer voice, we also acknowledge that this        hyperarousal. Volunteers described immediate,
     article is subject to several critical limitations.   short-term, and long-term impacts with nega-
     We are working with data from a small group           tive personal, social, and occupational out-
     of volunteers who agreed to participate in            comes. Volunteer responders were grossly
     the research and who may not necessarily be           impacted by the nature and duration of their
     characteristic of the majority of volunteers.         tasks and the cumulative effect of their multiple
     The research participants may be more or less         exposures. The Swissair response volunteer ac-
     traumatized. However, we suspect that those           tivities involved multiple exposures including
     who suffered the greatest long-term distress          identification with victims through personal
     after the disaster would not have participated        clothing and effects, exposure to grotesquely
     in this study given the avoidance of trauma           fragmented and decomposing human remains,
     reminders characteristic of those with PTSD           and direct contact with hundreds of grieving
     (APA, 1994, DSM-IV) and that the volunteer            family members. Further, ongoing international
     effects discussed here are a conservative por-        media coverage of the response efforts served to
     trait of PTSD impact on the SA111 recovery            compound the distress of the SA111 volunteers.
     volunteers. The data are all first-person             It is important, however, to acknowledge that
     accounts that were gathered retrospectively,          some volunteers gained meaning and strength
     approximately 3 years after the disaster oc-          from their interaction with family members
     curred. The data are therefore subject to recall      and their ability to contribute at a time of need.
     biases. Finally, this paper was based on a sec-       The personal contact contributed greatly to the
     ondary analysis of the original data completed 6      volunteers’ ability to complete their task with
     years after the disaster occurred. Given this         respect and dignity for human remains, honor
     time lag, it is possible that the findings may        for the lives of the deceased passengers, and
     not accurately reflect contemporary volunteer         service to their grieving families. The ability
     disaster experiences. However, we believe that        of volunteers to give meaning to their disaster
     the in-depth first-person accounts gathered in        experiences appears to have contributed to

     168    Brief Treatment and Crisis Intervention / 6:2 May 2006
Swissair Flight 111 Disaster Response Impacts

adaptive coping as found by Meichenbaum                 American Psychiatric Association. (1994).
(1994).                                                   Diagnostic and statistical manual of Mental
  Further research is required to investigate             disorders (4th ed.). Washington, DC: American
short- and long-term impacts, with attention              Psychiatric Association.
to volunteer needs in the field for communica-          Bowman, M. (1997). Individual differences in
tion, support, and debriefing. The development            posttraumatic response: Problems with the
                                                          adversity-diversity connection. London: Lawrence
of treatment vehicles and modalities must also
                                                          Erlbaum Associates.
be considered for short- and long-term follow-
                                                        Browne, R., & Neal, A. (Eds.). (2001). Ordinary
up of volunteers who serve in disaster response           reactions to extraordinary events. Bowling Green,
efforts. Given the profound impact of human               OH: Bowling Green State University Popular
remains exposure and the long-term personal               Press.
social and occupational costs of PTSD, it is rec-       Bronfenbrenner, U. (1979). The ecology of human
ommended that emergency and disaster organ-               development: Experiments by nature and design.
izations develop specific policies and protocols          Cambridge, MA: Harvard University Press.
for volunteer involvement, support, treatment,          Chu, J. (1998). Rebuilding shattered lives: the
and follow-up, in particular when responders              responsible treatment of complex post-traumatic
are exposed to human remains.                             and dissociative disorders. New York: Wiley.
                                                        Coarsey-Rader, C. V. (1995). Effects of investigation
Acknowledgments                                           of a fatal air crash on 13 government investigators:
                                                          Final report for grant from natural hazards research
We wish to acknowledge the interdisciplinary team         and applications information center. Boulder, CO:
of researchers from the Department of Community           University of Colorado.
Health and Epidemiology and the Psychology              Davis, N. (2003). Problems and symptoms that
Department of Dalhousie University that                   a rescue worker may experience thru helping.
collaborated in this study, in particular,                Rescue-Workers Online. Retrieved September 16,
coinvestigator Dr. Swarna Weerasinghe and                 2005, from http://www.rescue-workers.com/
research coordinator Kara Griffin. We also recognize    Denzin, N. K. (1989). Interpretative biography.
the essential role of the Community Advisory Group        Newbury Park, CA: Sage Publications.
that guided all phases of the study and the             DeWolfe, D. J. (2000). Field manual for mental health
important contributions of the volunteers                 and human service workers in major disasters.
themselves without whom this research could not           (2nd ed.). Washington: Center for Mental Health
have been conducted. It is with great respect that we     Services.
acknowledge the contributions of the volunteer          Freedman, S., Gluck, N., Tuval-Mashiach, R.,
responders to the disaster efforts and to this study.     Brandes, D., Peri, T., & Shalev, A. (2002). Gender
Without the participation of these individuals this       differences in responses to traumatic events: A
article could not have been written. Finally, we          prospective study. Journal of Traumatic Stress, 15,
acknowledge the generous funding of the Social            407–413.
Sciences and Humanities Research Council of             Fullerton, C. S., McCarroll, J. E., Ursano, R. J., &
Canada. Conflict of Interest: None declared.              Wright, K. M. (1992). Psychological responses
                                                          of rescue workers: Fire fighters and trauma.
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                                       Brief Treatment and Crisis Intervention / 6:2 May 2006            169
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