One could say I am a bit of an expert in disasters and the aftermath. As a medical manager on one of the country's 28 Urban Search and Rescue (USAR) Teams for 20 years, I have been deployed all over the country assisting with disasters, both natural and man-made, starting with 9/11 (21 years ago today), Hurricane Katrina, and as recently as 2021, the Surfside condo collapse in Miami, Florida.
Whether my team and I are sifting through rubble looking for survivors or in a boat, rescuing victims from rising flood waters, our mission is the same -- to assist people who need help. This is what my team and I do.
With climate change causing a in the number of weather-related disasters over the last 50 years, the need for disaster-related trauma care will only grow. Experts are of intense tropical cyclones (Category 4-5 hurricanes) with higher peak wind speeds, which can cause deaths, devastate communities, and displace thousands.
Crisis intervention efforts in the immediate aftermath of disasters -- from the Red Cross and other organizations -- have become much more effective in the past decade, but even that is not enough. Recognizing the mental health challenges that occur in tandem with the other effects of climate change on people throughout the world is just the first step in creating short- and long-term care plans for those struggling with disaster-related trauma.
We need to prepare for the possibility that climate change-related disasters will cause a corresponding mental health crisis.
A Coordinated Initial Response
As a physician on the USAR team, I am responsible for not only the physical well-being of my teammates, but also their mental well-being. We must also help the victims in both regards, in the initial response as well as the aftermath.
The first step in helping victims in a crisis is being able to recognize there may be a problem. Obviously, if someone was just rescued from a collapsed building or cut out of their attic after 2 days of rising floodwaters, one can assume they may need help. But, in any disaster, there is collateral damage, including those who may have been nearby, loved ones at home, or friends watching on TV.
It is important to recognize the potential issues and start to address them. I like to make eye contact and study the person's facial expressions while looking for signs that may be concerning. I also look for physical symptoms.
Sometimes, extreme emotional stress and trauma immediately following a disaster can manifest in symptoms like dizziness, shortness of breath, heart palpitations, or even body aches, in which case people affected may need medical attention. I do this with my first responder colleagues as well as the victims and families that I encounter.
It is also important to find effective ways to normalize grief and trauma, for both victims and first responders. This may be as simple as asking, "How are you doing?" to get the person to start to open up about how they are feeling. Or it may require more professional interventions from a physician or counselor.
But for many people, the trauma doesn't just go away -- weeks or months later, some experience depression or other acute symptoms due to feelings of loss, guilt, economic ruin, or other troubling situations.
Despite the fact that I have been responding to disasters for so long, as an individual, there is only so much I can do and only so many resources at my disposal. Most responses to disasters -- natural or human-induced -- are grassroots, local, and isolated.
It is sometimes difficult with a disaster such as the Surfside collapse since it is so localized when literally, three blocks away, life in Miami went on as if one of the largest disasters in recent times was not occurring down the street. But with the possibility of more natural disasters occurring because of climate change, we need a more intentional, coordinated approach to helping people -- both victims and first responders. The 988 national suicide prevention hotline is a great example of a national, ubiquitous resource.
Longer-Term Support
The problem with our current response to disasters is that, while efforts in the immediate aftermath are robust and "in your face," over time, those efforts naturally fade. Long-term, as people have difficulty processing what happened and the attention to the disaster they were involved in subsides, is when acute problems can arise and the need for therapy can be greater.
The classic symptoms of post-traumatic stress disorder -- negative thinking and moods, being easily frightened, disturbing dreams, and relationship problems -- often don't go away quickly or on their own.
Yet there are never enough clinical resources available. In the U.S., have a severe shortage of mental health professionals, and that shortage could worsen over the next several years. Fortunately, the pandemic has given increased attention and normalization to the importance of acknowledging and addressing mental health challenges.
In the coming years and decades, as climate change continues to cause disasters like flooding, hurricanes, droughts, and wildfires, the need for long-term crisis intervention for those affected will only deepen. More national attention and focus are necessary to make resources available for victims and first responders involved with disasters, including mitigating the shortage of mental health providers.
We've largely addressed the need for natural disaster crisis intervention on Day One and Week One. Now we need more awareness about the long-term effects of that trauma and the resources we need to provide.
is chief medical officer of , a leading EAP and digital health company. He is board certified in family practice medicine and worked in emergency departments for many years. Valerian is also an EMT, a tactical emergency casualty care instructor, a certified medical diver, a Black Belt, and a triathlete.