MENTAL HEALTH RESPONSE TO MASS VIOLENCE AND TERRORISM: A FIELD GUIDE

CHAPTER II: Survivors' and Families' Immediate Needs

Experiencing an act of terrorism or mass violence involving exposure to mass casualties, extreme trauma, and threats causes predictable human reactions. Most survivors and families have the same initial concerns and needs. They accept relief efforts more readily when first responders, emergency managers, law enforcement personnel, human services workers, and government officials consider the following:

Physical need for warmth, safety, rest, fluids, and food.
Emotional need for protection, comfort, control, reassurance, and a "listening ear."
Fear and anxiety about the safety and well-being of loved ones, friends, and coworkers.
Need for connection with loved ones and support systems.
Desire for frequent updates regarding the status of rescue and recovery efforts, criminal investigations, potential threats, and what is going to happen next.
Need for clear, sensitive explanations of: emergency medical procedures; medical examiner's office procedures and protocols; the criminal justice process; the rationale for highimpact operational decisions; and immediately available services, benefits, grants, and assistance.
Need for death notification conducted in a straightforward, clear, and compassionate manner.
Normal trauma reactions such as fearfulness, numbness, jumpiness, sleep and concentration problems, and replaying traumatic images and sounds.

In the days and weeks following mass violent victimization, initial shock gives way to the realization of personal losses. The lifechanging implications of death, the destruction of home and community, serious injuries, and the loss of a sense of safety and security in the world become increasingly apparent. Other consequences such as loss of employment, and relocation of home, school, or place of worship exacerbate disruption and grieving. Survivors and families psychologically pace themselves according to individual timeframes and personal coping styles.

Survivors and families often face numerous logistical and practical issues that can seem overwhelming. Workers may facilitate assistance with transportation, child care, locating a missing loved one or pet, funeral arrangements, finding temporary housing, filling prescriptions, replacing eyeglasses, and providing healthy foods and beverages. They also may help facilitate filling out the necessary paperwork for obtaining crime victim compensation and benefits, a death certificate, disasterrelated unemployment, insurance benefits, and financial assistance. Through helping with practical tasks, workers often earn survivors' trust and the privilege to support them when they express their pain, fear, sorrow, and anger.

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