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59 APPENDIX C Data Analysis Data Analysis and Findings First time exposure to trauma. Participants that had mul- tiple traumatic experiences reverted back to their first Emotional Response experience and spoke of what it meant to them and how they All participants expressed that they had an emotional re- dealt with it. Then they could communicate how the chosen sponse to the incidents that the research team chose to focus incident required similar or different responses from them. on during the interviews. Frequently the participants who The succeeding incidents of trauma were reported as having had experienced other incidents would bring in their first trau- less of a traumatic impact or at least the participant felt more matic exposure as a comparison or contrast to the chosen in control of their response and the situation. Participants incident. Participants also freely brought in other traumatic that experienced the chosen incident as their first trauma incidents besides these two as part of the interviews. spoke at length of its impact and how they attempted to deal There were variations in the degree of response that the par- with their emotional and physical responses. Some reported ticipants experienced. Participants, less involved at the site of becoming physically ill after their first day of working within the incident but responsible for peripheral tasks, were able to the role established for the incident response. First time expo- express feeling "sadness" that the incident had happened and sure to trauma is a risk factor for an adverse reaction since people had died. They were connected to the situation through they had no previously established coping strategies, lacked media coverage and shared stories from co-workers in the work predictability of response in the situation, and had no under- environment. This group did not indicate other symptoms of standing of the post-traumatic process. post-traumatic stress, or post-traumatic stress disorder. Perceived magnitude and gravity (gruesomeness) of the There were variations of symptoms experienced among the incident. Participants spoke of their lack of preparedness for participant groups of responders and accident investigators. the "real" situation. All their practice and tabletop discus- A continuum from post-traumatic stress response (i.e., prob- sions could not get them ready to see the actual event. See- lems sleeping, experiencing a physical illness) to symptoms ing the gruesome scene made it real and more difficult to of a significant disorder (i.e., change in personality, altered remove the memory of it. Feelings of sadness were positively functioning and behaviors, intrusive thoughts, labile emo- related to proximity to the site and hearing about the inci- tions) was reported and described by participants. Several dent from coworkers. Having survivors at the site created sought relief through medication and therapy, while others questions that were rehashed such as "why couldn't we save identified support systems of family, friends and co-workers more?" Guilt seemed more prevalent in this latter situation. as significant to their coping. The risk factors identified in the Type of exposure and tasks to do at the site and after. The following section influenced the reactions and coping strate- persons completing tasks that they didn't usually do and gies of participants. those involved in more gruesome activities spoke of their shock/surprise of how they felt unprepared for the realness of the situation. The stress of this combination heightened Antecedents their overall response to the trauma. During the analysis several factors emerged as antecedents Length of exposure or involvement in the incident that affect the participant's degree of emotional response to (marathon vs. sprint). Longer exposure to the cleanup the experience. The following characteristics could be viewed or details surrounding the incident increased the potential as risk factors: of experiencing post-traumatic stress reaction (PTSR) or

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60 many of its symptoms. If the person had not resolved pre- Preexisting process/protocols with all people having knowl- vious trauma, the new incident increased their need to seek edge of and involvement in traumatic accidents/disasters therapeutic resources. (awareness of and practice with what a real situation could Focus person maintains about the task being done. Persons be like with explicit details). that did their job without time for idle thinking (thought Degree of support/trust present in relationships among dwelling) and maintained an objectified perception about and between workers, departments and agencies. their work ("did the job you were expected to do") coped Flexibility in being able to show up for the emergency job better with the situation. Participants stated that this re- or transfer off the job without repercussions. sponse was similar to a firefighter's mentality. Those who Inference of no guilt for work done or inability to do all the personalized the situation (present when family members work (e.g., person becomes ill in response to first day of over were present or saw personal artifacts of the victims) had working). more difficulty moving beyond the memories of the inci- Defined outcomes with an end in sight, including the intent dent. Subjectivity was accompanied with internalization to move into normalizing work as soon as possible. and more emotional responses. Pre-knowledge of the role, length of time, and degree of Amount of external stressors present during incident. involvement in the task to be completed by all workers The number of other agencies and organizations (inves- ("marathon" vs. a "sprint"). tigative and regulator people) involved that are outside of Resources available (or have quick access to them) that the planned protocols add stress to the setting. Not know- support having control of the situation (tools, experts, ing what their protocols and needs are adds another layer of money etc.). stress to a traumatic event for the local people. The media Number of hours a person has to put in without a break; adds chaos and strains the local resources profoundly. level of exhaustion experienced in disaster work. An understood meaning and purpose to the work being done In summary, the following table lists key factors that help or (personally or corporately which is recognized/verbalized). hinder a person's ability to cope with a traumatic event. The Presence of familiar support systems, including formal number of risk factors the person experiences is positively (counseling services) and informal (family, spouse/ related to development of post-traumatic stress response or significant other, peers/coworkers) that meet the needs disorder. of the person throughout crisis to recovery. Number of "insiders" that are familiar with their situation Environmental Influences and post traumatic stress response (a lot of explaining not necessary) to provide support. The factors discussed above exist within an environment of Acknowledgment that this work is difficult and an expres- multiple variables that influence the stress response experi- sion of gratitude by significant leaders towards workers. enced by the workers. Supervisors and employees have vary- ing degrees of control over planning a proactively responsive environment. The following environmental variables relate Summary of Significant Findings to the tasks to be done that influence outcome and can sup- port or interfere with coping processes of individuals: From the themes (points and factors) that emerged during the semi-structured interviews, a composite description has Preexisting collaboration agreements that reduce confusion been created that explicates the ideal responsive environment and support a smooth transition from emergency response that would assist airline and airport workers in coping with to recovery. natural and man-made disasters. Hinders coping (heightens risk of PTSR) Helps coping First traumatic event with limited knowledge of post traumatic Has experienced multiple traumatic events with some resolution response Perceived magnitude/gruesomeness of the event Perceived magnitude/gruesomeness of the event Objectifies the tasks to be done or gives meaning to the work Personalization of the work and feelings of guilt (more could Short term focused task within the incident have been done) Comfortable with task and no surprises Long term involvement in the incident Limited outside intrusion and knowledge of their expectations Required task is new with unknown/hidden aspects Multiple unexpected demands from outside agencies/sources (additional stress)

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61 Pre-trauma Environment and Activities They are informed about what the real situation could entail before entering the site. At the end of each day during the crit- Assumptions exist that there would be a presence of key ical period, they participate in a group meeting (more than a environmental factors/behaviors that positively support the debriefing) that supports their ability to recall the work of the work of the employees. These relate to dynamics in the envi- day, how it was accomplished and what needs to be com- ronment including open communication, trust between and pleted. The environment would encourage members to speak among workers and departments, and a demonstration of freely of their feelings, graphically describe what they are respect for each other. The system would also have preexisting dealing with (senses overload), and discuss how they are cop- collaboration agreements and protocols in place to follow dur- ing with the whole incident. Normalization of the experiences ing a disaster. Team members would be cross-trained within and reinforcement of previous learning related to PTSR would their areas of comfort. be part of the group members' response. The system would integrate mental health support into the Mental health support personnel (or mentors or trained response and recovery planning team. The mental health sup- peers) would do family outreach. They would connect with port person(s) would have familiarity with the workers in all the settings, spend time in the work environments, and would family members that observe the worker at home to assess how assess/observe the current and ongoing levels of function that environment is being affected by the trauma/disaster. among and between workers. These observations would in- Workers that use spouses as significant support resources clude, but not be limited to, identification of daily stressors in may also shield ("protect") them from many of the "grue- the environment and coping strategies used by workers. The some" details especially if the spouse had no real understand- mental health support personnel would promote personal re- ing of what could be happening. The degree of sharing or siliency, provide information about symptoms of stress re- protection employed affects the degree of internalization used. sponse, and explain healthy coping strategies via brochures, Internalization also affects the development of PTSR symp- presentations and/or published materials for workers and toms. Moreover, the degree of sharing with a spouse could their families. also create a secondary traumatic response in their spouse or Mental health support personnel would also assess the cul- family members. Therefore, outreach would include assess- tural response to counseling and health seeking behaviors; ing the worker and other family members. they would work to reduce or eliminate the myths that inter- As workers complete their roles and others continue, this fere with health seeking behaviors. Therefore, they would supportive process is continually available to all who wish to build therapy into the culture of the work environment. This participate. Workers are referred to other resources (by peers, method recognizes mental health support as growth produc- mentors, and professionals) as observation identifies those in ing rather than a need for individuals who "are out of con- need of more intense assistance. Costs are managed by the trol," "not doing [their] job" and "need to get back in shape." agency and do not burden the employees for the duration of Also, the therapy process and what can be expected from their need. therapy would be discussed. The mental health support personnel or other contracted services would also train peers to act as mentors. These peers Recovery would be volunteers that have had some exposure to the types The mental health support personnel would be present of trauma that could be expected in the setting. If it is not pos- throughout the trauma, helping workers to see their strengths sible to recruit from the setting, a pre-identified "sister" or- in moving through the incident and recommending other ganization with trained mentors would assist in the time of a ways of coping and reframing of the incident (re-capping re- disaster. The mentors would provide support needed, obser- siliency information). Administration within the environ- vation of changes and recognition of depletion of coping ment would recognize the need of workers to talk more with strategies of individuals in the work environment during dis- one another to process their current feelings and experiences; aster response and recovery. thus, a reduction in productivity may be necessary to deal with these stress let downs. "Let downs" may also require em- ployees to have unscheduled days off to recuperate from the During Disasters experience. Established protocols are followed to minimize exposure Normal work hours and responsibilities would return as to trauma since extensive exposure puts individuals at greater quickly as possible to support predictability and feelings of risk for exhaustion and potential of physical illness. Workers being in control of work expectations. Acknowledgment of should be aware of their roles, know all associated aspects worker's contributions and expressions of gratitude would be (nothing hidden or unknown) and have practiced these roles. issued to all involved.

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62 Quantitative Analysis Dissociation (DIS) measures dissociative symptomatology, such as depersonalization, out-of-body experiences, and A number of self-report measures were administered to psychic numbing. each participant. These measures were meant to assess psy- Sexual Concerns (SC) measures sexual distress, such as chological and physical reactions to trauma exposure. These sexual dissatisfaction, sexual dysfunction, and unwanted measures had been used in previous work. A detailed descrip- sexual thoughts or feelings. tion of each measure is presented below. Dysfunctional Sexual Behavior (DSB) measures sexual behavior that is in some way dysfunctional, either because Trauma Symptom Inventory of its indiscriminate quality, its potential for self-harm, or its inappropriate use to accomplish non-sexual goals. The Trauma Symptom Inventory (TSI) is a 100-item self- Impaired Self-reference (ISR) measures problems in the report measure used in the evaluation of acute and chronic "self" domain, such as identity confusion, self-other distur- posttraumatic symptomatology, including the effects of rape, bance, and a relative lack of self-support. spousal abuse, physical assault, combat experiences, major Tension Reduction Behavior (TRB) measures the respon- accidents, natural disasters, and the lasting sequelae of child- dent's tendency to turn to external methods of reducing hood abuse and other early traumatic events. Each symptom internal tension or distress, such as self-mutilation, angry item is rated according to its frequency of occurrence over outbursts, and suicide threats. the prior six months using a four point scale ranging from 0 ("never") to 3 ("often"). This measure has three validity scales and ten clinical scales, all of which yield sex- and age- The Symptom Checklist-90-Revised (SCL-90-R) normal T scores. The various scales of the TSI assess a wide This is a 90 item self-report symptom inventory test. It has range of psychological impacts. These include intra- and been developed to reflect the psychological symptom patterns interpersonal difficulties often associated with chronic psycho- of psychiatric or medical patients. Each of the 90 items is a logical trauma in addition to symptoms typically associated problem or complaint that patients sometimes have. The with PTSD and ASD. respondent is to rate each item according to "how much dis- The following is a list of TSI validity scales: comfort that problem has caused during the past week, includ- ing today" on a 5-point scale of distress, ranging from "not at Response Level (RL) measures a tendency toward defen- all" to "extremely." The SCL-90-R is scored and interpreted in siveness, a general under-endorsement response set, or a terms of 9 primary symptom dimensions and 3 Global Indices need to appear unusually symptom-free. of Distress. These symptom dimensions and indices of distress Atypical Response (ATR) measures psychosis or extreme are listed below with a brief description of each dimension. distress, a general over-endorsement response set, or an The scores for each dimension are T-Scores that have a mean attempt to appear especially disturbed or dysfunctional. of 50 and a standard deviation of 10. The scores were compared Inconsistent Response (INC) measures inconsistent to a non-patient gender appropriate sample. The definition responses to TSI items, potentially due to random item of each scale is listed: endorsement, attention or concentration problems, or reading/language difficulties. Somatization Scale reflects distress arising from perception of bodily dysfunction. The following is a list of the clinical scales: Obsessive-Compulsive Scale reflects symptoms that are highly identified with the standard clinical syndrome with Anxious Arousal (AA) measures symptoms of anxiety, this name. including those associated with posttraumatic hyperarousal. Interpersonal Sensitivity Scale focuses on feelings of per- Depression (D) measures depressive symptomatology, both sonal inadequacy and inferiority, particularly in comparison in terms of mood state and depressive cognitive distortions. with others. Anger/Irritability (AI) measures angry or irritable affect, Depression Scale reflects endorsement of a broad range of as well as associated angry cognitions and behavior. symptoms compatible with depression, such as dysphonic Intrusive Experiences (IE) measures intrusive symptoms mood, feelings of hopelessness, and somatic complaints associated with posttraumatic stress, such as flashbacks, compatible with depression. nightmares, and intrusive thoughts. Anxiety Scale includes symptoms of nervousness, ten- Defensive Avoidance (DA) measures posttraumatic avoid- sion, apprehension, and somatic complaints associated ance, both cognitive and behavioral. with anxiety.

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63 Hostility Scale includes thoughts, feelings, or actions that than one that targets a specific age, disease or treatment group. are characteristic of the negative affect state of anger. The eight domains of health-related quality of life include Phobic Anxiety Scale measures a persistent fear response Physical Functioning, Role-Physical (role limitations due to to a specific person, place or object or situation which is physical health), Bodily Pain, General Health, Vitality, Social characterized as being irrational and disproportionate to Functioning, Role-Emotional (role limitations due to mental/ the actual stimulus which leads to avoidance or escape emotional health) and Mental Health. The scores on these behavior. eight health domains are collapsed into a Physical Component Paranoid Ideation Scale measures paranoid behavior as a Summary (PCS) measure and a Mental Component Summary disordered mode of thinking. (MCS) measure. Psychoticism Scale measures the extent to which the indi- vidual is isolated, withdrawn, and experiences difficulties Results in clear thinking. Global Severity Index (GSI) is designed to measure over- The Trauma Symptom Inventory was scored for each par- all psychological distress. ticipant according to the standardized instructions. T-scores Positive Symptom Distress Index (PSDI) is designed to were generated for all three validity scales and all 10 clinical measure the intensity of symptoms. scales. The means and standard deviations for all of the scales Positive Symptom Total (PST) reports number of self- are presented in Table 1. An examination of the means indi- reported symptoms cates that group performance was near the average in the gen- eral population for each scale. However, in order to identify individuals who may have been scoring in the extreme range, The Impact of Events Scale-Revised we identified participants who scored more than one T-score This is a 22-item self-report scale. Respondents are to report standard deviation (60 or greater) above the mean. The par- the distress caused by a variety of symptoms of PTSD. The ticipants with scores in this range are listed below along with symptoms cover the range of traumatic stress reactions and the scales on which those elevated scores occurred. include intrusion, avoidance and persistent hyperarousal. The The most frequent elevations were observed on the Anxious respondents were asked to rate the distress caused by each Arousal (AA), the Dissociation (DIS), the Dysfunctional symptom during the past week on a scale ranging from not at all (0) to extremely (4). In light of the unique nature of our data collection in which participants were responding to their Table 1. Trauma Symptom Inventory (TSI). experience of a disaster which may have occurred several years ago, two versions of the scale were created. One version asked Mean SD the participant to indicate how currently distressing each item was (IES-R Current). The second version asked them to recall Validity Scales 1. Atypical Response (ATR) 47.68 4.23 how distressing each situation was for them in the first few 2. Response Level (RL) 45.26 5.27 months following the disaster (IES-R Past). 3. Inconsistent Response (INC) 45.47 5.00 Clinical Scales The Connor-Davidson Resilience 4. Anxious Arousal (AA) 51.11 10.25 Scale (CD-RISC) 5. Depression (D) 47.16 5.00 6. Anger/Irritability (AI) 48.32 6.80 This is a 25-item scale that measures the ability to cope 7. Intrusive Experiences (IE) 48.32 6.68 with adversity. Participants rated items on a scale from 0 (not 8. Defensive Avoidance (DA) 49.00 7.02 9. Dissociation (DIS) 52.89 7.99 at all true) to 4 (true nearly all the time). The scale is rated as 10. Sexual Concerns (SC) 49.21 7.42 to how the subject has felt over the past month. The total score 11. Dysfunctional Sexual Behavior (DSB) 49.58 8.88 ranges from 0100 with the higher scores reflecting greater 12. Impaired Self-reference (ISR) 48.16 6.99 resilience. 13. Tension Reduction Behavior (TRB) 48.00 7.23 The SF-36v.2 Health Survey Participant 107 DSB, ISR, TRB Participant 102 AA, AI, DA, DIS, DSB, ISR The SF-36v.2 is a 36-item health survey that yields scores Participant 501 AA, IE, DA, DIS on eight scales of functional health and well-being. A mental Participant 101 AA, DIS Participant 306 DIS health and physical health summary index is also included in Participant 201 SC this survey. This measure assesses general health status, rather Participant 101 DSB

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64 Sexual Behavior (DSB), and the Impaired Self-Reference The analysis of the Symptom Checklist 90 revised revealed (ISR) scales. Each of these scales yielded elevated scores with that 12 of the 24 participants had an elevation on at least one three participants, except the DSB which yielded elevated of the subscales with two individuals having nine elevations scores with two participants. The AA scale indicates a high and one having six. The most frequent number of elevations number of symptoms of anxiety, including those associated observed was on the Somatization scale (six participants), the with posttraumatic hyperarousal. The DIS scale indicates dis- Obsessive-Compulsive scale (five participants), the Depres- sociative symptomology, such as depersonalization and psy- sion scale (four participants) and the Interpersonal Sensitiv- chic numbing. The DSB scale reflects sexual behavior that is ity Scale (three participants). Elevations on the Somatization in some way dysfunctional, either because of its indiscrimi- scale indicate the individual is reporting a high degree of dis- nate quality, potential for self-harm or inappropriate use to tress from the perception of physical symptoms. Elevations accomplish non-sexual goals. The ISR indicates a lack of cop- on the Obsessive-Compulsive scale indicate difficulties with ing resources. impaired concentration, distractibility and inattention. Ele- The Symptom Checklist 90 revised (SC-90-R) was scored vations on the Interpersonal Sensitivity scale reflect a high de- for each participant according to the standardized instruc- gree of feelings of personal inadequacy and inferiority, par- tions. T-scores were generated for all nine clinical scales and ticularly in comparison with others. Finally, elevations on the the three composite scales. The raw scores were compared to Depression scale indicate endorsement of a broad range of a non-patient gender appropriate normative sample when symptoms compatible with depression, such as dysphoric computing T-scores. The means and standard deviations for mood, feelings of hopelessness, and somatic complaints com- all of the scales are presented in Table 2. An examination of patible with depression. Clearly our participants were report- the means indicates that group performance was near the ing a high degree of psychological distress. average in the general population for most of the scales and Therefore, the scores for each scale are the sum of the items all three of the composite measures. The exceptions to this endorsed for each scale. The means and standard deviations observation are the Somatization scale, the Obsessive Com- for all of the scales are presented in Table 3. An examination pulsive scale and the Depression scale. All three were at least of the means indicates that overall the participants reported 5 T-Score points higher than the mean of 50. In order to iden- that the traumatic event was less stressful currently than when tify individuals who may have been scoring in the extreme it immediately happened. In order to identify individuals range on the remaining scales, we identified participants who who may have been scoring in the extreme range on the re- scored more than one T-score standard deviation (60 or maining scales, we identified participants who scored more greater) above the mean. The participants with scores in this than one standard deviation above the mean. The participants range and the scales on which those elevated scores occurred with scores in this range are listed below. An examination are listed. An examination of the scores indicated that several of the scores indicated that several participants were report- participants were reporting a high degree of psychological ing a high degree of current stress and past stress over the distress on many of the scales. traumatic event. Table 2. Symptom Checklist (SC-90-R). Mean STD Extreme Scores 1. Somatization: 56.2 6.53 60,64,65,68 2. Obsessive-Compulsive: 57.05 8.47 61,62,63,69,74 3. Interpersonal Sensitivity: 52.15 8.41 61,62,66,68 4. Depression: 55.1 7.66 60,63,70,74 5. Anxiety: 47.2 10.38 67,73 6. Hostility: 48.45 8.64 60,61,73 7. Phobic Anxiety: 48.5 5.63 66 8. Paranoid Ideation: 50.55 8.78 62,67 9. Psychoticism: 52.6 7.65 60,63 10. Global Severity Index (GSI): 53.1 9.57 64,67,74 11. Positive Symptom Distress Index (PSDI): 51.6 7.17 60,61,64,65 12. Positive Symptom Total (PST): 53.7 7.76 60,64,68,70 Participant 100 Som Participant 101 Som, Psy, PSDI Participant 102 Som, Psy, IS, OC, HOS, PST

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65 Table 3. The Impact of Events Scale (current and past). Mean SD 1. Impact of Events Scale-Revised Current 10.16 9.38 Participants who scored > 1sd above mean (19.54) Participant 306 34 Participant 307 22 Participant 400 25 2. Impact of Events Scale-Revised Past 19.74 14.36 Participants who scored > 1sd above mean (34.09) Participant 205 51 Participant 306 46 Participant 400 35 Three participants had elevations on the Impact of Events sures used. Surprisingly, all correlations were positive and Scale-Revised (past) and the Impact of Events Scale-Revised above 70. (current), with two of the three participants having elevations The SF-36v2 Health Survey (SF-36v2) was scored accord- on both versions of the scale. The scales addressed how cur- ing to the standardized instructions and Physical Component rently distressing each item was for each participant (IES-R Summary (PCS) measure, and a Mental Component Summary Current) and how distressing each situation was for them in (MCS) measure was produced for each participant. These the first few months following the airline/natural disaster scores are T-scores with a mean of 50 and a standard deviation (IES-R Past). For three of our participants, the perception of of 10. The higher number on either scale indicates better their subjective distress was high at the time of the trauma and functioning. The means and standard deviations for all of the remained high several years after their exposure to the trauma. scales are presented in Table 5. The means and standard deviations for all of the scales are Results from the SF-36v2 Health Survey indicated there were presented in Table 4. An examination of the means indicate four participants who reported a high number of physical that overall our participants rated themselves as very resilient. symptoms and two participants who reported a high number Results from the Connor-Davidson Resilience Scale (CD- of mental health problems. RISC) indicate a relatively high degree of self-reported resilience among our participants. Interestingly, the two participants with relatively low scores on the Connor-Davidson Resilience Integration of Qualitative Scale (CD-RISC) reported the least amount of psychologi- and Quantitative Methodologies cal distress. A series of Pearson Correlations were computed between One important theme that emerged from the quantitative each participant's Connor-Davidson Resilience Scale (CD- and qualitative analysis is that some of the participants con- RISC) and all of the subscales of the various self-report mea- tinue to report an above average number of symptoms of psy- Table 4. Connor-Davidson Resilience Scale. Mean SD Connor-Davidson Resilience Scale (CD-RISC) 78.74 8.01 Participants who scored < 1sd below mean (70.73) Note (66.68 is 1.5 SD below mean) Participant 100 66 Participant 204 68

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66 Table 5. The SF-36v2 Health Survey. Mean SD Physical Component Summary (PCS) measure 48.84 4.97 Participants who scored < 1sd below mean (43.87) Participant 100 38 Participant 101 40 Participant 307 42 Participant 103 43 Mental Component Summary (MCS) measure 43.95 4.98 Participants who scored < 1sd below mean (38.97) Participant 306 33 Participant 204 35 chological distress, several years after their exposure to trauma. Executives (AAAE) was utilized to generate contact informa- On the SCL-90, five participants produced scores in the above tion. In general, representatives on the roster list were the average range on three or more of the 12 indices examined. highest ranking management officials associated with a par- Six of the participants produced elevations on the Somatiza- ticular airport. Each member on the AAAE roster was sent an tion scale, reporting a high number of physical symptoms. email which contained an Internet link to an online survey in- Five of the participants produced elevations on the obsessive- strument. This survey used the software on www.surveymon compulsive scale which reflects a high degree of inattention, key.com. To ensure anonymity, the survey did not require distractibility and repeated thoughts. Four of the participants any participant to identify themselves or their airports. The produced elevations on the depression scale. Clearly, five of the survey was administered to 175 airports nationwide. participants were reporting an above average number of symp- Some demographic information was collected for the pur- toms of psychological problems some time after the trauma poses of measuring whether any group differences occurred. exposure had occurred. It was clear that a subset of our par- The demographic information is listed in Table 6. ticipants continued to report difficulties with psychological The airport locations were divided among Alaskan, Central, functioning some time after experiencing the trauma. Eastern, Great Lakes, New England, Northwest Mountain, The Impact of Events Scale-Revised also revealed that two Southern, Southwest, and Western Pacific. Type of Airport of the participants reported a high degree of distress caused (based upon FAA criterion) included general aviation, non hub, by a variety of symptoms of PTSD in the first few months fol- small hub, medium hub, and large hub. The yearly enplane- lowing the trauma and currently. The symptoms covered the ments included the following choices: no enplanements, less range of traumatic stress reactions including intrusion, avoid- than 100,000 enplanements, 100,001 to 250,000 enplanements, ance and persistent hyperarousal. 250,001 to 500,000 enplanements, and over 500,000 enplane- Despite having a number of participants report a high degree ments. The survey had 64 respondents which covered all re- of continuing psychological distress, participants reported a gions except Alaskan and all types of airports and enplanement high degree of resilience with a mean score of 78.74. Further, categories. In addition, exposure to both natural, airline and the resilience scores were positively correlated with the self- general aviation disasters within the preceding ten years was report measures of psychological trauma. It appears that several recorded. of our participants continued to view themselves as resilient while reporting a high degree of psychological trauma. Table 6. Demographic identifiers among sample. Online Airport Survey Airport Location In order to determine the extent of post-disaster mental Type of Airport (based upon FAA Criterion) health crisis programs existing at airports in the United States, a survey was conducted among airport management personnel. Yearly Enplanements A membership roster of the American Association of Airport

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67 The first question that respondents answered was the fol- Interestingly, 36 of 64 respondents reported they already lowing: "In regard to your Airport Emergency Plan (AEP), have a mental health recovery program in place at their airport. does your airport currently have any formal or informal pro- This does not seem to be congruent with this study's findings gram(s) designed to deal exclusively with the mental health in the field. The incongruity could possibly be explained trauma that employees may face after responding to an aircraft with a wide variance of definitions as they pertain to a men- accident or natural disaster?" Thirty-six respondents indi- tal health recovery program. For instance, it is possible that cated they do currently have a program in place to deal with an airport may simply have a clause in their emergency plan to employee mental health traumas post-accident, while 28 indi- have employees contact the Red Cross or the Employee Assis- cated that they do not have such programs. It should be noted tance Program (EAP) should they encounter mental health that no definition of a "formal or informal program" was trauma. While this may be a productive measure, it may not used within the survey, and the interpretation was left up to be comprehensive enough to completely assist employees the respondent. It is possible there are wide variances between with their own resiliency and would not be considered a the structures and types of programs amongst those answer- "classic" mental health recovery program. ing in the affirmative. The majority of respondents feel a mental health recov- The second question asked was the following: "Would you ery program is a worthwhile addition to their plan (62.5%). be in favor of a program/template that would help your organ- This perception held true irrespective of whether the airport ization initiate a program to assist employees coping with trau- already had a plan in place or not and whether they had expe- matic events (deal with what they have witnessed) in the course rienced an aviation or natural disaster within the past 10 years. of responding to a disaster?" Forty respondents indicated they Only 9.4% did not favor the idea of such a program, with would be in favor, with six not in favor and 18 uncertain. There was no significant difference between those organizations who 28.1% unsure. had post-disaster mental health trauma programs in place and From the data, it appears most airports would be open to those who did not with regard to being in favor of implement- some type of guidance on how to implement a mental health ing such a program, 2 (2, N = 64) = .666, p > .05. recovery program and integrate it within their emergency plan. Within the preceding 10 years, airports who had experi- Regarding the favorability of implementing a program, exten- enced an airline disaster (n = 4), a general aviation disaster sive regulation or cumbersome application could be the reason (n = 24), or a natural disaster (n = 17) reported no group for the higher number of "unsure" respondents. However, a differences in their preference for wanting post-disaster formal definition of such a plan would have to be thoroughly mental health programs, 2 (2, N = 64) = 4.693, p = .096; developed and applied in order to alleviate burdensome obsta- 2 (2, N = 64) = 1.233, p > .05; and, 2 (2, N = 64) = .205, cles in implementation. This definition could also increase p > .05, respectively. Airport location, classification and num- the robustness of currently implemented plans, whether they ber of annual enplanements also demonstrated no group dif- are simplistic or involved. In any event, further study into the ferences with regard to favoring or not favoring the creation issue of mental health recovery programs could generate more of a program, 2 (14, N = 64) = 16.261, p> .05; 2 (8, N = 64) focused data given that the more detailed definition of a recov- = 5.908, p > .05; and, 2 (8, N = 64) = 4.388, p > .05. ery program is operationally defined.