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'Psychological First Aid' critical after Pilger tornado, Von Maur shooting

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  • Pilger coping

    Family friend John Thoreson, left, of Willow Lake, South Dakota, gives Deb Alexander a hug as cleanup at the Alexander farm home in Pilger, Nebraska continued. A tornado hit Pilger, causing widespread damage on June 16th.

Posted: Thursday, July 3, 2014 1:00 am

PILGER — Thousands of hands pitch in to help in the days after a disaster like the tornadoes that struck this community and others in Northeast Nebraska earlier this month.

There’s the buzz of people talking, a din heard while debris is shifted and a roar of large machinery doing what hands alone cannot.

But what happens when the people go away? When the quiet of rural Nebraska gives a tired tornado survivor time to think?

Robin Zagurski knows. And, she worries.

It's her job.

"I go up and introduce myself," said Zagurski, a licensed clinical social worker in the University of Nebraska Medical Center Department of Psychiatry. "I tell them I am part of mental health services. Then, I tell them that it's all right to talk to a therapist.

"I say, 'How are you?' ”

Zagurski specializes in what is called “Psychological First Aid.” She arrives at disaster scenes like Pilger immediately with other emergency first responders to assess the mental health of the victims.

She offers psychological first aid by letting people vent and tell their stories and then gets them ready for therapy if needed.

Zagurski, who worked at the Von Maur mall shooting in Omaha in December 2007 and the Little Sioux Boy Scout Camp tornado in Iowa in June 2008, was in Pilger already on June 17 and remained in area towns for a tour of six days.

"Part of what I listen for is past history of trauma, something that'll be an indicator that there will be more problems down the road," Zagurski said. "I am listening for anything out of the ordinary, but mostly I am just letting them tell someone what happened, letting them talk about their situation."

Sometimes, victims think they are bugging other people, she said. They don't want to complain or tell anybody what happened. After all, how do you talk about your situation when somebody next door had the same thing happen?

That's a sign of guilt, one of the many emotions that people have in times of crisis.

Zagurski said for at least six weeks after an event, people can be relieved, calm, guilty, angry or incredibly sad.

Most of that list of emotions was seen that Monday night when a Daily News reporter and photographer walked the streets of Pilger soon after the tornado went through.

Some residents told jokes like, "Hey, I've got some stuff for sale."

Some were angry and stopped just short of threatening harm to law enforcement or anyone else who came on their property.

As Zagurski shared days later, the most common responses are a caregiver's calm and nervous laughter.

"The adrenaline is there, but you are relieved so you get into that giggling," she said. "I always call it a 'funeral laughter.' It's where you go to a funeral and you know you are not supposed to laugh, but sometimes you do.”

Children think they have to "buck up" for their parents, when really they can have their own reactions, Zagurski said. Couples of any sort may not agree on how to handle a clean-up and what to do with what they have left.

"Psychological First Aid is a structured form of kindness," Zagurski said. "A lot of it is just having good listening skills and knowing when to let someone vent and when to stop and intervene.”

She said mental health experts go over self-care measures. When victims are trying to clean up and figuring out what is salvageable and what is not, people can feel like they can't rest, they have to keep going, she said.

"Part of what we are doing is reminding them to take breaks, to eat regularly, try to sleep the same hours they regularly would," Zagurski said. “Maybe even build in some pleasant activities so they can recharge.”

Because people handle disaster differently, mental health workers don’t become overly concerned until emotions begin to affect victims’ daily lives.

"We do see people who seem to function very well for a week or two, and then they start to fall apart,” she said. “They are exhausted. They have used up all of their resources.”

That’s when peculiar behaviors start to pop up.

"People have trouble thinking and making decisions,” Zagurski said. “They can't even decide what toothbrush to grab.”

You start to see more arguments, she said. There is some discussion about whether domestic violence rates increase. People have trouble sleeping. They have trouble eating. They might have trouble staying still or they might have trouble getting up.

"We go back and have more contact with those people as soon as possible,” Zagurski said. “Sometimes people invite us back by themselves. They say, ‘Come by and talk to me tomorrow.’ ”

Such follow-up care is extremely important, she said. But most mental health assessment is during the “First Aid” stage in the first day or two following a disaster.

"I get to meet some incredible people and have some wonderful conversations with them,” Zagurski said of the job she has done for 16 years. “That's quite a gift they give to me.

“But after I do what I do and go home, I spend the next day crying.”

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