Checklist for Communities

Enhancing your capacity to respond to victims

In order to increase the resiliency of all Canadian communities following a terrorist attack or incident of mass victimization, local communities should pre-plan and prepare their response to persons harmed and injured. Responding with compassion, support and practical assistance to the victims and survivors of the incident in the immediate, intermediate- and long-term will help prevent isolation, letdown, grief, anger and other negative outcomes that are harmful to communities. Working with victim focussed agencies and volunteers will help first responders and investigators by limiting their role in sharing information and directly helping victims, they are able to focus efforts on the primary response to the incident.

How to Use the Checklist

The Checklist below is comprised of 13 broad sections that can be expanded and collapsed as necessary. Each section of the Checklist provides detailed information and lessons learned from international experiences for use in meeting the needs of victims and survivors in the aftermath of a terrorist incident or case of mass victimization.

The Checklist begins with a Pre-Incident Preparedness section and then leads into the Time of Incident/Incident Management section, which covers the IMMEDIATE NEEDS of victims (crisis response phase). The 9 following sections of the Checklist continue to address some of the IMMEDIATE NEEDS, but also address the INTERMEDIATE NEEDS (consequence management phase). The last 2 sections of the Checklist address the LONG-TERM NEEDS (recovery phase) of victims. It is important to note that the reactions and responses of victims will not follow a set and orderly timetable, and the needs of victims will overlap at times and evolve.

Please check your local emergency response plan against this Checklist in order to augment your response aptitude towards victims and survivors of a terrorist event or a mass victimization.

Pre-incident Preparedness

  1. Training

    The Public Health Agency of Canada offers a variety of training courses that will prepare people for responding to both natural and man-made disasters. The first, for health care professionals and hospital staff, is: Surge, Sort, Support: Disaster Behavioural Health. Another course offered is Emergency Health Services Basic for people who support their communities though Emergency Health Services (EHS). They also offer a course entitled Emergency Social Services Basic for those in their community who provide emergency social services (ESS).

  2. Jurisdiction

    The response to a terrorist incident is going to involve a multi-organizational effort due to the scope of the event. It will require input and assistance from all levels of government, and will entail the coordination of multiple agencies within each level. This may include fire, police, medical services, health officials, armed forces, and public officials from provincial and federal government departments. The roles that various agencies assume will, in part, be established by the scope of the event, but it is important that the emergency response plan outlines who is responsible for each type of response, that a chain of command is established, that there be a clear plan for when agency mandates overlap, and that all parties are kept informed of their roles.

  3. Functional Needs Framework

    People with special needs (including children, seniors, people with disabilities, people with severe mental illness, those who have been previously traumatized, etc.) make up a large proportion of society and they require significant consideration in emergency response planning based on essential, sometimes overlapping, functional needs: communication, medical needs, maintaining functional independence, supervision, and transportation (C-MIST).

  4. Planning
    • Helping Victims of Mass Violence & Terrorism: The First 24 to 48 Hours (Office for Victims of Crime, USA)
    • Helping Victims of Mass Violence & Terrorism: 48 Hours and Beyond (Office for Victims of Crime, USA)
    • The Emergency Management Planning Guide 2010-11 (Public Safety Canada) – Threats and risks to Canadians and Canada are becoming increasingly complex due to the diversity of natural hazards affecting our country and the growth of transnational threats arising from the consequences of terrorism, globalized disease outbreaks, climate change, critical infrastructure interdependencies and cyber attacks. Emergencies can quickly escalate in scope and severity, cross jurisdictional lines, take on international dimensions and result in significant human and economic losses. The purpose of this Guide is to assist federal officials, managers and coordinators responsible for emergency management (EM) planning.
    • Preparing For After Resource Kit – VOICES of September 11thIn 2014, VOICES completed Preparing for After, a Resource Kit that documents best practices in preparing for, responding to and recovering from acts of mass violence.The Resource Kit is based on extensive research and interviews conducted with those who responded to the 9/11 terrorist attacks, the Oklahoma City bombing and the shootings at Virginia Tech, Northern Illinois University and in Tucson, Arizona.Funded by the U.S. Department of Justice, the project documents lessons learned that will guide service providers, organizations and government agencies in providing services to victims families, survivors and others impacted by traumatic events. Community leaders, emergency managers, law enforcement, mental health professionals and other key stakeholders will find this information useful in preparing for and responding to both the immediate and long-term needs of the community.
    • Commission of Inquiry into the Investigation of the Bombing of Air India Flight 182 – THE FAMILIES REMEMBER:In the evening of June 22, 1985, Air India Flight 182, a Boeing 747 named Kanishka took off from Montreal bound for London and later New Delhi. In the early morning of June 23rd it was blown apart from a bomb planted by terrorists in Canada, killing all on board. Learn more about the response to this act of terrorism including: 1) THE HUMAN LOSS suffered; 2) HEROIC EFFORTS of Irish officials in responding to the emergency; 3) THE CANADIAN RESPONSE; 4) THE AFTERMATH and the journey towards 5) RECONCILITATION & HOPE by the families impacted.
    • Toolkit for Response for Advocates in Colorado (TRAC) (Colorado Department of Public Safety). This toolkit is a planning guide. It is designed to lead you through basic steps in the process of developing a mass crisis response plan to terrorist incidents or mass casualties, with a focus on the needs of victims/survivors. It was developed by the State of Colorado for both emergency response personnel and victim advocates. The toolkit includes resources for pre-planning, initial response, community response, and long term recovery. It also contains sample forms, checklists and additional resources.
    • Office for Victims of Crime (U.S.) – Helping Victims of Mass Violence & Terrorism – Planning, Response, Recovery & Resources (PowerPoint slides and Webinar with audio)
    • Meeting the needs of survivors and families bereaved through terrorism (Victim Support England & Wales)
    • RAN RVT ‘The power of victims of terrorism: how to give support’
    • RESCUE, RESPONSE, AND RESILIENCE – A critical incident review of the Orlando public safety response to the attack on the Pulse nightclub
  5. Registration of Canadians Abroad

    Registration of Canadians Abroad is a free service offered by Foreign Affairs, Trade and Development Canada that keeps you connected to Canada in case of an emergency abroad, such as an earthquake or civil unrest, or an emergency at home.

    Whether you’re planning a vacation or living abroad, sign up in a few minutes or less.

    http://travel.gc.ca/travelling/registration

Time of Incident/Incident Management

Incidents or events where there are injuries and loss of life may require the inclusion of specialists who have comprehensive knowledge and/or expertise in the unique needs and challenges faced by victims. These specialists can be assigned wherever their services are required, including:

  1. Victim Liaison

    As part of your immediate response strategy, you may want to consider including a victim services expert (sometimes known as family liaison officer) who can assist the incident command centre/structure in a city to ensure that the victim lens is considered in actions taken by leadership in the immediate aftermath of an incident.

    Resources
  2. Within protocols for coordination and collaboration

    Federal, provincial/territorial, and local authorities must work in collaboration to identify victim needs and needed resources, coordinate services to victims, develop strategies for responding, and address related issues. It is suggested that coordination between different levels of government regarding response to victims be included in any response plan.

    Resources
  3. At Survivor Resource Centre(s)

    Many communities have identified the need for Survivor Resource Centres in the aftermath of a terrorist incident which are designed for victims, injured persons, and family members only and should be established immediately in a safe, but centralized location where forms of communication and technology work well. In setting up a Survivor Resource Centre, you may want to consider:

    1. Information services – Victims have ongoing, strong need for information about what’s happening and why. Briefings should be provided directly to them, with information provided from an official source; it should be provided to families as soon as it is received and before the media receives it, which will alleviate demands on officials. These services could also provide information on missing persons and provide a means for families to be re-connected;
    2. Immediate crisis counselling/psychological first aid to help stabilize those affected, provide support to prevent maladaptive coping, facilitate a better understanding of what is occurring, and determine their immediate needs;
    3. Health services, which will likely include medical care for those severely injured, information on the whereabouts of hospitalized victims, attention to various spiritual/cultural needs;
    4. Needs assessments and planning to directly address the trauma and its potential effects in the short-term and long-term, with the ultimate goal of assisting those impacted in recovery. The assessment will take into account the unique needs of the victims, including those relating to age, health, language, and cultural considerations;
    5. Coordination of emergency needs provision, which inncludes, but is not limited to: transportation and travel, temporary housing assistance, emergency food and clothing, employment considerations, childcare/animal care, etc.
    Resources

Other issues for consideration at the Time of Incident/Incident Management:

  1. Remote communities

    While it is generally believed that terrorist incidents will target more densely populated areas, it is possible that smaller, and more rural communities will experience a terrorist or mass victimization event, either as an intentional target, or by accident. For this reason, these communities must also develop emergency response plans and protocols which help to address the needs of victims and survivors. While much of the information that is contained in this Checklist can also be applied directly to remote communities, it is important to note that there will be challenges that are unique, and these must be addressed in all preparation. These challenges will vary from community to community, based on their degree of remoteness.

    Location – Communities that are removed from major travel routes are often difficult to reach, as there are greater distances for specialized services to travel, there are fewer route options, and there are limits to the modes of transportation available to those seeking to help. This is especially true for communities in the more northern regions, where some communities are fly-in only and weather can further complicate whether the community is accessible.

    Communication – The ability to communicate effectively can also impact emergency response. In larger centres, the use of cellular technology is becoming the norm for communication among both emergency responders and the general population, with smart phones being the preferred tool. This may not hold true in remote locations, which can cause delays in information exchange if it is not planned for. Response plans must consider that the cellular network is generally not as strong in rural or remote communities. Alternative means for delivering information to victims and survivors may be required, such as radio or television broadcasts.

    Under resourcing – Remote and rural areas may lack specialized services or access to them that is more readily available in larger, more populated regions. This may include access to specialized equipment, types of healthcare, mental health services, and the increased cost for providing many public services. Lack of nearby services may also mean that key stakeholders are asked to perform many roles in a crisis. This practice may lead fatigue among those who are asked to perform multiple roles, and emergency response plans should avoid this where possible. There may be need to rely on pre-established relationships with the Canadian Red Cross, so that they can dispatch volunteers to the community, where appropriate.

    Small Population – Remote communities often have a smaller population base than urban areas, which means that there is a smaller and less diverse volunteer pool, and there is an increased likelihood that potential volunteers are also personally affected by the incident. This may impact the services offered to victims and survivors, and may also put a further strain on available emergency responders. Response plans need to ensure that there are contingency plans in place to remote settings. When local resources or response is exhausted, it may be necessary to call on provincial/territorial and federal assistance more quickly in an under-resourced community.

  2. High-risk groups & Psychological First Aid

    Depending on the nature of the attack and the number of injuries and/or fatalities, there may be a large group of people eligible for victim services. Many people will be traumatized by directly witnessing killings, seeing injured loved ones/peers/bystanders, and seeing, smelling, and hearing indications of the attack. Those who respond to the scene in first responder capacities may also be vulnerable. Some victims and responders may be in the “high-risk” group for psychological difficulties, especially if they were directly impacted or feared for their lives. Those who have experienced a past similar tragedy or trauma could be more vulnerable. The Canadian Psychological Association states that natural disasters and human-caused catastrophes negatively and disproportionately affect older adults/seniors.

    Psychological first aid is an approach that provides psychosocial and emotional help to victims of traumatic events in the immediate aftermath of a tragedy and/or community catastrophe. It ensures that survivors of a calamity can manage initial distress, identify coping actions to help them recover, and that they have the resources they need for interpersonal support.

    Resources
  3. First Receiver Facilities (Hospitals)

    In disasters and other emergency situations, it has been well documented in several major incidents that families surge at hospitals looking for loved ones. Psychological casualties may outnumber the physically injured by as much as 4/1 or greater. Local emergency response plans should consider how to support First Receiver Facilities in their dealings with large numbers of family members so that they do not become overwhelmed. Emergency response plans may address the need to immediately deploy individuals trained in Psychological First Aid (Social Workers, Chaplaincy, Victim Services & Volunteers) into hospitals settings to assist the hospital administration and/or the Family/Patient Information and Support Centre (FISC) within a hospital.

    Resources
  4. Volunteer Management

    In various disasters that have occurred around the world, volunteers often descend upon the scene to offer assistance. Managing them can lead to difficulties and emergency response plans should prepare for this. Consider using the media early on to advise concerned citizens to stay away until they are needed, as officials don’t want the scene flooded with volunteers who may be in the way or in harm’s way. For more detailed information about the use of volunteers, please see section six of the Checklist.

    Resources
  5. Victim assistance dogs or trauma K-9s

    These specially trained dogs have been used in incidents of mass victimization to help calm victims and survivors in the immediate aftermath at Survivor Resource Centres. They have been shown to be especially effective with children and first responders.

    Resources
  6. Recovery, identification, and notification

    There are some humanitarian considerations surrounding the identification of casualties, the notification to family members and the recovery of any remains. Family members should be notified with sensitivity and assured that the remains of their loved one are treated with dignity and respect. After the stability of the scene of the incident is assured (which can sometimes take weeks/months), there may be a need for DNA identification or visual identification. The family members will need to be supported through this process. Consider how to allow immediate family members, survivors and loved ones to return to the scene of the incident once it is safe to do so, as there is often the need to see for themselves what occurred and many family members will descend upon the scene.

    Resources
  7. Public recognition & solidarity

    It is very important to the victims that police and city leaders/politicians immediately and publicly declare compassion for the deceased and injured persons, as well as providing recognition of the harm and denouncing any criminal activity in mass violence situations. Impacted families and survivors must receive positive social responses from officials.

    Resources
  8. Media coordination

    Depending on the situation, there may be local and international media interest in the incident, this will require special considerations. The mass media presence in communities following disastrous events may exacerbate the trauma experienced by the communities.

    Resources

Missing Persons

When an emergency such as a terrorist attack or mass casualty incident occurs, one of the immediate responses for people is to ensure that their loved ones are safe and unharmed. Amidst chaos and disruption, communication systems previously used to stay in touch with loved ones (e.g. land lines, cell phones, websites, social media, etc.) can become unusable due to damage from the attack, or from the tremendous volume of users, preventing these connections between loved ones. People are then compelled to try every means available to reach their loved ones; some flood into local hospitals looking for loved ones, while others descend to the area of the attack. The sheer number of people can easily overwhelm facilities and hamper the efforts of first responders. While the efforts of first responders focus on locating the injured and survivors, providing timely and accurate information to those with missing loved ones will help to mitigate this impact.

To lessen trauma resulting from not knowing if loved ones are safe, protocols should be developed in emergency plans to ensure that family members are reconnected as quickly as possible. Victim and Survivor Reception centres should be equipped with different media for survivors to communicate with family members outside of the disaster area; include private areas where notifications (injury or death) can take place and ensure such notifications occur prior to releasing names publicly, while respecting privacy and confidentiality guidelines. Should there be multiple reception centres, plans should include information-sharing protocols to ensure that families are given consistent and not conflicting information.

The public requires information about where to report a missing loved one. As rescue and recovery operations continue, family members often focus on remaining hopeful that their loved one will be found. The reality is that identification of human remains may take years and even decades. Within families of the missing, some may hope that their loved one escaped/survived, while others may accept that their loved one died in the attack. The lack of a physical body may leave families in a suspended state – not knowing if a loved one is alive or dead. Not having the body denies families of rituals typically used to say goodbye and to transition into a mourning phase (e.g. proper burial, holding memorials, etc.). As a result, recovery may happen at a slower pace. Specialized services offered by professionals and bereavement support groups have been found to be immensely helpful in giving voice to the confusion, uncertainty, psychological paralysis that may accompany situations where a loved one remains missing.

Families of the missing may require support services in both the immediate aftermath and longer term – to manage the uncertainty around the missing loved one but also to acknowledge the additional losses experienced by victims and survivors of man-made disasters.

Losing a loved one in a terrorist incident has unique and long-term implications. Emergency response plans should include the following provisions:

  1. Reassure families that aid workers understand the needs of families and are working to provide answers as quickly as possible.
  2. Provide clear direction as to how, and by whom, missing person reports will be taken. If taken by police, families should be given contact information for the officer taking the report (name, contact information) so that they can add additional information or receive updates. Where possible, use call centers for the reporting of missing persons.
  3. Provide information regarding the process of recovery and identification, including how loved ones will be identified and how this changes as time passes. Families should be advised when the focus moves from rescue of a loved one to recovery of remains. Prepare families for the possibility that they may receive their loved one’s remains over a period of time.
  4. Develop protocols about how remains will be returned to the family.
  5. Never release victim identities/names prior to notifying next of kin.

Locating remains of a missing loved ones does not eliminate all of the trauma experienced by victims of a terrorist attack or mass victimization. Continued supports and services may be necessary to mitigate trauma experienced beyond that which arises from having a missing loved one.

Resources

Technology

Many plans and protocols for emergencies that involve the likelihood of mass victimization take in to consideration the technological needs of those responding to the disaster, including the implementation of dedicated broadband channels for first responders and redundancy systems to overcome network failures. Victims of these disasters often face challenges accessing information, and often turn to any means possible quickly and reliably obtain information when telephone lines and cell towers become overwhelmed. A response plan may want to consider the following:

  1. The inclusion of an IT expert/firm to manage all information, with recognition that some information is provided only to victims/survivors (separate from information provided to the public).
  2. Information management should consider multiple options for the consistent dissemination of information, including websites, SMS, social media channels. Website traffic will increase substantially and current band width capacity may not be able to handle it, which means the public and victims will not get the information they need/want immediately if it is not disseminated across multiple platforms.
  3. The preparation of a website in advance of an incident that can be made public quickly and can be updated easily (within hours of the incident occurring). The website should be ready to go but be activated only once an incident occurs – it should not remain live all the time. There should be a public information website and also a distinct victim/survivor information website.
  4. Developing systems to deliver notifications to families. They should be centralized so that families are not contacted multiple times by different agencies.
  5. Consider technology in advance of the setup of your Survivor Resource Centre by ensuring that cellular reception is strong and that SMS messaging functions well, so that families can remain in communication with their personal support systems. Many of them will be overwhelmed with calls, text messages and inquiries from family and friends and have a strong need to keep their loved ones updated on happenings.
  6. Asset Mapping: Asset Mapping is a capacity-focused way of rebuilding affected communities with a solution focused approach to addressing the community’s needs and problems. The core belief is that the community is the best source of assets to assist those affected. Modern technology has enabled both formal and grassroots asset mapping efforts, as seen in the aftermath of recent natural disasters, such as the 2013 Boston Marathon bombings and Hurricane Sandy in late 2012. Asset mapping allows for a direct link between those in need and those offering support or services. The asset mapping model can also be used to help families and victims reunite following an incident, using tools like Google’s person finder.
Resources

Media

The media response following a terrorist incident or event that results in mass victimization can be immediate and intense. There are both positives and negatives that victims and service providers must consider prior to establishing contact with media sources, to ensure that victims are not re-traumatized or harmed by the media coverage:

  1. Advance notice

    Victims should be provided advance notice of police and emergency response press conferences/briefings so that they do not feel that they need to be continually watching and waiting for updates, or hear information about their loved ones through the media coverage.

  2. Release of information

    Once victims are identified, family members will often be approached by the media to provide information about their loved one, and supply pictures. Families should be provided with guidance in dealing with the media, so that they can understand the potential impacts of their interactions.

    Resources
  3. Coping with coverage

    The media plays an important role as an information source but the media’s intensity, especially after a terrorist attack, can have a negative impact on victims and families. Graphic live images of explosions, death, and human suffering are often broadcast when there is no concrete information about an event. These images are often replayed, posted and printed again and again in the immediate aftermath of the event and into the long-term. People who have been directly injured or lost loved ones are subjected to non-stop television, print and other media accounts of the horror and suffering they lived through or that claimed the life of their loved ones. Pre-planning may minimize the negative impact to those affected by the tragedy.

Resources

Volunteers

Following a terrorist attack or incident of mass victimization volunteers often play a significant role in providing support and assistance to victims, survivors and their families. These volunteers can be trained or untrained, and often provide much needed support and information to those affected. A trained volunteer is one who has received some training in working with people who are traumatized, and is associated with an organization in the community, like the Red Cross or a community-based victim services program. An untrained volunteer is member of the community who wants to help. They may have specialized skills that will be helpful in the crisis, but they are generally individuals who simply want to assist. Both can have roles in responding to a terrorist attack or mass victimization.

Emergency response plans should incorporate the roles of voluntary organizations and unsolicited volunteers in their plans. It is helpful if they determine their role and responsibilities, establish a reporting structure, train organizations on their roles and responsibilities, communicate and brief them on how and when they will be called into action, and have a plan for how and when unsolicited volunteers may be of use (and who they report to). These roles and guidelines need to be established prior to a crisis to ensure that the volunteers can assist as soon as they are called in.

  1. Preparedness plans should identify the primary agencies that will manage volunteers during response and recovery. These should be organized by identified needs and capabilities of agencies to respond.
  2. Volunteer agencies (or a representative for several agencies) should be integrated into the response plan, so that they may better prepare volunteers for when they are called upon.
  3. Clearly identify who makes the decision to call in voluntary agencies, and who they report to when they are providing service.
  4. Where possible, potential volunteers should be pre-screened, to ensure that they can be called in as soon as their assistance is required.
  5. Training should be provided to staff and volunteers on the emergency response plan, so that they are informed of expectations, and what sorts of responses they may be called upon to provide.
  6. Volunteers should be given identification that clearly identifies that they are volunteers, and, if possible, the role that they are carrying out.
  7. Voluntary agencies should be included in debriefing exercises.
  8. Include volunteers, where appropriate, in follow-up care with victims and survivors.

Resources

Donations

In times of crisis, those who are not directly affected often seek to assist those who are impacted through donations – generally in the form of money or goods. They are often motivated to do this in the immediate aftermath, often going to the scene of the disaster to attempt to help. While these donations are often invaluable resources for those impacted by the event, well-meaning individuals can often cause increased confusion at the site of a terrorist event, disaster or mass victimization incident, divert resources from responding, or discourage further donation if there is no one available to receive their donation.

Preparedness plans should consider the inclusion of a donation strategy that is implemented quickly and shared with the public. It should contain information about what is needed, where and when to donate, and how the funds and goods are distributed to the families in need. It should also include information about what is NOT needed. It is imperative that the strategy use traditional media AND social media platforms to deliver messages to the public about how and where to donate. It is commonplace for victims and for the public to gather and share information on social media, using hashtags to tie the information to the crisis.

Victims should be consulted early in the process to ascertain what they require, and be kept informed as to how to convey their needs and how to access needed donations. City officials may need to appoint someone to be in charge of donations and decide how they are distributed to victims, injured persons, and/or first responders in the weeks and months following the incident.

Use the media to inform the public of what is needed and where it can be dropped off to discourage people from dropping off donations at the command post so that officials do not need to deploy security assets to watch over donations.

Resources

Trauma Response & Resilience

Responders and service providers need to be aware that, despite having the shared experience of the trauma, the victims and witnesses are unique and their needs will be different from one another, and will change over time. This needs to be reflected in the way that each person is treated, and the services that are offered to them. Emergency response plans should ensure that victims and survivors can access both system-based and community-based victim services.

  1. Be able to meet the needs of victims as they change. Each person will have unique needs and will be impacted in a different, yet profound way.
  2. Over the longer-term, allow Survivors Resource Centre(s) to transform into what survivors need, such as a place to share stories in an emotionally safe way with others who had been similarly affected.
  3. Consider the impacts of responding to mass victimization and other horrific incidents on first responders such as law enforcement, paramedics and fire officials and have plans in place to support their mental health and well-being.
Resources

Special considerations for children

Children who have experienced disasters and mass violence are often underserved for a variety of reasons, including their age, their comprehension level, and resource availability. Their caregivers often become overwhelmed in the face of turmoil, preoccupied with their own health or recovery. It takes time in order to recover mentally and physically from the disaster. As a result, children are often left unsupported, in the care of others, or unaware of what has happened.

We must effectively respond to the needs of children in order for them to have a successful recovery. Children often remember traumatic experiences into adulthood. If they are not provided with specialized supports, their experience can continue to influence their life negatively over the long term. To support a child who has experienced a terrorist attack or mass victimization, care givers can:

  1. Recognize the reaction of the child to a disaster as normal within an abnormal situation.
  2. Ensure that the child feels safe.
  3. Allow them to express their feelings about what they saw, heard, or experienced. Let them tell their story in their own words.
  4. If they have questions, provide factual information in age appropriate language.
  5. Let the child decide how they best cope. Some might play, run around, read a book, watch TV, or cuddle.
  6. Re-establish familiar behaviours, patterns, bonds. If Friday night was pizza night, try to make that happen, or reconnect with friends at a park, if possible.
  7. Remember to understand that the solutions offered need to fit children. They need often need smaller clothes, meals, doses of medicines than are initially available, and often can’t walk as far as adults can.
  8. Seek counselling for the child and family, if necessary. It is often beneficial to work within the family unit, in a setting that is built for children. A school will likely be available, and is often the optimal therapeutic space.
  9. Use sensitive organized play and games as tools for recovery, particularly peer-group led recreation. Groups may also work. They should be organized in a gender and age sensitive manner.
  10. Remember that children may be victims or patients, but they are also subjects with rights.

Resources

Cultural competency

Culture includes the ideals, values and assumptions about life that are widely shared and that guide specific behaviours. Cues can be observable (like clothing) or subjective (such as beliefs). There are many facets to culture, which may include: national origin; customs and traditions; spoken languages; age and generation; gender identity; religious beliefs; sexual orientation; physical ability or limitations; socioeconomic status; education level; and family/household composition.

Culture is also the filter through which people will process their experiences and events, including in times of crisis. Cultural competence is the integration of knowledge and understanding of an individual`s culture in the provision of services to increase the likelihood of their satisfaction and success. It includes acknowledging and respecting cultural differences of both an individual and their community.

Studies have shown that increased cultural competence will have a positive effect on outcomes; clients are more at ease, more open to assistance, and more likely to resume a level of functioning that is similar to where they were before the crisis if the interventions are approached with cultural competence. The reality is that it will be difficult to be fully attentive to all cultural concerns in a crisis. There is often no warning as to what communities will be affected by a terrorist incident, or the diverse needs that members of those communities present with. Past history, exposure to the crises, and ongoing stress may result in differing reactions. Awareness and recognition of these concerns is an important factor in emergency response plans.

Those providing assistance to victims/survivors should strive to be sensitive to cultural, religious, racial, and linguistic diversity (English/French may not be spoken by persons who are harmed). Culture may influence how one expresses emotions, interprets traumatic experiences or views recovery and healing. The service provider needs to be aware that assumptions can be damaging, and be mindful of any assumptions they hold. Giger and Davidhizar have identified five key areas of consideration when interacting with people of other cultures:

  • communication, both verbal and nonverbal;
  • personal space, or the area that immediately surrounds a person;
  • social organization, the beliefs, values, and attitudes that are learned and reinforced through social organizations, such as family, kinships, tribes, and political, economic, and religious groups;
  • time, and how people from different cultures view time can help avoid misunderstandings and miscommunication;
  • and environmental control, the belief that events occur because of some external factor—luck, chance, fate, will of God, or the control of others, which may affect the way in which a survivor responds to disaster and the types of assistance needed.

To make sure culturally competent assistance is offered, emergency response plans should:

  1. Be aware of the diversity within communities and establish working relationships with cultural groups prior to a crisis to establish effective communication strategies. This will help to ensure that appropriate concerns can be addressed quickly with informed knowledge of cultural differences and without making assumptions in a time of crisis. If possible, workers should reflect the diversity of the community affected. These workers can also serve as a helpful resource for other workers in the team and facilitate effective sharing of information and collaboration.
  2. Maintain up to date profiles of the cultural composition of communities/regions.
  3. Encourage early communication between the worker and the victim/survivor to establish a clear understanding of cultural concerns. Often conveying that you are willing to work within cultural needs will help to establish rapport and trust. Trust is a key factor, without it, clients may not be open to the assistance. Trust can mean that the victim/survivor has confidence in the person providing the service, and/or that they believe that the worker is trying to provide service in a culturally sensitive lens.
  4. Offer training and resources to the worker to ensure that the worker is respectful, nonjudgmental and displays good will and courtesy to cultural rules and traditions.
  5. Have provisions for making appropriate referrals when additional assistance is needed or requested by the victim. This would include contact information for community leaders, interpreters, clergy or spiritual leaders, volunteers, and other stakeholders.
  6. Attempt to identify potential issues that may arise (i.e., social rituals, need for specific meals) and include proposed solutions in order to deliver culturally competent care.
  7. Refer victims/survivors to culturally appropriate post-crisis resources.

Resources

Mental Health

Violence has a huge impact on the lives of victims and family members, which can manifest itself in unexpected ways. It is often amplified in the victims of terrorist incidents, for a number of factors specific to the fact that the death or injury occurred in conjunction with a terrorist act, an intentional act. While responding to victims of a terrorist event is not significantly different than responding to victims of natural disasters, experience and research show that victims of mass criminal victimization react differently than victims of natural disasters largely because of the human factor – that someone did this deliberately to hurt innocent people. The impact from human made disasters may be more prolonged, recovery may take longer, may have the most profound psychological effects and the impact may last longer than natural disasters.

There are several factors that illustrate this point. Victims of terrorism may not feel safe anymore, whereas once the immediate crisis of a natural disaster is over, people can begin to rebuild. The intensity and length of media coverage is another factor that contributes to the prolonged impact felt by terrorism victims. This media interest may not subside for some time, may re-emerge when other attacks take place or when a trial takes place, and is repeated on significant dates, such as anniversaries. This repeated exposure, in both broadcast and print media, forces victims to relive the traumatic event.

How we respond to victims of terrorism in the aftermath of an event can impact their recovery. The response must be sensitive to the unique needs that these victims have from the outset. Too many past traumas have shown that lack of coordination has led to more pain and intensified grief for those impacted. It is also key that the support to victims must extend beyond the initial crisis. The needs of those impacted evolve over time, and emergency planners need to be aware of this fact. The impact and trauma generated by terrorism requires both short-term or crisis response as well as long-term mental health care and support.

  1. Crisis response (incident up to 9 months) – Help victims build adaptive capacities, decrease stressors, and reduce symptoms of trauma immediately following the terrorism or mass violence event.
  2. Consequence management (up to 18 months or longer) – Help victims recover from the traumatic event and to restore their sense of equilibrium. It is important to note that mental health supports may need to be provided for decades following the incident.
  3. Long-term recovery phase (2+ years onward).
  4. Special consideration and provisions should be provided for children to help them cope with trauma and loss.

Crisis Resources: Children/Youth

Crisis Resources: The Elderly

Crisis Resources: Adults/General

Crisis Resources: Caregivers

Longer-term needs

Victims of terrorist acts have long identified that there must be an acknowledgement that the needs of victims carry on past the initial incident, and continue for the very long-term. Most often the focus is on the need for long-term mental health concerns to be addressed. While this is valid, and is most often a pressing need, victims have also identified that the response by authorities and government, or their perception of a lack of response, can have significant impacts on long-term recovery. Victims, therefore, will often require support in:

  1. After the crisis response

    There will come a time, in all crises, when the formalized response concludes, when the victims and survivors are presumed to be able to return to a level of functioning similar to where they were prior to the crisis. For the most part, those affected will have received adequate supports to return to this level of functioning, but there will be some who are unable to. The reasons for this will vary. It is important that preparing to address the long term needs of a community includes an awareness of these individuals. Most often, financial concerns are a significant barrier to recovery. Long-term needs planning should include resources available to those who need them after the formal response. This may include a list of mental health practitioners who work with clients, housing supports, advocates, and self-help resources that victims and survivors can access at their own pace.

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  2. Victim advocacy

    A victim’s need for information about what happened and why it happened continues long after the crisis has passed. They often can benefit from additional support in connecting with those who can assist in gathering information. An advocate can also provide a face and voice through sensitive media coverage; protect dignity; defend legal status; assist in obtaining financial assistance, medical and psycho-social supports; and lobby for counter-terrorism legislation.

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  3. Compensation & financial issues

    In Canada, compensation for victims of crime is a responsibility of the provincial and territorial governments. Each province has developed different compensation schemes and has different criteria to determine eligibility. In the aftermath of a terrorist attack or incident of mass victimization that may take many lives and leave even more victims injured, compensation issues can become very complicated, especially in the Canadian context, where there are significant differences in the compensation available to victims, depending on where the harm occurred. The provincial compensation schemes are not equipped to deal with a terrorist attack (most provinces/territories have very limited schemes or none at all), and victims will need further compensation to cover medical and mental health costs, lost wages, and funeral expenses to reimburse victims for out-of-pocket expenses related to their victimization. All response plans should clearly identify the compensation and/or financial assistance program in their own province/territory (and its limits) because it is likely that more financial resources will be needed to adequately compensate victims and survivors.

    Large funds comprised of donations from the public are common following terrorism, natural disasters or mass violence incidents. These funds are often collected by the Canadian Red Cross. Many communities have identified the need for a fund manager following such incidents, which is someone appointed someone to disburse donations to the victims, injured persons, and/or first responders in the weeks and months following the incident.

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  4. Vocational rehabilitation

    A terrorist attack with can have lasting physical and mental health impacts on those who were physically present during the attack (witnesses), those who provided support and services in the immediate aftermath of the attack (first responders), and those who lost loved ones (victims). One of the challenges that they face is a re-integration into the workforce; quite often they are unable to perform the tasks and duties that they did prior to the harm, and they require assistance coping with their return to the workforce, if at all. The impact of not returning to work at all can have serious financial consequences upon families. Victims, witnesses and first responders may need advocacy in their dealings with various insurance and/or employee assistance programs.

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  5. Criminal justice system

    Participation in the criminal justice process may provide victims with some of the information and answers that they seek about what happened and why; advocates can facilitate victim participation in an investigation or prosecution directly related to the terrorist or mass violence event. It is important for service providers and support persons to note that criminal justice processes can re-victimize victims and survivors.

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  6. Ongoing victim outreach and education

    Victims may require support and assistance in establishing and maintaining a connection with others impacted by the tragedy. These connections allow them to share their experiences with others who are experiencing the same, have a unified voice when approaching various agencies/officials, and offer a voice to guide assistance for future victims.

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Memorials

Physical memorials can have a significant effect for victims of terrorist acts, both in the immediate aftermath, and over the long-term.

  1. Physical memorials of remembrance are important as they allow family members to gather and pay tribute, as well as members of the public, and should be erected as quickly as practicable following the incident.
  2. Victims should be included and consulted in the development of permanent memorials.
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Lessons Learned

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