As Christchurch continues to clean up the mess caused by last month's earthquake, a new study has found rescue workers are often the unrecognised sufferers in the aftermath of natural disasters and other major traumatic events.
And experts say more needs to be done to protect volunteers rescuers from becoming victims.
The study, led by Dr Wei Qiang Zhang from the Beijing Military General Hospital appears online today in the Australian and New Zealand Journal of Public Health.
Chinese and Australian researchers examined 1187 soldiers who were deployed to assist after the 2008 Wenchuan earthquake and found the soldiers presented a high incidence of health problems. Many suffered psychological problems including fatigue and depression, as well as a range of physical ailments.
Skin and respiratory problems were most common, probably related to extrication work or exposure to extremely hot or wet conditions.
Abdominal pain and diarrhoea were also common, and the authors say these can be linked to intense psychological situations and a sudden change in food.
Baseline essential to measure effects
Co-author Dr George Liu from Latrobe University in Melbourne says there have been lots of studies looking at mental health and post traumatic stress disorder (PTSD), but little research into the physical health of rescue workers until the aftermath of September 11.
"In the US (after the 9/11 terrorist attacks), some volunteers suffered physical and mental health problems," he says.
"[They] are struggling to get compensation from the state because they have to prove those physical sufferings are a consequence of the rescue mission, but it's very hard to prove."
Liu says the advantage with basing this study on soldiers is that they undergo regular assessments for mental and physical health, so there is an established baseline to work from.
"In this case, it's unique because we have the baseline and we can make an absolute conclusion on the physical health impact," he says.
Liu says that although the soldiers were not professionally trained for the rescue mission, they were better prepared than many of the volunteers.
He says untrained rescue workers are much more likely to suffer mental or physical harm when compared with professionals performing the same tasks.
"Some volunteers went to the earthquake scene and they had never been trained," Liu says, "They just went there and they don't know how to do anything. And they actually became victims. They needed the local people to take care of them."
He says many of the physical injuries that soldiers sustained in the rescue mission were because they were poorly equipped for the work.
"The well-trained professionals, like the fire-fighters, and those with the Red Cross, had protective clothes and masks."
"The soldiers were young and inexperienced, not trained to work under such extreme conditions. They did not have masks or protective clothing, and they used their hands to work."
Liu says the mental stress of the work, including long working hours and the inability to sleep or to rest, also has a significant impact on volunteers' physical health.
"Psychological symptoms such as sleep disturbance, depression and irritability are important effects, and are more likely to occur in untrained rescue workers," says Liu.
"Our work underlines the need for emergency response procedures to address the physical and mental health needs of both the victims and the rescue workers."
Stress management plan
Susie Burke from the Australian Psychological Society specialises in techniques to manage the mental health of disaster rescue workers.
She says there are a lot of things that can be done, such as mental health screening of volunteers and comprehensive pre-briefing before sending them on a deployment.
Burke recommends teaching techniques to reduce anxiety before and during deployment, and to recognise and manage the signs of stress before they become debilitating. She says after the mission a thorough de-briefing process is necessary.
She says unfortunately in practice the pressure to get volunteers on the scene means the psychological preparation and debriefing process is sometimes compromised.
"It's the same situation in New Zealand now and in Australia." she says, "You have to deploy less trained people because [the professional teams] have been deployed around the clock and there simply aren't enough people to go round."