Thompson et al.: Psychosocial in Emergency Operations Centres
International Journal of Mass Emergencies and Disasters
March 2017, Vol. 35, No. 1, pp 61-83.

Perceptions of Psychosocial Training on Behavioural Responses in Emergency
Operations Centres

Alanna Thompson
Adam Vaughan
Laurie D. Pearce
and
Ciara Moran
Justice Institute of BC
715 McBride Boulevard,
New Westminster, BC
Email: lpearce@jibc.ca

When a disaster strikes, the well-being of Emergency Operations Centre (EOC) personnel is
often not the first priority for emergency managers working to help provide support to their
local community and the incident command site. Through the development and testing of an
iterative series of simulation exercises with EOC personnel, this study identified adverse
psychosocial outcomes that may emerge within an EOC during an emergency. Having
identified a number of practices which led to less than desired psychosocial outcomes,
researchers developed a training and awareness video to identify the practices and
demonstrate strategies to overcome negative impacts. A comparative analysis was undertaken
to compare EOC actions pre- and post-exposure to the video. The results indicated a change
in behaviour following the viewing of the video and supported training initiatives that stress
the importance of strong leadership in an EOC, encouraging staff to take breaks, respecting
diversity, and providing psychosocial support.
Keywords: emergency operations, disaster, psychosocial

Around the world, large populations of people are experiencing the devastating effects of
extreme weather, infectious diseases, natural and human-induced disasters, and chemical,
biological, radiological, nuclear and explosive (CBRNE) events. The material consequences
for individuals, families and communities are immense. While the physical traumas from such
disasters are visible, the psychological and social consequences may go unnoticed. Those

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engaged in emergency and disaster management have identified a need for policies, protocols
and procedures that will provide effective psychosocial support for decision makers, first and
second responders and receivers, other professionals, and community members. In this context,
the phrase “psychosocial support” refers to resources that address the combination of
psychological, emotional, behavioural, and social aspects and impacts of a disaster (BC
Ministry of Health 2009).
During a disaster, it is common to activate an Emergency Operations Centre (EOC)
comprised of senior personnel to manage the resource needs of the community at the strategic
level and provide support to the incident commander at various on-site command posts (Justice
Institute of British Columbia 2010). Addressing the psychosocial needs of EOC personnel is
challenging, given that they are under intense pressure to resolve the crisis as quickly as
possible while saving as many lives as possible. Although not mandatory, post-event recovery
strategies can be used among emergency response groups following incidents and other
specific events where such a response is indicated. Debriefings, demobilizations, and defusings
– short, structured meetings immediately following the conclusion of a critical incident of
people who normally work together and were involved in the same incident - are well-known
examples of such strategies (Bryce 2001; Tuckey 2007). These sessions provide personnel with
the opportunity to gain information and receive support regarding the incident and to help
manage their stress reactions. Trained peers and professionals conducting defusings and
debriefings can also use these times to assess the need for further psychosocial supports for
attending personnel. Taking a proactive approach to managing stress, strain, and trauma in the
EOC can complement the operational response. What is not clear in the research literature is
how to best provide psychosocial support to EOC personnel in the moment in order for them
to maintain their psychological well-being and complete operational tasks during the crisis
period.
The purpose of the present study is to enhance the responses to psychosocial issues among
EOC personnel during disaster situations. This paper begins with a literature review and then
presents the research methodology and participant demographics. The results are presented in
four different areas: (1) effective leadership; (2) the importance of taking regular breaks from
work in the EOC; (3) respecting diversity; and (4) the importance of having a Team Support
Worker to provide psychosocial support to EOC personnel. The paper then provides a
discussion of the results and outlines the implications for emergency managers. The concluding
sections include the limitations of the study and areas for future research.
Literature Review
EOCs are typically activated when a community or agency is faced with a disaster or
emergency event which requires coordination and support at levels greater than can be achieved
at the local site level (e.g., a major fire or extended flood). Generally, EOC personnel are
comprised of senior decision makers representing emergency services agencies (e.g., police,
fire and ambulance); staff from non-emergency services agencies such as engineers, public
works, communications, social services; municipal emergency management; and other
agencies as needed such as utility companies, non-governmental organizations such as the Red

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Cross, and the military. EOC personnel are responsible for strategic decision-making and
providing support to site operations in difficult and sometimes no-win situations during
disasters.
Following an operational period, emergency management procedures and actions during
the event are reviewed and at times examined as they relate to impacts on the people and
communities affected. Reports on lessons learned from such operations are crucial for
continuous improvement in response and recovery efforts. A review of the relevant research
revealed a lack of assessment of EOC staff needs relating to identifying and addressing
potential psychosocial issues in an operational EOC. However, some studies highlighted ways
to reduce stress during the operational period and recognized important issues to consider in
EOC administration.
It must be acknowledged that disaster response personnel often remain psychologically
healthy throughout their careers. The trajectory of trauma is complex; while individuals may
experience emotional and physical distress in the course of their work and following a disaster
event, many do not develop psychopathology (Alexander and Klein 2009; Bonanno and
Mancini 2012). Potential long-term consequences of disaster response work and cumulative
effects of exposure to trauma can involve compassion fatigue, job dissatisfaction, substance
abuse, and the development of physical health issues over time such as cardio-vascular
problems and gastrointestinal distress (Jackson et al. 2004). The challenge in training EOC
personnel to respond to psychosocial needs as they arise is finding a way to honour the coping
strategies that EOC personnel have learned to use on the job to get through a crisis, while
assisting them in recognizing ways to help others who may have different coping techniques
in the EOC and on-site. Several themes were identified in the emergency management literature
that relate to the potential to address psychosocial concerns. These are: diversity, effective
leadership and self-care and support for others, each of which will be discussed here.
Diversity Amongst EOC Personnel
EOC teams consist of individuals of different genders, different cultures and different
work-related backgrounds. Therefore, it is important to consider the experiences and various
levels of expertise that contribute to the abilities of both individuals and the collective team to
deal with stressors that arise in an emergency. In their study on the collective framing of crisis
management, Bergeron and Cooren (2012) explain that although individuals may share the
same experience of being in a particular EOC during a crisis event, their perspectives on the
event and areas of focus can be quite different due to their varied occupations and
responsibilities.
Stress levels can differ greatly between EOC staff from emergency services agencies and
those from non-emergency services agencies. Individuals from non-emergency services
agencies tend to experience higher levels of stress in EOCs because they have less experience
with emergency situations. This stress can result in cognitive deficiencies and a lack of
confidence in oneself (Lutz and Lindell 2008). As a result, those from emergency services
agencies tend to take on more work and often take on leadership roles within an EOC, creating

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an environment that closely mimics a “quasi-military” emergency response workplace, further
alienating those from non-emergency services agencies (Lutz and Lindell 2008).
One significant challenge faced by temporary EOC teams is how to share information
efficiently among the different representatives to make sense of the emergency and the
priorities for action (Faraj and Xiao 2006; Wolbers and Boersma 2013). Confusion regarding
areas of responsibility between federal, state and local emergency management personnel and
lack of role clarity was listed as one of the significant issues during the Hurricane Katrina
disaster (Townsend 2006). In a study exploring trust as it relates to multi-agency coordination
in EOCs, personnel interviewed from both emergency services and non-emergency services
agencies described role clarity as an essential element in developing a coordinated response
(Curnin et al. 2015). Participants from non-emergency services agencies described a lack of
understanding from emergency services personnel on the nature of their work and their role in
the EOC, thus creating an obstacle to trust and recognition. Interviews with emergency services
personnel revealed the opinion that individuals from non-emergency services agencies need to
be clear on their respective roles, and the roles of other non-emergency services representatives
in order for the EOC to operate effectively. What is not apparent is how clarification of EOC
roles can be obtained. Events are unpredictable and high-stakes decisions must be made during
the disaster response period. A sense of trust among EOC team members must be established
quickly based on roles and areas of professional expertise to ensure that information is shared
freely and all individuals in the EOC are recognized in the decision-making process (Curnin et
al. 2015; Faraj and Xiao 2006), as a lack of trust can impair team functioning and response
capability. Familiarity amongst EOC personnel, clarification of roles, and the open sharing of
information can be enhanced through participation in simulated training exercises, scenario
planning, and Incident Command System training (Curnin et al. 2015; Paton 2014; Waugh and
Streib 2006). Also, the quality of leadership in an EOC can have a significant impact on the
level of trust and openness within the team.
Effective Leadership
Leading a team of disaster response personnel during a crisis involves managing people
and stressors (e.g., political pressure, media scrutiny, miscommunication of information, time
constraints), all while making critical decisions with life-or-death outcomes, as well as socioeconomic and political ramifications (Devitt and Borodzicz 2008; Meyers 1994). The
detrimental effects of critical incident stress can be mitigated by leaders who build rapport with
their personnel, participate with their team in training exercises, and offer resources such as
psychological first aid and debriefings to address psychosocial concerns following emergency
response (Brookshire 2011; National Child Traumatic Stress Network and National Center for
PTSD 2006).
In their research on strategic crisis leadership, Devitt and Borodzicz (2008) developed a
model that encompasses four domains of skills and qualities of an effective leader – Tasks,
Interpersonal, Personal, and Stakeholder Awareness (TIPS). Tasks includes skills such as
decision making, planning, prioritizing, and creativity in problem-solving; Interpersonal
involves the communication style of the leader, emotional awareness of self and personnel, and

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strategies for regulating emotions and maintaining relationships; Personal emphasizes the
qualities of a good leader, including confidence, credibility, and ethics; and Stakeholder
Awareness focuses on leadership skills in addressing issues involving politics, media, and
communication with other disaster response teams. The researchers argue that the position one
holds within an organization, one’s years of experience, and history of involvement in other
major incidents and disasters are necessary, but not sufficient for effective crisis leadership.
Rather, a good crisis response leader balances all four of these skill areas and leader
characteristics. Complementary to their work, Blythe (2008, p. 11) states that, “no learned crisis
leadership skill will overcome a lack of character, ethics, or integrity,” in highlighting the
caring behaviours, knowledge, insight, and communication skills required of strategic crisis
leaders.
In the EOC, effective leaders should have the situational awareness to recognize
psychosocial issues and the knowledge of resources and strategies available to promote the
well-being of workers during the operational period. Confidence and a willingness to call upon
such resources when needed are also qualities of a competent leader in the EOC. Taking into
account both the physical and emotional well-being of workers, the first priority in disaster
response is to ensure the safety of responders. As Ballam (2011, p.20) states, “safety is not a
class or a piece of equipment, it’s a culture and it has to be from the top down.”
Self-Care and Support for Others
In the development of proposed competencies for disaster response professionals,
knowledge of strategies for both self-care and supporting colleagues is listed as important. This
includes awareness of rest breaks as a way to decrease stress among workers (Everly et al.
2008). It is crucial to ensure ample coverage of personnel for regular shift rotations in order to
reduce the risk of overtiredness and mistakes that could harm workers or the communities they
are serving (Meyers 1994; U.S. National Response Team 2009). In an investigation of the role
of second responders in the Christchurch, New Zealand earthquakes of 2010 and 2011,
interviews with responders revealed a lack of breaks and shift rotations during the response
period (McNally 2014). Additionally, study participants described a need for health and safety
training related to disaster situations as opposed to training based on day-to-day work
environments. Greater involvement of human resources professionals was also recommended
for planning and developing best practices in psychosocial support for second responders.
Providing the opportunity for workers to take breaks, and encouraging this practice during
the response period is listed as a key strategy in coping with the psychological stress related to
handling bodies following a disaster (McCarroll et al. 1993). To this point, The National Center
for PTSD (Young, Ford, and Watson 2007), indicates that taking regular breaks for exercise
and nourishment are key strategies for coping with stress thereby staving off fatigue and
increasing one’s ability to engage effectively in operational tasks. Young et al. (2007)
recommend the implementation of a “buddy system” to encourage this practice. Similar to the
concept of police officers having back-up when responding to call-outs that are potentially
violent in nature, or of firefighters watching out for one another when entering a structure to
contain a fire, an agreement is made with a colleague to support each other in the EOC. This

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practice is essential during a disaster response. The purpose of such support is not only to
provide practical coverage for operational tasks, but also to observe when the other person may
require a break if they appear tired or distressed. A comprehensive guide developed for
managing worker fatigue during disaster operations, including an assessment of events to
which workers respond; the conditions of the work; the identification of risk factors and
controls for managing worker fatigue; and an evaluation of past strategies used for worker
fatigue management (U.S. National Response Team 2009) may assist human resources
personnel in advanced planning of strategies for worker care during disasters.
A common coping strategy used in emergency services and disaster response work is
emotional compartmentalization or emotional distancing (McFarlane, Williamson, and Barton
2009; Halpern et al. 2009; Walsh 2009). While this strategy can be useful and perhaps
necessary in performing the work required during disaster response, it has been recommended
to make on-scene peer support available in order to provide EOC personnel with immediate
access to psychosocial support, if needed. This normalizes the need for support while
acknowledging that some may not be comfortable speaking with professionals who are
“outsiders” (Castellano and Plionis 2006; Kronenberg et al. 2008). Clinical support is also
advised, as mental health professionals can assess the job performance and psychological wellbeing of individuals throughout the operation and enlist co-workers as sources of social support
in the moment. Furthermore, the inclusion of a respite area for personnel, where they can retreat
from the EOC or site and take a break to eat, change their clothes, or make a phone call, is
another way to support these workers (Substance Abuse and Mental Health Services
Administration [SAMHSA] 2005). Overall, the supports perceived to be most important by
emergency services personnel in the first 24 hours following a response to a disaster include:
1) recognition, 2) genuine concern, support, and assistance offered from a supervisor, 3) the
opportunity to have a rest, and 4) the presence of someone to reach out to and who shows a
willingness to listen, thus decreasing the stigma related to talking about the experience of the
incident (Halpern et al. 2009). Learning how to recognize the signs of critical incident stress in
co-workers was acknowledged as a valuable tool in being able to provide these supports
(Halpern et al. 2009). Given that EOC personnel also include non-emergency services staff, a
further investigation of EOC needs is warranted.
In her handbook on disaster response, Meyers (1994) describes the qualities of an
individual, such as a Team Support Worker in the EOC, who is dedicated to promoting mental
health. These qualities include being “specifically knowledgeable in the field of disaster mental
health… having the authority to make key decisions …and serve as advisor to the top official
in charge of the EOC” (Meyers 1994, p. 37) on issues related to support for personnel. It is
indicated that whenever possible, this representative should be introduced to EOC personnel
by the director, with his or her duties clearly explained to others in the EOC, to emphasize the
acceptance and importance of this work.
Mental health expertise in the EOC can address concerns outlined by Jackson et al. (2004:
73), who stated,
if the individuals responsible for managing responder safety are too close to or absorbed
in the details of an operation, it is much less likely that they will be able to fully

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understand and address the risks at a complex disaster scene. This can make it difficult
or impossible to make good safety decisions and meet worker safety needs” (p. 73).
According to Jackson et al. (2004), in order to make good safety decisions and to meet
worker safety needs, the person responsible for providing mental healthcare should be
independent (within reason) of the details of the operation. Based on these findings, the
researchers for this project developed a research methodology to identify existing EOC
activities and to develop strategies to enhance the responses to psychosocial issues among
senior EOC personnel during disaster situations.
Methodology
Through a two-phased approach consisting of developing a simulated disaster-based
exercise and then following up with data collection, the following research question was
addressed: What is the perceived impact of psychosocial training on the behaviours of EOC
personnel in response to psychosocial concerns in a simulation exercise?
The research team developed a simulation exercise in collaboration with the Expert
Working Group—an assortment of practitioners, academics, and other pertinent stakeholders
with applied EOC experience. The exercise consisted of an extreme winter weather scenario
with incidents and events designed to elicit psychosocial responses from the participants, who
were expected to decide how to respond as the exercise progressed. Examples of incidents
within the exercise include: the death of an on-duty paramedic, flooding of emergency routes,
power failures in critical facilities, a major apartment fire, multiple motor vehicle accidents
involving fatalities and culminating with a roof collapse at a hockey arena during an
international youth hockey tournament.
The project consisted of two components: an exploratory phase and a test phase. In the
exploratory phase, the researchers conducted two simulation exercises in order to document
the pertinent areas of psychosocial concern in an EOC. Ways in which decisions were made
and the outcomes of these decisions in the two exploratory exercises are discussed in our
previous paper by Javor et al. (2014). Emergent psychosocial themes were then integrated into
a training and awareness video designed to build awareness of psychosocial concerns during
disasters and related response strategies.
The test phase was a replication of the simulation exercises used in the exploratory phase
(with some minor modifications based on the feedback received from participants).
Additionally, participants in this phase were asked to watch the psychosocial training and
awareness video prior to the exercise. Results from this study include data from participant
groups in both the second exploratory exercise and the test exercise.
Participants
In 2012, 26 emergency management directors from British Columbia were contacted for
participation in both the second exploratory phase and test phase of the study. Seven
communities agreed to participate and nominated senior personnel to attend. These individuals

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represented municipal and provincial agencies in the areas of communications, emergency
management, emergency social services, engineering, parks and recreation, planning, public
works and first responders. Participants were then contacted by researchers, invited to
participate in this research study and contact letters and letters of consent were provided prior
to the exercise. Participants were also advised that they could withdraw from the study at any
time.
In the exploratory phase, 20 participants (16 males, 4 females) were recruited from
municipalities in Metro Vancouver, the Fraser Valley, and the province-wide BC Ambulance
Service. The first series of exercises was conducted in February 2012 and involved three
simulated municipal EOCs. The average age of participants was 34 years, with a standard
deviation of five years. Among participants, 90% were senior decision makers in their
respective agencies, meaning that they had an average of 15 years of experience and held
management positions with titles such as directors, chiefs, managers, staff sergeants, and
inspectors.
In the test phase, 21 participants (15 males, 6 females) were recruited from four
municipalities and the BC Ambulance Service to participate in the exercise in March 2012. The
average age was 37 years, with a standard deviation of six years. Approximately 90% of
participants held senior management positions within their respective agencies. There was no
overlap of participants between the exploratory phase and the test phase.
Procedure
Both the exploratory exercise and the test exercise were held in a specially designed
simulation training building. One large main meeting room was used for the introduction and
debriefing of the exercises, and four “pods” - separate rooms set up as simulated EOCs - were
used, each with four to six members from both emergency services agencies and municipal
departments. Participants were grouped by municipality, providing individuals with the
opportunity to train together and increase their familiarity with those they would not normally
work with in their day-to-day professional activities. Each pod was equipped with audio and
visual recording devices for the purpose of collecting data during the exercise. Televisions,
speakers, computers, and printers in the pods were used as tools for relaying information in the
most realistic way possible to participants during the simulation. While the participants in the
simulated EOC teams engaged in the exercise, the researchers were positioned in the control
room listening and watching each of the teams respond to the disaster scenario, and taking
notes based on their observations.
Semi-structured interviews with Subject Matter Experts (SMEs) were conducted before and
after each simulation exercise. In addition, semi-structured interviews were conducted with
individual participants; and focus groups were held following each exercise. Interview
questions concentrated on participants’ perceptions of the realism of the exercise, the resources
available to them, decision-making processes in the group, and the communications and inputs
throughout the exercise. The training video was designed following the exploratory phase, with
the purpose of demonstrating strategies to buffer negative impacts of stress in the EOC that
were perceived in the exploratory exercise. The training points for inclusion in the video and

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the recommendations for best practice in providing psychosocial support to EOC personnel
were based on the extensive literature review, the common themes developed through thematic
coding in the exploratory phase, interviews with participants, and the feedback from SMEs.
In the test exercise, in addition to addressing the realism and the decision-making processes
in the pods, interview questions concentrated on the participants’ perceptions of the training
video, including its effectiveness, its potential influence on decision-making and actions taken
in the pods, and its usefulness for future training. All audio and video recordings from the
exercises and follow-up focus groups and interviews were transcribed verbatim. The field notes
of the researchers were collected for each pod in each exercise for reference in the data analysis
process.
Analysis
The research team used both deductive and inductive methods of analysis. A code book
was developed prior to the exercise and informed by interviews with SMEs and literature
reviews on decision theory and the psychosocial dimensions of disaster management. Using a
qualitative data analysis software program, NVivo 10 (QSR International 2012), transcripts of
audio recordings from all EOC pods in the exploratory phase and the test phase were coded
and analyzed, and corresponding video footage was analyzed for non-verbal behaviours.
Analyses were iterative in process (Srivastava and Hopwood 2009). More specifically, a
thematic analysis was conducted to identify patterns within and across the exercise and
interview transcripts (Braun and Clarke 2006). In addition to the themes developed through
analysis of the exploratory exercise, behavioural responses in the test exercise were analyzed
according to the training points presented in the video.
The researchers engaged in reflexivity to identify their thoughts regarding any patterns,
potential themes, and contradictions in order to develop a rich understanding of the data.
Reliability was obtained through discussions that occurred among the researchers responsible
for coding the data during joint coding sessions, and weekly team meetings held to discuss the
coding process and interpretations, including any new themes that emerged in the process of
analysis. Inter-rater reliability was conducted by having a number of transcripts coded
separately by more than one researcher.
Results
In order to enhance responses to psychosocial issues among senior EOC personnel,
researchers explored the perceived impact of psychosocial training on the behaviours of EOC
personnel in response to the stressors included in the exercise. During the test phase,
participants demonstrated an awareness of the impacts of the psychosocial injects during the
exercise, and put into action the training points presented to them in the video. However, as the
exercise progressed and participants became more engaged and more stressed, their proactive
behavioural responses to psychosocial issues deteriorated. In acknowledging this phenomenon,
post-exercise, some participants commented that they wished they had more time to reflect on
the training points, and others remarked on what might assist in reminding EOC personnel to
respond to psychosocial prompts. “You get so tied up that you forget the psychosocial part.
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Everybody is just focusing and reacting and doing the best they can to help citizens as opposed
to people next to them, who they see as relatively okay.” (C3EP06)
Overall, four main psychosocial themes emerged as potential areas for improving responses
within an EOC environment: a) leadership, b) encouraging breaks, c) respecting diversity, and
d) providing psychosocial support to all parties involved in the disaster.
Demonstrating Strong Leadership
Effective leadership is relevant to all of the psychosocial considerations as it is needed to
maintain cohesiveness and motivation among EOC personnel throughout the disaster response
period. Participants in both phases of this study identified the importance of having a strong
leader in the EOC. Remarks made throughout the simulation, individual interviews and focus
groups highlighted various perspectives on the qualities and responsibilities of an effective
EOC leader. In one of the focus group interviews, an EOC director did share his reflections on
his responsibility for the inclusion of everyone in the group and stated:
[…] while I’ve worked with [name of female] and [name of 2nd female] quite a bit, I’ve
worked with these other two guys in an emergency context more and maybe I leaned
more heavily on them. I probably would have done a check and balance with [2 females]
at some point and made sure that they didn’t feel that I was favouring the boys. […]
you want to make sure everybody feels valued and that you’re tasking them
appropriately. So in a longer event that was not quite as condensed as this that would
definitely be something I would get to. (C2EP01)
Some participants expressed their appreciation for a leader who is very decisive and keeps
the team focused on the priorities of the EOC while steering them away from getting too
involved in site-level operations. In the words of participant B4EP06, “He [the director] was
very decisive […] Very concise and stuck to his guns but not with his head in the sand.” Others
recognized the skill of the EOC Director in building consensus within the group, exploring
different perspectives on a problem and ensuring all have an opportunity to share their
knowledge and opinions, while ultimately assuming responsibility for the decisions of the
group. As participant B4EP05 suggests:
The more you get immersed, the less you are able to step back and make the right decisions.
You run the risk of taking on too many roles. Look at the bigger picture and then bounce the
ideas off everybody […] make those higher-level decisions that will have consequences and be
willing to make them, but think it through.
Some participants explained that it is essential for EOC leaders to balance the needs of
individual team members with the overall goals of the EOC, and suggested further training that
could be of benefit.
C3EP01: […] the one thing that I somewhat disagree on is letting everyone talk. In our
EOC during actual events is that there can be a lot of talking and everyone has their say
and an hour has gone by before the section managers get out of their briefing which

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can’t happen. There needs to be a strong leader.… One thing we’re lacking in B.C. is
strong training for people to run crisis team meetings.
C3EP04: To cut people off?
C3EP01: Not so much to cut people off, but here’s an agenda, I don’t care about
everything you have in your head or what’s going on in your section. I want to know
what your current status is, the four bullet points and the three things that you need or
you’re having trouble with […] Boom, boom, boom.
It appears that a strong, well-respected EOC leader is knowledgeable and decisive, yet
considerate of others in the room. When commenting on the urgency with which EOC teams
perform their duties, participants indicated that deliberations must be balanced with the need
to make quick decisions, sometimes without hearing all perspectives. These remarks are also
consistent with an analysis of collaboration and leadership in for effective response in
emergency management settings (Waugh and Streib 2006).
Taking Breaks: Possible Yet Difficult
The act of taking a break or reprieve from work is typical in most work environments,
however, it is not uncommon for personnel from emergency services agencies to work long
hours consecutively during disasters (Adams et al. 2012). The findings from this study suggest
that regular breaks are possible but that cultural norms within the EOC may act as a significant
barrier.
For example, using the query text search feature of NVivo 10 for analysis, it was noted that
eight verbal references to participants taking breaks were identified in the exploratory exercise,
compared with seventy-one references in the exercise in the test phase after having watched
the training video. In the exploratory exercise some participants took brief breaks, but most did
not take a break. Participants in one of the three pods did not take any breaks, nor did they
discuss the need to take breaks. In another pod, supplies and food were requested for the EOC;
however, no breaks were taken by participants. In the third pod, the EOC Director asked the
other participants if any of them required a break, and if so, to go ahead and take turns. Later,
he checked in again with the group by asking, “How’s everybody doing anyway? Everybody
want to take five seconds? Take a deep breath?” It appears that this EOC Director was trying
to normalize the need to take a break, and encourage the practice within the group (D3EP06).
In this pod, participants also checked in with the EOC director regarding whether he or she
needed a break, a drink, or something to eat.
Twenty out of twenty-one participants took at least one break during the test exercise.
Comments from the individual who did not take a break are presented below along with
comments from her fellow pod-members:
Interviewer: Why didn’t you leave [to take a break]?
C3EP06: […] It’s hard sometimes […] how many of us would actually do it [take a
break] in a real event if you have few staff and we have to all be okay for another few
hours or so?

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C3EP04: That’s where the Director […] has to say ‘you need to go and get yourself a
cup of coffee right now and just get away for a second.
The following exchange among participants in another focus group which took place after
the exercise highlights perspectives on why people avoid taking breaks from the EOC:
C1EP03: Worker care is one of those things that sometimes falls to the wayside at this
level. […] people want to keep working, they want to find a solution and going to the
bathroom is not at the top of their priority list.
C1EP01: In real life, you feel like you can’t leave.
C1EP06: You’re not going to leave.
C1EP01: Ya. Here you had that latitude, right.
C1EP06: If we hadn’t watched that [psychosocial training video], there would have
been no break.
Interviewer: So what is it that stops that from happening in real life?
C1EP03: Pride.
C1EP01: You don’t want to miss out on anything.
C1EP06: Control.
C1EP03: Control, ya.… Ownership.
C1EP02: You get shot down even if you ask.
C1EP01: I remember having to go to the bathroom and holding it in. It was bad but it’s
just the way it is.
C1EP04: Unless there’s going to be lives at risk, you just keep going based upon your
own level of comfort. I know when I worked [name of specialized first responder unit];
hell I worked 50 hours straight without sleeping sometimes. You just keep going.
Taking breaks appears to be the simplest training point to put into action immediately in
the simulation exercise. The participants did so; however, they expressed that it is difficult to
feel like one can leave a real operational EOC, given both the very real and perceived sense of
responsibility to their colleagues and the communities in which they serve. There is a clear
need to continue building awareness and strategies for taking care of oneself in order to take
care of others and avoid being a liability in the EOC.
Respecting Diversity: Acknowledging Differences among Workplace Cultures
Coping strategies, roles, experiences, and leadership styles vary among individuals in an
EOC. Participants in both phases acknowledged that there could be differences among
uniformed and non-uniformed personnel in how they respond to psychosocial concerns or
incidents. In an individual interview following the exploratory exercise, one participant
explained how observing others in the EOC can help determine who might need support:
…knowing people and what’s out of the ordinary for them. For somebody who is
inexperienced or typically doing a desk job where they don’t deal with much more than

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emails or phone calls that might have a different impact on them. As a team member or
as a Director you have to look at that differently and recognize that. (B4EP04)
Although the above comment is supportive of the need to recognize differences among
EOC personnel, it can also be interpreted as a lack of awareness or respect for the operational
duties of non-first responder personnel in assuming that their primary role is simply to answer
the phone or send and receive email messages.
The following excerpt highlights a perspective of a participant from an emergency services
agency background in the exploratory exercise.
I was mentioning it to the – I can’t remember her name – we had a female in here and
she’s not from police, fire, or ambulance. So she was sort of the communications person
and was doing a lot of writing. I made a joke to her, I said, ‘so how was that spending
three hours with three triple-A type personalities?’ She said, ‘oh I’m used to that’ and
that’s the thing because people that are normally in these types of jobs are those types
of people. They’re problem solvers and I know how to do it and I’m going to get it done.
(B3EP01)
This remark appears to indicate a perception that emergency services personnel take charge
and act as the decision-makers, while the non-emergency services staff are there to support
them.
Also in the exploratory exercise, another participant representing an emergency services
agency noticed the reaction of a non-emergency services participant. He chose not to address
it in the moment. His comment relates to emotional compartmentalization as coping strategy
and how he perceives the reactions of individuals with differing workplace cultures in the EOC.
B4EP06: I’m a heartless bastard…at the time I am because there’s work to be done ….
The one inject that came in with photos of kids in the rubble, I know I looked at the
pictures but I just dropped them on my desk. … but one of the ladies … she did a great
job, but it noticeably upset her. It identified the need to be conscious of that the next
time I’m in an EOC. … A couple of us that just said, ‘Are you okay? Can we get back
to this thing and focus?’ In hindsight, maybe that could have been emphasized more.
Some people who are immersed in that as a culture, it affects differently and certainly
you do the job first and deal with it later if you are going to deal with it at all.
The same participant then acknowledged the value of offering psychosocial support, and
how flagging it for follow up in memory or by writing it down could be useful because “…it
benefits the worker. At the end of the day you get someone that can get something off their
chest and move forward in life instead of dwelling on something (B4EP06).”
In the test phase, comments from some participants indicated that they perceived a respect
for diversity of experiences in their EOC teams. As participant C2EP06 observed:

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There was [name of female], who is probably the newest person to this role, when she
had her opportunity to ask questions for clarification or her own education, she was able
to get in and get an answer to them too.
Participant C2EP05 explained their view of how different professional backgrounds were
treated in their EOC team:
It’s like uniforms or rank at the door, we are coming in to do a job. […] it doesn’t matter
where you work, what you were wearing, who you were in the ranking of things.
It is important to note here that the researchers did not prescribe individual roles for each
participant; instead, pods were permitted to allocate EOC positions independently and
generally did so based on individuals’ professional specialties and the role that one would
typically be assigned in an EOC. A fully-staffed EOC would typically have more personnel
than those who participated in the exercises. Thus, some personnel had to cover more than one
responsibility from time to time. This is not atypical, as in the initial stages of setting up an
EOC not all of the personnel would arrive at the same time. However, initially, in terms of
gender, female participants were often placed in paperwork and filing roles and were restricted
in making director or lead role decisions in the exercises in both phases, despite the reality that
they were in senior decision-making positions.
Providing Psychosocial Support to EOC Personnel: More than Debriefing
In the exploratory exercise, when asked about the opportunities for psychosocial
interventions and the responses of the EOC throughout the simulation, several participants
equated addressing psychosocial concerns with debriefing and stated that it would happen after
the operational period had ended. This indicated a need for further training in the area of
psychosocial support for emergency management personnel to increase awareness of both selfcare strategies and ways to support colleagues during the operational period, not simply once
the event has ended. Other participants explained that it was not a priority for their EOC team.
Appointment of a Team Support Worker to the EOC.
The test exercise introduced the concept of a team support worker being present in the EOC
during the operational period. Addressing the safety of EOC personnel and ensuring they have
support in performing their duties is not a new idea; as these points are included within the
descriptions of the Risk Management and Logistics sections in an EOC adhering to the Incident
Command System (Justice Institute of British Columbia 2010). Nevertheless, of the 24
responsibilities listed under the role of the Risk Manager, only one, “Advise on actions to
reduce loss and suffering to proactively support response and recovery” (Emergency
Management British Columbia 2011, p. 25), speaks in any way to psychosocial issues.
It is evident that psychosocial support within the EOC itself could be useful to assist in
mitigating the impact from exposure to the crisis. In response to a focus group question that

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asked if participants had any physical or emotional responses to any of the psychosocial cues
during the simulation, one participant stated:
C4EP03: I was trying to ignore some of them. I didn’t want to pay attention in detail to
the screams and the people on the radio. I felt it would be disrupting.... It obviously had
an effect, hearing them for three hours.... I tried not to focus on it.
This remark is consistent with the notion of emotional compartmentalization as a coping
mechanism during disaster response. Another participant responded:
C4EP04: You’d listen because you don’t want to miss something and then when you
hear what it is, it can affect you.... If it was real life then that would be really hard to
keep your spirits up if you didn’t know what was going on because you know them.
They’re your coworkers.
Two participants in the test phase reflected on the addition of a team support worker, versus
the current risk management role in the EOC:
C1EP01: We talked about in principle the Risk Officer, that’s their role to do, they’re
the mental health. Yet they’re so busy from the legal perspective and liability that they
don’t have time. We almost need another position that looks after the worker health.
C4EP01: A separate position should be created. The Risk Officer is supposed to do
some of it, but is usually not fit to deal with the emotional part of it.
Other participants considered the potential benefits of a team support worker for EOC
personnel and expressed the usefulness of such a role.
C4EP05: that role might be like a family contact. So I know that if I was in an EOC and
things were really busy, I’d be hard pressed to break away and try to contact my family
and find out ‘is everything okay? Is everybody okay?’ But it might be nice if an outside
person was doing that on your behalf and just came up and said ‘oh by the way, I was
talking to your wife. Everything’s okay at home. Don’t worry about it. Things are fine.’
And so it doesn’t involve my time, even though, maybe I still would want to do it at
some point in the day but if they were doing it for me then it would be nice reassurance.
More specifically, they recommended that this person should be independent of the
operation/logistical decision-making and focus solely on the well-being of EOC staff.
According to C4EP05, the team support worker is “monitoring the events and knows when it’s
appropriate to say ‘time to take a break.’ I don’t think that an EOC Director could do that, or
any other individual based on their responsibilities.” The same participant highlighted the
importance of sincerity in offering support by stating: “I think that you could almost do more
damage if you don’t appear to be sincere… if it’s just reading from the rule book.” (C4EP05)
Universally, participants indicated that they would appreciate having someone in the EOC
dedicated to ensuring there is psychosocial support available to personnel during the
operational period. They emphasized that this person would need to have disaster response

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training - such as Psychological First Aid - and sound judgement in timing their support, in
order to facilitate, rather than impede the response efforts of the EOC. In the test exercise, the
importance of how psychosocial support is offered is emphasized by one participant’s concern
related to the reality of an operational EOC:
C1EP06: Does the EOC stop every ten minutes and have a moment of silence? It’s, this
sounds so cold, but it’s not realistic to think that we would do that. [...] I mean maybe
disaster psychosocial would be outside the EOC waiting to support individuals like that.
But to actually stop everything, that just couldn’t happen.
Discussion
The introduction of the team support worker concept in EOC settings prompted some
reflections and rich discussions among the exercise participants. The results indicate that
training to increase awareness of psychosocial issues in the EOC and introducing strategies for
response can have an impact on the behaviours of EOC personnel, so that they respond
proactively to psychosocial cues in a simulated environment. The level of response to
psychosocial concerns appears to be heavily dependent on the amount of stress in the EOC,
and the familiarity and experience of EOC personnel in using psychosocial interventions.
Following the presentation of a training video in the test phase, participants acted in accordance
with the training points presented. However, as the number of stressors increased over the
course of the simulation, these behavioural changes were not sustained.
Implications
An attunement to psychosocial issues that can arise in an operational EOC and an awareness
of the resources and strategies to address these issues, particularly when stress levels increase,
is essential in addressing any negative psychosocial impact of disaster response work. Given
that participants in the test phase appeared to forget the training points presented, or failed to
treat them as priorities, memory cues are required to solidify the new training. Participants
suggested that posters be developed to highlight the key training points, and that they should
be hung in the EOC alongside the other posters to make this new training an accepted part of
the culture and the “new normal” for addressing psychosocial concerns. As stated, “You need
those reminders or else when a stressful event comes, you may not be thinking about it. Having
regular training would help (C3EP01).”
Recommendations from the SMEs and participant focus groups support the need to appoint
someone in the EOC as a team support worker. This specific role ensures that psychosocial
concerns are addressed as they arise and individuals are taking care of themselves throughout
the response period, such as taking breaks, having access to nutritious food, and opportunities
to receive support and practical assistance if feeling stressed. In an interview with the research
team, one SME described his experience of receiving psychosocial support in an EOC during
the response period following a major earthquake:

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I personally asked for having psychological support on-scene in the EOC on a 24-7
basis. And this actually, probably saved my life. I had heavy numbness in both arms, at
once. I realized I couldn’t hold my pen in a meeting I was chairing. And she [support
worker] was also very careful in noticing that detail. So that nobody else noticed I put
my hands on my lap, understanding that I needed to do something after the meeting.
And this is when she came to me, telling me that I needed medical assistance – medical
attention immediately. (M. Doré, Ph.D., CEM, in Justice Institute of British Columbia
2013)
Additionally, a team support worker in the EOC can provide support to EOC personnel in
working through difficult and stressful operational decisions that are no-win situations, such as
decisions that may pertain to life-or-death circumstances and psychosocial issues for citizens
of the communities served during the disaster response period (Brown et al. 2015). Reflective
listening and open-ended questions from the team support worker can potentially assist
decision-makers to move through the difficult process. In a study exploring the decisionmaking process in EOCs (Javor et al. 2014), findings indicate that decisions related to
deploying psychosocial resources were delayed or never made, possibly due to uncertainty on
resources available and how to deploy them, or a lack of awareness regarding the psychosocial
impact of disasters. The specialized skills and knowledge of psychosocial care of a team
support worker may help to identify appropriate actions to address psychosocial concerns in
the community and relieve some of that decision-making stress for EOC personnel.
Although the availability of clinical support is advised (SAMHSA 2005), this may not
always be possible, such as in a rural community where mental health professionals may not
be present in a full-time capacity. The person assigned to the role of team support worker need
not be a psychologist; however, knowledge of resources to connect individuals with clinical
support is needed, and formal training in areas such as psychological first aid, crisis
intervention, basic counselling skills, and motivational interviewing is required. A knowledge
of stress reactions in disaster response work and factors for effective collaboration in multiagency settings is also required (Brown et al. 2015; Curnin et al. 2015; Faraj and Xiao 2006).
For a smaller community that has fewer people in its EOC, ensuring that someone performs
the key support function is critical, regardless of that person’s defined daily role. At the most
basic level, a team support worker should ensure that basic necessities such as providing
adequate nourishment, furniture, and washroom facilities are available to EOC staff. In addition
to having the role of a team support worker included in the EOC, it was noted by one participant
that, “All EOC staff need to be trained to make sure they look on their neighbour [in the EOC],
make sure they’re okay and taking breaks (C3EP06).”
There is no single right way to provide psychosocial support in the EOC
Participants clearly expressed that sincerity is required as the foundation for any
psychosocial intervention in the EOC. This point is consistent with the elements of good crisis
leadership as outlined by Blythe (2008), along with a) the expression of caring, b) a vision for
resolving the crisis, and c) effective communication in order to get the correct information and

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share it openly with all stakeholders. Acknowledging the work performed by EOC personnel
and expressing gratitude to team members is not only considered to be good manners, it is also
reported to be an effective strategy in mitigating the negative impact of disaster response on
emergency management workers (Mitchell 2011).
Rather than having a step-by-step manual of techniques to use, it is essential to train EOC
personnel on the main principles of providing psychosocial support so that they become
familiar and comfortable with the information. In doing so, leaders can address psychosocial
concerns in their own style, and in a manner that best suits their particular team, based on the
circumstances they face, and integrate a team support worker to provide psychosocial support
when necessary. For example, in reference to applying basic psychosocial principles, policy
could be put in place to inform EOC members about the range of agencies they can use such
as a peer counsellor or Disaster Psychosocial Services workers. Leadership in creating joint
training opportunities that include a team support worker and EOC personnel is also crucial for
building trust and credibility by increasing role clarity, and demonstrating the skills and benefit
of psychosocial support during the disaster response period, resulting in enhanced openness
and collaboration (Brown et al. 2015; Curnin et al. 2015; Kronenberg et al. 2008; Paton 2014;
Waugh and Streib 2006).This study explored the quality of interactions among EOC personnel
in vivo, how these relationships can be enhanced among individuals from different agencies,
and the obstacles to openness and collaboration in the EOC. The findings did not reveal a lack
of desire on the part of participants to support one another; rather, the importance of having
cues to remind them of how to offer support to others in the EOC that may have different
experiences and work backgrounds. Participant actions in the test phase and their reflections
demonstrate an eagerness to continue to build working relationships in an EOC for operational
effectiveness.
Given the nature of emergency services and disaster response, and the inability to avoid
acute psychosocial stressors, “primary prevention efforts may thus be better directed at chronic
stressors associated with the job and broader work environment” (Tuckey and Hayward 2011,
p.17). The psychosocial training video designed through the course of this study can be used
in formal EOC training as personnel first enter the field of emergency management.
Presentation of this information promotes a preventive approach to dealing with stress in
disaster response work.
Limitations and Future Research
To maximize the benefits of the research and training opportunities within this study,
efforts were made to enhance the realism of the simulation exercise and elicit genuine
responses from participants. Incremental changes were made between the two phases,
including how psychosocial injects were delivered. In addition to the presentation of the
training video prior to the test phase, these changes may have also impacted the participants’
behaviours in response to psychosocial concerns.
A wealth of information was generated from both the individual and focus group
interviews; however, although not apparent, it is possible that the participants were not as
candid in the group interview setting as they were in the one-on-one interviews. Thus,

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individual perspectives on the training points, the impact of the training video and the final
exercise may not be as fully stated as possible. Future research may need to triangulate these
results with quantitative surveys to capture any data that was not previously captured. Although
the number of participants and geographic area were limited in this study, the richness of the
data in exploring the impact of introducing psychosocial support in an operational EOC is
significant. Senior EOC personnel changed their behavioural responses and engaged
proactively in practising the training points. Based on the review of the literature, there is a
universality to the common psychosocial stressors within an EOC.
Analysis of the data in both phases of this study was challenging, as the researchers relied
on visual observations of behaviours and contextual information - such as the timing of specific
events in the simulation - when participants’ actions in response to psychosocial injects were
not verbalized. In some cases, clarification was sought in the interview following the exercise;
however, much of the non-verbal data could only be described and thus, researchers were
cautious about interpretation. Future research could include a more in-depth follow-up phase
with individual participants to explore their non-verbal responses to psychosocial cues. Lastly,
because the importance of the EOC Director and team support workers cannot be understated
as direct conduits to addressing the psychosocial concerns in the EOC, future studies should
explore the various leadership styles of EOC directors and the methodologies used by team
support workers to determine the approaches that are most beneficial to reducing psychosocial
issues.
Several participants expressed an interest in learning how the other pods performed during
the exercise, and how their own pod performed in relation to decision making and responses to
injects. The design of the study did not include a process for providing such feedback, as the
focus was on observing responses to psychosocial injects, and not evaluating the emergency
operations tasks and procedures in general. Additionally, many of the researchers did not have
expertise in the Incident Command System and the roles of each member within an EOC.
Having a feedback component on the general functioning of the simulated EOC would be an
added bonus to participants for engaging in the study, and future research could incorporate
this element.
The training video and exercise materials for the Winter Blues exercise are available on the
online collaboratory – a digital library that acts as a resource for training and research. It is
available barrier free. The research team encourages those who choose to access and use this
training exercise to share their experiences for the project researchers. Future research could
include a follow-up study using semi-structured interviews with teams who have used this
training package.
Conclusion
There is a need for dedicated psychosocial support in an operational EOC and training for
all EOC personnel in recognizing and acting on psychosocial concerns during disasters. When
EOC leaders understand potential threats to the physical and psychological safety of EOC
personnel well ahead of time, they can plan and ensure appropriate resources are in place to
mitigate the impact of stressors and increase the resiliency of their team (Reissman and Howard
2008). The EOC Director and a team support worker can create a sense of predictability in the
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environment by educating personnel on what they can expect to witness throughout the
operational period, how to respond to incidents, and strategies for coping with the psychosocial
effects of the events (Burke and Paton 2006). In doing so, it is believed that stress levels would
likely decrease among EOC workers, while feelings of competence in their roles would
increase.
While “just in time” training is important when provided to personnel immediately prior to
their engagement in emergency operations tasks, it is inadequate. This is particularly the case
for non-first responder personnel, given that they will encounter trauma and circumstances not
typically characteristic of their day-to-day work (Pearson and Weinstock 2011). Quick
reference tools or ‘just in time’ training which are more commonly created as cell phone apps
are not the ideal solution. Rather, these tools should be used to enhance the cultural
establishment of these protocols throughout one’s career. As stated, “Get [in] at a grass roots
level. Start this really early on in training in Emergency Management. Especially people who
are just considering a career in it and are working on their certificates. Make this a big piece of
how they learn. (C1EP03).”
The current study takes a preventive approach to enhancing the psychosocial well-being of
emergency management personnel. Offering a multiagency training exercise aimed at
increasing awareness of psychosocial concerns and intervention strategies well in advance of
any operational response can help to lessen the negative impact of disaster situations on
response personnel (Curnin et al. 2015; Paton 2014). The research team hopes that psychosocial
training will increase in frequency throughout emergency operations training programs, so that
it becomes part of a new culture in which both physical and psychological safety is taken into
account and prioritized for EOC personnel, frontline responders, and the communities they
serve.
Acknowledgements
This research was supported by funding from the Canadian Safety and Security Program,
Centre for Security Science, Defence Research Development Canada; Project Champion
Health Canada.
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