In the world of TBI treatment, research, and care, we often contemplate the daily challenges of living with the chronic symptoms of TBI. In the wake of recent natural disasters, it is also important to consider the difficulties that people with a history of TBI might face when dealing with extraordinary situations. Emergency situations present cognitive, emotional, and physical challenges for the healthiest individuals, and these challenges are likely to be more pronounced for individuals with a history of TBI. To safely navigate an emergency situation, people with TBI must pay closer attention to the post concussive symptoms that they experience in their daily lives. Below are some examples of the issues associated with TBI that need special consideration in an emergency.
Some of the more common cognitive issues associated with TBI are difficulties with quick decision making, planning and organization, problem solving, and word finding. Memory problems are also a common cognitive post-concussive symptom, and people with TBI often reply heavily upon routine to remember basic daily tasks. All of these limitations make dealing with an emergency situation more difficult. For instance:
- An individual that lacks proper judgement may deem a situation safe when it is not.
- A lack of organizational abilities may present a challenge when trying to plan for an anticipated natural disaster, such as a hurricane or tornado.
- Someone who struggles with quick decision making may not be able to access the quick thinking needed to get out of a dangerous situation.
- Someone who has difficulty articulating thoughts into words may have a hard time communicating their situation to a first responder.
- Routines are likely to be upended during an emergency, which could hamper the ability to stay calm and focused on the critical task of safely removing oneself from danger.
Psychological and stress disorders
Psychological and stress disorders can take many forms, all of which can be associated with TBI. People with these disorders are likely to panic even in non-stressful situations, making it nearly impossible to function calmly in emergency situations. Some commonly diagnosed psychological and stress disorders after a TBI are:
- Post-Traumatic Stress Disorder (PTSD) – Heightened emotions and sensory stimuli that can occur during an emergency situation can also provoke PTSD. This can make it challenging to approach and assist the individual.
- Anxiety Disorder – Although it is normal and expected to experience some anxiety during an emergency situation, a person with anxiety disorder may experience a heightened fear response that limits the individual’s ability to respond appropriately, or the fear response may persist even after the emergency has passed.
- Panic Disorder – An emergency situation can elicit a panic attack, in which the individual experiences physiological responses such as a rapid heart rate, sweating, and nausea. This physiological response can further frighten the individual and even immobilize the individual until the attack has passed.
Emergency situations often create chaotic settings that are particularly difficult for people with sensory impairments. TBI can cause long-term sensory and communication impairments including:
- Visual and hearing loss – This can become a challenge to see or hear the common indicators of an emergency (such as lights or sirens) and access emergency instructions.
- Sensitivity to light and sound – People with a TBI commonly experience light and sound sensitivity. The intensified lights and sounds in an emergency situation can elicit anxiety, overwhelm the individual, and make it difficult for the individual to focus and take appropriate action.
- Headaches – As one of the most common effects of a TBI, an increase in headaches resulting from the stress, anxiety, lack of sleep, and increased sensory load can trigger debilitating headaches that make responding to an emergency much more challenging.
The ability to move swiftly in an emergency situation is often critical to evading danger, and this may be significantly hampered by mobility challenges. Mobility deficits during emergencies are likely to increase the already elevated risk of re-injury to people with a history of TBI. Trying to move quickly to evade danger such fire or flood increases the likelihood of falls or other injuries. These potential dangers are particularly worrisome as recurrent TBI events are the greatest risk factor for long term deficits.
TBI can cause long-term mobility challenges including:
- Slow and/or labored movement
- Loss of function of a limb or body part
- Loss of depth perception and proprioception (the ability to control one’s movements in space)
With this in mind, below are three tips that will help prepare you or your loved one with a TBI for emergencies:
Tip 1: Have a conversation. If you live with a family member, partner, or friend, talk to them about the tasks that are difficult for you. They may not realize how hard it is for you to do the basic every-day tasks that can be taken for granted. If you live alone, talk to a friend or neighbor. It’s important that someone near you knows about your challenges and limitations so that they can help you if an emergency arises. They can help guide you to make the right decisions, provide assistance to keep you safe, and help keep you calm if you are thrown off balance due to disruption of your routine.
Tip 2: Make lists. Stress and panic are the most fierce when we are unprepared. Make a list of possible emergencies (for example, a fire, a burst pipe, a flood, a pet emergency, a break-in) and make a step-by-step plan of how to deal with each situation. This will prevent you from having to make on-the-spot decisions that may or may not be the right ones. Have a list of phone numbers of people that you can reach out to (these people should be familiar with your situation- see Tip 1). Make copies of these lists—both your plans and your contacts—and keep them in a few obvious places in your home. Review them often so you are always familiar with what steps you need to take if an emergency arises. Make sure your contacts are aware of your plans.
Tip 3: Give first responders all the info they need to help you. First responders can do their job better if they know that you need to be helped in different ways. For example, a 911 operator may take a different approach to keeping you calm if s(he) knows that you have a history of PTSD. Consider alerting local fire and police departments of your condition so that they are aware if they ever need to tend to you in an emergency. One way to communicate your needs to first responders is to keep an alert or medical sticker on your home window or car bumper. First responders do pay attention to these alerts.
The best way to help yourself in an emergency be prepared and ask for help. Let yourself depend on people that care about you and can help you in an emergency. Though it is impossible to predict when an emergency will occur, some advance planning on how to navigate an emergency situation and who to lean on if one arises could make the difference for survival.