Emergency Response and EMDR – A Brief History


Today’s Trauma Recovery Network (TRN) did not spring full-formed from the ether. The history of HAP, the Humanitarian Assistance Program, since its formation in 1995, has provided the challenges and experience that steadily moved Trauma Recovery/HAP and the growing number of regional self governing TRN associations and chapters to form the present day TRN.
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United by their expertise in EMDR therapy, and by the TRN Mission, Principles and Standards, the chapters numbered 21 by 2014 and are still increasing. In normal times they are actively engaged in preparedness tasks — professional development, public education, and liaison with other community emergency responders. At times of emergency, they are ready to roll, as providers of pro bono care locally; and if called by another chapter, they are available to supplement services where needed.
Following is an overview of how TRN came about:

In the Beginning…

EMDR therapy had only been developed in the previous decade when the bombing of the federal building in Oklahoma City (1995) stimulated creation of EMDR Humanitarian Assistance Programs, precursor to Trauma Recovery/HAP. An EMDR clinician on the scene sent out an appeal for others to come and help. They did, providing both early treatment for PTSD to first responders and training to local clinicians who were impressed by the efficacy of treatment.

Training…

For the next decade, HAP developed in two different directions. One of these was the ever expanding program to bring low cost EMDR training to clinicians in nonprofit clinics and public agencies, supported by dedicated volunteers in the HAP faculty. More than 10,000 clinicians have been trained in HAP workshops, including more than 900 whose agencies serve veterans or enlisted military.

Disaster Response, at Home and Abroad…

The second direction of growth was disaster response, both in the U.S. and abroad.

Internationally, Trauma Recovery/HAP volunteers served in earthquakes in Mexico, India, and Turkey, and flooding in Indonesia and Bangladesh. The Indian Ocean tsunami in late 2004 led to HAP projects in Thailand, India and Sri Lanka, and a year later in Indonesia . EMDR trainers and facilitators were most often sent on these missions with the intent to treat survivors and first responders, and then turn to training local clinicians in EMDR. More recent projects in Haiti, Sri Lanka, India and the Philippines have been focused on training, rather than treatment.
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Meanwhile, expansion of EMDR beyond the U.S. led to creation of EMDR associations in many countries of Latin America and Europe. These soon formed regional associations (EMDR Ibero-America and EMDR Europe). And in most of these countries, the new EMDR associations formed national Humanitarian Assistance Programs (HAPs) modeled on the U.S. format. By 2011, a fourth regional EMDR association, EMDR Asia, had emerged, comprised and led in large part by clinicians trained previously in Trauma Recovery/HAP projects.

Two innovations during this period, that were not disaster-focused, were the projects of HAP Germany in China and HAP U.S. in the West Bank of Palestine. Each project was aimed to increase capacity for trauma treatment in a territory that was underdeveloped in public mental health resources. Both projects have continued and two similar U.S. projects have been added in Nairobi, Kenya and Addis Ababa, Ethiopia. Trauma Recovery/HAP today puts primary emphasis on expanding these development projects, rather than responding to disasters. We believe that more good can be accomplished by delivering skills to many clinicians in calmer times, in these areas that are prone to disasters, than by trying to teach new approaches to a few overwhelmed clinicians in the midst of emergencies.

Lessons Learned…

Two major U.S. disasters — the 9/11/2001 terrorist attacks and Hurricanes Katrina and Rita in 2005 — elicited massive effort from dozens of HAP volunteers and led to critical rethinking of our approach to mental health needs in emergencies.

In September, 2001, New York City was a center of skilled EMDR clinicians. They galvanized around a strong leader and quickly invented procedures for identifying and referring potential pro bono clients among the many New Yorkers emotionally scarred by the attack of 9/11. The effort lasted for many months, focused primarily on treatment, not on training, and the substantial costs were offset by donations through HAP’s national appeal. There was no organization before the event and afterward, the organization remained, and focused with great success in helping to offset the costs of the project to HAP.

When Hurricane Katrina hit in August, 2005, the impact was more massive on the affected region than anything previously seen in the U.S. A major fraction of the population in New Orleans became temporary refugees spread out across the whole U.S. Many never went home again as sections of the city remained in ruins for years. From HAP’s perspective, a critical fact was that there were practically no EMDR clinicians in Louisiana.
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The first effort was to organize a training event, but the trainers soon saw that the local participants needed treatment before they could absorb the training. Ultimately, several training sequences were held in New Orleans and along the Gulf Coast from Lake Charles, LA to Hattiesburg and Biloxi, MS. Additionally, 40 volunteers came from across the U.S. to provide week-long counseling to 600 state workers who had been first responders. Later groups of volunteers offered counseling and multiple EMDR training events to local clinicians. The most important fact about Katrina from the trauma treatment perspective was the lack of EMDR trained clinicians and beyond that the lack of any prior planning for managing the behavioral health aspects of a community disaster.

Comparing HAP’s role in 9/11 and in Katrina, it was merely good fortune that there were EMDR clinicians in New York who could mobilize from scratch, but the resources needed in New York greatly exceeded the supply, and agencies like the FDNY had not realized in advance that they could greatly benefit by prior training of their own clinicians in EMDR. In Katrina, on the other hand, all EMDR resources had to be imported and at great human and financial cost. In both disasters we learned that even the greatest effort at relief after the disaster would not be able to offset the absence of careful preparedness in the community before the disaster.

A Better Approach…

Clearly, disasters happen all the time and more or less unpredictably. We needed a better approach. Clinicians returning from New Orleans realized that their own communities were also not ready to cope with the psychological trauma of a major community emergency. In two locations, Western Massachusetts and Minneapolis, they began to call together local EMDR clinicians to follow the example of New York during 9/11 and create the first chapters of what became the national Trauma Recovery Network. As the number of chapters has grown, and the members have reached out to form continuing relationships with local emergency managements, TRN chapters have begun to make an impressive record of effective response to local situations that Trauma Recovery/HAP could never have helped without the new network of well prepared TRN associations and chapters. Following are some of the emergencies they have aided in their respective regions:

Yarnell AZ wildfires 2013

Oklahoma tornado

Alabama tornado

San Diego wildfires

Boston Marathon bombing

Hurricane Sandy, NY NJ CT

Sandy Hook Shooting, CT

Multi-cultural Clinical Training, Minneapolis

Columbine Shooting, Colorado