Serving Victims of Mass Violence
Krista Flannigan, Karen Thomas  -  2016/9/27
http://ovc.ncjrs.gov/ovcproviderforum
 
 
1.Does triage work on-scene for victims of mass violence (VOMV)? If so, how? 2. What are some age-appropriate options/methods to use with children of VOMV? 3. Is there any research in various techniques of assisting children of VOMV in small groups or is it more effective one-on-one? 4. What are some best practices for parents and their children who are VOMV? 5. How are VOMV elderly assisted both on-scene and in follow-up? 6. What are some options when agency manpower resources are very limited to assist VOMV? 7. What can our city's police agency do as hands-on assistance for VOMV?
 
1.  Karen Thomas
 There are several immediate crisis counseling models that we have used on-site for emergency services personnel. One is the Critical Incident Stress Management (CISM) debriefings and the other is the National Organization for Victim Assistance (NOVA) "Group Crisis Intervention" models conducted. Both of these organizations offer training in their individual models.
 
2.  Karen Thomas
 Additional resources related to child victims of trauma: www.childwelfare.gov - “Parenting a Child Who Has Experienced Trauma”
 
3.  Jack Van Wye
 I was more interested in non-physical injury types of triage, namely, emotional trauma on-scene as first responders.
 
4.  Krista Flanniga
 The National Institute of Mental Health has some great resources regarding trauma and different populations. Please go to: http://www.nimh.nih.gov/health/topics/coping-with-traumatic-events/index.shtml
 
5.  Karen Thomas
 Part 2: The triage by Emergency Response Team medics inside the Norris Hall classrooms had two specific goals: first, to identify the total number of victims who were alive or dead; and second, to move ambulatory victims to a safe area where further triage and treatment could begin. The tactical medics employed the START triage system (Simple Triage and Rapid Treatment) to quickly assess a victim and determine the overall incident status. https://governor.virginia.gov/media/3772/fullreport.pdf
 
6.  Karen Thomas
 In an incident of this nature, the triage team must concentrate on the overall situation instead of focusing on individual patient care. Patient care is limited to quick interventions that will make the difference between life and death. At Virginia Tech, the medics were able to quickly identify those victims who were without vital signs and would likely not benefit from medical care. This initial triage by the two tactical medics accompanying the police was appropriate in identifying patient viability.
 
 
Asked on behalf of Victimology & Victim Services course @ Becker College...In incidents of mass violence or terrorist attacks, in your experiences, what do victims and their families seem to need the most? Thank you.
 
1.  Karen Thomas
 Part 3: The victims/families’ needs will increase in the days and weeks that follow so it is important that the advocate stay in contact with them to ensure that they continue to receive accurate information and are aware of all of the services that are available to them. Resources: http://www.vaemergency.gov/em-community/plans/local-templates http://www.vaemergency.gov/webfm_send/742/COVEOP_2012_ESF_6_Mass_Care_version_2012_Nov.pdf
 
2.  Karen Thomas
 Part 2: Along with mental health crisis counselors, trained victim advocates should be onsite to provide immediate assistance to the families of the injured victims and those of the deceased. Ideally, a victim advocate is assigned to each family and they stay with that family until they learn which hospital their loved one has been transported to for treatment or until a law enforcement representative/chaplain has provided death notification. The advocate then transitions to providing crisis counseling, accompaniment to the hospital/morgue/funeral home, and other direct services to the family to meet their immediate needs.
 
3.  Karen Thomas
 In my experience, the primary needs are ACCURATE INFORMATION from an informed point-of-contact and having a trained crime victim advocate assigned to assist them throughout the process. In the immediate aftermath it is important to establish a reunification center or family assistance center where anyone seeking information about their loved ones is directed to this site.
 
4.  Krista Flanniga
 During the acute phase of an incident of mass violence or terrorism, victims and families are in greatest need of accurate information—where are loved ones, status of victims, has suspect been apprehended, status of the investigation/response, a roadmap of what will happen next, etc. In the early and later aftermath, victims and families continue to need updated information but they also require resources to address immediate basic needs and longer term needs and emotional support.
 
 
Asked on behalf of students in Victimology & Victim Services course @ Becker College...Is there one type of Mass Violence incident that is much harder to help victims deal with? Thank you.
 
1.  Krista Flanniga
 All incidents of mass violence are unique as are the victims that are affected. Various challenges arise based on the size, scope and severity of the incident as well as the population impacted. Incidents involving children as victims can be especially difficult for the responders, survivors and the community.
 
2.  Karen Thomas
 The impact of violent crime, whether it involves one-victim/one-suspect or multi-victim mass violence, is a life changing experience for that person and their families and loved ones. One thing that makes a mass casualty criminal victimization different from other violent crimes, is the ongoing news coverage and continued scrutiny of the incident, how the victim(s) is portrayed in the news coverage, the sometimes inaccurate details broadcast immediately after the incident, and the rumors and innuendos that may be reported by the media. Surviving victims or families of the deceased may be deluged with media requests and some may be labeled “heroes” which can have detrimental effects on that person and negatively impact their mental health recovery.
 
 
What do you feel is the most important service for victim's of mass violence to receive months after their victimization.
 
1.  Krista Flanniga
 For the intermediate and long term a Community Recovery and Resiliency Center (CRRC) can offer a variety of resources and connections for victims and family members. A CRRC is often the next transition of services from a Family Assistance Center and can be available up to 18 months past the incident and/or through a prosecution.
 
2.  Karen Thomas
 Part 2: Victims may need ongoing mental health counseling for a long period of time. I have found that many times victims and families want to have the opportunity to come together to talk about what happened, or just to know they can speak with someone who has been through the same thing. You may want to consider conducting a “victim retreat” in eighteen to twenty-four months after the incident that is facilitated by trained victim advocates and trauma informed care therapists.
 
3.  Karen Thomas
 It is important to stay in contact with the injured victims and the families of the deceased, not only to keep them updated on the status of the investigation/prosecution, but also to assure them that someone is still there for them. If a prosecution will occur, victim advocates and law enforcement will continue to work with these victims for months and years to prepare them for the trial. If there is no prosecution, it is even more important to maintain contact with the victims/families at a minimum on a monthly basis leading to the first anniversary date and then less often in the years to come.
 
4.  Krista Flanniga
 During the acute phase of an incident of mass violence or terrorism, victims and families are in greatest need of accurate information—where are loved ones, status of victims, has suspect been apprehended, status of the investigation/response, a roadmap of what will happen next, etc. In the early and later aftermath, victims and families continue to need updated information but they also require resources to address immediate basic needs and longer term needs and emotional support.
 
 
What type of follow up do you recommend be provided to victims who were not physically injured but were present at the time of the incident?
 
1.  Krista Flanniga
 Therefore, victims should have available to them some crisis/trauma counseling/intervention services. This does not have to be mental health therapy as trauma reactions are normal reactions to an abnormal situation. However, therapists trained in trauma response can be very effective. And victim advocates can also be a continued valuable resource.
 
2.  Krista Flanniga
 Victims of trauma, whether or not they suffer physical injuries, often experience emotional/psychological, behavioral, cognitive, spiritual and physical reactions to crime. What and how this manifests is based on a number of factors including existing coping mechanisms, past experience with trauma and support systems.
 
 
With the way people are connected to events instantaneously through modern media outlets, what do you think is most important for media representatives to know in order to balance the need to report and sensitivity and care for the victims and their loved ones?
 
1.  Krista Flanniga
 It is recommended that media receive training regarding victim trauma reactions as well as the impact the media has on victim trauma. There are some great resources in an OVC online toolkit –“Helping Victims of Mass Violence and Terrorism” found at ovc.gov. There are links to guidebooks for the media’s interaction with victims as well as how advocates can work effectively with the media.
 
2.  Krista Flanniga
 Also, OVC is conducting a webinar series about the toolkit and the recommended protocols. The next one is regarding communications plans. Please look for information regarding these webinars.
 
3.  Krista Flanniga
 All incidents of mass violence are unique as are the victims that are affected. Various challenges arise based on the size, scope and severity of the incident as well as the population impacted. Incidents involving children as victims can be especially difficult for the responders, survivors and the community.
 
4.  Krista Flanniga
 Great question. Social media can be a useful tool to relay information quickly. However, caution must be exercised. A designated, official source should be made available, as social media can be misused or abused.
 
 
What is the biggest challenge when you have inexperienced volunteers?
 
1.  Karen Thomas
 If the volunteers have been trained by the agency that they are working with; however, they have not had the opportunity to utilize the skills in real time then they should be assigned to shadow or pair with a seasoned volunteer.
 
2.  Karen Thomas
 Spontaneous volunteers who arrive at the scene can be a tremendous burden to the staff who assign people to tasks. They can also be detrimental to the services provided to the victims. It is important that the Incident Command System is followed during a mass casualty incident. Ultimately, untrained volunteers should be sent away from the site or perhaps referred to agencies such as the red cross to assist in distribution of materials. They should not interact with the victims.
 
 
What steps can local and national agencies take to educate the public about charity scams that pop up after incidents of mass violence?
 
1.  Krista Flanniga
 Also, even though this is not necessarily fraud, victims should be cautioned about lawyers or financial planners/accountants asking for victims to enter into a contract for services. They are usually looking to be able to access any of the donated funds that victims receive through a sometimes exorbitant fee for service. In past incidents, licensed professionals will often provide their services pro-bono.
 
2.  Krista Flanniga
 The most common types of fraud are those attempting to collect “donations” on behalf of victims or organizations. This can be done through phone solicitations, webpages (such as GoFundMe) or even door to door. Fraud alerts can be posted through the media and information distributed through victim advocates
 
3.  Krista Flanniga
 Coordination with local Office of the Attorneys General - as they have fraud divisions -can assist in getting out information about this type of fraud and prevention techniques. This is an area where the media can be helpful! They can post public services announcements regarding various types of fraud.
 
 
Do you have any best practices for contacting victims next of kin?
 
1.  Karen Thomas
 If family is not local, most law enforcement agencies have protocols in place to contact the law enforcement agency in the jurisdiction where the family resides to have the local agency notify the family or go to the families residence and stay with the family while they call the department who can then provide the notification by phone. See page 123 of the Virginia Tech Report: https://governor.virginia.gov/media/3772/fullreport.pdf
 
2.  Karen Thomas
 Death notifications must be delivered with accuracy, sensitivity, and respect for the deceased and their families. Ideally, death notification should be delivered in private, in person, and in keeping with a specific protocol adopted from one of the effective models. It is important to follow the local jurisdiction’s policy and procedure regarding providing death notification. Ideally, a law enforcement officer and victim advocate or chaplain would notify the family and the advocate or chaplain would stay with that person until additional support arrives for them.
 
3.  Krista Flanniga
 There are death notification protocols in every jurisdiction. It is important to be aware of your state’s statutes regarding who is legally authorized (usually the county coroner or medical examiner) to provide notifications and what their policies and protocols are. In an incident of mass violence, it is realistic to expect that a ME will need assistance by trained and experienced individuals to provide the notifications. Please refer to www.ovc.gov “Helping Victims of Mass Violence and Terrorism” for some example protocols.
 
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