Updated February 2022
Safety, Health, and Crisis Management on AUSM-Mexico Study Abroad Programs
The health and safety of study abroad participants is the highest priority for the Autonomous University of Social Movements (AUSM). A safe and educationally valuable program is constructed on several foundations: experienced staff, reliable and knowledgeable local partners, comprehensive pre-planning for emergencies, a solid educational program that keeps students occupied in intellectual pursuits, and family-oriented contexts that occupy student’s free time. Staff works closely with local partners to assess current health concerns and safety issues, and we adapt quickly to changing political conditions and unfolding events. With years of experience taking groups to Mexico, the Autonomous University of Social Movements has the know-how, experience, local connections, and commitment to maximize the safety and health of participants.
AUSM staff conducts a complete health and safety evaluation before each semester, and we do additional evaluations whenever an incident in one of our regions calls for it. This includes analysis with our partner groups in each region and a review of U.S. Consulate updates.
COVID – 19 and Study Abroad Modifications
The U.S. Department of State travel advisory rates Mexico travel (as of Jan 31, 2022) at “Level 4: Do not travel” due to COVID. Cases peaked in late January and have been in decline since then, though the disease is still widespread.
Our program spends significant time in three areas in Mexico – the state of Chiapas and Mexico City.
In Chiapas, students spend most of their time in the indigenous community of Oventic in the highlands, about an hour north of San Cristobal de las Casas. As of this update (Feb 11, 2022), Oventic is closed to outside visitors, which means the language and secondary schools are also closed, mainly due to the COVID pandemic. We are in regular touch with the Junta de Buen Gobierno (Junta of Good Government) which is located in Oventic, and we will announce when Oventic is again open for visitors. Since Oventic is currently closed, our program in Chiapas is on hold. The following information is updated regularly and applies to travel in Chiapas under more normal circumstances.
The U.S. State Department recommends “increased caution due to crime” in Chiapas. There are no travel restrictions on U.S. government employees, which includes tourist areas in Palenque, San Cristobal de las Casas, and Tuxtla Gutierrez.
Pursuant to this report and based on our safety evaluation, we do not permit night-time travel between San Cristobal and Palenque. Chiapas is a large state. Most of the increased crime occurs along the border with Guatemala and in the coastal region. Our students are based in San Cristobal de las Casas and spend significant time in the Zapatista cultural center of Oventic. Both are far from areas where increased crime has been reported.
The U.S. State Department recommends “increased caution due to crime and kidnapping” in Mexico City. Both violent and non-violent crime is prevalent in Mexico City. Mexican government statistics indicate criminal incidents in the capital city occur at a significantly higher rate than much of the rest of Mexico, with particular caution required in areas outside of the frequented tourist areas, although petty crime frequently occurs in tourist areas as well. Neighborhoods such as Tepito and Guerrero warrant additional vigilance, especially at night. There are no travel restrictions on U.S. government employees.
Pursuant to this report and based on our safety evaluation, we maintain a 9 pm curfew for students in Mexico City. Our students live either in a locked community center near downtown or in a gated community in the southern part of the city.
Click here for the How Safe is Mexico website, which compares safety in Mexico to U.S. and other international destinations.
Safety, Health, and Crisis Management
We take the safety of our students very seriously, and our record over the past ten years is evidence – no deaths and no serious injuries. We’ve had several medical emergencies, the most serious of which required emergency surgery for a pre-existing condition. The student complained of pains at 4 pm, and by 11 pm, she was in surgery. We can deal effectively and quickly with emergencies of this sort because we have strong local partners and transportation at each site. This also facilitates evacuation procedures in case of natural or political emergencies.
Anecdotal evidence suggests that student behavior (and occasionally misbehavior) is a major cause of illness, injury, and other problems. Sometimes young people act as though they are invulnerable or reject the advice of more experienced leaders (any parent/guardian can attest to this kind of attitude). Staff members work to gain the trust and confidence of participants so that advice and guidance are taken seriously.
Excessive alcohol consumption can lead to unfortunate incidents and can put our students and our program at risk. Excessive consumption of alcohol or use of illegal drugs are both strictly prohibited and may result in immediate expulsion from the program at the student’s expense. Because of the problems alcohol can cause, AUSM has a much more rigorous alcohol policy than most study abroad programs. The staff explains to students that this is a question of responsibility – toward homestay families, social movement organizations, and AUSM’s binational partner organizations – in addition to being a safety concern. The cooperative interaction of staff and participants is an essential element in the overall health and safety program. As in any travel situation, there are no guarantees of complete safety. However, with years of experience taking groups to Mexico, AUSM has the know-how, experience, local connections, and commitment to maximize the safety and health of participants.
Site-by-Site Safety Evaluations
San Cristobal de las Casas is a colonial city of about 100,000 in the highlands of Chiapas. As a major tourist center, the city attracts tens of thousands of tourists each year, mainly from the U.S., Holland, Italy, Spain, France, and Germany. Because tourism is central to the economy, local police and politicians are careful to provide strong security. We are not aware of a single death of a foreigner over the past 17 years in San Cristobal nor any cartel-related violence. The main challenges faced by our students are sometimes unwanted social advances, particularly in bars, and two cases of public groping. During the 17 years of our program including over 700 students, two women were groped (incidents lasting less than 10 seconds each) on public streets. We carefully orient students how to avoid these situations, including not traveling alone, not frequenting certain bars at night, and always being aware of surroundings. We do not permit trips to Agua Azul or Palenque, popular tourist areas about six hours from San Cristobal, because they require night-time travel. There have been reports of night-time robberies on the highway about four hours outside San Cristobal. San Cristobal de las Casas has ample medical facilities and is located 50 minutes from a major international airport. There have been several reports of localized confrontations between indigenous groups, mainly disputes over land tenure, in the eastern jungle area of Chiapas and, more recently, in the far northern region. These areas are not visited by our students and are located five to eight hours from San Cristobal.
Oventic is an indigenous community in the highlands of Chiapas. It has been and continues to be, one of the safest places we know of in the world. In the past 17 years, there have been no student deaths or serious injuries in the region. The community itself has 24-hour security provided by local indigenous security committees. There have been no reports of indigenous or military violence in the region over the past 17 years. The community has a large, reputable health clinic that can treat most common illnesses and medical emergencies. The clinic has two ambulances to transport people to the nearest major regional hospital located 15 minutes away for serious incidents.
Mexico City is the largest metropolitan area in the western hemisphere. As such, the city suffers from the same kind of criminal activity that one might find in any major US city. Students live in a gated community with 24-hour security committees and abide by a 9 pm curfew unless accompanied by MSN staff or members of their host families. Host families have 12 years of experience hosting students. There have been no student deaths or serious injuries in the host community in the past 12 years. Before students travel outside the gated community, they receive extensive orientation on safety precautions, use of public transportation, areas of the city to avoid, etc. Students are not allowed to travel outside the gated community during daylight hours except in groups of three or more. To date, the AUSM program has had no problems with assaults or robberies and only one report of an attempted purse snatching. We attribute this record largely to our extensive orientation program, our local partners’ security protocol, and our careful approach to all programmed activities.
AUSM staff carefully orient participants upon arrival at each site to avoid activities that may expose them to crime or danger. Orientation topics include how to avoid pickpockets, careful use of ATMs, taxis, and public transportation systems, the requirement that students always travel in groups of at least three, methods for avoiding and reacting to sexual harassment, street smarts, and local conditions concerning crime, health, and safety. We also discuss the sexual assault policy outlined below. Students are given emergency contact numbers to carry with them and are shown safe spaces in the city or village where they live. Students are actively engaged in academic classes and meetings with social movement organizations, spending time with homestay families, and attending cultural events during the great majority of their time.
In 2009, AUSM identified a possible safety concern – a traditional week-long vacation during the middle of the semester-long program. Immediately we began restricting vacations to the San Cristobal area, and in Fall 2011, we eliminated the vacation week entirely. We had no serious health or safety problems with students during vacation week, but we took this measure because of stories we heard about student behavior during the vacation week. It is much easier to provide for strong student safety in the context of homestays and a rigorous academic program. The combination of a thorough orientation, full schedule, experienced homestay families, and strong support from our partner organizations in Mexico has led to a high degree of safety for our study abroad programs.
Participants receive pre-trip orientation materials and an extensive orientation during the first week of the program, which includes:
• Orientation on gender dynamics and what to do in case of sexual harassment or sexual assault.
• Water and food. Participants have bottled or treated water available at all times.
• Advice regarding cleanliness and other preventive measures that can prevent illness.
• Orientation regarding emergencies and nearby medical facilities.
• A private discussion with each participant concerning pre-existing medical conditions.
• Orientation on specific health issues and conditions in each site visited during the program.
The U.S. Department of State Consular Information Sheet notes that “adequate medical care can be found in all major cities in Mexico.” Most of the study abroad program sites are in major cities, including San Cristobal de las Casas in Chiapas and Mexico City. Rural areas may have less ready access to adequate medical facilities. Participants spend eight weeks in the indigenous community Oventic, a rural community located in the highlands of Chiapas. Oventic has a free clinic that effectively treats most common illnesses and minor to moderate injuries, and the clinic’s lab also does clinical tests for common illnesses. Oventic is located an hour from San Cristobal de las Casas via paved roads. In emergency cases, the Study Abroad program has our own transportation available 24-hours for evacuation from Oventic to San Cristobal de las Casas. Participants spend three weeks in the rural communities in Tlaxcala. Rural clinics are available in communities throughout the state, and all the communities are located within an hour or less of major medical centers via paved roads. The study abroad program has private transportation for evacuation to Tlaxcala City in emergency cases, and Mexico City is only two hours away.
Pre-departure health issues
AUSM is not licensed to practice medicine. As such, we do not make medical recommendations, including pre-departure vaccinations. We strongly encourage participants to consult with their physicians before departure concerning vaccinations and other pre-travel health care options. We understand that ascribing to a particular school of medicine or religious belief may influence the ultimate decision regarding vaccinations and other health care procedures. That said, we provide the following information on pertinent health issues. For further information, please contact your physician and/or the Centers for Disease Control and Prevention (CDC).
There have been reported cases of the A/H1N1 virus (aka “swine flu”) in the majority of the world’s countries. According to the World Health Organization, “most people who have contracted the new A (H1N1) virus have experienced influenza-like symptoms (such as sore throat, cough, runny nose, fever, malaise, headache, joint/muscle pain) and recovered without anti-viral treatment.” In general terms, the new flu has been mild, if somewhat more contagious than seasonal flu. The A/H1N1 virus is treatable with common influenza medications, including Relenza and Tamiflu. Mexican health authorities have over a million anti-viral treatments that have proven effective in fighting A/H1N1. The medications have been available for free from public health authorities when influenza is diagnosed.
Malaria is a serious disease transmitted to humans by the bite of an infected mosquito. Symptoms may include fever and flu-like illness, including chills, headache, muscle aches, and fatigue. Malaria may cause anemia and jaundice. If not immediately treated, infections may cause kidney failure, coma, and death. Malaria can often be prevented by using anti-malarial drugs and by taking protective measures to prevent mosquito bites. However, in spite of all protective measures, travelers may still develop malaria. Malaria symptoms will occur 7 to 9 days after being bitten by an infected mosquito. In the first week of travel, fever in a malaria-risk area is unlikely to be malaria; however, any fever should be promptly evaluated. Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history. Malaria is not a problem at altitudes over 3,500 feet above sea level, including Mexico City, San Cristobal de las Casas, Oventic, and Tlaxcala, all over 6,000 feet. However, travel through lower altitudes may be necessary to reach these areas.
Typhoid Fever is an infection caused by a species of the Salmonella bacterium. It includes bloody diarrhea in about half the cases, but it is often characterized only by fever, severe toxicity, and a rash. It is spread by the oral route from contaminated food and water. Untreated, there is a 30% mortality rate. Vaccines are 60-70 % effective in prevention. Careful dietary discretion is the main line of defense. One vaccine involves a single injection, with immunity lasting 2 years. A second one is administered orally every other day for 4 doses, and lasts 5 years. Antibiotic resistance has been developing, but the bacteria are still sensitive to certain well-known antibiotics. Salmonella is an occasional problem in Chiapas, and several students have contacted salmonella during the study abroad program. For most healthy patients, symptoms last a few days to a week, after which most people recover quickly.
Hepatitis A is a highly contagious virus that causes liver inflammation. It is most commonly spread through person-to-person contact or contaminated food or water. Most people from the United States have not been previously exposed to the Hepatitis A virus. They are at risk of contracting the disease during travel to areas where the disease is more prevalent. A very effective vaccine is now available and is given 2-3 weeks prior to travel.
Rabies is a viral disease almost always caused by animal bites (especially dogs) and, if untreated, is considered a uniformly fatal disease. It is endemic in Mexico. There are two methods of prevention:
- avoid contact with possible rabid animal saliva, including items which may have come in contact with the saliva; and
- immunization, both pre-and post-exposure.
Pre-exposure immunization can be given by either intramuscular or intradermal injection, both requiring completion of the 3-shot series five weeks prior to travel. Post-exposure treatment is required immediately following any suspected contact. Avoid bites from all animals, especially handling or feeding puppies, kittens, monkeys, or other animals. They can have rabies before it is obvious. If you should be bitten or have direct contact with the saliva of a suspected rabid animal, immediately wash the affected area with a soap solution and running water for about 20 minutes to neutralize and rinse out the virus. Then proceed immediately for post-exposure treatment; the sooner, the better. If at all possible, the animal should be captured and kept under cautious surveillance until the diagnosis and therapy are completed. If capture is not possible, a clear description of the animal and the circumstance of contact should be recorded.
Tuberculosis is a bacterial disease spread by airborne droplets from a person with untreated pulmonary T.B. or ingesting TB-contaminated unpasteurized milk products. Transmission is more likely in conditions of crowding and poverty. A TB skin test can indicate prior exposure to Tuberculosis. If negative, a repeat test after returning to the United States will reveal exposure to the disease. Infection with Tuberculosis may not be apparent for months or even years after exposure, but the skin test becomes positive rather soon. The development of clinical disease can be easily prevented by a course of antituberculosis antibiotic. T.B. is not common in Mexico.
Hepatitis B is a serious and often chronic viral infection of the liver. Since this type of hepatitis is most often acquired from contact with infected blood, sexual contact, or skin-to-skin contact of mutual open cuts and sores, appropriate precautions to avoid exposure via these routes should be observed. This includes avoiding tattooing, ear/body piercing, cuddling children with sores, and draining insect bites. A series of three immunizing injections is available, requiring at least two doses taken previous to departure. This will provide partial protection. The third shot may be taken five months after the second dose, and may be given after returning home to achieve full, long-lasting immunity. An accelerated schedule can also be used as an alternative.
In the case of Mexico, no immunizations are required for entry into the country from the U.S. or into the U.S. from Mexico. However, several are available. You should discuss with your physician which immunizations you may want before traveling to Mexico. Immunizations require planning, generally at least eight weeks before departure. Among the possible immunizations are the following:
- MMR (measles, mumps, German measles)
- • Polio
- • Diphtheria-tetanus
- • Typhoid
- • Hepatitis A
- • Hepatitis B
- • Influenza
- • Rabies
With reasonable attention to health and hygiene rules, your stay in Mexico should be a healthy one, aside from minor ailments due to adjustments to new food, water, and climate. We recommend you see your physician on returning to the U.S. in order to test for any possible lingering infection contracted overseas.
Student responsibility for personal health
Each study abroad participant must submit a health report based on a physician’s examination within the past twelve months. The exam should reveal any current health problems. The participant and physician should develop strategies for dealing with current health problems, considering that the participant will be spending 13-14 weeks in Mexico and may not have access to the quality of health care to which s/he may be accustomed in the United States. Participants who require regular medication, either prescription or over-the-counter, should bring sufficient supplies for the 13-14 week program. This includes eye care products. Participants who require, or who are likely to require, specific medications for their conditions must communicate with AUSM about the process for obtaining these medications in the host country. This needs to be done two months in advance of the beginning of the program so that appropriate planning can take place. This group includes students who need to know about managing diabetes, epilepsy, allergies, or other chronic ailments.
Mental health issues
Students who are in counseling or therapy, who have received treatment for psychological or emotional problems in the past two years, or who feel the need for these services should schedule appointments with their mental health professional before they leave to discuss the overseas program and the related issues of living and working in a new environment. Psychological counseling will not be easily available during the 14-week program in Mexico, especially counseling in English.
STIs and HIV/AIDS
Sexually transmitted infections (STIs) exist in every society. Mexico is no exception, but they are not always discussed as openly and frankly as in the U.S. To protect participants and their partners, sexually active students should be certain they are disease-free before leaving the U.S. where diagnosis and treatment are relatively easy to obtain. Participants should take all appropriate precautions when involved in sexual activity.
Everything that students know about AIDS avoidance in this country applies in Mexico. Participants should be no less vigilant abroad than they are at home. Because discussion of STIs and AIDS is often less open in Mexico than in the United States, this may create an impression of freedom from risk. This is not true. Those participants who will be sexually active are encouraged to practice safe sex. Condoms are available in most pharmacies.
Alcohol and other drugs
Excessive consumption of alcohol affects the ability of students to make rational decisions and may result in the immediate expulsion of a participant from the program. The legal age for alcohol consumption in Mexico is 18 years old, which means alcohol will be legally available to participants. This may be a new experience for some participants. We encourage participants to consider the potential consequences of reduced motor skills and impaired judgment that can often result from alcohol consumption. We strongly encourage participants to avoid alcohol consumption. Consumption of alcoholic beverages is strictly prohibited during class hours and while in indigenous communities. If participants decide to consume alcohol, please do so carefully and in a culturally appropriate manner. Never drive a vehicle, operate machinery or swim while or soon after drinking. In no case are students allowed to consume more than two alcoholic beverages in any 24 hours, and inebriation is grounds for immediate expulsion from the program. Marijuana and other drugs that are banned in the United States are also illegal in Mexico. Penalties for possession or use of illegal drugs can be quite severe. Possession or use of illegal drugs is strictly prohibited and is grounds for immediate expulsion from the study abroad program.
All students must either purchase health insurance through AUSM’s insurance carrier or provide proof of their health insurance. At a minimum, health insurance should cover emergency hospitalization and emergency repatriation to the U.S.
The AUSM crisis management plan is designed to deal with unforeseen crises that may arise during the study abroad program, including accidents, natural disasters, civil unrest, political uprisings, physical or sexual assault, kidnapping or serious medical problems.
Evaluation of current conditions
Our current analysis of the political situation in the areas where we travel leads us to conclude that widespread civil unrest and/or a political uprising is very unlikely. Accidents and natural events cannot be predicted but must be planned for (see below). Kidnapping and other serious crimes affecting U.S. students are rare, and we are not aware of a single case of kidnapping or death of a U.S. university student in Mexico during the past 17 years. During the 17 years of our program, we have had two concerning incidents of sexual assault in which students were groped on the street in San Cristobal de las Casas with each incident lasting less than ten seconds – and no cases of more violent assault or rape. We had one case of a serious medical problem – a twisted ovary that required emergency surgery. A doctor affiliated with our program conducted the surgery and was able to preserve the fertility of the student.
Our crisis management plan is very important. We practice a careful and caring strategy for keeping our students and staff the safest: hope for the best, but always plan for the worst.
The AUSM on-site staff is responsible for crisis management. While under normal circumstances, we prefer to make collective decisions on major changes in the program, taking into consideration the wants and needs of students, during a crisis we expect students to follow the lead of on-site staff and ask questions later. On-site staff will do whatever is necessary and possible in a crisis to protect students. This responsibility may, at times, appear to conflict with the values or respect for the students’ individual choices. But in matters relating to personal safety and crisis management, the authority of on-site staff and AUSM will supersede the individual wishes of students. While every person responds to and deals with crises uniquely, there is little time “in the heat of the moment” for extensive discussions or negotiations. In a crisis, students are expected to respond quickly to the plan of action outlined by the on-site staff.
By their very nature, crises are unexpected events that take us out of our normal range of experience. Good judgment and flexibility are important in dealing with any crisis. AUSM relies on experienced on-site staff and local collaborating organizations to collect information and develop the specific elements that make up a comprehensive response to a crisis.
Sexual or physical assault
Unfortunately, in Mexico (as in the U.S.), groping women by strangers is not uncommon, particularly on crowded public transport and tourist areas. According to U.S. law, AUSM is obligated to report cases of sexual assault to the student’s home university. Students are oriented to:
- Always travel in groups of at least three people.
- Be aware of your surroundings. One of our groping cases happened at 2:00am on a side street in San Cristobal de las Casas where the victim was talking on a cell phone, which distracted her from her surroundings.
- Women in Mexico generally don’t wear shorts, low-cut blouses, or shirts that expose the midriff, and men generally don’t wear shorts or muscle shirts. Many Mexican women are accustomed to wearing a modest “commuter’s outfit” when traveling on public transportation.
- We ask students to do their best not to engage or respond to catcalls and to seek a safe public space quickly.
- Don’t use unmarked taxis. All taxis should have a photo I.D. of the driver and an official taxi license plate. Students are oriented to identify legitimate taxis in each locality.
- Avoid taverns and nightclubs that are known to be troublesome. Staff will orient students on known trouble spots.
The following lists and information are maintained to facilitate response to crises:
- The roster of students with a copy of passport and emergency family contact.
- Students with special medical needs.
- Contact information for each student that brings a phone and their respective homestay families.
- Contact information for on-site staff, including cell phones.
- Local maps.
- Emergency telephone numbers for police, medical facilities, local collaborators, and the U.S. Embassy.
Communication is central to overcoming a crisis. This includes internal communication within the group and external communication with authorities, family members, and local collaborators. All communications should be clear and concise. Ask the other party to repeat key pieces of information, including telephone numbers and names. In almost any emergency contact, the caller should be prepared with the following information:
- Your name
- Where you are
- Nature of the emergency
- Telephone number where you can be contacted, and until when
- When you will call back
- Specific requests for action, with a clear understanding of how the contact person will respond to each situation
In the case of a natural disaster or political unrest, the first step is communication with local collaborators, local officials, and the U.S. Embassy to evaluate the situation. On-site staff will develop a plan of action depending on the nature of the crisis at hand. Options include remaining in the present site, evacuation to a nearby urban center, or evacuation from Mexico. The plan of action includes:
- Inventory of personnel. Immediately locate all students and collect them in one place to facilitate communication and quick decision-making. Evaluate medical conditions and make sure everyone is calm. If anyone requires immediate medical attention, arrange for transportation and medical assistance. The list of contacts below provides medical contacts at each site.
- Inventory of personal belongings. On-site personnel assigns a team to collect and inventory personal belongings.
- Food and water. On-site personnel assigns a team to procure emergency food and water.
- Prepare travel plans if necessary. In the case of an evacuation, ground transportation is provided by a van owned and operated by AUSM. If this vehicle is damaged or unable to be used, on-site staff will contact alternative ground transportation (contacts listed below for each locality). In case of evacuation from Mexico, the following airports can be utilized:
- Tuxtla Gutierrez airport, about 1 hour from San Cristobal. Regular flights to Mexico City leave about every hour throughout the day.
- Comitán, about 1 1/2 hours from San Cristobal. A small local airport with only one flight per day to Mexico City.
- Mexico City international airport has hundreds of flights each day to other parts of Mexico and dozens of flights to different U.S. cities.
- Toluca international airport, located about an hour from Mexico City. Buses depart every 20 minutes from the World Trade Center on Avenida Insurgentes, arriving to the WTC by taxi or subway.
In the case of physical or sexual assault, kidnapping or other crimes, the first contact is with local medical officials (if necessary), the second contact is with local police, the third contact is with the U.S. Embassy, the fourth contact is with family members in the United States, and the fifth contact is with local collaborators. Discussions with local collaborators may include counseling assistance, legal advice (including contact with a lawyer), and/or alternative medical facilities that may be appropriate to a particular medical need.
As soon as the victim is stabilized and/or witnesses are available, on-site staff should conduct an interview documenting in writing as much information as possible about the incident, including at least:
- Time and place of incident
- Description of perpetrators
- Description of vehicles involved
San Cristobal de las Casas: the Ornela Clinic is located ½ block from the MSN house in San Cristobal de las Casas.
Oventic: the clinic is located two doors down from the front entrance.
Mexico City: Major medical facilities are located in almost every neighborhood.
US Embassy: 555-080-2000
- Dr. Raymundo Sanchez Barraza (Universidad de la Tierra) +52 (967) 103-7965 (mobile)
- Elisa Benavides +52 (555) 538-0816 (office), +52 (818) 470-8692
- Gerardo Meza +52 (554) 861-7151 (mobile), +52 (555) 034-2416 (office)
Post-crisis defusing process
Almost every crisis involves a period of intense initial response, followed by an evaluation and defusing process once the immediate trauma has passed. The immediate on-scene or near scene demobilization process should:
- Mitigate the immediate impact of the event
- Accelerate the recovery process
- Assess the need for debriefing and other support
- Reduce cognitive, emotional, and physiological symptoms
Within a short period of time, usually the day of the event, the group should take part in an initial defusing process:
- Establish a non-threatening social environment
- Allow rapid ventilation of stressful experience
- Equalize access to facts and information
- Restore cognitive processing of event
- Provide information for stress survival
- Affirm the value of individuals
- Establish linkages for additional support
- Develop expectancies for the future
The defusing components are as follows:
- Introduce facilitator(s)
- State Purpose
- Invite voluntary participation
- Establish ground rules (not therapy, not investigation)
- When possible, assure confidentiality (no notes, recording, etc.)
- Describe process
- Offer additional support
- Ask individuals to describe what just occurred
- Answer questions of clarification
- Review experiences and reactions
- Assess need for more help
- Reassure participants, as necessary
- Accept/summarize their exploration
- Normalize experiences and reactions
- Teach multiple stress survival skills
- Advise diet & nutrition, alcohol/caffeine avoidance
- Pay attention to rest & relationships
- Recommend recreation & exercise
- Offer handshake and comment to each participant
- Provide one-on-one follow-up
- Determine whether to proceed with debriefing
The defusing process may provide the necessary support to groups or individuals; however it may happen that the defusing will reveal need for further support. Indicators that additional support may be necessary include:
- Intense emotions, unusual behavior
- Unfinished business
- A sense (sometimes subtle) of incompleteness
- Excessive silence
Within two or three days of the crisis, on-site staff should facilitate a more in-depth, guided discussion that aims to:
- Screen and prioritize individual needs
- Identify areas for follow-up support and referrals
- Prevent stress dysfunction
The process involves seven distinct stages. It is important to follow all the stages in order to realize optimal effectiveness. The process moves the participants from the cognitive level (less threatening to express) through the emotional level (essential to explore and address) and back to the cognitive level (where the participants find comfort). The seven stages of the process are as follows:
Introduce intervention team members; explain the process; set expectations
Have each participant describe the nature of their participation from a cognitive perspective “What did you see/hear/do?”
Solicit cognitive responses to: “What
aspect held the most negative impact
for you?”-transition from cognitive
to emotional processing.
Solicit emotional reactions to or consequences of cognitive responses given in Stage 3. “How has this experience affected you?”
Transition from emotional domain
back to cognitive. “What lessons could be learned from this experience?” or “What is something positive that you will take away from this experience?”
Educate participants to normal reactions (not necessarily shared by everyone) and teach basic stress management, if applicable.
Summarize experience with emphasis on positive learning aspects.
Before debriefing, it is important for on-site staff to:
- Review case documents, incident reports, press clippings, etc
- Circulate among the group to establish informal contacts, study relationships and individual behaviors, and gather additional background information
- Hold strategy meeting to agree on focus, roles, and responsibilities.
After debriefing, it is important for on-site staff to:
- Make one-on-one contact with all participants, inviting those deemed needful of further individual support to attend follow-up sessions.
- Conduct post-debriefing review with team:
- – “How did we do?”
- – “What did we learn?”
- – Coordinate any follow-up
- – Check-in with each team member, “Are you okay?”
- If necessary, write post-action report keeping it general, ensuring confidentiality, and focusing on lessons learned.
Some of the issues that are likely to emerge for students and staff in the aftermath of a crisis are:
- Coping with the loss of personal belongings;
- Lack of opportunity to say good-bye to friends;
- Inability to bring closure to projects/ coursework;
- Dealing with the sudden need to plan next steps;
- Dealing with previous experience of loss and disappointment that the situation may evoke;
- Loss of control of daily activities and immediate future;
- Abandoning previous goals and aspirations;
- Concerns about status, earning academic credit, refunds, etc.
- Feelings of powerlessness, being manipulated.
Sample Medical Evacuation Procedures
- On-site administrator consults with local doctor, central administrative office in Chicago (773-583-7728), insurance representative, 24-hour hotline to obtain pre-approval for medical evacuation (medevac). Determine insurance carrier and contact for the student. All students’ insurance and contact information are available from the Chicago AUSM office.
- If the administrator office concurs medevac is necessary, determine
- a. How soon medevac should occur.
- b. If medical or nonmedical accompaniment of patient is necessary.
- c. If the patient is stable enough to transport to home country/state or will need to have medical care in country abroad with appropriate medical facilities.
- Inform administrators of any special needs in itinerary such as
- a. Destination
- b. Special seating arrangements (stretcher, first class)
- c. Special airport arrangements (wheelchair, stretcher, ambulance)
- d. Special airline medevac or airline’s permission in advance to fly
- (Usually necessary if you want to bump another passenger, if stretcher needed, if medically accompanied, if IV necessary, or if any other visibly obvious, serious medical problems.)
- Ensure the patient has passport and visa needed for departure from abroad and entry into USA or country en route. If passport is unavailable, contact U.S. Embassy consul to make another passport or arrange for proper documents.
- Inform administrator if student wants parents or family notified and /or review pre-departure form to see if student has pre-approved emergency contact(s).
- Brief patient about medevac procedure going over medevac checklist and reviewing standard medevac handout with student.
- Prepare patient’s medical chart and ensure that all results are translated into English. Instruct patient to carry chart, etc in carry-on luggage. Include any x-ray or lab results.
- Make sure patient has any necessary medications or supplies he/she will need along the way.
- If patient is traveling alone and will need to overnight in a city enroute, remind patient that airline is usually responsible for providing food and lodging while the patient is enroute to destination. Have patient check at airline desk for lodging voucher. This situation is unlikely in the case of medevac from Mexico to the U.S.
- If patient is traveling with accompaniment, determine if patient will need to go directly to hospital when arriving at destination.
- If direct hospital evaluation/admission will be needed, call administrator to determine which hospital and consultants will be used and go there directly from the airport.
Procedure for Medical Evacuation with Emergency Evacuation Assistance Company
- Contact the insurance company as soon as the decision to medevac the patient is taken. Many students carry their own insurance and contact information is available from the AUSM office in Chicago.
- Give insurance company the following information:
- Patient name
- b. Age
- c. Citizenship
- d. Medical problem
- e. Medical equipment needed in transport (e.g., blood, oxygen)
- f. Medical personnel needed in transport (e.g., anesthesiologist, nurse, other specialist)
- g. Name and phone number of local attending physician
- h. Place to which you want to medevac patient
- i. Central administration and on-site telephone numbers and fax number, Embassy number
- j. State U.S. Guarantee of payment: Fiscal Data
- k. Whether someone will accompany the patient
- Develop a medevac checklist individualized for each incident in consultation with the insurance company for procedures /practice in case of medical evacuation.