Acute-Phase Mental Health Consequences of Disasters: Implications for Triage and Emergency Medical Services,☆☆,

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Abstract

[Burkle FM: Acute-phase mental health consequences of disasters: Implications for triage and emergency medical services. Ann Emerg Med August 1996;28:119-128.]

See related editorial, External Emergency Medical Disaster Response: Does a Need Exist?

Section snippets

INTRODUCTION

Disaster is not a rare event. Norris found that 69% of persons living in the southeastern United States have been exposed to some traumatic event, with 13% of the total sample reporting a lifetime exposure to natural or human-generated disaster.1 Psychosocial and behavioral disruptions exist as a predictable consequence of any disaster. However, disasters frequently expose vulnerabilities in the capabilities of both mental health systems and community infrastructure to respond. The inability of

ACUTE MENTAL HEALTH RESPONSES

Differing views have been expressed regarding the extent of psychologic disorders following a disaster.2 However, there is no such thing as no response. Whereas rates of diagnosable disorders are low, symptoms are plentiful.2, 3, 4, 5, 6, 7, 8, 9, 10, 11 Most individuals evidence some signs of emotional disturbance as an immediate or acute-phase reaction to a disaster. Most victims recover spontaneously or with the assistance of a sympathetic listener. Bourne12 suggests that these reactions in

TRAUMA POTENTIAL

Bolin13 has drawn several conclusions regarding the potential of certain disasters to potentiate psychologic dysfunction. He cautions that these conclusions were derived without consideration of the influence of individual victim characteristics such as those described in the previous section. Trauma potential is greater in disasters that (1) are intense and expose many survivors to the death or injury of primary victims; (2) expose the survivors to dead bodies, especially if the deaths were

REACTIONS OF CHILDREN

Documented reactions of children after a disaster are often sketchy and fragmented, and studies performed have often had major methodologic weaknesses.16, 23, 24 Far less is known of the manifestations of stress reactions in children than in adults. The dearth of adequate studies of children in the immediate aftermath of disaster has been attributed, in part, to parental unwillingness to acknowledge stress in children, denial that children have any major psychologic sequelae, and underreporting

RESPONSES IN ELDERLY PERSONS

There is little evidence that elderly persons are more vulnerable than others to mental health consequences of disasters.45, 46 However, increasing age is considered a mental health risk factor, and elderly persons, because of age, are more vulnerable to certain risks.47 The impact of loss of a dependent spouse, relative, or pet may be greater. The elderly appear as a group to have a greater sense of loss of property, and relocations, daily medications, and even a minor injury may provoke fear

REACTIONS OF RESCUE WORKERS

Rescue workers or tertiary victims, which must include physicians and nursing and hospital staff, represent a specific area of concern. The stress experienced by nonprofessional, volunteer, or bystander rescuers resembles that of the primary or secondary victims.2 Professional rescuers report severe distress after inability to rescue victims, especially a child or colleague. Rescue resources may be overwhelmed, and rescuers may perceive their efforts as hopeless. Most, 80% to 90%, report good

TRIAGE

Triage is a critical event in disaster management. Triage is not always needed in disasters. It is performed only as necessary and depends on the resources available. In large-population, mass casualty disasters, when supplies, personnel, and evacuation are compromised, triage is necessary to ensure the greatest good for the greatest number.8, 57 The existing taxonomy of disasters, including popular triage schema, focuses on the primary physical trauma-related casualty. An example of a

EPIDEMIOLOGY

Mental health and behavioral consequences of disasters have concerned health care providers, disaster planners, and researchers for decades. There were no easy generalizations gained from early epidemiologic studies.60 Methodologic research primarily highlighted case studies. There were variations in data sampling and observation and failures to include control groups. Interpretations ranged across disaster types, severity, and duration and differed widely over societies studied. Varied

MANAGEMENT AND COORDINATION

Priorities in the management of psychologic consequences have evolved slowly. Bugge73 reports that in 1986 it was not clear that psychologic assistance should be included in Norwegian disaster plans. Within 3 years, experience in disaster exercises dictated that psychosocial personnel were to be alerted immediately along with medical personnel. They found that strong leadership, communication, and cooperation with and acknowledgment of authority of local leaders and resources are critical to

CRITICAL INCIDENT STRESS DEBRIEFING

Most rescuers report a need to work through emotional experiences by sharing their feelings with others. Critical incident stress debriefing (CISD) represents an organized approach to management of the stress response. The goal of CISD is to aid individuals in understanding their reactions, allowing for appropriate personal evaluation, self-forgiveness, and a reconsideration of perceptions. CISD, formalized by Mitchell77, is a carefully structured process that uses preincident preparation,

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    From the Department of Surgery, John A Burns School of Medicine and School of Public Health, University of Hawaii, Honolulu, Hawaii.

    ☆☆

    Address for reprints: Frederick M Burkle Jr, MD, MPH, University of Hawaii, John A Burns, School of Medicine, 1319 Punahou Street, Honolulu, Hawaii 96826, 808-973-8387, Fax 808-949-4232

    Reprint no. 47/1/74144

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