Acute-Phase Mental Health Consequences of Disasters: Implications for Triage and Emergency Medical Services☆,☆☆,★
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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2023, Computers in Human BehaviorCitation Excerpt :In the context of our research, this work cycle is defined by the incident response phases. Some other examples of work cycles that could be similarly applied are the operational levels of triage in emergency medicine (Burkle, 1996) and the Military Decision Making Process in defense planning (Hernandez et al., 2017). Work cycles can be used to examine when teams expect members to possess more or less autonomy and the impact that their actions could cause in order to assess where an AI teammate should dynamically adapt.
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2022, Social Science and MedicineCitation Excerpt :Among children with highly fearful and high error-related brain activity, the stressors related to Hurricane Sandy predicted the increase in internalizing symptoms (Meyer et al., 2017). The consequences reflected the vulnerability of children in extremely stressful situations (Burkle, 1996). Therefore, child mental health after natural disasters is an important health issue.
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2021, International Journal of Disaster Risk ReductionCitation Excerpt :Responses were coded as follows: 1 = no reported sources of aid or assistance; 2 = one reported source of aid; 3 = two reported sources of aid; 4 = three reported sources of aid; 5 = four reported sources of aid; and 6 = five reported sources of aid. Finally, demographic characteristics include gender, income, education, and recruitment methods, which can at times explain disaster outcomes [65–69]. Age and home tenure are measured as continuous variables.
Methods: Study Designs in Disaster Epidemiology
2017, Disaster Epidemiology: Methods and ApplicationsAir show disaster
2016, Ciottone's Disaster MedicineFlood of emotions: Emotional work and long-term disaster recovery
2012, Emotion, Space and SocietyCitation Excerpt :An extensive literature has developed around the mental health effects of disasters (Brooks and McKinlay, 1992; Freedy and Hobfoll, 1995; Penick et al., 1976). For example, psychologists have researched people’s responses to violent disasters such as terrorist attacks with a focus on conditions such as post-traumatic stress disorder (Burkle, 1996, North and Pfefferbaum, 2002). In recent years, researchers have also focused on the mental health impacts of natural disasters such as Hurricane Katrina in 2005 (Abramson et al., 2008; Galea et al., 2007; Schoenbaum et al., 2009; Weisler et al., 2006) and the 2004 tsunami (van Griensven et al., 2006; Wickrama and Kaspar, 2007).
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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.
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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
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Reprint no. 47/1/74144