Transcript Slide 1

DEEP
Center
Disaster Behavioral Health
Awareness Training for
Health Care Professionals
Copyright © 2004: All Rights Reserved
Disaster Behavioral Health Awareness
Training for Health Care Professionals
James M. Shultz MS, PhD
Zelde Espinel MD, MA, MPH
Raquel E. Cohen MD, MPH
Jorge R. Insignares MD
Lisa Rosenfeld MPH
DEEP Center
University of Miami
School of Medicine
Brian W. Flynn EdD
Rear Admiral, USPHS (Ret)
Assistant Surgeon
General (Ret)
Jon A. Shaw MD, MS
Department of Psychiatry
University of Miami
School of Medicine
Robert J. Ursano MD
Director, Center for the Study of
Traumatic Stress
Uniformed Services University
of the Health Sciences
Joseph A. Barbera MD
Director
Institute for Crisis, Disaster, and
Risk Management
The George Washington University
Mauricio Lynn MD
Abdul Memon MD
S. Shai Gold
Jackson Memorial Medical Center
University of Miami
School of Medicine
DISASTER BEHAVIORAL HEALTH AWARENESS TRAINING FOR HEALTH CARE PROFESSIONALS
TERRORISM OVERVIEW
Terrorism:
The New
American Reality
American Perceptions
Many Americans used to think
that the United States
would not be a
target for terrorism
until a series of events
changed this perception…
World Trade Center bombing, February 26, 1993
Alfred P. Murrah Building
Oklahoma City
April 19, 1995
American embassy
bombings: Kenya & Tanzania
August 7, 1998
September 11, 2001
Anthrax, Fall, 2001
Orange Alert
Holiday Season
2003
Madrid, Spain
March 11, 2004
BE AWARE
Terrorism
is the new
reality for
Americans.
Terrorism
Terrorism refers to a
threat or action
that creates terror or horror
and is undertaken to achieve
a political, ideological,
or theological goal.
Source: Ursano et al., 2003
Terrorism
The threat or use of violence
for political purposes
by individuals or groups…
when such actions are intended to
shock, stun, or intimidate
a target group
wider than the immediate victim.
Source: CIA, 1990
Terrorism and
Weapons of Mass
Destruction
Terrorists use
Weapons of Mass Destruction
(WMD)
to create
Mass Violence
Types of Terrorist Weapons
Agro
Biological
Chemical
Data/“Cyber”
Explosive/Incendiary
Firearms
+
Nuclear/Radiological
Weapons of Mass Destruction
Agro:
Weapons of Mass Destruction
Biological:
Anthrax attack through U.S. mail, 2001
Weapons of Mass Destruction
Chemical:
Sarin gas attack in Tokyo subway, 1995
Weapons of Mass Destruction
Data/Cyber:
Hacking of federal Internet servers, 2002
Weapons of Mass Destruction
Explosive/Incendiary:
Bombing of Oklahoma City Federal Bldg, 1995
Weapons of Mass Destruction
Explosive/Incendiary:
Fuel-laden airliners flown into WTC,
September 11, 2001
Weapons of Mass Destruction
Firearms:
Weapons of Mass Destruction
Nuclear/Radiological:
Hiroshima & Nagasaki, 1945
Goals of
Terrorism
Goal of Terrorism
“The primary goal of terrorism
is to disrupt society
by provoking intense fear
and shattering all sense
of personal and community safety.”
Source: Hall et al. 2002
Psychological Goals of
Terrorism
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To terrorize and induce fear
To disrupt normal function
To violate belief in “safety from harm”
To undermine community security
To shatter belief in a just world
To destroy morale
To create chaos
Sources: Gurwitch, et al., 2002; Ursano et al., 2003
Goal of Terrorism:
“The primary goal of terrorism
is to create terror.
The target of terrorism is not only those
who are killed, injured, or directly affected.
The target is the entire nation—
in the United States,
nearly 300 million people.”
Source: Ursano, et al., 2003
Psychosocial Impact of Disasters
Fear and Distress
Response
Impact of
Disaster
Event
Behavior
Change
Psychiatric
Illness
Sources: Ursano, 2002; Institute of Medicine, 2003
Threat of Terrorism and Mental Health:
A Public Opinion Poll
Terrorism is psychological in nature because
it is meant to cause psychological suffering:
Strongly agree: 55%
Agree:
32%
Total:
87%
Source: National Mental Health Association (NMHA)
National Association of State Mental Health Program Directors (NASMHPD)
Widmeyer Communications, 2004
Terrorism is
psychological
by design.
Source: Shultz et al., 2004
Terrorism
Challenges Hospital
Surge Capacity
Mass Casualty Incident
In a mass casualty terrorist incident:
Large numbers of medical casualties
will challenge the surge capacity
of hospitals near the scene.
Mass Casualty Incident
Terrorism is psychological by design:
Many survivors arriving at hospitals
may be psychological casualties:
• Persons experiencing fear and distress
• Persons fearing hazardous exposure
• Persons experiencing psychogenic illness
Mass Casualty Incident
The combination of
medical casualties and
psychological casualties may
overwhelm surge capacity.
Mass Casualty Incident
The influx of psychological casualties,
compounding the flow of medical patients,
will challenge the ability of hospitals
to maintain optimal function
and provide quality care.
Mass Casualty Incident
Hospitals must be prepared
to provide quality care and behavioral
health support for large numbers of
patients seeking care following a
terrorist event.
Behavioral Health
in the Face of
Terrorism
Behavioral Health
deals with
optimal, healthy
human functioning
within family, community, and
occupational roles.
Why Behavioral Health?
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Terrorism provokes extreme fear
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Fear paralyzes
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Fear interferes with functioning
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Terrorism poses a challenge to
behavioral health
Disaster Behavioral Health
deals with optimal,
healthy human functioning
within family, community, and
occupational roles
during extreme events—
disasters and acts of terrorism.
Disaster
Behavioral Health
Training
for Health Care
Professionals
Why must
health care organizations
focus on
behavioral health issues?
Disaster Behavioral Health Training
Institute of Medicine
 Train All Relevant Health Care Professionals
in Disaster Mental Health and Psychological
Consequences of Terrorism
Provide information about
 Expected responses
 Specific elements of intervention and
management of distress
 Behavioral change and psychiatric illness
 Community resources
Source: IOM Report, 2003
Disaster Behavioral Health Training
Florida Hospital Core Competencies
 Provide behavioral health training
for all hospital professionals
emphasizing disaster stress,
normal reactions, and support
resources.
Source: Recommended Core Competencies & Planning / Mitigation
Strategies for Hospital Personnel within the State of Florida, 2004
To favorably influence
optimal, healthy,
functional individual and
collective behavior
Behavioral Health
is a Critical Preparedness
and Response Issue at All Levels
Individual Level
Health Care System Level
Community Level
Individual Level:
What are we trying to do?
Get people to do
what is in their best interest
AND
Prevent people from doing
what is not in their best interest
Health Care System Level:
What are we trying to do?
• Provide care for disaster victims
• Maintain care for current patients
• Safeguard staff
• Support responders
• Lead effectively in crisis
Community Level:
What are we trying to do?
• Promote community health
• Reduce exposure, illness, injury
• Reduce mortality
• Promote pro-social behavior
• Reduce fear-driven behavior
• Safeguard the health care system
Behavioral health
concerns
are absolutely
life and death issues.