Transcript Slide 1

Disaster Behavioral Health
Randal Beaton, PhD, EMT
Tools and Resources
for Idaho
Emergency Responders
Southeastern
Health
District
6
Participant Poll
What type of organization do you work for?
A.
B.
C.
D.
Hospital
EMS, pre-Hospital
Health District
Other
Randal Beaton, PhD, EMT
Research Professor
Schools of Nursing
and Public Health and
Community Medicine
Faculty
Northwest Center for
Public Health Practice
University of Washington
Relevant Clinical Experience
• Volunteer EMT
• Counseled victims of 9/11 who lost
co-workers
• “Psychological casualties” of Nisqually
earthquake (2001)
• Stress management for First Responders
– mostly firefighters and paramedics – in
private practice
“You can observe a lot by watching”*
*Berra, 1998
Relevant teaching and research background
• Published studies on benefits of disaster
training and drills
• NIOSH funded research into cause and
effects of PTSD in firefighters
• Core faculty of HRSA funded BT
Curriculum Development Grant
(UW ’03 – present)
• Helped to write and drill UW
School of Nursing Disaster Plan – 2002
NMDS drill (May 13, 2004)
Preamble/Assumptions
Disasters generally refer to natural or human
caused events that cause property damage
and large numbers of casualties.
Community wide disasters
generally require outside
assistance and/or assets.
Tsunami Disaster
Photo by Dr. Mark Oberle, Phuket, Thailand
Effects on Victims & Care Givers
Disasters can also affect the
psychological, behavioral,
emotional and cognitive
functioning of the disaster
victims (primary, secondary,
tertiary, etc.) and rescue
workers, first responders
and first receivers.
Tsunami Disaster Victims
Photo by Dr. Mark Oberle in Phuket
Overarching Goal
Enhance the networking capacity and training
of state of Idaho healthcare professionals to
recognize, treat and coordinate care related
to behavioral health consequences of
bioterrorism and other public health
emergencies.
HRSA critical benchmark #2-8
These training modules will address:
 behavioral health aspects of disasters
Disaster Cycle
There are a number of distinct
conceptual stages in the disaster cycle:
Pre-event warning
threat stage
Preparedness
Planning
Disaster
Cycle
Evaluation
Recovery
Impact/Response
NMDS drill (May 13, 2004)
Disaster Behavioral Health
Disaster behavioral health interventions differ
from traditional behavioral health practice by:
• Addressing Incident-specific, stress reactions
• Providing outreach and
crisis counseling to victims
• Working hand-in-hand with paraprofessionals,
volunteers, community leaders, and survivors of
the disaster
Source : http://www.disastermh.nebraska.edu/state_plan/Appendix%20D.pdf
Aims of Disaster Behavioral Health
• To prevent maladaptive psychological and
behavioral reactions of disaster victims
and rescue workers
and/or
• To minimize the counterproductive effects
such maladaptive reactions might have on
the disaster response and recovery
Questions
Disaster Behavioral Health
Randal Beaton, PhD, EMT
Modules 1,2 & 4
Psychological phases of a disaster;
Temporal patterns of mental/behavioral
response to disaster; (Resilience briefly);
Signs & symptoms of disaster victims
Learner Objectives: Modules 1 - 4
•
Identify the psychosocial phases of a
community-wide disaster and to describe the
behavioral health tasks of disaster personnel
during each phase
•
Describe the various temporal patterns of
behavioral health outcomes following a
disaster, including resilience
•
Identify the signs and symptoms of disaster
victims, first responders and first receivers who
may need a psychological evaluation
Module 1: Psychosocial Phases of a Disaster
*
* From Zunin & Myers (2000)
Implications/Tasks of each Phase for Disaster
Personnel - Pre-disaster
• Warning – e.g. weather forecast
• Educate
• Inform
• Instruct
• Evacuate or “stay put”
Pre-Disaster
• Threat, e.g., impending terrorist activity
• Risk communication: To reduce anxiety,
must also tell people what they should do
(without jargon)
TopOff 2 – Seattle, May 2003
Impact
• Prepare for surge
• Advise/instruct/give directions
• Risk Communication update
• Leadership
Heroic
Disaster survivors are true
“First Responders”
Honeymoon (community cohesion)
• Survivors may be elated and
happy just to be alive
• Realize this phase will not last
Disillusionment
• Reality of disaster “hits home”
• Provide assistance for the distressed
• Referrals to disaster mental health
professionals
Inventory
Psychological community needs
assessment
– Short-term
– Mid-range
– Downstream needs
Working Through Grief (coming to terms)
• This is when disaster victims actually begin
to need psychotherapy and/or medications
(only a small fraction)
• Trigger events – reminders
• Anniversary reactions – set back
Reconstruction (“a new beginning”)
Still, even following recovery, disaster
victims may be less able to cope with next
disaster
Behavioral Health Tasks, by Phase
Disaster
Phase
Pre-event
warning
Impact
Heroic
Honeymoon
Behavioral
Health Tasks Implications
Risk Comm.,
Educate,
Inform,
Forecast,
Instruct,
Evacuate
Advise,
Risk
Comm.,
Mitigate
First
responders are
often disaster
survivors,
citizens and
rescue workers
“rise to the
occasion”
Realize it will
not last
Available at:
http://www.nwcphp.org/edu/dbh/DisasterPhases.doc
Behavioral Health Tasks, by Phase, Continued
Disillusionment
Inventory
Working through
Grief
Reconstruction
“Assistance” for
distressed
Psychosocial
needs
assessment,
short-term,
mid-range, and
down-stream
needs“
Psychotherapy
and/or medications
Psychoeducational
Need to re-establish
“sense of safety”
Anniversaries –
Triggers Reminders
can rekindle
dormant
trauma/symptoms
Even when this is
completed,
survivors are still
more susceptible
to trauma from
future disasters.
Available at:
http://www.nwcphp.org/edu/dbh/DisasterPhases.doc
Module 2: Temporal Patterns of
Mental/Behavioral Responses to Disaster
Adapted From Bonanno (2004)
100
90
80
Disruption
70
60
Resilience
50
40
30
20
10
0
Event
2 Years
Resilience
• Differs from recovery
• Individuals “thrive”
• Relatively stable trajectory
Module 2: Temporal Patterns of
Mental/Behavioral Responses to Disaster
Adapted From Bonanno (2004)
100
90
80
Disruption
70
60
Acute/Recovery
50
40
30
20
10
0
Event
2 Years
Acute Distress and Recovery
• Post-disaster recovery usually occurs
within:
– Days
– Weeks
– A few months
Module 2: Temporal Patterns of
Mental/Behavioral Responses to Disaster
Adapted From Bonanno (2004)
100
90
80
Disruption
70
60
Acute/Chronic
50
40
30
20
10
0
Event
2 Years
Chronic Distress
Acute/Chronic Distress and/or Lasting
Maladaptive Health Behavior Outcomes
Module 2: Temporal Patterns of
Mental/Behavioral Responses to Disaster
Delayed Onset Distress
Adapted From Bonanno (2004)
100
90
80
Disruption
70
60
Delayed
50
40
30
20
10
0
Event
2 Years
For more information:
Coping With a Traumatic Event
CDC Publication
Available at:
http://www.bt.cdc.gov/masstrauma/copingpub.asp
Module 4: Signs & Symptoms Suggesting
Need for Psychological Evaluation
• Suicidal or homicidal thoughts or plan(s)
• Inability to care for self
• Signs of psychotic mental illness – hearing
voices, delusional thinking, extreme
agitation
TopOff 2 – Seattle, May 2003
Signs and Symptoms, continued
• Disoriented, dazed – not oriented x 3;
recall of events impaired (R/O TBI)
• Clinical depression – profound
hopelessness and despair, withdrawal and
inability to engage in productive activities
Signs and Symptoms, continued
• Severe anxiety – restless, agitated, inability
to sleep for days, nightmares,
overwhelming intrusive thoughts of the
disaster
• Problematic use of alcohol or drugs
Signs and Symptoms, continued
• Domestic violence, child or elder abuse
• Family members feel their loved ones are
acting in uncharacteristic ways
For more information:
Field Manual for Mental Health and Human
Service Workers in Major Disasters
Available at:
http://www.mentalhealth.org/publications/
allpubs/ADM90-537/default.asp
Disaster Behavioral Health
Randal Beaton, PhD, EMT
Module 10
Post-Disaster Assessment
Learner Objective: Module 10
To identify and describe some basic
principles of a post-disaster
assessment of community
psychosocial needs.
Principles of Psychological Needs Assessment
Post-disaster
• Type of Disaster
• Vulnerable populations
• Scope of the disaster
• Downstream factors
TopOff 2: Dirty Bomb Scenario
Disaster Typology
Natural
Floods,
Unintentional Hurricanes,
Earthquakes,
etc.
Intentional
“Act of God”
Man-made
Technologica Biological
l
e.g., Bhopal,
Haz-Mat,
Nuclear Power
plant accident
Epidemic
e.g., 1918
Influenza
Pandemic
Chemical,
Bioterrorism
Nuclear,
Radiological,
Explosion, Acts
of Terrorism
“It is not the event but the effect
that makes the disaster.”
Vulnerable Populations
(Community Composition)
• Psychiatric populations
• Children/infants – Schonfeld Hot Topic
Archive
• Elderly
• Pregnant Women
• Women with young children
• Native American Tribes
Population Exposure Model
DeWolfe, see SAMHSA publication
Population Exposure Model
(DeWolfe)
A. Seriously injured victims • bereaved family
members
B. Victims with high exposure to trauma • victims
evacuated from the disaster zone
C. Bereaved extended family members and
friends • rescue and recovery workers with
prolonged exposure • medical examiner’s
office staff • service providers directly involved
with death notification and bereaved families
Population Exposure Model
(DeWolfe) (continued)
D. People who lost homes, jobs,
pets, valued possessions • mental health
providers • clergy, chaplains, spiritual leaders •
emergency health care providers •school
personnel involved with survivors, families, of
victims • media personnel
E. Government officials • groups that identify with
target victims group • businesses with financial
impacts
F. Community-at-large
Downstream Factors
• Economic impact on community
• Job loss
• Housing needs
• Community Disruption
• Loss of “symbols”
Red Cross Role (in needs assessment)
• Can “assist” disaster victims
• Make appropriate referrals
Disaster Response and Recovery
Disaster Response and Recovery: A
Handbook for Mental Health Professionals
available at:
http://www.empowermentzone.com/disaster.txt
Disaster Behavioral Health
Randal Beaton, PhD, EMT
Module 13
Providing Post-Disaster
Behavioral Health Assistance
Learner Objective: Module 13
• To describe some basic approaches to
(early) post-disaster behavioral health
assistance for disaster victims
TopOff 2
Key Principles of Post Disaster Behavioral
Health Approaches
• No one who experiences a
disaster first hand is
unfazed
• Disaster stress and grief reactions
are normal and expected –
“normalize” these reactions
Key Principles of Post Disaster Behavioral
Health Approaches (continued)
• Many emotional reactions
of disaster survivors stem
from problems of living
brought about by the
disaster
• Most disaster survivors do not see
themselves as needing behavioral health
services following a disaster
Key Principles of Post Disaster Behavioral
Health Approaches (continued)
• Disaster survivors may reject all
forms of disaster assistance
• Disaster behavioral health
assistance is more practical
than psychological
• Disaster behavioral health services
need to be uniquely tailored to the
communities they serve
Things to Remember
“Therapy by just walking around”
Things to Remember
Disaster counselors assume a
variety of roles: “carry water”, pitch
tents, serve meals and “listen”.
Highest priority for
counseling efforts:
Disaster workers
Helping Survivors in the Wake of
Disaster Resource
A National Center for PTSD Fact Sheet
Available at:
http://www.ncptsd.org/facts/disasters/fs_helping_
survivors.html
Disaster Behavioral Health
Randal Beaton, PhD, EMT
Module 16:
Rural Issues
Learner Objective: Module 16
To identify some special considerations for
rural settings in terms of disaster
behavioral health preparedness,
response and recovery
Module 16:
Rural Mental Health Preparedness
versus Urban Settings
Rural America
• 65 million Americans
• Frontier/Small towns
• Transportation/highway systems
• Rural “attitude”
Rural America
• Sites of Farms
(food supply)
• Sites of power facilities
(including nuclear)
• Sites of headwaters and reservoirs
(water supply)
Rural Emergency Preparedness
• Rural health departments have less
capacity/resources/range of personnel.
• Downsizing of rural hospitals has
decreased/eliminated infrastructure.
• EMS systems rely on volunteers.
• General lack of funding and equipment.
Rural Preparedness
• Several preparedness planning
challenges are relatively unique to rural
areas (e.g. coordination between state
bioterrorism staff and Tribal nations).
Rural Preparedness
• Rural areas are affected by weather,
tourism, a fragile financial and economic
based and are geographically isolated,
making it difficult to support medical
systems.
Rural Preparedness: Barriers
• The main barrier to rural preparedness is
lack of funding.
Rural Preparedness
• The Federal Government and the States
must be financial partners but
implementation must occur at a local level.
Rural Mental Health Preparedness
• Not much good research
• Perceived risks – terror vectors
– Agri-terrorism; water sources
• Paucity of resources – personnel and PPE
• Evacuation issues
– Communication
• Pathogens will not spare rural communities:
– Native Alaskan Flu of 1918
Rural Risk Communication
• Local news broadcasters viewed as
more credible
• Perception is that terrorists will
target urban population centers
• Terrorists might target rural settings
– so no one feels safe!
Rural Health Concerns Resource
• Bridging the Health Divide: The Rural
Public Health Research Agenda
available at:
http://www.upb.pitt.edu/crhp/Bridging%20the%20Health
%20Divide.pdf
University of Pittsburgh publication