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Integration of Disaster Mental Health Services with Emergency Medicine

Published online by Cambridge University Press:  28 June 2012

Josef I. Ruzek ,
Bruce H. Young ,
Matthew J. Cordova  and
Brian W. Flynn
Josef I. Ruzek*
Affiliation:
National Center for Post-traumatic Stress Disorder (PTSD), Veteran's Administration, Palo Alto Health Care System, Menlo Park, California, USA Veteran's Administration Palo Alto Health Care System, Menlo Park, CaliforniaUSA Pacific Graduate School of Psychology, Palo Alto, California, USA
Bruce H. Young
Affiliation:
National Center for Post-traumatic Stress Disorder (PTSD), Veteran's Administration, Palo Alto Health Care System, Menlo Park, California, USA Veteran's Administration Palo Alto Health Care System, Menlo Park, CaliforniaUSA
Matthew J. Cordova
Affiliation:
Veteran's Administration Palo Alto Health Care System, Menlo Park, CaliforniaUSA Pacific Graduate School of Psychology, Palo Alto, California, USA
Brian W. Flynn
Affiliation:
Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
*
National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, California 94025USA, E-mail: Josef.Ruzek@med.va.gov
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Abstract

Despite limited resources, emergency medical settings will be called upon to play many roles in the context of disasters and terrorist attacks that are related to preparedness, surveillance, mental health services delivery, and staff care. Such settings are a central capture site for those individuals likely to be at highest risk for developing mental health and functional problems. Because much of the potential harm to survivors of disaster or terrorism (and their families) will be related to their mental health and role functioning, preparedness requires the active integration of behavioral health into emergency medicine in every component of disaster response. There are many challenges of doing this including: (1) finding ways to integrate activities of the medical care, emergency response, and public health systems; (2) determining whether an incident has actually occurred; (3) making differential diagnoses and managing other aspects of initial medical needs; and (4) coping with the risks associated with system overload and failure. Delivery of direct mental health care must include: (1) survivor and family education; (2) identification and referral of those requiring immediate care and followup; (3) group education and support services; and (4) individual counseling. In order for effective response to occur, the integration of psychosocial care into disaster response must occur prior to the disaster itself, and will depend on effective collaboration between medical and mental health care providers. At workplaces, emergency medical care centers must ensure that staff and their families are properly trained and supported with regard to their disaster functions and encouraged to develop personal/family disaster plans.

Keywords

disasterearly interventionemergency medicinemental healthpatient educationpost-traumatic stress disorderterrorismtrauma

Information

Type
Special Reports
Information
Prehospital and Disaster Medicine , Volume 19 , Special Issue 1: Psychosocial Themes , March 2004 , pp. 46 - 53
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2004

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References

1. National Institute of Mental Health: Mental Health and Mass Violence: Evidence–based Early Psychological Intervention for Victims/Survivors of Mass Violence: A Workshop to Reach Consensus on Best Practices. NIH Publication No. 02-5138, Washington, D.C.: U.S. Government.Printing Office, 2002. Available at http://www.nimh.nih.gov/research/massviolence.pdf Accessed 10 June 2003.Google Scholar
2. North CS: Psychiatric epidemiology of disaster responses. In: Ursano, RJ, Norwood, AE (eds), Annual Review of Psychiatry, Vol. 22. Washington, DC: American Psychiatric Association, 2003, pp 37–62.Google Scholar
3. Smith, D, Christiansen, E, Vincent, R, Hann, N: Population effects of the bombing of Oklahoma City. Journal of the Oklahoma State Medical Association 1999; 92: 193–198.Google Scholar
4. Vlahov, D, Galea, S, Resnick, H, et al. : Increased use of cigarettes, alcohol, and marijuana among Manhattan, New York, residents after the September 11th terrorist attacks. Amer J Epidem 2002; 155: 988–996.CrossRefGoogle ScholarPubMed
5. Schnurr, PP, Jankowsh, MK: Physical health and post-traumatic stress disorder: Review and synthesis. Seminars in Clinical Neuropsychiatry 1999; 4: 295–304.Google Scholar
6. Norris, FH, Friedman, MJ, Watson, PJ, et al. : 60,000 disaster victims speak: Part I. An empirical renew of the empirical literature, 1981–2001. Psychiatry 2002; 65: 207–239.Google Scholar
7. MacKenzie, EJ, Morris, JA Jr., Jurkovich, GJ, et al. : Return to work following injury: The role of economic, social, and job-related factors. American Journal of Public Health 1998; 88: 1630–1637.Google Scholar
8. Schnyder, U, Buchi, S, Morgeli, H, et al. : Sense of coherence—a mediator between disability and handicap? Psychotherapy and Psychosomatics 1999; 68: 102–110.CrossRefGoogle ScholarPubMed
9. Solursh, DS: The family of the trauma victim. Nursing Clinic of North America 1990; 25: 155–162.Google Scholar
10. Watkins, PN, Cook, EL, May, SR, et al. : Post-burn psychologic adaptation of family members of patients with burns. Journal of Burn Care and Rehabilitation 1996; 17: 78–92.Google Scholar
11. Pfefferbaum, B, North, CS, Flynn, BW, et al. : The emotional impact of injury following an international terrorist incident. Public Health Review 2001; 29: 271–280.Google ScholarPubMed
12. Ursano, RJ, Norwood, AE, Fullerton, CS, et al. : Terrorism with weapons of mass destruction: Chemical, biological, nuclear, radiological, and explosive agents. In: Ursano, RJ, Norwood, AE (eds), Annual Review of Psychiatry, Vol. 22. Washington, DC: American Psychiatric Association, 2003, pp 125–154.Google Scholar
13. Hassett, AL, Sigal, LH: Unforeseen consequences of terrorism: Medically unexplained symptoms in a time of fear. Archives of Internal Medicine 2002; 162: 1809–1813.Google Scholar
14. Goldberg, R, Boss, RW, Chan, L, et al. : Burnout and its correlates in emergency physicians: Four years' experience with a wellness booth. Acad Emer Med 1996; 3: 1156–1164.Google Scholar
15. Ruzek, JI, Cordova, MJ: The role of hospitals in delivering early intervention services following traumatic events. In: Orner, R, Schnyder, U (eds), Reconstructing Early Intervention afrpr Trauma. Oxford, United Kingdom: Oxford University Press, 2003, pp 228–235.CrossRefGoogle Scholar
16. Joint Commission on Accreditation of Health Care Organizations: Special Issue: Emergency Management in the New Millennium. Perspectives 2001; 21(12).Google Scholar
17. US Department of Health and Human Services. Mental Health All-Hazard Disaster Planning Guidance. DHHS Pub. No. SMA 3829. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2003.Google Scholar
18. Ohbu, S, Yamashina, A, Takasu, N, et al. : Sarin poisoning on Tokyo subway. Southern Medical Journal 1997; 90: 587–593.Google Scholar
19. Young, BH, Ford, JD, Ruzek, JI, et al. : Disaster Mental Health Services: A Guide for Clinicians and Administrators. Palo Alto, California: National Center for Post-Traumatic Stress Disorder, 1998.Google Scholar
20. Watson, PJ, Friedman, MJ, Gibson, LE, et al. : Early intervention for trauma-related problems. In: Ursano, RJ, Norwood, AE (eds), Annual Review of Psychiatry, Vol. 22. Washington, DC: American Psychiatric Association, 2003, pp 97–124.Google Scholar
21. Gentilello, LM, Rivara, FP, Donovan, DM, et al. : Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Annals of Surgery 1999; 230: 473–483.Google Scholar
22. Resnick, HS, Kilpatrick, DG, Dansky, BS, et al. : Prevalence of civilian trauma and post-traumatic stress disorder in a representative national sample of women. Journal of Consulting and Clinical Psychology 1993; 61: 984–991.CrossRefGoogle Scholar
23. Talbert, FS, Wagner, PJ, Braswell, LC, Husein, S: Analysis of long-term stress reactions in emergency room patients: An initial study. Journal of Clinical Psychology in Medical Settings 1995; 2: 133–148.CrossRefGoogle Scholar
24. Galea, S, Ahern, J, Resnick, H, et al. : Psychological sequelae of the September 11 terrorist attacks in New York City. New England Journal of Medicine 2002; 346: 982–987.Google Scholar
25. Pfefferbaum, B, Vinekar, SS, Trautman, RP, et al. : The effect of loss and trauma on substance use behavior in individuals seeking support services after the 1995 Oklahoma City bombing. Annals of Clinical Psychiatry 2002; 14: 89–95.CrossRefGoogle ScholarPubMed
26. Schnyder, U, Morgeli, H, Nigg, C, et al. : Early psychological reactions to lifethreatening injuries. Critical Care Medicine 2000; 28: 86–92.Google Scholar
27. Brewin, CR, Rose, S, Andrews, B, et al. : Brief screening instrument for posttraumatic stress disorder. British Journal of Pychiatry 2002; 101: 158–162.Google Scholar
28. Prins, A, Ouimette, PC, Daniela, S, et al. : The Primary Care PTSD Screen (PC-PTSD): Development, operating characteristics, and clinical utility. (Manuscript submitted for publication).Google Scholar
29. Young, BH, Ruzek, JI, Ford, JD: Cognitive-behavioral group treatment for disaster-related PTSD. In: Young, BH, Blake, DD (eds), Group Treatments for Post-Traumatic Stress Disorder. Philadelphia: Brunner/Mazel, 1999, pp 149–200.Google Scholar
30. Brewin, CR, Andrews, B, Valentine, JD: A meta-analysis of risk factors for posttraumatic stress disorder in victims of violent crime. Journal of Consulting and Clinical Psychology 2000; 68: 748–766.CrossRefGoogle Scholar
31. Ruzek, JI: Providing “Brief Education and Support” for emergency response workers: An alternative to debriefing. Military Medicine 2002; 167 Supplement: 73–75.Google Scholar
32. Mitchell, JT: When disaster strikes: The critical incident stress debriefing process. Journal of Emergenry Medical Services 1983; 8: 36–39.Google Scholar
33. Mitchell, JT, Everly, GS: Critical incident stress management and critical incident stress debriefings: Evolutions, effects and outcomes. In: Raphael, B, Wilson, J (eds), Psychological Debriefing: Theory, Practice and Evidence. Cambridge, England: Cambridge University Press, 2000, pp 71–90.Google Scholar
34. Bisson, JI, McFarlane, AC, Rose, S: Psychological debriefing. In: Foa, EB, Keane, TM, Friedman, MJ (eds), Effective Treatments for PTSD. New York: Guilford Press, 2000, pp 39–59.Google Scholar
35. Litz, BT, Gray, MJ, Bryant, RA, et al. : Early intervention for trauma: Current status and future directions. Clinical Psychology: Science and Practice 2002; 9: 112–134.Google Scholar
36. Bryant, RA, Harvey, AG, Dang, ST, et al. : Treatment of acute stress disorder: A comparison of cognitive-behavioral therapy and supportive counseling. Journal of Consulting and Clinical Psychology 1998; 66: 862–866.CrossRefGoogle ScholarPubMed
37. Bryant, RA, Sackville, T, Dang, ST, et al. : Treating acute stress disorder: An evaluation of cognitive behavior therapy and supportive counseling techniques. American Journa1 of Psychiatry 1999; 156: 1780–1786.Google Scholar
38. Bryant, RA, Harvey, AG: Acute Stress Disorder: A Handbook of Theory, Assessment, and Treatment. Washington, DC: American Psychological Association, 2000.CrossRefGoogle Scholar
39. Bowler, RM, Murai, K, Tme, RH: Update and long-term sequelae of the sarin attack in the Tokyo, Japan subway. Chemical Health and Safety 2001; January/February: 1–3.Google Scholar
40. Ohbu, S, Yamashina, A, Takasu, N, et al. : Sarin poisoning in the Tokyo subway. Southern Medical Journal 1997; 90: 587–593.Google Scholar
41. Karsenty, E, Shemer, J, Alshech, I, et al. : Medical aspects of the Iraqi missile attacks on Israel. Israel Journal of Medica1 Science 1991; 27: 603–607.Google Scholar
42. Ramalingaswami, V: Psychological effects of the 1994 Plague outbreak in Surat, India. Military Medicine 2001; 166: 29–30.Google Scholar
43. Hedrick, SC, Chaney, EF, Felker, B, et al. : Effectiveness of collaborative care depression treatment in Veterans' Affairs primary care. Journal of General Internal Medicine 2003; 18: 9–16.Google Scholar
44. Unutzer, J, Katon, W, Callahan, CM, et al. : Improving mood-promoting access to collaborative treatment. Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. JAMA 2002; 288: 2836–2845.Google Scholar
45. Lewis, LM, Callaham, ML, Kellermann, AL, et al. : Collaboration in emergency medicine research: A consensus statement. Acad Emer Med 1998; 5: 152–156.Google Scholar
46. Sperling, JD, Levy, PD, Garritano, J, Chiang, W: Acute stress disorder and major depressive episode diagnoses among emergency department staff involved in the response to the World Trade Center tragedy. Acad Emer Med 2003; 10: 548.Google Scholar
47. Young, BH, Ruzek, JI, Wong, M, et al. : Disaster mental health training: Guidelines, considerations, and recommendations. In: Friedman, MJ, Watson, PJ, Ritchie, EC, Orner, R (eds), Mass Violence and Early Intervention. New York: Guilford Press, in press.Google Scholar