Biomedical Engineering Reference
In-Depth Information
11 The Role of Psychiatry and Social
Services in the Hospital Response to
Bioterrorism
JULIAN D. FORD
11.1 Introduction The Psychological
Dimension of “Terror” in Bioterrorism
Psychiatry and social services play a critical role in
addressing the public health impact of terrorism and
disasters (Norris, Young, Ford, Ruzek & Gusman,
1997). Terrorism and disasters expose people not
only to physical danger and pathogens, but also
to psychological trauma [1,2] (Norris, Friedman,
Watson,Byrnes,Diaz,&Kaniasty, 2002). Terrorism
is by definition intended to cause psychological fear
and a sense of dread and helplessness due to life-
threatening danger [3], and which precisely fulfills
the criteria for “traumatic stress” in the American
Psychiatric Association's Diagnostic and Statistical
Manual (1994). Post-traumatic stress in the wake
of disasters has been implicated as a contributor to
physical illness and medically unexplained health
problems [4,5], as well as mental health prob-
lems, and therefore represents a major public health
concern. This chapter will provide an overview
of the psychological sequelae and interventions
that hospitals can provide to prevent or amelio-
rate persistent post-traumatic stress psychosocial
impairment in the wake of terrorism.
Clear evidence of this psychological contagion was
provided by the response to the 1995 sarin attack
in the Tokyo subway. More than 500 persons
came to the Emergency Department at a nearby
hospital within the first few hours following this
attack and more than 5500 sought medical eval-
uations subsequently. Although some persons had
severe physical symptoms related to nerve gas
exposure (of whom 12 died), more than 90%
were “acute psychological casualties—worried
well—who feared they might have been exposed to
sarin gas” [7]. The hospital, like most, was unpre-
pared for the flood of psychological casualties,
and did not at first identify the need for psychi-
atry personnel because of the focus on addressing
the medical sequelae of chemical contamination.
Psychiatry and social service professionals were
called upon, but only after the medical staff and
clinicians were overwhelmed by the demand for
not only diagnosis and treatment but also informa-
tion and guidance. Psychiatry and social service
staff and clinicians also found themselves largely
unprepared to address the sheer volume and inten-
sity of stress reactions, having primarily had expe-
rience in the assessment, care, and placement of
patients whose acute crises occurred in the context
of chronic psychiatric disorders.
The medical and psychiatric/social service
response to patients and family members who are
experiencing an acute sense of psychological terror
must be grounded in an understanding of the nature
of psychological terror. Fear of a specific threat
11.1.1 The Challenge: Managing the
Psychological Impact of Real or Potential
Biological Contamination
Biological contamination, or the threat thereof, can
lead to a contagion of fear that travels by vector
similarly to the spread of actual physical harm [6].
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