Biomedical Engineering Reference
In-Depth Information
health providers (Adams, Ford, & Dailey, 2004).
Thus, public health providers, traditional healers,
opinion leaders, and “trusted advocates” within
communities affected by disaster or terrorism may
be the best sources of both programmatic guid-
ance and front line assistance for ethnocultur-
ally diverse individuals, families, and societies.
Careful and respectful ethnographic observation of
norms, traditions, and resources within different
cultural sub-groups is an essential prerequisite
to providing post-disaster or terrorism assistance.
The community that existed before a disaster or
terrorist incident is never the same as what exists
in the aftermath, and these changes are a source
of psychological loss that requires culturally sensi-
tive social and medical healthcare. For example,
displacement was found to be a risk factor for
cardiovascular morbidity among survivors of the
Lebanese Civil War [18].
(Orner, 1995). For example, interviews with 51
Oklahoma City body handlers (many of whom
were inexperienced and knew someone killed)
revealed low levels of self-reported peri-traumatic
stress or depression symptoms that decreased
significantly after 1 year [19]. A small proportion
(<10%) reported acute and chronic PTSD symp-
toms (and also physical health and alcohol use
problems) initially and a year later. Four years
later, firefighter rescue workers and 27 of their
partners [20] reported little evidence of psychiatric
disorders including PTSD.
However over half of the partners described fire-
fighters as having continuing symptomatic difficul-
ties, suggesting that under-reporting may obscure
actual symptom prevalence. Although most first
responders do not report difficulty with PTSD
or psychosocial symptoms, the lasting impact of
traumatic stress on first responders is not limited
to anxiety, but also may involve depression or
suicidality and substance abuse [19]. The inter-
view study of first responders' primary partners
provided no evidence of heightened risk of family
problems or divorce—although one third of the
partners reported that their relationship with their
spouse had changed permanently since he had been
deployed to respond to the Oklahoma City bomb
site [20]. A number of factors have been empiri-
cally identified that place first responders at risk for
serious and persistent post-traumatic stress prob-
lems (Table 11.1). None of these indicators should
be considered definitive in identifying first respon-
ders who need psychiatric or social services [13],
but they provide a basis for careful observation
that can prevent failures by healthcare providers to
proactively detect responders who are in need of
specialized post-traumatic interventions over time.
11.1.4 Unique Effects on First
Responders and Their Families
Emergency responders (e.g., fire, police, EMS,
search and rescue, emergency management,
military, and construction and transportation
personnel) and recovery workers (e.g., Red Cross,
Salvation Army, FEMA, or other disaster or emer-
gency relief volunteers and personnel) enter the
disaster setting with preparation and relatively
well-defined roles and responsibilities—“with a
job to do,” rather than as “a victim.” However,
the line between responder and victim often blurs
in the midst or aftermath of disaster (e.g., emer-
gency responders often are killed or injured, lose
team members to death or injury, and witness
death, suffering, and destruction). First responders
and recovery workers receive and provide a great
deal of emotional/social and practical support—but
only for a relatively limited time. First responders
surveyed soon after rescue and relief operations
often acknowledge experiencing traumatic stress
reactions (both during deployment and afterward),
but typically describe them as manageable and
transient unless exacerbated by co-worker deaths
or recurrent or particularly horrific traumatic inci-
dents or by subsequent work or life stressors
11.2 Management of Acute Traumatic
Stress and Grief Reactions in Patients
and Staff
The first job for hospital-based psychiatry and social
services providers in the wake of terrorist inci-
dents is to identify and manage the acute traumatic
stress and grief reactions of patients first and also of
staff. Healthcare providers and hospital staff are first
