Biomedical Engineering Reference
In-Depth Information
strategies that can enable the person to feel more
in control and hopeful, and “connect” the person
with other people who can together form (or recon-
stitute) a viable mutual support system. This is not
psychiatric evaluation or treatment, but is a means
to re-establish affected persons' essential personal
and social resources [21] and provides an oppor-
tunity to begin the process of psychiatric triage by
identifying persons who show signs of persistent
clinically significant psychological distress.
The focus in PFA is on determining the person's
primary concern, from the person's own point of
view, and how you can help them make progress in
achieving that goal within your role. PFA involves
paying attention to one's own emotional and phys-
ical reactions, and using PFA skills to manage
these reactions effectively so that as a provider you
can think clearly and be helpful. PFA follows the
basic code of “primum non nocere” (first do no
harm), by orienting all healthcare provider to not
do anything that creates further stress, confusion,
or pressure for affected persons unless this is
absolutely necessary to ensure safety or resolve
crises. The process in PFA is to observe first,
then ask simple respectful questions, and then say
what you will do to help (preferably describing
a plan that involves affected persons as full part-
ners, rather than simply doing things for or to
them). PFA establishes a vital human connec-
tion and provides accurate simple information that
addresses affected persons' immediate concerns,
thus helping to contain and control terrifying and
still potentially highly dangerous situations and to
build an alliance with affected person that will
make them willing to work with responders and
providers.
“second disaster,” where well-intended response
and recovery efforts backfire and create additional
problems or even traumas for affected persons and
their families and communities. For example, the
media and helpers descended upon bereaved fami-
lies in the immediate aftermath of the Oklahoma
City bombing, until the Red Cross Disaster Mental
Health Services helped the community establish a
Family Center that had very carefully controlled
access and provided families with evidence-based
grief counseling.
The latter case of insufficient system capacity
to meet rapidly spreading mental health needs is
virtually inevitable both in the immediate after-
math and in the mid- to long-term recovery phase
when the initial heroic efforts and the honeymoon
period of initial recovery are followed by exhaus-
tion on the part of not only affected persons but
also responders and the overall response system
[22]. The best scenario is one where a multi-
stage psychiatry and social service response is
planned well in advance, with provisions for rapid
deployment of experienced disaster mental health
responders during the first days and weeks after
an incident, followed by continued gradual deploy-
ment of fresh mental health providers both from
within and outside the affected communities over
the next several months in order to prevent the
existing mental health system from becoming over-
whelmed by subsequent “surges” in psychiatry and
social service cases. A model for strategic psychi-
atry preparedness and staged deployment can be
found at www.ctrp.org.
11.2.3 Identification and Brief Preventive
Interventions with High Risk Individuals
and Families
Despite the benefits of psychiatric and social
services, most people in disaster-affected commu-
nities do not seek help for stress or psycho-
logical problems (Adams et al., 2004), although
persons with prior mental health problems are the
most likely to seek specialized help (Adams et al.,
2004) [20]. Both physical health care and mental
health services tend to show small but significant
increases in utilization in the wake of disaster or
11.2.2 Mitigating the “Second Disaster:”
Providing Psychological Surge Capacity
After the initial catastrophic impact of a terrorist
incident (which may last only minutes or for many
days), the two major risks for affected persons
and communities are that the response efforts
may inadvertently worsen conditions (iatrogen-
esis) or may be insufficient to meet their needs
[22]. The former case has been described as the
