Download Disaster Behavioral Health Awareness Training for Health Care

DEEP
Center
Disaster Behavioral Health
Awareness Training for
Health Care Professionals
Copyright © 2004: All Rights Reserved
Disaster Behavioral Health Awareness
Training for Health Care Professionals
James M. Shultz MS, PhD
Zelde Espinel MD, MA, MPH
Raquel E. Cohen MD, MPH
Jorge R. Insignares MD
Lisa Rosenfeld MPH
DEEP Center
University of Miami
School of Medicine
Brian W. Flynn EdD
Rear Admiral, USPHS (Ret)
Assistant Surgeon
General (Ret)
Jon A. Shaw MD, MS
Department of Psychiatry
University of Miami
School of Medicine
Robert J. Ursano MD
Director, Center for the Study of
Traumatic Stress
Uniformed Services University
of the Health Sciences
Joseph A. Barbera MD
Director
Institute for Crisis, Disaster, and
Risk Management
The George Washington University
Mauricio Lynn MD
Abdul Memon MD
S. Shai Gold
Jackson Memorial Medical Center
University of Miami
School of Medicine
DISASTER BEHAVIORAL HEALTH AWARENESS TRAINING FOR HEALTH CARE PROFESSIONALS
CASE EXAMPLES
Supplement:
Case Examples
Case 1: Chemical Weapons
Site: Israel, Gulf War, 1991
Perpetrator: Iraq
Agent: Scud missiles with
possible poison gas payload
Scud Missile Attack, Israel, 1991
Case 1






January 18 - February 28, 1991
23 missiles attack alerts
5 false alarms
1,059 ER visits
234 direct casualties (22%)
825 behavioral and psychological
casualties (78%)
 Psychological:Medical = 3.5:1
Source: Karsenty et al. 1991
Scud Missile Attack, Israel, 1991
Case 1
Suffered acute
anxiety: 544
Auto-injected
atropine without
exposure to the
agent: 230
Died: 11
 7 suffocated in their gas masks
 4 fatal heart attacks
Injured while
running to sealed
rooms: 40
Source: Karsenty et al. 1991
Case 1
Scud Missile Attack, Israel, 1991
Lessons learned
 More fatalities were
from fear behaviors
than from missile
impact.
 More hospitalizations
were for
psychological
responses than for
medical injury.
psychological
“footprint”
medical
“footprint”
Case 2: Chemical Weapons
Site: Toyko Subway, 1995
Perpetrator: Aum Shinrikyo cult
Agent: Sarin Gas
Sarin Attack, Tokyo, 1995
Case 2
 May 20, 1995: Monday
morning rush hour
 Simultaneous, multipoint attack
 Sarin placed on 5
trains converging on
central Tokyo
 15 stations affected
 Major focal point:
Kasumagaseki station
Source: Olson, 1999
Sarin Attack, Tokyo, 1995
 5,510 treated in 280
medical facilities
 1,046 admitted to
98 facilities
 134 responders
among the injured
 12 deaths
 >4,000 had no medical
signs of injury or exposure
 Psychological:medical = >4:1
Case 2
Sarin Attack in Tokyo Subway
Case 2
Examined and
discharged:
4023
Hospitalized: 984
Severely
injured: 62
Killed 12
Source: Norwood, 2002
Sarin Attack, Tokyo, 1995
Lesson learned
Case 2
Psychological casualties outnumbered
medical casualties.
psychological
“footprint”
medical
“footprint”
Case 3: Radiological Contamination
Site: Goiania, Brazil, 1987
Perpetrator: None (non-terrorist)
Agent: Cesium 137 from abandoned
radiotherapy device—1,600 Curies
released
Radiological
Contamination, 1987
 112,000 people sought
medical examinations
 Many had vomiting and
diarrhea although they
were not contaminated
 Reports of fainting from
fear at monitoring
stations
Lesson learned: Individuals
can exhibit symptoms
without exposure.
Case 3
Case 43: Surat Plague Outbreak
Site: Surat, India 1994
Perpetrator: none (non-terrorist)
Agent: Yersinia pestis
Surat Plague Outbreak
1994
 September 1993
earthquake in the
state of
Maharashtra
 Decline in public
health measures
 Increase in rat
population
Case 4
Surat Plague Outbreak
1994
 150 cases/28 fatalities
 Physicians and
pharmacists fled the
city with antibiotics
 Hoarding of antibiotics
 Within 4 days, one
quarter of population
left the city
 Rumors of bioterrorism
Case 4
Lesson learned:
Lack of risk
communication
leads to widespread
fear behaviors
among the public
and professionals.
Case 5: Biological Weapons
Site: US Mail System, 2001
Perpetrator: Domestic terrorist ?
Agent: Modified anthrax
Bioterrorism
Fall 2001 Anthrax
Outbreak via the
U.S. Mail
Release of several
grams of anthrax
spores in 7 mailed
envelopes
Case 5
Bioterrorism
Fall 2001 Anthrax Outbreak
 5 deaths
 18 nonfatal infections
 30,000 employees
treated with
antibiotics
 Hoarding of
Ciprofloxacin
Case 5
Bioterrorism
Case 5
Fall 2001 Anthrax Outbreak
Shutdown of:
 Brentwood mail processing center
 US House of Representatives
 Hart Senate
Office Building
 Supreme Court
 HHS Building
Bioterrorism
Case 5
Fall 2001 Anthrax Outbreak
 HAZMAT calls: 60,000 excess calls
nationwide in first 2 weeks
 In this outbreak, fear was “contagious”
 “Anthrax anxiety” was common
 “Contagious somatization”: anxious
search for physical symptoms
suggesting contagion
Bioterrorism
Case 5
Fall 2001 Anthrax Outbreak
 Accusations of differential, discriminatory
treatment of postal workers relative to
government office workers
Lessons learned:
1.Even a small-scale
event has cascading
effects.
Source: Ursano, 2003
2.Terrorism cuts
along the fault lines
of society
Case 6: Severe Acute
Respiratory Syndrome (SARS)
Site: Asia, North America, and Europe
Perpetrator: None (non-terrorist)
Agent: Corona virus
SARS
 Walking off the job
 Absenteeism
 Stigmatization of
patients, their doctors
and neighbors
 Discrimination
 Loss of jobs
 45% of a group of 150
patients who have
recovered from SARS
had psychiatric
problems
Source: New York Times, 2003
Case 6
“Virtual
visits” to
the
hospital
Lesson learned:
Epidemic infectious
disease can generate
fear behaviors
among health care
providers.
Case 7: Flu season 2003-2004
Site: North America
Perpetrator: None (non-terrorist)
Agent: Influenza virus
Flu Fears
Case 7
 Virulent strain of the
influenza virus created
widespread outbreaks in
several states.
 Deaths of young children
prompted fear.
 Citizens rushed to be
vaccinated.
 Vaccine shortages
occurred nationwide.
* Typical annual death toll
from flu: 36,000
Orange County, Florida:
Thousands line up for free flu shots
Flu Fears
Case 7
 In January 2004, CDC
announced that the
influenza vaccine did
not offer protection
against the outbreak
strain of influenza
Lessons learned:
1. Epidemic disease produces widespread fear
among the general population.
2. Deaths of children exacerbate fears.