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IX. EMERGENCY EXPOSURE SITUATION IX.8.1 Medical Management of Radiation Injuries Psychological Effects of Radiation Injury IAEA International Atomic Energy Agency Contents • Introduction • Medical consequences of radiation • • • • accidents Psychological consequences of radiation accidents What is psychological stress caused by the accident? What can we do about stress? Management of psychological effects IAEA Introduction • Importance of psychological impact of radiation accidents underestimated in past • Psychosocial effects may far outnumber any direct health effects • Reactions to nuclear and radiological accidents similar • Role of scientific community, and physicians in particular, in influencing public perception of risk and addressing psychological consequences of accidents IAEA Medical Consequences of Radiation Accidents • Health effects directly related to radiation exposure • Deterministic • Stochastic • Health effects indirectly related to radiation exposure • Caused by accident • Caused by intervention IAEA Reasons of Stress Reactions at Radiation Accidents • • • • • • Unknown threat Can not be felt Long term consequences of radiation Conflicting information in mass media Speculation of “radiation theme” by politicians Lack of education of general public, physicians and other professionals • Inadequate actions of official authorities on mitigation of consequences of radiation accidents for general public IAEA What is Psychological Stress Caused by Accident? • Normal reaction to abnormal event • Unusually strong psychological and emotional reactions which could interfere with ability to function during or after accident • Can become post traumatic stress disorder IAEA What is Psychological Stress Caused by Accident? • New diagnostic entity “chronic environmental stress disorder” proposed • Principal characteristics: • apathy, asthenia, diminished interest and “learned helplessness” IAEA Early stress reactions • Physiological • Cognitive • Emotional IAEA Early Physiological Stress Reaction • • • • • • • • Nausea Muscle tremors Sweating Dizziness Chills Increased heart rate Increased blood pressure Hyperventilation IAEA Early Cognitive Stress Reaction • • • • • • Confusion Difficulty in making decisions Impaired thinking Difficulty problem solving Memory loss Calculation difficulties IAEA Early Emotional Stress Reaction • • • • • • • • Anxiety Anger Fear Irritability Sense of guilt Feeling overwhelmed Grief Hopelessness IAEA Late Stress Reactions • Physiological • Cognitive • Emotional IAEA Late Physiological Stress Reactions • • • • • Fatigue Increased use of alcohol and drugs Exaggerated startle response Sleep disturbance Development of somatic disease IAEA Late Cognitive Stress Reactions • Decreased attention span • Poor concentration • Memory problems • Flashbacks IAEA Late Emotional Stress Reactions • • • • • • Feeling abandoned Resentment Feeling alienation Autism Numbness Depression IAEA What Can We Do About Stress? • Accidents can not be predicted BUT Psychological reaction to radiation accident could be mitigated using different programs: • Preventive program • Action program during an accident • Action program after an accident IAEA Preventive Program • Increase of population literacy in the field of radiation influences • Introduction of special course in formation for medical and paramedical staff, police, firemen IAEA Action Program During an Accident • provide timely, clear information to general • • • • public and specialists single trusted spokesperson organization of medical aid station determination of order and ways of evacuation provide psychological assistance IAEA Management of Psychological Consequences After an Accident • • • • • medical response psychological assistance social adaptation material support of the state long term rehabilitation programs of victims IAEA Psychological Stress of Relocation • Correct calculation of a dose of radiation influence • It is required to weigh all pro and contra • Negative impact on mental well being • Elderly people especially likely to suffer IAEA How to Reduce Psychological Effects • • • • • • • Have ongoing information program Give clear, simple and timely advice Provide consistent advice and assessment Use international guidance Ensure protective action justified Correct false information Social support and education IAEA Requirements for Warning Message • • • • • • • • Accurate, timely and complete Clear Simple Sufficient Concrete Consistent Frequently repeated Provided through multiply channels IAEA Psychological Support in Different Types of Accident Accident Psychological support is needed for: Affected victims General public Emergency responders Nuclear (reactor) Yes Yes Yes Criticality Yes Yes Yes Involving lost/stolen sources Yes Yes Not always Transportation Yes Yes Not always Yes, if any Yes Not always Laboratory accidents Yes No No Result of use/misuse of industrial sources Yes No No Medical misadministration in diagnosis and therapy Yes No No Nuclear power satellite re-entry IAEA Psychological Stress of Injured Individuals • Patient needs • Comfort, relief of • • • • • • symptoms Stability and authoritative support Information Concern Hope Control Stimulation IAEA • Patient problems • Overly scientific • • • • • approach Repeated tests, examinations Photographs Reactions of others Too many “experts” Too much media attention Psychological Support of Emergency Responders • Provide instructions BEFORE an event • Should have necessary knowledge about irradiation effects • Should be psychologically prepared to work in stress conditions • Periodic control of state of health of emergency responders, made by physicians, psychologists (psychotherapists); • Medico psychological rehabilitation of emergency responders, if necessary IAEA During an Event • Provide an initial briefing on the following questions: • Mission tasks • Hazards • Radiation protection • Contamination control IAEA During an Event (Continued) • Provide adequate rest • Care, attention (show concern) • Provide guidance IAEA Immediately After, and Continuing as Necessary • Provide debriefing sessions • Provide counseling as needed IAEA Medical Staff Problems • Fear / anxiety • Isolation by others • Lack of knowledge (medical treatment, long term effects, etc.) • New experience: • Interactions with “experts,” public officials, reporters, etc. • Loss of autonomy (activities may be monitored/managed by authorities) IAEA Supporting Mental Health • Role of The Physician in Supporting Mental Health and Reducing The Patient’s Anxieties • • • • • One physician in charge Keep patient and patient’s family informed. Be honest Encourage self-help and family support Assure patient privacy Discuss tactics of dialogue with a patient and his relatives with psychologist • Provide psychological comfort when transferring the patient to other hospitals IAEA What Must We Do After a Radiation Accident ? • Truthful explanation of early and delayed effects of a radiation accident for all categories of involved people • Provision of correct explanation of social and economic compensations for victims • Provision of qualified supervision over delayed health effects of radiation accident of involved people and population with attraction of international experts • Work with mass media IAEA Mitigation of Psychological Consequences • One of the functional requirements • Applicable for all planning categories • Should be performed by facility, local or national level of response • Depending on planning category IAEA Conclusion • Psychological effects – more important in • • • • • current situation What is stress caused by accident? What can we do about stress? Management of psychological effects Psychological support in different types of accidents Mitigation of psychological consequences IAEA
