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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 HOSPITAL AS A PATIENT CARE PROVIDER: PATIENT CARE STRATEGIES II Patient Care Strategies Expand surge capacity Conduct behavioral triage Conduct behavioral intervention Manage contamination, isolation, and quarantine Maintain quality patient care Support patient families Meet special population needs Provide culturally-competent care Communicate with the public Plan Prepare & Mitigate Respond Recover Pre-event Event Post-event Train Drill Evaluate Activate Restore Evaluate Patient Care Strategies II Key Concepts Manage contamination, isolation, and quarantine Maintain ongoing quality patient care Strategy: Manage Contamination, Isolation, and Quarantine Patient Care Strategies Expand surge capacity Conduct behavioral triage Conduct behavioral intervention Manage contamination, isolation, quarantine Maintain quality patient care Support patient families Meet special population needs Provide culturally-competent care Communicate with the public Plan Prepare & Mitigate Respond Recover Pre-event Event Post-event Train Drill Evaluate Activate Restore Evaluate Goal: Manage Special Contingencies Care effectively for patients who are potentially contaminated or must undergo isolation or quarantine. Plan for Special Contingencies Potentially-exposed patients Patients selected for: Decontamination Isolation Manage Special Contingencies— Potentially-exposed Patients Potentially-exposed Patients Provide full registration for all victims. Provide written information after decontamination, triage, and initial treatment, including agent-specific information. Provide information as it becomes available: Patient care information Test results Credible event information Emphasize the positive actions being taken. Source: Barbera & McIntyre,2003, Jane’s Mass Casualty Handbook: Hospital Potentially-exposed Patients Monitor patients under observation for delayed symptoms. Enroll discharged patients in a surveillance system. Provide behavioral health evaluation and referral if indicated. Provide written information on normal reactions to stress and community resources. Source: Barbera & McIntyre,2003, Jane’s Mass Casualty Handbook: Hospital Manage Special Contingencies— Patients Needing Decontamination Decontamination Behavioral Goal: Decrease hyperarousal Decrease anxiety and fear Strategies: Explain procedure Remove activities from public view Permanent Decon Area Jackson Memorial Medical Center, Miami, FL Post-Decontamination Triage Area Jackson Memorial Medical Center, Miami, FL Manage Special Contingencies— Patients Needing Isolation “Virtual visit” to the hospital during the SARS outbreak, Hong Kong, 2003 Public Health Disease Containment Quarantine: Compulsory physical separation, including restriction of movement, of populations or groups of healthy people who have been potentially exposed to a contagious disease, or efforts to segregate these persons within specified geographic areas. Source: Barbera et al., 2001 Public Health Disease Containment Isolation: Separation and confinement of individuals known or suspected (via signs, symptoms, or laboratory criteria) to be infected with a contagious disease, to prevent them from transmitting disease to others. Source: Barbera, et al., 2001; Gostin 2000 Public Health Disease Containment Quarantine Possible infection with contagious disease Isolation Confirmed infection or contagious disease Behavioral Health Implications of Isolation/Quarantine Behavioral Goals Reduction of psychological distress Compliance with containment measures Stressors Separation from loved ones Fear of impending illness Fear of death Stigma Social isolation Behavioral Health Implications of Isolation/Quarantine Strategies Provide basic needs Provide information as it becomes available Maintain communication with loved ones Provide access to media Provide psychoeducation Provide compassionate/empathic care Provide behavioral health support SARS, 2003 SARS, 2003 In Hong Kong and Singapore: Mandatory quarantines implemented in large residential areas 50% of the population fled before quarantine could be enforced In Canada: Voluntary “shielding” strategy implemented Extensive public education Home visits by doctors Worked well Source: Pilch, 2004 Shelter in Place (Shielding) Citizens instructed to remain at home for several days or weeks Self-imposed measure to contain or minimize an epidemic Education, information, food, and access to home health care provided Alternative to quarantine Source: Pilch, 2004 Shelter in Place (Shielding) Maintains normal routines Keeps families together Decreases traffic flow Minimizes patient surge Targets delivery of health services to persons developing symptoms Minimizes restrictions on civil liberties Source: Pilch, 2004 Behavioral Health Perspective: Manage Contamination, Isolation, and Quarantine When dealing with special contingencies due to contamination or infection… Plan for the behavioral needs of patients who are exposed or require decontamination or isolation. Strategy: Maintain Ongoing Inpatient Care Patient Care Strategies Expand surge capacity Conduct behavioral triage Conduct behavioral intervention Manage contamination, isolation, and quarantine Maintain quality patient care Support patient families Meet special population needs Provide culturally-competent care Communicate with the public Plan Prepare & Mitigate Respond Recover Pre-event Event Post-event Train Drill Evaluate Activate Restore Evaluate Goal: Maintain Ongoing Inpatient Care Maintain quality care for current patients. Manage degradation of care to accommodate the patient surge. Maintaining Ongoing Inpatient Care “In a massive disaster, many chronically ill patients could lose access to their physicians or settings where they usually receive care or obtain medications.” “In a disaster event, care for hospitalized patients may deteriorate.” Source: JCAHO, 2003 Plan for Maintaining Care for Existing Patients Prepare to optimize care for inpatients Prepare for early discharge Prepare for patient transport Prepare for “graceful degradation” of care Plan for Graceful Degradation Treat and board patients in hallways. Ration care and personnel contact as needed. Provide protection from legal actions due to unavoidable delivery of substandard care during declared emergencies. Source: JCAHO, 2003 Track Patients Track patients within the hospital and across the community to achieve the highest-possible quality care and reunite family members Behavioral Health Perspective: Maintain Quality Patient Care While accommodating a surge of incoming patients during a terrorist event… Hospitals must maintain ongoing quality care for current patients and carefully manage degradation of care.