Bioterrorism and Frontline Medical Providers: Psychological Pointers

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Bioterrorism and Frontline Medical Providers
Psychological Pointers
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The Psychology of Bioterrorism

• Differences between terrorism and other types of
  disasters
• Bioterrorism is a special case of terror

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Incidence of Psychological Reactions

• Sarin Attack on Tokyo Subways
• Killed 12
• Severely injured 62
• Hospitalized 984
• Examined and discharged 4023
• Estimates of psychological reactions versus real
  exposure have been as high as 51

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Anticipating the Reactions and Initial Responses

• A concern for basic survival. Fear and anxiety
  about personal safety and the physical safety of
  loved ones.
• Grief over loss of loved ones and loss of valued
  and meaningful possessions.
• Concerns about relocation and the related
  isolation or crowded living conditions.
• A need to talk about events and feelings.

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Anticipating the Reactions and Initial Responses
(continued)

• Do say or do
• These are normal reactions to a disaster.
  (educate about normal reactions)
• Attend nonverbally allow silence, maintain good
  eye contact, empathic facial expressions, nod or
  mutter uh-huhs,
• Paraphrase and reflect feelings So youre
  saying that . . . They need to know that you
  are trying to understand.
• It is understandable that you feel this way.
• You are not going crazy. (This is a real fear
  when people undergo psychological deompensation.
  They may think they see dead loved ones, for
  example).
• It wasn't your fault, you did the best you could.
  
• Things may never be the same, but there is the
  chance of things getting better.

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Anticipating the Reactions and Initial Responses
(continued)

• Don't say or do
• It could have been worse.
• You can always get another pet/car/house.
• It's best if you just stay busy.
• I know just how you feel.
• You need to get on with your life.

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Dealing with More Complicated Psychological Impact

• Domain Negative Responses Positive Responses
• Cognitive Confusion,
  disorientation, Determination, courage,
• worry, intrusion identify problem
• decreased concentration,
• Emotional Shock, sorrow, grief, Feeling
  involved, sadness, fear, challenged
• sleep difficulties
• Interpersonal Withdrawal, anger Affiliation,
  helping altruistic behavior
• Physiological Fatigue, headache, Alertness,
  muscle tension, activation
• increased heart rate,
• hyperarousal, nausea

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Dealing with More Complicated Psychological
Impact (continued)

• Determination and fearlessness
• Identify immediate problem.
• Feeling involved, altruism, and helping
• Alertness and activation.

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When to Refer for Mental Health Services

• Triage Problem of real vs. functional symptoms
• Chest pain Difficulty breathing Shock
  symptoms Fatigue Nausea/vomiting Dizziness Pro
  fuse sweating Rapid heart rate Thirst Headaches
   Visual difficulties Clenching of
  jaw Nonspecific aches and pains

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When to Refer for Mental Health Services

• Disorientation - dazed, memory loss, inability to
  give date or time, state where he or she is,
  recall events of the past 24 hours or understand
  what is happening,
• Depression - pervasive feelings of hopelessness
  and despair, unshakable feelings of worthlessness
  and inadequacy, withdrawal from others, inability
  to engage in productive activity
• Anxiety - constantly on edge, restless, agitated,
  inability to sleep, frequent frightening
  nightmares, flashbacks and intrusive thoughts,
  obsessive fears of another disaster, excessive
  ruminations about the disaster
• Mental Illness - hearing voices, seeing visions,
  delusional thinking, excessive preoccupation with
  an idea or thought, pronounced pressure of speech
  (e.g., talking rapidly with limited content
  continuity)
• Inability to care for self - not eating, bathing
  or changing clothes, inability to manage
  activities of daily living
• Suicidal or homicidal thoughts or plans
• Problematic use of alcohol or drugs
• Domestic violence, child abuse, or elder abuse

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Longer-Term Effects Checklist

• Nightmares
• Intrusive thoughts
• Uncontrolled affect
• Relationship problems
• Job/school related problems
• Decreased libido
• Appetite change
• Blame assignation
• Decreased immune response

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Signs That You May Need Stress Management
Assistance

• Difficulty communicating thoughts
• Difficulty remembering instructions
• Difficulty maintaining balance
• Uncharacteristically argumentative
• Difficulty making decisions
• Limited attention span
• Unnecessary risk-taking
• Tremors/headaches/nausea
• Tunnel vision/muffled hearing
• Colds or flu-like symptoms.
• Disorientation or confusion
• Difficulty concentrating
• Loss of objectivity
• Easily frustrated
• Unable to engage in problem-solving
• Unable to let down when off duty
• Refusal to follow orders
• Refusal to leave the scene
• Increased use of drugs/alcohol

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Ways to Help Manage Your Stress

• Limit on-duty work hours to no more than 12 hours
  per day
• Make work rotations from high stress to lower
  stress functions
• Make work rotations from the scene to routine
  assignments, as practicable
• Use counseling assistance programs available
  through your agency
• Take frequent, brief breaks from the scene as
  practicable.
• Talk about your emotions to process have seen and
  done
• Stay in touch with your family and friends
• Participate in memorials, rituals, and use of
  symbols as a way to express feelings
• Pair up with a responder so that you may monitor
  one another's stress

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Taking Care of Yourself While You Are Taking Care
of Them

• Psychological Self-Care
• Make time for self-reflection. Schedule routine
  times to go to the chapel or place that induces
  meditation for you. Notice your inner
  experiences -- listen to your thoughts,
  judgments, beliefs, attitudes, and feelings.
  Take time to do nothing so that you can hear
  them. Write in a journal.
• Have your own personal psychotherapy
• Read literature that is unrelated to work
• Share your thoughts and feelings aloud with
  others, particularly colleagues.
• Engage your intelligence in a new area, e.g., go
  to an art museum, history exhibit, sports event,
  auction, theater performance
• Say no to extra responsibilities sometimes

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Taking Care of Yourself While You Are Taking Care
of Them

• Emotional Self-Care
• Spend time with others whose company you enjoy
• Stay in contact with important people in your
  life
• Reread favorite books, re-view favorite movies.
  Veg out and soothe yourself.
• Express your outrage in social action, letters,
  donations, marches, protests
• Play with children

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Special Populations

• Children
• Young children may regress (e.g., thumbsucking,
  afraid of strangers, monsters, darkness, etc.).
• They may seek more contact and reassurance from
  parents and other caregivers.
• School performance may drop.
• Help by creating routine and structure.
  Temporarily lower your performance expectations.
• Limit television watching

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Resources

• Psychological First Aid Manual
• Self-Care for Providers
• Alcohol, Medication, and Drug Use After a
  Disaster
• Family Planning for Disasters How to Plan and
  Protect Your Familys Health
• How You Can Support Well-Being in Disaster
  Victims
• http//www.ncptsd.vagov/pfa/PFA.html?printableye
  s
• How at risk am I or my family?
• Name of specific agent
• How is agent being transmitted
• How rapidly it might spread
• How one can protect self and family
• Recommendations of your communitys Department of
  Public Health
• www.bt.cdc.gov

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Resources (continued)

• Field Manual For Mental Health and Human Service
  Workers in Major Disasters
• Training Manual For Mental Health and Human
  Service Workers in Major Disasters
• www.samhsa.gov/centers/clearinghouse
• Family Preparedness Plan
• Emergency Supply Kit
• http//www.nctsnet.org/nctsn_assets/pdfs/edu_mater
  ials/9-1120Card20Material20-20NRC-sw.pdf