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Responders prepare for psychological aid

by Mary Helen Yarborough
Public Relations
When a disaster strikes, images streaming through the media reveal the resulting physical and structural damage with a glimpse of human reaction. Cameras may capture the external stress on people’s faces but not the depth of agony and psychological trauma that could endure for years.
 
MUSC’s Dean Kilpatrick, Ph.D., has studied communities and people affected by disasters, including those affected by the Pan Am 103 downing over Lockerbie, Scotland; the Sept. 11, 2001 terrorist attacks on New York City; Hurricane Hugo;  and Florida’s four-hurricane summer of 2004.
 
Research in which Kilpatrick was involved concluded that while many people are stressed during and long after a disaster, most people do not seek help even if help is readily available.
 
In 1988, Libyan-backed terrorists exploded a packed Pan Am Flight 103 as it passed over Lockerbie, Scotland. Hundreds of people lost loved ones, many of them American college students returning home from a summer trip. Although the U.S. Office of Victims of Crime authorized payment for mental health services to the families, only 6 percent of them used the funds allowed for the counseling, Kilpatrick said. Forty-eight percent of these families had emotional or behavioral problems, but only 36 percent sought treatment. About three-fourths of those who sought treatment thought it was helpful, he said.
 
What causes people to avoid seeking help when they truly need it is the fear of the stigma attached to psychological disorders. “And many people simply go into denial” about how an event has affected them, Kilpatrick said.
 
“Smokers smoke more, people who drink will drink more,” Kilpatrick said.
 
Kilpatrick’s studies generally concluded that while the prevalence of post-disaster post-traumatic stress disorder (PTSD), major depression and generalized anxiety disorder (GAD) were substantial, most people were resilient; and PTSD and MD increased risk of alcohol and tobacco use.
 
After four hurricanes struck Florida in 2004, Kilpatrick and his team of researchers conducted surveys of residents in two-thirds of the state. They found that about 11 percent of the population met the criteria for at least one of the three disorders: PTSD, GAD, and major depression in the six to nine months after the hurricanes struck.
 
A number of disasters could strike the Charleston area: hurricanes, earthquakes, plane crashes, bridge collapses, chemical and biological releases, and terrorist attacks. Aspects of so-called “silent disasters” would include bioterrorism and exposure to toxic agents that increase psychological trauma, Kilpatrick said. Even in situations in which people have not been exposed to toxic agents, such as during Three Mile Island (TMI), public panic persists. “In 1979, the nuclear reactor at Three Mile Island almost had a meltdown, but there was minimal, if any, actual discharge of radioactive material,” Kilpatrick said. “Therefore, any effects of the Three Mile Island incident were due to concerns about possible exposure or perceptions that they may have been exposed, rather than the actual effects of radiation.”
 
Kilpatrick said a five-year follow-up after the 1979 TMI incident found that residents who lived within five miles of the plant had higher levels of distress, somatic complaints, anxiety symptoms, higher levels of stress hormone, increased blood pressure, and more physician-rated problems that required prescribed medications.
 
These cases can turn from disasters to crises, which must be managed vigorously. Similar reaction could be anticipated following bioterrorism, radiation exposure or exposure to toxic substances in which people are physically harmed.
 
“Our primary role should be to provide accurate information and help manage hysteria,” Kilpatrick said.
 
Connie Best, Ph.D., has worked with AHEC to educate responders and health officials about how to address those psychologically harmed. She has developed a tool, Psychological First Aid Behavioral Checklist, that helps responders and health providers assess a victim’s mental state and level of psychological trauma.
 
“Any comprehensive disaster preparedness plan should also include ways to address the immediate psychological needs of the community,” Best said.
 
The number of people experiencing psychological effects will generally outnumber those who have been physically injured, Best said.
 
For example, about 2,800 people were killed on Sept. 11, 2001, but those who perished left behind an estimated 12,000 relatives, most of whom were emotionally devastated.
 
Twelve years after the Pan Am disaster, 300 families were evaluated for chronic psychological illness at the loss of their loved ones. Forty-eight percent of them had emotional or behavioral problems that required mental health treatment.
 
So while first responders are tending the physically injured, communities are urged to better aid those whose injuries don’t bleed or burn. The psychologically wounded will create a surge on health care facilities and could overwhelm response operations.
 
Many who are physically injured from a disaster may walk away from the hospital, but their injuries inside may have just begun. Shattered nerves and broken hearts aren’t easily repaired like bridges and buildings. That’s why MUSC and AHEC are working to educate the first response and health care communities to be prepared for the walking wounded and the psychological toll that disasters can take on a community.
 
Kilpatrick offered six suggestions for improving community disaster response:
  • Improve preparation. “This is hard, because denial is powerful, and preparation means we have to think about bad things that might happen,” Kilpatrick said.
  • Disseminate research-based knowledge about disaster-related mental health problems and interventions to mental health and public health professional, disaster relief agencies and public policy officials.
  • Forget the notion that mental health response equals counseling disaster victims. “The issue is much bigger than that,” Kilpatrick said.
  • Develop and disseminate psycho-educational self-help materials that are useful to the vast majority of disaster survivors who never develop mental disorders after disasters.
  • Use what we know about human behavior to improve disaster preparation and delivery of post-disaster services.
  • Use our knowledge and expertise to strengthen communities and foster resilience.
   

Friday, Aug. 24, 2007
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