1. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org “Worried well” refers to: A.Co-victims of a chemical attack who only think they may have been exposed to an agent B.People living in Western U.S. calling local emergency responders to analyze suspicious powdery substance thought to be anthrax (in Fall of 2001) C.Agitated citizen at a mass dispensing venue denied treatment because their exposure (to whatever) was not credible D.All of the above

2. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org “Worried Well”  Not a unitary phenomena  May consume scarce resources in a mass casualty event

3. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org “Worried Well”  May arrive at a treatment facility first and impede access of those “really injured”  EMS, Public health and hospitals need plans for “worried well”

4. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org “Walk-Ins”  Most disaster victims will self-transfer (not wait for EMS)  May be contaminated

5. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org “Walk-Ins”  Early “walk-ins” will be “worried well” and/or most mobile and less seriously injured  Hospitals need to plan for walk-ins

6. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org Panic: A.Is almost inevitable in the aftermath of any large scale disaster B.Is rare and largely preventable C.Occurs under a circumscribed set of circumstances in which needed resources are scarce and/or escape options are limited D.B and C

7. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org The Myth of Panic  True panic is relatively rare, preventable and largely circumstantial  Historically, people and communities respond cooperatively and adaptively in most natural and manmade disasters: e.g. evacuation of the WTC towers on 9/11/2001

8. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org Sharing Information with the Public  National Threat Level System

9. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org EVERYDAY HAZARDS: Estimated number of injuries requiring hospital visits in 2001, in thousands, from accidents by selected causes. Source: US Consumer Product Safety Commission

10. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org Source: US Consumer Product Safety Commission EVERYDAY HAZARDS : Estimated number of injuries requiring hospital visits in 2001, in thousands, from accidents by selected causes.

11. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org “Dread Risk” We fail to accurately assess or respond to:  Low probability  High consequence events (Gigerenzer, 2004)

12. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org Risky Roads: Car travel and traffic fatalities in the months following September 11, 2001 Total Vehicle miles on rural roads, in millions

13. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org Risky Roads : Car travel and traffic fatalities in the months after September 11, 2001 continued. Traffic accident fatalities Sources: National Highway Traffic Safety Administration; US Department of Transportation

14. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org ?

15. Which post-disaster techniques promote community and individual resilience? A.Timely and accurate risk communication B.Reuniting families and loved ones C.Provide care to those most vulnerable D.All of the above

16. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org Early interventions (during first month post-intervention)  Psychological First Aid  Crisis Counseling

17. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org Psychological First Aid  Support and presence  Reduce psychological arousal – take a breath, you’re going to be OK  “Screen” and mobilize support for those most distressed  Keep families together or facilitate reunions

18. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org Traumatic Incident Stress Information for Emergency Workers NIOSH Guidelines CDC link: http://www.cdc.gov/niosh/unp-trinstrs.html NIOSH Guidelines CDC link:

19. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org Optimal efforts to conduct assessments or early treatment of mental health problems should be conducted within a hierarchy of needs  Survival  Safety  Security

20. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org Optimal efforts to conduct assessments or early treatment of mental health problems should be conducted within a hierarchy of needs  Survival  Safety  Security  Food  Shelter

21. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org Optimal efforts to conduct assessments or early treatment of mental health problems should be conducted within a hierarchy of needs  Survival  Safety  Security  Food  Shelter  Crisis Counseling

22. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org Maladaptive Behavioral Outcomes  Posttraumatic stress disorder  Secondary Traumatization  Depression  Substance and alcohol abuse

23. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org “It is not the event but the effect that makes the disaster.”

24. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org Vulnerable Populations Those with pre-existing or prior mental illness Exposure variables Lack of social resources

25. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org Prior exposure to violence and trauma School aged children (< 10 y.o.) First responders - unique exposure & risk Beaton & Nemuth, J Traumatology 2004 Vulnerable Populations (continued)

26. Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine http://nwcphp.org

27. Questions?