Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine “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

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

Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine “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”

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

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

Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine 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

Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine 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

Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine Sharing Information with the Public  National Threat Level System

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

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

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

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

Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine 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

Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine ?

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

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

Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine 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

Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine Traumatic Incident Stress Information for Emergency Workers NIOSH Guidelines CDC link: NIOSH Guidelines CDC link:

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

Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine 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

Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine 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

Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine Maladaptive Behavioral Outcomes  Posttraumatic stress disorder  Secondary Traumatization  Depression  Substance and alcohol abuse

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

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

Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine 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)

Northwest Center for Public Health Practice University of Washington School of Public Health and Community Medicine

Questions?