Brian W. Flynn

Integration of disaster mental health services with emergency medicine.

Despite limited resources, emergency medical settings will be called upon to play many roles in the context of disasters and terrorist attacks that are related to preparedness, surveillance, mental health services delivery, and staff care. Such settings are a central capture site for those individuals likely to be at highest risk for developing mental health and functional problems. Because much of the potential harm to survivors of disaster or terrorism (and their families) will be related to their mental health and role functioning, preparedness requires the active integration of behavioral health into emergency medicine in every component of disaster response. There are many challenges of doing this including: (1) finding ways to integrate activities of the medical care, emergency response, and public health systems; (2) determining whether an incident has actually occurred; (3) making differential diagnoses and managing other aspects of initial medical needs; and (4) coping with the risks associated with system overload and failure. Delivery of direct mental health care must include: (1) survivor and family education; (2) identification and referral of those requiring immediate care and follow-up; (3) group education and support services; and (4) individual counseling. In order for effective response to occur, the integration of psychosocial care into disaster response must occur prior to the disaster itself, and will depend on effective collaboration between medical and mental health care providers. At workplaces, emergency medical care centers must ensure that staff and their families are properly trained and supported with regard to their disaster functions and encouraged to develop personal/family disaster plans.

Development and validation of the Italian version of the 15-item Dispositional Resilience Scale

Studies have shown that psychological hardiness is an important stress resilience resource for individuals. The 15-items Dispositional Resilience Scale (DRS-15) is a short, reliable and valid self-report instrument to measure hardiness that is not available in Italian. The present study was undertaken to create an Italian version of the DRS-15, and evaluate its psychometric properties and validity in the Italian context. An Italian version was produced using multiple independent bilingual translators. This version was administered to a non-clinical sample of adults (N=150), along with measure o psychological well-being (PWB-18) and health. A sub-sample (N = 66) completed the DRS-15 again one month later. Results showed good reliability in terms of internal consistency and test-retest stability. With regard to the subscale, stability was high for all three subscales, whereas two subscales (Commitment and Control) showed marginal internal consistency. DRS-15 total and subscales scores showed a theoretically meaningful pattern of correlations with PWB-18 subscales, supporting the validity of the Italian DRS. Also, multiple regression analysis revealed a correlation between DRS-15 scores and self-rated general health, even after controlling for age and sex. The new Italian DRS-15 provides a valid, reliable and easy to use tool fr assessing stress resilience in clinical and research settings.

Disaster behavioral health: legal and ethical considerations in a rapidly changing field

Disaster behavioral health is increasingly regarded as a central part of disaster preparedness, response and recovery. Legal and ethical issues have received relatively little attention and have sparked divergent opinions. Optimally, understanding and applying legal and ethical considerations requires an understanding of the evolution of the disaster behavioral health field and the context of disaster response and recovery. In addition, there are many legal and ethical questions identified for consideration, and many ways to approach reaching understanding and consensus. Traditionally, discussions of disaster behavioral health, including legal and ethical issues, have not included understanding decision making processes that occur in extreme circumstances. Models which interpret disaster response operations as complex adaptive systems are presented for consideration as useful tools for preparing mental health workers for effectively delivering services in acute disaster response environments.

Communications in the Aftermath of a Major Earthquake: Bringing Science to Citizens to Promote Recovery

ABSTRACT In the immediate and early aftermath of a geological disaster, one major goal of communications by geoscientists should be to provide information that will help those impacted make safe and healthy behavioral choices. This requires moving from answers geared exclusively to the domain of physical science and embracing the art and science of risk and crisis communication. The messages should provide a sense of safety, calming, self‐ and community efficacy, connectedness, and hope. This paper suggests ideas and strategies drawn from the literature of disaster communications and from our own personal experience. We also propose a model draft message to be delivered in the immediate aftermath of an earthquake disaster.

Perception of Earthquake Hazard and Risk in the Province of Quebec and the Need to Raise Earthquake Awareness in This Intraplate Region

ABSTRACT In 2014 and 2015, two telephone surveys were conducted by the Insurance Bureau of Canada to evaluate the perception of earthquake hazard and risk in the province of Quebec, Canada. An additional survey evaluated the uptake of earthquake insurance in Quebec and in British Columbia. The surveys brought to light some sobering aspects regarding the perception and knowledge of earthquake hazard and risk and of individual earthquake response in Quebec. The surveys show that despite the large proportion (>75%) of the population who live in medium‐to‐high hazard zones, most Quebecers remain unaware of the potential danger or downplay the associated risk of damage and falsely assume that their basic insurance policy includes earthquake coverage. Also, only a small proportion of the population (15%) know the appropriate actions to take during an earthquake (i.e., drop, cover, and hold on [DCH]). This situation leads to the question of what role seismologists can play to improve earthquake awareness and preparedness. To increase awareness of the proper reaction during an earthquake, we suggest that seismologists use every opportunity to communicate DCH. The DCH message is especially important when the public’s attention is increased, for example following felt or damaging earthquakes, either local or distant. Seismologists could include DCH in their postearthquake media communications and in their public lectures. The low earthquake awareness is a major impediment to preparedness. Enhancing earthquake preparedness of the general population is a big challenge, and communicating hazard information is just one element of a larger picture. Direct earthquake experiences, attitudes and beliefs, and the perception of personal risks are all important factors in message receptivity with respect to earthquakes. Improving the general public’s preparedness requires coordinated and well‐considered strategies and actions derived from seismological and social sciences knowledge with the active participation of emergency management organizations. In regions with low earthquake awareness, this requires a coordinated, well‐considered long‐term plan with a strong public involvement at the local level.

Stress and resilience in military mortuary workers: care of the dead from battlefield to home.

The death of a military service member in war provokes feelings of distress and pride in mortuary workers who process the remains. To further understand their reactions, the authors interviewed 34 military and civilian personnel to learn more about their work stresses and rewards. They review stresses of anticipation, exposure, and experience in handling the dead and explore the personal, supervisory, and leadership strategies to reduce negative effects and promote personal growth. These results can be applied to many other situations requiring planning, implementing, and supervising mortuary operations involving mass death.

Psychosocial Responses to Disaster and Exposures: Distress Reactions, Health Risk Behavior, and Mental Disorders

Disaster events cause a range of mental and physical health effects. Nuclear exposures result in unique psychological responses by affected individuals and communities. Planning, preparation, response, and recovery are enhanced by a focus on population health management, integration of relevant community and cultural variables, and effective use of risk communication.

Sustaining Integration: A Way Forward

This chapter captures selected key concepts and suggestions from the entire book and presents those as factors that can be used to enhance the probability of sustaining integration when it is established. Also discussed are factors that endanger integration including changes in leadership, authorities, political landscapes, evidence and practice, visibility of positive impact, and competing demands. In addition, suggested foundational elements for sustained integration are discussed. These include mutual trust and respect, demonstrated benefit of integration, adequate and appropriate resources (including human resources), adequate funding, time, and adaptability.

Integration in the Emergency Operations Center (EOC)/Emergency Communications Center (ECC)

The chapter discusses the importance and benefits of integrating disaster behavioral health into the emergency operations centers (EOC) which are lead and organized by emergency managers. The nature of, and special stresses existing in, EOCs and emergency communications centers are discussed. Options for understanding and mitigating these stressors are explored. First person experiences are described. Establishing and practicing integration within these settings is strongly encouraged.

Why Is Integrating Disaster Behavior Health Essential to Emergency Management? Challenges and Opportunities

From an emergency management (EM) perspective, this chapter discusses the integration of disaster behavioral health (DBH) services and EM. It describes the challenges posed by the limited history of the EM profession and the reluctance to address any non-tangible needs of either victims or service providers. The chapter conveys one of the authors’ personal experience in the Oklahoma City Bombing, both a victim and service provider, and how that experience changed procedures within his department. From a disaster behavioral health perspective, this chapter looks at the contributions behavioral/mental health professionals can make to enhance and improve the practice of EM. To illustrate, the author describes how the inclusion disaster mental health (DMH) during planning stages of the response to the Ebola virus outbreak may have anticipated the intense emotional stress and social stigma experienced by medical staff caring for patients with the virus.