NJ Preparedness Training Consortium

1. NJ Preparedness Training Consortium Psychological Aspects of Bioterrorism & Disaster Response For Nursing Professionals

2. The Ultimate Tool of The Terrorist… • Is not chemical, biological, nuclear or radiological……. It is psychological, Terror of Fear

3. Officials Must Consider the Possibility of…. • Extreme fear and panic • Blame and mistrust of authorities • Mass Sociogenic Illness • Misattribution of Normal Arousal

4. Understanding Terrorism • The goal of terrorism is the creation of extreme fear, destroying the individual and communal sense of safety and security.

5. Assisting Victims of Terrorism • Neighbor-Helping-Neighbor Approach

6. The Roll of Nursing in the Era of Bioterrorism As one of the most trusted professions in America, nurses are uniquely positioned to provide information regarding disaster preparedness to the community. November 14-16, 2003 CNN/USA Today/Gallup

7. The Roll of Nursing in the Era of Bioterrorism • Nurses must have a personal and family disaster plan

8. How to Prepare for National Emergencies: What You Can Do • There are three initial steps that families can take: • Assemble an emergency supply kit • Develop a family communication plan • Learn more about the different types of emergencies you could face • http://www.ready.gov

9. Emergency Kit Contents • At least three days worth of water, including one gallon per person per day for drinking and sanitation purposes • At least a three-day supply of non-perishable food • Prescription medications, a first aid kit and a first aid manual • One blanket, change of clothing and footwear per person • Extra set of keys, a credit card, cash or traveler’s checks • Flashlight and extra batteries/Battery-powered radio and extra batteries • Important documents like birth certificates

10. Family Communication Plan Contact Name_______________________________ Telephone Numbers Work______________________ Home______________________ Cell______________________ Out of Town Contact__________________________ Telephone Numbers Work_____________________ Home______________________ Cell______________________ Neighborhood Meeting Place _________________ Meeting Place phone number___________________ Dial 9-1-1 for Emergencies

11. STRESS • 43% of all adults suffer adverse health from stress. • 75 to 90 % of all physician office visits are for stress-related . • Stress is linked to the 6 leading causes of death– heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide.

12. Medical Care/NursePolice/Fire/EMS/Rescue Workers • Individuals who traditionally work in stressful environments often develop various coping skills and strategies. • Resilience & Recovery - Core Identity Development/Personality - Learned behavior & reactions - Typical response to difficult situations

13. Medical Care/NursePolice/Fire/EMS/Rescue Workers • Skills enable response to maintain a level of function, especially during difficult situations • Approaches  can be considered healthy or positive. • Approaches  can have a negative or unhealthy consequence.

14. Medical Care/NursePolice/Fire/EMS/Rescue Workers • They can be appropriate for the individuals involved. • They may seem unusual or strange to an outsider.

15. People can use rituals to find comfort • Family • Friends • Activity • Religion/Spirituality

16. Even the most experienced and skilled professionals can be affected by their work.

17. Acute Stress Vs. PTSD • Difference • Long term impact

18. Symptoms of a Stress Reaction • Can last • a few days • a few weeks • a few months • and occasionally longer • Support and understanding of loved ones needed

19. Difficulty feeling love and intimacy Difficulty taking interest and pleasure in day-to-day activities Symptoms of a Stress Reaction

20. Symptoms of a Stress Reaction • Professional assistance may be necessary

21. Types of Traumatic Events • Natural Disasters • Technological Disasters • Disasters of Human Intention • Other Interpersonal Violence • Sudden Traumatic Loss • Serious Medical Illness

22. What is a Traumatic Incident? • A situation that is extraordinary and may overwhelm coping mechanisms

23. Traumatic Stress reactions can be broken down into 4 categories: • Emotional • Cognitive • Behavioral • Physical

24. Feelings of shock Anxiety Guilt Grief Severe panic Fear Intense anger Irritability Agitation Resentment Shame Emotional

25. Blaming someone Confusion Heightened or lowered awareness Indecisiveness Self-blame Poor concentration Memory problems Nightmares Intrusive images Cognitive

26. Change in activity Change in speech patterns Withdrawal Emotional outbursts Change in sexual functioning Erratic movement Antisocial acts Suspiciousness/ paranoia Behavioral

27. Fatigue Nausea Muscle cramps Chest pain Difficulty breathing Elevated blood pressure Rapid heartbeat Thirst Headaches Physical

28. TRAUMATIC STRESS • Years ago, PTSD was commonly called “combat fatigue” “soldiers heart” or “shell shock.” • Many people believed that only soldiers or other people who had been in a war could get PTSD.

29. Traumatic Stress • Trauma is considered an event outside the normal range of experience.

30. Learning from Our Past Experience • The mental fallout from the Oklahoma City bombings in 1995 didn’t peak until 12 to 18 months after the event.

31. Beyond the range of normal experience

32. The New York State Office of Alcoholism and Substance Abuse Services • reports that demand for alcohol and drug treatment in New York City increased immediately after the World Trade Center attacks.

33. Phases of Disasters (Zunin/Myers) • PREDISASTER • HEROIC • HONEYMOON • DISILLUSIONMENT • RECONSTRUCTION Trigger Events & Anniversary Reactions 1 to 3 Days TIME FRAME 1 to 3 Years

34. Who is at greatest risk for severe stress symptoms?

35. Rescue workers Medical Personnel Leaders “Hero” Persons deemed responsible Media representatives Elderly Children Single parents Injured Bereaved Groups Potentially Vulnerable to Terror-Related Issues Demartino 2001

36. Who is at greatest risk for severe stress symptoms? • Workers who directly experience or witness any of the following during or after the disaster are at greatest risk for severe stress symptoms and lasting readjustment problems

37. Who is at greatest risk for severe stress symptoms? • Life threatening danger or physical harm (especially to children)

38. Who is at greatest risk for severe stress symptoms? • Exposure to gruesome death, bodily injuries, and seriously injured persons.

39. Who is at greatest risk for severe stress symptoms? • Extreme environmental or human violence or destruction

40. Who is at greatest risk for severe stress symptoms? • Loss of home, valued possessions, neighborhood, or community

41. Who is at greatest risk for severe stress symptoms? Workers who experience: • Loss of communication with or support from close relations

42. Who is at greatest risk for severe stress symptoms? • Workers who experience: • Extreme fatigue • Weather exposure • Hunger • Sleep deprivation

43. Who is at greatest risk for severe stress symptoms? • Workers who experience: • Intense emotional demands (such as searching for possibly dying survivors or interacting with bereaved family members)

44. Who is at greatest risk for severe stress symptoms? • Extended exposure to danger, loss, emotional/physical strain

45. Who is at greatest risk for severe stress symptoms? • Workers who experience: • Exposure to toxic contamination • Gas or fumes • Chemicals • Radioactivity

46. Risk Factors:Summary • Life threatening danger/physical harm • Exposure to gruesome death and bodily injury • Extreme environmental/human violence or destruction • Loss of home, possessions, community • Loss of communication with, or support from, close relations

47. The psychological problems that may result from disaster experiences include: • Physical reactions: • Tension • Fatigue • Edginess • Difficulty sleeping • Bodily aches or pain • Startling easily

48. Learning from Our Past Experience • One year after the bombing, 3 times as many residents of Oklahoma City reported increased drinking as those in a control community (Indianapolis). • Elevated rates of substance abuse, depression and suicide.

49. Distrust Irritability Conflict Withdrawal Isolation Feeling rejected or abandoned Being distant Judgemental Over-controlling The psychological problems include interpersonal reactions in relationships at school, work, in friendships, interpersonal relationship, or as a parent:

50. What severe stress symptoms can result from disasters? • Most disaster rescue workers only experience mild, normal stress reactions, and disaster experiences may even promote personal growth and strengthen relationships.