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Oklahoma City Federal Building Bombing

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									Oklahoma City Federal
  Building Bombing
     Memories and Milestones
          John R. Tassey, Ph.D.
University of Oklahoma Health Sciences Center
           Oklahoma City, Oklahoma




                      “The day of the bombing is
                      a standard by which all
                      Oklahomans now measure
                      time... “We are simply not
                      the same people we were
                      before.”

                      Stephen Jones,
                      Timothy McVeigh’s lead defense attorney




                                                                1
                         A.P. Murrah Bombing
       Wednesday 19 April 1995 at 9:02 Central Time
• 46% fatality rate inside the Murrah
  Building (92% combined)
• 167 deaths in blast
• Nine children under the age of 6
  killed
• One first responder killed
• 683 people injured
• 800+ people sought medical care

  Oklahoma City Bombing Injuries . Shariat, Mallonee,
  Stidham, Injury Prevention Service Oklahoma State Department
  of Health. December 1998.




                   A.P. Murrah Bombing
                                               • 324 buildings within a
                                                 sixteen-block radius
                                                 destroyed or damaged
                                               • 258 additional nearby
                                                 buildings had shattered glass
                                               • 86 cars destroyed or
                                                 burned[3][4
                                               • $652 million damage][5




                                                                                 2
        OKC Federal Building Bombing
                Survivors
      Percentage of approximately 550
                employees
100
 90
 80
 70
 60
 50
 40
 30
 20
 10
  0




                                              Psychiatric disorders among survivors of the Oklahoma City
                                              Bombing. (1999) North, Nixon, Shariat, Mallonee, McMillen,
                                              Spitznagel, Smith. JAMA 1999 282:755-62.




            OKC community impact
           immediately after bombing
                       Percentage
45
40
35
30
25
20
15
10
5
0
          Knew         Attended   Attended   Unable to
        someone        one/more   one/more     work
      injured/killed    funeral   memorial
                                                           North, et.al., (1999) JAMA 1999 282:755-62.




                                                                                                           3
              Survivors of 1995 OKC Bombing
             Reported onset of “PTS” Symptoms
                            1st Day
                             76%




                                                              1st Week
                                                                18%
                                  <6 Months
                                     2%          1st Month
                                                     4%
North, et.al., (1999) JAMA 1999 282:755-62   .




                     PTSD Symptoms (Criterion B)
                      Oklahoma City Bombing (N= 182)

             Reminders



            Flashbacks



            Nightmares


              Intrusive
              Memories


                          0              20         40       60          80


      North, et. al., JAMA 1999 282:755-62.




                                                                              4
              PTSD Symptoms (Criterion C)
                Oklahoma City Bombing (N= 182)

  Sense of 4short'd Future

           Restricted Affect

                Detachment

            Loss of Interest

             Psyc Amnesia

          Avoid Reminders

      Avoid Thot's & Feel'g

                                  0          20        40     60


North, et. al., JAMA 1999 282:755-62.




              PTSD Symptoms (Criterion D)
                Oklahoma City Bombing (N= 182)

 Physiologic Reactivity

          Easily Startled

          Hypervigilance

       Diff Concentrat'g

         Irritability/Anger

                Insomnia

                              0         25        50   75   100



North, et. al., JAMA 1999 282:755-62.




                                                                   5
             Association to PTSD diagnosis
                    Oklahoma City Bombing (N= 182)

              Criterion B                                                                      79



             Criterion C                                   36



             Criterion D               94%                                                        82



    Criterion B, C, & D                                   34


                            0              20               40              60               80              100


   North, et. al., JAMA 1999 282:755-62.




           PTSD Symptom Follow-up Data

   • 137 survivors assessed at approximately 6 and 17
     months post disaster
   • Combined index and follow-up data yielded a higher
     (41%) incidence of PTSD than detected at index
     (32%) or follow-up (31%)
   • All PTSD was chronic (89% unremitted at 17 months)
     with no delayed-onset cases
   • Criterion C, unlike B and D alone, was pivotal to
     current PTSD status
   • The findings at index were sustainable
The course of posttraumatic stress disorder in a follow-up study of survivors of the Oklahoma City bombing. (2004)
North, Pfefferbaum, Tivis, Kawasaki, Reddy, Spitznagel. Ann Clinic Psychiatry. Oct-Dec;16(4):209-15.




                                                                                                                     6
       PTSD Symptoms (Criterion F)
      Oklahoma City Bombing (N= 182)
                   70
                   60                             Diagnosis

                   50                             No Diagnosis
                   40
                   30
                   20
                   10
                    0




North, et. al., JAMA 1999 282:755-62




  Post-Disaster Psychiatric Diagnoses
                  Oklahoma City Bombing (N= 182)


                                                Non-PTSD Dx Only
                              PTSD + Other Dx




                             PTSD Only
                                                          No Diagnosis


                        Other Post-Disaster
                               PTSD




 North, et. al., JAMA 1999 282:755-62.




                                                                         7
Prevalence of Pre - & Post- Disaster Disorders
                        Oklahoma City Bombing (N= 182)

               50
               45                 Pre-Bombing
               40
                                  Post-Bombing
               35
               30
                                                          No New
               25
                                                          Cases!
               20
               15
               10
                5
                0




   North, et. al., JAMA 1999 282:755-62.




          Survivors of 1995 OKC Bombing
                           Reported coping measures

                100
                 90
                                           Diagnosis
                 80
                                           No Diagnosis
                 70
                 60
                 50
                 40
                 30
                 20
                 10
                    0
                            Took Rx Meds         Drank Alcohol     Turned to family



 North, et. al., JAMA 1999 282:755-62.




                                                                                      8
          Survivors of 1995 OKC Bombing
                           Alcohol Use Revisited
• Acknowledged alcohol users from sample of
  OKC bombing survivors seeking counseling
  (N=43)
• Reported increased alcohol use related to
    –   Injury
    –   Retrospective report of initial reaction
    –   Grief
    –   PTS symptoms

• Increased alcohol use related to functional
  impairment
 Pfefferbaum & Doughty (2001). Increased alcohol use in a treatment sample of
 Oklahoma city bombing victims. Psychiatry.64(4):296-303




                                                      "Time heals nothing, "It
                                                        makes it a little more
                                                        bearable, but it heals
                                                        nothing"
                                                      Debi, whose brother, a U.S.
                                                        Department of Housing and
                                                        Urban Development worker,
                                                        was killed in the OKC Bombing




                                                                                        9
      Physiologic Reactivity Seven Years After
            Exposure to Terrorist Event

•     Sixty survivors
•     Sixty age- and gender-matched “controls”
•     Compared on both psychometric and physiologic assessments
       – Heart rate and systolic, diastolic, and mean arterial blood pressures
          were
•     Measured before, during, and after bombing-related interviews
•     Posttraumatic stress was significantly more prevalent in the survivor
      group
•     Survivors had significantly greater autonomic reactivity to trauma
      reminders on all measures than comparison subjects.
•     The results suggest that physiologic assessment may capture long-term
      effects of terrorism that are not identified by psychometric instruments.

Tucker, Pfefferbaum, North, Kent, Burgin, Parker, Hossain, Jeon-Slaughter, and Trautman. Physiologic
    Reactivity Despite Emotional Resilience Several Years After Direct Exposure to Terrorism . Am J Psychiatry
    164:230-235, February 2007.




             Survivors of 1995 OKC Bombing
                      Current Status
• 63% of survivors had utilized psychological
  counseling services
• 94% were employed at the time of the bombing
• 80% of respondents were employed at time of survey
• 14% of survivors had experienced changes in
  employment status since the bombing; of these,
        – 55% were unemployed
        – 24% received medical disability/workers' compensation
        – 21% had taken early or regularly scheduled retirement

    Oklahoma City Bombing Injuries . Shariat, Mallonee, Stidham, Injury Prevention Service
    Oklahoma State Department of Health. December 1998.




                                                                                                                 10
       Morgue and Forensic Recovery Workers
                              OKC Bombing (N= 51/135)

   •    Oklahoma State Medical Examiners Office
   •    Local funeral service employees
   •    NDMS DMORT
   •    54th Quartermaster Graves Registration Unit
   •    OU Pathology and Dentistry Departments
         – Faculty
         – Residents
         – Students
Body Handlers After Terrorism in Oklahoma City:
Predictors of Posttraumatic Stress and Other Symptoms.
(2002)Phebe Tucker MD, Betty Pfefferbaum MD, JD,
Debby E. Doughty PhD, Fred B. Jordan MD, Dan E.
Jones PhD, Sara Jo Nixon PhD. Am J Orthopsy Vol. 72,
No 4, 469-475.




              Morgue and Forensic Recovery Workers
                         OKC Bombing
                                        Demographics
                 •     25 to 56 years old (Average: 34.7 years)
                 •     35 Male
                 •     16 Female
                 •     88% Caucasian
                 •     73% Married
                 •     28 % Knew person(s) killed in bombing

 Tucker, et. al. (2002) Am J Orthopsy Vol. 72, No 4, 469-475.




                                                                  11
     Morgue and Forensic Recovery Workers
                                 Coping Strategies (N = 51)

                     90
                     80
                     70
                     60
                     50
      Percentage




                     40
                     30
                     20
                     10
                      0
                           Attended Visited Site Time w/ Watched Tried to Saw Good
                           Memorials             Others TV/Games Forget     Side
Tucker, et. al. (2002) Am J Orthopsy Vol. 72, No 4, 469-475.




                   Morgue and Forensic Recovery
                         Workers (N=51)

   • 10% workers reported increased alcohol
     use first 2 months after bombing
   • 14% workers reported seeking mental
     health treatment
   • Exaggerated startle response persisted
     one year later
             Tucker, et. al. (2002) Am J Orthopsy Vol. 72, No 4, 469-475.




                                                                                     12
            Morgue and Forensic Recovery
                      Workers
       Post traumatic stress and depression scores
      25

      20

      15

      10

       5

       0
               PTS @ 04-19-95             PTS @ 1 Year           Depres @ 04-19-95   Depress @ 1 Year


Tucker, et. al. (2002) Am J Orthopsy Vol. 72, No 4, 469-475.




      Morgue and Forensic Recovery Workers
      Factors Associated with Higher PTS and
               Depressive Symptoms

  •    Occurrence of new physical problems
  •    Increased alcohol use
  •    Seeking mental health treatment
  •    Not correlated with demographics,
       exposure or experience

      Tucker, et. al. (2002) Am J Orthopsy Vol. 72, No 4, 469-475.




                                                                                                        13
            Perceived effects and recovery in
                    OKC Firefighters
      • Survey of 310 (39%) OKC
        firefighters
      • Surveyed in 1996 & 1998
      • Compared to out-of-state
        firefighters (N=106)
      • Age range from 21 to 60 years
      • Non-Hispanic White = 84%
      • Years firefighting from 0 - 30
        years
      Perceived effects and recovery in Oklahoma City Firefighters. Nixon,
          et. al. (1999). Journal of the Oklahoma State Medical
          Association. Vol. 92, No. 4, April. Pp. 172 - 177.




                            OKC Firefighters
                          Number of Days on Site
               Number of Firefighters
200
180
160
140
120
100
 80
 60
 40
 20
  0
      No days 1 day 2-8 days                9-13        >13
                                            days        days
                 Nixon, et. al. (1999). Journal of the Oklahoma State Medical Association. Vol. 92,
                 No. 4, April. Pp. 172 - 177.




                                                                                                      14
                     OKC Firefighters:
                 Perceived effect of bombing
60

50

40

30

20

10

  0
        Severe Moderate            Mild             Don't know
                                            No Effect

Nixon, et. al. (1999). Journal of the Oklahoma State Medical Association. Vol. 92,
No. 4, April. Pp. 172 - 177.




                                OKC Firefighters:
           Helpfulness of Mitchell-Model CISM

                                          40
                                          35
                                          30
                                          25
                                          20
                                          15
                                          10
                                            5
                                            0
                                                     Very          Somewhat                Not   Couldn't
                                                                                                   Tell
      Nixon, et. al. (1999). Journal of the Oklahoma State Medical Association. Vol. 92,
      No. 4, April. Pp. 172 - 177.




                                                                                                            15
                   OKC Firefighters:
            Perceived recovery @ one year
    50
    45
    40
    35
    30
    25
    20
    15
    10
     5
     0
                Not Recovered                 Somewhat Recovered                      Full Recovery
 Nixon, et. al. (1999). Journal of the Oklahoma State Medical Association. Vol. 92,
 No. 4, April. Pp. 172 - 177.




                 OKC Firefighters:
         Post-bombing diagnoses 3 years after
                        1995 OKC Bombing (N = 181)
                                                   Diagnoses

                                                                   PTSD

                                                                            Major Depressive Disorder



               No diagnosis




North, et. al. 2002: J Traum Stress 15: 171-5 Am J Psychiatry
159:857-9




                                                                                                        16
                                  OKC Firefighters:
                         Post-bombing Alcohol Use
                                                  (N = 181)
   50
   45
   40             Pre-
                  existing
   35
   30
   25
   20
   15
   10
    5
    0
          OCFD Post Bomb                Wagner, et.al.            Boxer & Wild          OCFD Lifetime
                                          (1998)                    (1993)

          North, et. al. 2002: J Traum Stress 15: 171-5 Am J Psychiatry 159:857-9




                OKC Firefighters
      Perceived Levels of Emotional Support

            50
            45
            40                                                        Spouse
            35
                                                                      Co-workers
            30
            25                                                        Faith
            20
            15
            10
              5
              0
                    Very High    High        Mod         Low       Very Low      None    N/A



Nixon, et. al. (1999). Journal of the Oklahoma State Medical Association. Vol. 92,
No. 4, April. Pp. 172 - 177.




                                                                                                        17
            OKC Firefighters
  Perceived Levels of Emotional Support
• Both groups of firefighters reported their relations
  with co-workers had more often improved rather than
  worsened after the bombing
• Oklahoma City firefighters described much greater
  support from their community than the out-of-state
  firefighters reported
• Oklahoma City firefighters reported greater support
  from both religious communities and mental health
  counselors than their out-of-state counterparts
   Nixon, et. al. (1999). Journal of the Oklahoma State Medical
   Association. Vol. 92, No. 4, April. Pp. 172 - 177.




Did divorces increase after the Oklahoma
              City bombing?
 In the first year after the bombing, relations with significant others
 worsened more often for Oklahoma City firefighters than for the
 comparison group

 One-half Oklahoma City firefighters reported lasting changes in
 their relationship; equally divided between positive and negative
 changes

 Among Oklahoma City firefighters, 10 divorces occurred during the
 three years prior to the bombing, while 24 divorces occurred
 between 1995 and 1997

 The upward trend in the divorce rate among OCFD personnel
 began well before the year of the bombing
 Nixon, et. al. (1999). Journal of the Oklahoma State Medical
 Association. Vol. 92, No. 4, April. Pp. 172 - 177.




                                                                          18
     Did divorces decrease after the Oklahoma
                   City bombing?
         Lower observed divorce rates following the Oklahoma City
         bombing than the prevailing 10-year cubic divorce trend would
         have predicted

         Comparison of counties in and around Oklahoma City to those
         farther away showed divorces were lower closer to Oklahoma
         City

         The noted effect dampen over time

         Did Divorces Decline after the Oklahoma City Bombing? Nakonezny, Reddick and
         Rodgers, Journal of Marriage and Family. Vol. 66, No. 1 (Feb., 2004), pp. 90-100.




                         PTSD in OKC Bombing
                          Firefighters’ Partners
     • Twenty-four female partners of firefighters involved in
       OKC bombing recovery efforts(13%)
     • 22 to 57 years (Mean = 39; 70% aged 30 to 50 years)
     • Caucasian (N = 23, 96%)
     • Married to, or cohabited with, their firefighter partners
       for an average of 10 years
     • Two were neither married to, nor cohabited with,
       current mates at the time of bombing but were
       married to firefighters at the time of the study.
Persistent Physiological Reactivity in a Pilot Study of Partners of Firefighters After a Terrorist Attack
Pfefferbaum, Tucker, North, Jeon-Slaughter, Kent, Schorr, Wilson, Bunch, Journal of Nervous and Mental Disease
Issue: Volume 194(2), February 2006, pp 128-131.




                                                                                                                 19
                     PTSD in OKC Bombing
                      Firefighters’ Partners
 • Assessed 43 to 44 months later
 • 40% met both B (intrusive re-experiencing) and D
   (hyperarousal) criteria
 • More than one half of the sample exhibited
   autonomic reactivity on at least one measurement
 • One participant met all DSM-III-R symptom group
   criteria for bombing-related posttraumatic stress
   disorder
 • Most of the participants with post-bombing disorders
   suffered from pre-existing conditions
Persistent Physiological Reactivity in a Pilot Study of Partners of Firefighters After a Terrorist Attack
Pfefferbaum, et. al., Journal of Nervous and Mental Disease Issue: Volume 194(2), February 2006, pp 128-131.




   Suicide Rate Among Police Officers
 • Statistical rate of suicide by police officers is
   not greater than that of the general population
   when controlled for sex, age and race
 • Law enforcement personnel are 26% less
   likely to commit suicide
 • One “OKC bombing-related” police officer
   suicide (1997)

     Aamodt, M. G., & Stalnaker, N. A. (2001). Police officer suicide: Frequency
     and officer profiles. In Shehan, D. C, & Warren, J. I. (Eds.) Suicide and Law
     Enforcement. Washington, D.C.: Federal Bureau of Investigation.




                                                                                                               20
                 “When someone is a
                   victim, he or she
                   should be at the center
                   of the criminal justice
                   process, not on the
                   outside looking in."
                 President William Jefferson Clinton

                 Oklahoma City 1997




 OKC Bombing American Red Cross
   Case Status since April 1995
3000

2500              Closed
                  Reopened
2000
                  New
1500

1000

500

  0




                                                       21
 OKC Bombing American Red Cross
     Case Status since 2000
90
80                                               Closed
70                                               Reopened
                                                 New
60
50
40
30
20
10
0
      2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011




      OKC Bombing American Red Cross
       Caseload Carryover since 1995
          New cases + reopened cases – closed cases
120

100

80

60

40

20

 0




                                                                    22
            New Mental Health Cases
18
16
                                         Survivor
14
                                         Responder
12                                       Family
10
8
6
4
2
0
     2004    2005   2006   2007   2008      2009     2010   2011




     Re-Opened Mental Health Cases
16

14                                       Survivor
                                         Responder
12
                                         Family
10

8

6

4

2

0
     2004    2005   2006   2007   2008      2009     2010   2011




                                                                   23
   Observations from OKC Bombing
• Occurrence of new physical symptoms can be
  associated with depression/ PTSD in responders
• A terrorist event may reduce divorce, but not for
  everyone and not for long
• Physiological arousal persists and can also be
  measured in responders’ spouses
• Mental health care is sought well in to the second
  decade
• All new cases for last three years were first responders




“We remember the day of the bombing not because we
can’t forget but because we choose to remember. “
Mick Cornett, Mayor
Oklahoma City 2010




                                                             24

								
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