Docstoc

Anthrax

Document Sample
Anthrax Powered By Docstoc
					Psychological
   Aspects
      of
 Bioterrorism
  Psychology of Biological
          Attack
• Fear

• Prototypical Response – Mass
  Casualty

• Compare/Contrast Psychology of
  Biological vs Non-Biological Attacks

• Effective Strategies to Deal With
  Psychological Fall-out from Biological
  Attack
                              Fear
• We like to be scared because it is fun*
   – Horror movies
        • Friday the 13th, Halloween, etc
   – Action thrillers
        • Twister, Armageddon, Jurassic Park
   – Authors
        • Stephen King
   – Media Coverage: scary = good story

*Chozinski,
          JP; Mass Hysteria Lecture; Wilford Hall Medical Center:
19 December, 2001.
Fear
                       “You can’t see it, feel it, or taste
                      it. In many cases, you might not
                      even know you’ve been hit until
                      you begin to get a headache or a
                       fever. It’s a biological terrorist
                      attack … a nightmare that could
                               become reality”




Blackmon, R. HealthCare Alabama, Summer 2000; 13-17.
               Fear and Biowarfare

                      “Humans deeply fear
                       infection and death
                       from communicable
                             disease”




Smith CG et al; Bioterrorism; NCMJ 2000; 61:150-163.
               Fear and Biowarfare




                          “Humans deeply
                         fear infection and
                             death from
                           communicable
                              disease”

Smith CG et al; Bioterrorism; NCMJ 2000; 61:150-163.
                3 Phases of Disaster
                     Response
 1. Impact Phase
      – Time of acute stressor

 2. Period of Recoil
      – Initial threat gone
      – Need to be with others

 3. Post-Trauma
      – Realization of reality
      – Know “what was lost”

Tyhurst, JS: Individual reactions to community
disaster. Am J Psychiatry 1951; 107:764-769.
              Symptoms
• Following Mass
  Casualty Event:
   – Fear
   – Anxiety
   – Panic/Hysteria
   – Somatization
   – Grief
   – Guilt
 Panic/Fear/Hysteria
Panic + Fear => Hysteria =>
 Contagious Somatization
                 Acute Syndromes
• Acute Stress Reaction                    • Hysterical Reaction
   – Will occur in majority                    –   Headaches, Dizziness
   – Many will need attention                  –   Nausea, Vomiting
   – Acute Autonomic Arousal                   –   Hyperventilation
      • Tension
                                               –   Chest tightness
      • Tachycardia
                                               –   Inability to concentrate
      • Hyperventilation
      • Sweating
                                               –   Abd. Pain, Cramps
      • Tremor                                 –   Visual disturbances
   – May lead to Acute                         –   Diarrhea
     Stress Disorder                           –   Numbness


 Holloway HC et al; The threat of biological weapons; JAMA 1997; 278:425-27
Chronic Syndromes
      • Phobias
      • Sleep disorders
      • Post-Traumatic Stress
        Disorder
      • Substance Abuse
      • Major Depressive
        Disorder

      *These will occur in
        minority*
         Treatment: Triage
• Goal: careful, rapid evaluation and treatment
• Prepare for massive numbers seeking
  attention
• Distinguish disease from ASR and hysteria
• Reassure those who are not physically ill
• Remove those who are truly in state of panic
  or with severe psychological fallout
• Failure to accomplish this will result in
   – Delay in treatment of real casualties
   – Unnecessary treatment and use of
     resources
        Treatment: Strategies
• Reassurance; make them feel safe
• Give them tasks
   – Sense of empowerment
   – Remove feeling of helplessness
• Move out of role of patient as soon as
  possible
• Cohort into groups if necessary
   – Do not “knee-jerk quarantine”*
   – Do not isolate, but remove from the stress
   – Provide accurate, but not overwhelming
     information
 *Holloway et al.
                    Chronic Sequelae
                       Prevention
• Treat acute reactions
• Hospitalize those with severe
  psychological damage
• Verbalization/Group Discussion
   – Psychological de-briefings
      • Survivors discuss events and
        feelings
      • Clear up misperceptions
   – May decrease long-term PTSD*
 *Marshall   SLA: Men Against Fire. Goucester, Mass, Peter Smith 1978
  Compare/Contrast: Attack
                Traditional     Biological
Threat         Tangible       Intangible
Victim         Rescued        Self-referral
Presentation
Casualty       Immediate      Trickle-in
Timing
Victims        Obvious        Unknown
Wounds         Visible        Invisible
Perpetrator    Known/Nature Unknown
Preparation    Adequate       Adequate?
     Compare/Contrast: Panic
     • Disasters do not lead to panic
              when they are:
• Known or familiar
• Limited
• Discernable and understandable to
  those that live through them


DiGiovanni C, MD: Domestic terrorism with chemical or biological agents. Am
J Psychiatry 1999; 156(10):1500-1505.
      Compare/Contrast: Panic
     • Disasters are more likely to lead to
              panic when they are:
•   Sudden or unanticipated
•   Unfamiliar threat
•   Invisible threat that evades sensory clues
•   Prolonged or recurrent threat
•   Contagious
•   More likely to affect those close to you

DiGiovanni C et al.
     Compare/Contrast: Panic
      • THREAT FROM BIOLOGICAL
               AGENTS :
•   Sudden or unanticipated
•   Unfamiliar
•   Invisible
•   Prolonged or recurrent threat
•   Contagious
•   More likely to affect those close to you
            Bio Attack: Is Panic
                Inevitable?
No*                                 Yes
   – Tendency toward                    – 1973 Auckland NZ
     adaptability and
     cooperation                        – 1979 Three-Mile Is.
   – Lawless behavior is                – Expectations
     infrequent                           different at time of
   – Panic is rare and                    Spanish flu
     preventable
   – Spanish flu of 1918
   – WTC ’93, ‘01


*Glass, TA and Schoch-Spana, M. Bioterrorism and the people: how to
vaccinate a city against panic. CID 2002; 34:217-23.
Panic in Biological Attack:
        Conclusion
 Assume mass panic
would occur with a large
scale biological attack,
 and take steps now to
minimize or prevent this
    from occurring.
    Psychological Specialists
          in Disaster

•   Psychiatrists
•   Psychologists
•   Disaster relief specialists
•   Priests, Ministers, Rabbis
 Psychological
Specialists in BW
     Attack
 Compare/Contrast: First
     Responders
Traditional
              • Medical personnel
                – Emergency rooms
                – Clinics
                – Paramedics
              • Primary care
                physicians
              • Infectious disease
                MD’s
              • Biologists
              • Lab techs
              • Later, HazMat teams
     Attending to 1st Responders
      • Fear of contagion
      • Working in gear
          – Claustrophobia
          – Anxiety
          – Dehydration

“The mental health of emergency
 workers and medical personnel
will have to be monitored during a
      BW terrorism crisis.”*

*Simon J. Biological terrorism: preparing to meet the threat. JAMA 1997; 278:428-30.
Compare/Contrast: Heroism
• No burning building
• No victims to “rescue”
• Altruistic response potentially curbed by
  fear of the unknown
• No site to clean up
• What is a heroic deed in BW
   Compare/Contrast: First
           Aid?
• No wounds to dress
• No place to hold
  pressure
• Buddy care
  – Worked well in Kobar
  – Would this fail in
    biological attack?
       Compare/Contrast:
          Symptoms
• Potential Stimulants of Panic and
  Fear
  – Intense competition over resources
     • Fighting for drugs
  – Alienation – especially if quarantined
  – Fear of all people – neighbors, own
    family
Symptoms
•Following Mass
Casualty Event:
   –Fear             • PotentiallyUnique to
                       Biological Mass Casualty
   –Anxiety
                       – Magical thinking about
   –Panic/Hysteria
                         microbes
   –Somatization
                       – Fear of invisible agents
   –Grief
                       – Fear of contagion
   –Guilt
                       – Anger at terrorists or
                         government
 Treatment: Psychology of
    Biological Attacks
• Largely same strategies of dealing
  with ASR and hysteria outlined
  earlier
• Remove patients that are truly
  panicking
• Remember group discussion can be
  helpful and preventative of chronic
  psychological problems
• Consider anxiolytics (benzos)
  acutely
         Psychology of Strict
             Quarantine
• Pros                     • Cons
  – Shows public             – Takes away social
    willingness to go to       support
    extremes                 – Takes away dignity
  – May be instrumental      – Fosters helpless
    in containing spread       feelings
  – Reassures those that     – Can breed contempt
    are not quarantined        for those in authority
                             – Example: HCW with
                               fever
   Holloway et al.
        Solutions?

Can You Vaccinate A Unit,
Base, City, State, Nation, or
  World Against Panic?
       Prevent Group Panic
• Education and Communication




                   • Confidence in Leadership




• Perception of Justice
               Education
• Advance Education
  – Potentially preventative
  – Seminars
  – Training Exercises
    • Don’t forget to include psychological triage
      and treatment in your exercises
• After Event Education
  – Tell them specifics
  – “De-mystify the microbe”
            Education and
            Communication
    “Providing information is as important as
             providing medicine”7

• Clear – one voice is best
• Timely – allows time for panic
• Credible
• Consistent – same message is
  critical
• Accurate
              Education and
•
             Communication
    Bad information
  discredits authorities
• Pills are easier to
  swallow when the doctor
  is trusted
         Education and
         Communication
• What does the public want to
  know?
  – Nature of the attack
    • Demystify the world of microbes
  – Steps taken to mitigate the threats
  – Scope of the epidemic
  – Exactly what to do
Education and
Communication
       • Use the Media
         – Involve your
           public affairs very
           early
         – Tremendous
           power
         – Scheduled times
         – Involve them early
         – Squash rumors
           early
        Education and
        Communication
• Coordinate with civil authorities
• Involve Public Affairs
• Military’s involvement and reaction
  will be noted by public
 Confidence in Leadership
• Public must know there a plan
  – During the attack
  – In advance
  – Associate a face with the plan
• Lack of Confidence could breed
  chaos
  – Run on drugs
  – Lead to vigilantism, fleeing from cities,
    looting and rioting, etc
           Perception of Justice*
  •   Define perpetrator or problem ASAP
  •   Outline plan to apprehend
  •   Assure public this will be done
  •   If not accomplished:
       – Continued fear of continued attack
       – Threat remains unknown and undefined
       – All risk factors for public panic

*Holloway et al.
    WTC Attack vs. Anthrax
            Scare
                      WTC                 Anthrax
                     Attack                Scare
Education and    Who attacked us       Uninformed public
                       Why                  “Just an
Communicatio    Consistent message      outdoorsman”
      n                               Avg Citizen is save?

Confidence in     Bush, Guliani       Different expert on
                 Airport security        every station
 Leadership     Worldwide coalition    Military hoarding
                                            vaccine?
Perception of     Clear objective       Who done it?
                 Clear enemy – Al      Origin of agent?
   Justice            Queda
                  Visible results
                Summary
• Psychological sequelae of a BW attack can
  be immense; potential to overwhelm triage
  and treatment capabilities
• Nontraditional first responders should know
  how to deal with fear, panic, hysteria in the
  population
• Education and effective communication is
  crucial
• Leaders must act in a way to ensure the
  public trust and confidence
• Psychological casualties should become a
  part of any mass casualty exercise, especially
  those involving biological agents
                      Bibliography
•   Blackmon R. HealthCare Alabama, Summer 2000; 13-17.
•   Chozinski JP. Mass Hysteria Lecture; Wilford Hall Medical Center:
    19 December, 2001.
•   DiGiovanni C, MD. Domestic terrorism with chemical or biological
    agents. Am J Psychiatry 1999; 156(10):1500-1505.
•   Fullerton CS, Ursano RJ. Behavioral and psychological
    responses to chemical and biological warfare. Military Medicine
    1990; 155:54-9.
•   Fullerton CS, Ursano RJ. Health care delivery in the high-stress
    environment of chemical and biological warfare. Military Medicine
    1994; 159:524-8.
•   Fidler DP. The malevolent use of microbes and the rule of law:
    legal challenges presented by bioterrorism. CID 2001; 33:686-9.
•   Glass TA, Schoch-Spana M. Bioterrorism and the people: how to
    vaccinate a city against panic. CID 2002; 34:217-23.
•   Holloway HC et al. The threat of biological weapons; JAMA 1997;
    278:425-27.
                      Bibliography
•   Jones FD, Fong YH. Military psychiatry and terrorism. TMM Part
    1; Military psychiatry: preparing in peace for war. 1990:264-9.
•   Jones FD. Neuropsychiatric casualties of nuclear, biological, and
    chemical warfare. TMM Part 1; War psychiatry. 1994:86-111.
•   Marshall SLA: Men Against Fire. Goucester, Mass, Peter Smith
    1978.
•   Simon JD. Biological terrorism: preparing to meet the threat.
    JAMA 1997; 278:428-30.
•   Smith CG et al. Bioterrorism: a new threat with psychological and
    social stresses; NCMJ 2000; 61:150-163.
•   Tyhurst, JS. Individual reactions to community disaster. Am J
    Psychiatry 1951; 107:764-769.
•   Zilinskas RA. Bioethics and biological weapons [Ed]. Science
    1998; 279:635.

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:0
posted:2/19/2012
language:
pages:45