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Active Shooter: What You Can Do to Mitigate Harm
This document outlines how to quickly respond to an active shooter situation, and appropriate responses from workplace leadership and personnel.
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Restoring a Sense of Well-Being in Children After a Disaster
From the Document: "Children are often exposed both directly and indirectly to the effects of disasters. While some will live in close proximity to an area or community directly impacted by disaster, many others will learn about it through the media or from their parents or friends. It is important for parents, caregivers, and professionals to answer children's questions and reassure them about their safety."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Managing a Worplace or an Organization After a Disaster
"A disaster such as an earthquake or hurricane creates unusual challenges for management. You and your staff may find yourselves suffering from its effects. Emotional stress, physical injury, bereavement, loss of property, and disruption of normal routines may limit the availability and energy of your work group. At the same time, the group may face new responsibilities--caring for its own members, and facilitating community recovery. Besides meeting customers' special needs for assistance following a disaster, personnel are often called on to support local authorities in providing community services. The following can help you structure your response. Much of the human suffering associated with a disaster happens after the event itself, and can be mitigated by effective management."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Disaster Related Deaths and Infection: Truth, Myth, or In-Between: Health Considerations of Human Remains in the Disaster Setting
"Death is an expectable part of disaster. In some disasters such as earthquakes in which history shows that deaths can be in the hundred's of thousands, management of the remains of the dead are a major concern. For disaster victims as well as professional first responders who will recover and take care of remains this aspect of a disaster is especially distressing. Learning to not look at the faces and hands of the dead, can decrease ones identification with the victims ('It could have been me. It could have been my spouse/child.') and protect to some extent from the distress. However the number of dead, their condition, child deaths and loss of ones own friends and relatives adds to the stress burden of exposure to death and the dead. Posttraumatic Stress Disorder can be one outcomes of extensive exposure to grotesque death. Often there are also health concerns associated with the exposure to remains. Knowledge about the facts of risk and of best practices that help minimize difficulties on site, may help reduce the distress of those who are recovering remains, volunteers who may be disaster victims as well as professional first responders are at risk and need knowledge, training, education and leadership as well as compassion, concern, rest and respite."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Disaster Related Death: Managing Concerns About the Dead or Missing
"In all disasters, respect for the spiritual and religious customs associated with remains and burial is an important part of recovery for the affected population. Often customs may not be the same as ones own. Protecting the body and soul of the dead, the rituals of burial, who conducts the ceremonies and whether one can afford the ceremony/burial when you have just lost all your possessions are common concerns. Those who provide medical, psychiatric and mental health care we well as first responders and those recovering remains should seek out local religious leaders for specific guidance on customs for death and burials. For example, in Haiti, although 80% of the population are Catholic, nearly half of the population also practice Vodou. (AKA Voodoo, Vaudou or Vodoun). Belief in Vodou may or may not be acknowledged to a stranger. Specific rules and customs related to death and burial are very important in Vodou."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Addressing the Needs of the Seriously Mentally Ill in Disaster
"In the acute stages of a disaster, those with serious mental illness may function relatively well. Like the rest of the population, they often 'rise to the occasion' to assist themselves and others in a time of great need. However, persons with severe and often chronic mental illness are a vulnerable group whose well-being is especially threatened by the social disruption of the post-disaster setting. Addressing their disaster needs can mitigate or prevent adverse outcomes."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Managing a Workplace or an Organization After a Crisis
From the Document: "Disasters that impact the workplace, whether natural or human-made, create unusual challenges for management. You and your staff may be impacted by its effects. Emotional stress, physical injury, grief, and disruption of normal routines may limit the availability and energy of your work group. At the same time, the group may face new responsibilities -- caring for its own members and facilitating community recovery. Besides meeting customers' special needs for assistance following a crisis, personnel may have other unique requirements and stressors. Much of the human suffering associated with a disaster happens after the event itself, and can be mitigated by effective management. The following can help you structure your response."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Invisible Injuries of War: Impact on Military Families and Children
This fact sheet for providers addresses the impact of the invisible injuries of war on military families and children. "The invisible injuries of service members resulting from our nation's war on terrorism pose complex challenges for military families, especially military children. With injuries such as post traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI), there are often dramatic changes in personality and behavior without a change in one's appearance. This 'injury duality' -- looking the same, but not acting the same -- is troubling for family members, friends and co-workers, and can be particularly confusing for children who thrive on parental consistency, trust and safety. This Courage to Care addresses the vulnerabilities of children whose service member parent suffers an invisible injury. This injury may include not only PTSD and mTBI, but also depression and health risk behaviors (i.e. increased use of alcohol and illegal or prescription medications, etc.) that are prevalent in many returning service men and women. Health professionals who work with military families and children should be alert to the effects of these kinds of injuries on children and on parenting, as this essential component of healthy development is often disrupted due to the family's injury experience."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
2010
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Psychosocial Concerns After Hurricane Harvey: 'Tips for Health Care Providers'
From the Document: "Health care providers assume many roles in the midst of natural disasters: caregiver, leader, comforter, and information source. Hurricane Harvey has displaced thousands, destroyed countless homes and property, and claimed numerous lives. Although the hurricane's strength has dissipated, its aftermath will be felt for considerable time to come. As health care providers mobilize to help, they should be mindful of the losses experienced by the population they will assist. Interviewing with sensitivity is essential, and is the first step in assessing specific needs. This fact sheet provides information for healthcare providers after hurricanes and pays special attention to some of the issues for individuals providing support in the aftermath of Harvey."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Psychological and Behavioral Issues Healthcare Providers Need to Know When Managing a Chemical, Biological, Radiological or Nuclear (CBRN) Event
From the Introduction: "An event involving exposure or potential exposure to CBRN [chemical, biological, radiological or nuclear] agents will create fear and uncertainty. While CBRN agents have occasionally been used for malicious purposes, such as by terrorists, most exposures are unintentional and result from the failure of or damage to man-made systems designed to contain and safeguard the population. The man-made nature of a CBRN event often increases the likelihood and severity of adverse psychological effects. Following widespread exposure to a CBRN agent, the management of acute psychological and behavioral responses will be as important as the treatment of any CBRN-related injuries and illnesses."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
2017?
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Information for First Responders on Emotional Reactions to Human Bodies in Mass Death
From the Introduction: "In your work responding to emergencies and disasters, you may see, smell, and handle the remains of individuals of all ages. Working with or around them may arouse strong feelings of pity, horror, repulsion, disgust, and anger at the senselessness of this tragedy. You may feel guilty for not helping enough. These reactions are normal and a part of being human. You may feel emotionally numb, or you may even use 'graveyard humor' to make the suffering and death seem less terrible. These are also normal responses. Strong emotions or reactions may be most painful when a victim is a child, or reminds you of someone you love, or of yourself. Even if you've worked in disaster environments before you may react differently here than you have in the past. Remember strong emotions are honorable and they confirm your humanity."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Leadership Document to Inform Planning, Response and Policy for Workplace Preparedness and Behavioral Risk Management of Disaster and Terrorism
"In the United States, the workplace has been the primary target of terrorism and bioterrorism. Natural disasters such as Hurricanes Rita and Katrina have disrupted and in some instances destroyed industries, large and small, under¬scoring the vulnerability of occupational settings and the impact of disaster on the health, security and livelihood of individuals, families and communities. In June, 2006, the Center for the Study of Traumatic Stress of Uniformed Services University convened a conference, Workplace Preparedness and Response for Disaster and Terrorism: Creating a Community of Safety, Health and Security through Integration, Knowledge and Evidence-Based Interventions, to address workplace preparedness from the perspective of human continuity planning and behavioral risk management."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
2006-06-30
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Psychological Concerns after Hurricane Katrina Tips for Medical Care Providers
"Health care providers assume many roles in the midst of natural disasters: caregiver, leader, comforter, and information source. Hurricane Katrina has displaced thousands, destroyed countless homes and property, and claimed numerous lives. Although the hurricane's strength has dissipated, its aftermath will be felt for considerable time to come. As health care providers mobilize to help, they should be mindful of the losses experienced by the population they will assist. Interviewing with sensitivity is essential, and is the first step in assessing specific needs. This issue of Courage to Care provides information for health care providers after hurricanes and pays special attention to some of the issues for individuals providing support in the aftermath of Katrina."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
2006
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Hurricane Katrina: Evacuee Mental Health and Care
"Mental health planning and care delivery to evacuees from Hurricane Katrina and other disasters requires a 1) public health approach for populations, 2) treatment delivery for expected normal rates of all psychiatric illness in the population, 3) care for trauma related disorders, 4) care for emerging disorders such as substance withdrawal and associated medical conditions with psychological consequences and perhaps most importantly, 5) community building. The relocation of hurricane survivors from the New Orleans Superdome to the Texas Astrodome following Katrina is a primary model for this plan. This evacuation will move as many as 20-25,000 people."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Information for Relief Workers on Emotional Reactions to Human Bodies in Mass Death
"In your work with this disaster you are likely to see, smell, and handle the dead bodies of men women and children of all ages. Working with or around human remains may arouse strong feelings of pity, horror, repulsion, disgust, and anger at the senselessness of this tragedy. You may feel guilty for not helping enough. These reactions are normal and a part of being human. You may feel emotionally numb, or you may even use 'graveyard humor' to make the suffering and death seem less terrible. These are also normal responses. Strong emotions or reactions may be most painful when a victim is a child, or reminds you of someone you love, or of yourself. Even if you've worked in disaster environments before you may react differently here than you have in the past. Remember strong emotions are honorable and they confirm your humanity. Here are lessons learned by other people who have worked with bodies in disaster environments. Although these tips cannot make a horrible event easy they will help you continue to work, and to live with your experiences and memories without being haunted by them."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Business Leadership in Bioterrorism Preparedness
"The workplace has been the primary target of terrorism in the United States. The events of 9/11, the anthrax attacks of 2001, the Oklahoma City bombing, and the 1993 World Trade Center underscores the fact that terrorism has occurred where and when people work. The goal of terrorism is to erode our sense of national security, disrupt the continuity of society and destroy social capital-morale, cohesion and shared values. In taking a proactive role to protect their organization's security, business continuity and employee health, business leaders should be aware of the following: 1) the workplace is a newly recognized environment for preparedness 2) the workplace has existing resources to facilitate preparedness 3) the workplace will encounter resistance to prepare 4) the workplace can reframe preparedness to promote resiliency, business continuity and social cohesion."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Psychological Concerns after Hurricane Katrina: Tips for Medical Care Providers
"Health care providers assume many roles in the midst of natural disasters: caregiver, leader, comforter, and information source. Hurricane Katrina has displaced thousands, destroyed countless homes and property, and claimed numerous lives. Although the hurricane's strength has dissipated, its aftermath will be felt for considerable time to come. As health care providers mobilize to help, they should be mindful of the losses experienced by the population they will assist. Interviewing with sensitivity is essential, and is the first step in assessing specific needs. This fact sheet provides information for health care providers after hurricanes and pays special attention to some of the issues for individuals providing support in the aftermath of Katrina."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Hurricane Katrina: Sustaining Effectiveness in First Responders
"First responders must work together to help individuals in the aftermath of a disaster. This cooperation is often a community's first step towards repair. By providing direction, protection, treatment, and security first responders help the affected population 'rebuild community. Katrina has destroyed cities, towns, and neighborhoods. Thousands of people are displaced, and must now live in crowded conditions. The recovery effort will require communities to work with local first responders, with first responders who arrive from afar, and with other agencies and communities at distant locations. All first responders bring to the relief efforts their unique training and skills. The ideas listed below will help first responders of all job-types work most effectively with each other and the communities they assist."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Media Management in Body Recovery from Mass Death
"The media are often the major means of communication about disasters. Accurate information about such events is critical for the public perception of what has transpired and likely next steps. It is the responsibility of all persons involved in the recovery of bodies from mass death to provide truthful and accurate information to the media. However, there should be only a limited number of persons who are authorized to provide information to the media. Such information, while accurate and truthful, must respect and be sensitive to the dead, the living, and the workers. Guidelines are applicable before, during, and after the event. The following information applies to United States authorities. These practices may help you to provide the media with the best possible information."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Leadership and Supervision for Body Recovery in Mass Death
"When the magnitude of death and destruction from an event is severe, many different groups of workers are involved and often work in isolation from each other. Some will undergo the same or similar stresses and emotions; many will have unique stressors and emotions that supervisors are required to understand and manage. Supervision is paramount in maintaining organized and efficient recovery efforts. The following management practices can help minimize difficulties on site and after the event."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Recovery in the Aftermath of Workplace Violence: Guidance for Supervisors
"Supervisors face particular challenges following any violent incident in the work setting. Even after the work area is secured, and victims or perpetrators are no longer present, emotional reactions and distress behaviors may compromise performance. Leaders may take steps to reduce untoward consequences for employees and for the workplace. The first requirement for the office staff recovery is assuring safety. Leaders should be aware that victims, intended victims, colleagues and bystanders may experience significant emotional distress whether or not physically injured-but those closest to the event, or with close relationships to the victim(s) or perpetrator(s) will likely be most affected. For most employees, the cornerstone of emotional recovery is talk and leaders can best assess their employees by talking with them. Leaders should demonstrate their willingness to discuss the event and their own emotions. As some people will not want to participate in group discussions it is essential that supervisors speak with these individuals one to one to gauge their feelings and mental state. An 'open door policy' and management presence or informal 'checking in' may be helpful. The second most important leader action in recovery is promoting a sense of normalcy and a return to normal work schedules and routines. A sense of normalcy is achieved gradually. The more traumatic and dramatic the event, the more likely that people will be emotionally affected and these memories will only gradually fade. Most people move on to integrate a tragedy or otherwise significant event into their consciousness without continuing mental distress or disability. The actions below will help managers foster a sense of safety and of return to normalcy."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Recovery in the Aftermath of Workplace Violence: Guidance for Workers
"Returning to work routines following any violent incident at the workplace can be very challenging. Even after the work area is secured, and victims or perpetrators are no longer present, emotional reactions and distress may reduce concentration, motivation, and performance. However, there are steps you can take to reduce the negative impact of your traumatic experience. The first requirement for individual and office recovery after violence is assuring safety. You should know that victims, intended victims, colleagues and bystanders may experience significant emotional distress whether or not they were physically injured. People closest to the event or those with close relationships to the victim(s) or perpetrator(s) will likely be most affected. For the majority of people the cornerstone of emotional recovery is talk. You can help yourself and your colleagues by talking with them. When you demonstrate your willingness to discuss the event and your own emotions you help others do so. Some people will not want to participate in group discussions. If you are very uncomfortable in group settings it is important to be able to speak one-to-one to a supervisor. After workplace violence many supervisors have an 'open door policy' to allow this to happen. Since a sense of 'normalcy' and a return to normal work schedules and routines helps most people adjust after violence, your supervisors will encourage this. A sense of normalcy occurs gradually. The more traumatic and dramatic the event, the more likely that people will be emotionally affected, and these memories and reactions will only gradually fade. Most people move on to integrate a tragedy or otherwise significant event into their consciousness without continuing mental distress or disability. The actions below will help you develop a sense of safety and speed return to normalcy."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Guidelines for Notifying Families of Dead or Missing Loved Ones
"This document is written for leaders, health care providers, and disaster workers who assist local and national authorities following natural disasters, terrorist actions, or other events that result in large numbers of dead, injured, and missing persons. In a natural disaster of great magnitude and scope, multiple countries are directly affected and many nations' citizens from outside the region are killed or missing. In such an event, providing information to families whose loved ones are missing is accomplished by government organizations (including embassies, state department consular staff, and military services) as well as a number of non-governmental organizations such as the Red Cross. Nations have different organizations that are likely to be involved. Procedures for notification of the next of kin when a family member or loved one is missing or has been confirmed dead are usually highly structured, formal and depend on the particular citizen's country's laws, customs, procedures, and traditions. Non-local disaster workers will be most successful when acting through local authorities. In the absence of official authorities, guidance can be sought from local personnel who hold a respected place in the affected communities. Local officials should perform the notification whenever possible. Local customs will usually dictate who does the informing, who in the family is informed, documentation of the circumstances of the death (manner and cause of death, condition and location of the remains) and actions yet to be taken, if any, before the body is returned to the family. When a person is missing, the following information will help authorities to communicate with family members: the circumstances at the disaster site, status of efforts to recover bodies, and how remains will be returned. Do not offer guarantees about the time required or assurances that a body will be recovered. "
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Body Recovery and Stress Management for Leaders and Supervisors
"The magnitude of death and destruction in this event require special measures to manage body recovery. Physical safety and security of body handlers takes priority over providing psychological counseling. Supervision is paramount in maintaining an organized, efficient work party for recovery efforts. Jurisdictional issues will be present and will not be easily resolved due to conflicts between investigative and recovery tasks. Provide a management structure to direct workers to where they are needed and provide supervision. One of the risks with a task of this magnitude is workers "getting lost" with no one who knows who or where they are. It is difficult to predict the kinds of psychological problems that any individual will have, however, the following management plan can help minimize later difficulties."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Hazardous Materials Clean Up and Continuous Operations
"Hazardous materials recovery teams can perform for long periods of time with the right support. Civilian and military personnel have long been expected to operate at an acceptable level of efficiency in difficult, continuous, and sustained operations. This has led to a large body of studies done on operational requirements. Identified factors that may contribute to various types of performance degradation include: protective equipment and environmental demands (heat, cold, high altitude); extreme environments (undersea, polar, outer space); conditions of low stimulation inducing boredom; night operations; prolonged combat and exposure to life-threatening work; sleep deprivation; and other situations. In non-military settings, workers often have work and union rules, the freedom to quit a job, and they cannot be ordered to perform certain tasks except in very special circumstances. Failure to adhere to performance guidelines can be the result of organizational breakdown. In this way, organizational disruption can lead to sleep loss, fatigue, poor performance, accidents, psychological stress, and reduced effectiveness."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Pandemic Planning and Response: Critical Elements for Business Planning
"Pandemic preparedness and response is a shared responsibility involving government (local, state and federal) and the private sector. A pandemic has the potential to be a catastrophic disaster of unprecedented scale. It is estimated that the clinical disease attack rate will be 30 percent in the overall population. Rates of illness will be highest among school-aged children (about 40 percent) and decline with age. Among working adults, an average of 20 percent will become ill during a community outbreak. While many businesses have extensive contingency plans in response to threats from diverse natural and manmade disasters, pandemic planning must address the extreme health and mental health impact assumptions and containment strategies projected for a severe pandemic influenza. A pandemic will likely reduce dramatically the number of available workers in all sectors, and significantly disrupt the movement of people and goods, which will threaten essential services and operations within and across our nation. The ability to implement effective pandemic preparedness plans, continuously monitor all business activities, and effect rapid adjustments based upon observed and anticipated impacts will be the hallmark of the business that copes most effectively during a pandemic The following points related to an organization's human continuity are often forgotten and must be incorporated into workplace pandemic planning to sustain employee health, mental health and productivity."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Center for the Study of Traumatic Stress [website]
"The Center is working to increase knowledge of the consequences of trauma and disaster and to apply this knowledge to helping people cope with traumatic events. The Center provides education, consultation and training to our nation and its communities on the effects of trauma and disaster and individual and organizational recovery following these events while maintaining a wide-ranging, vigorous research program to extend our knowledge of the consequences of event-related stress."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Psychological Consequences of the September 11 Terrorist Attack: Transcript of the Interview of Dr. Robert Ursano by Sam Donaldson, Sept. 18, 2001
This is a transcript of the interview of Dr. Robert Ursano (Chairman, Department of Psychiatry, Uniformed Services University of the Health Sciences) by Sam Donaldson on September 18, 2001 regarding trauma-related responses to the September 11 attacks on the United States. He discusses post-traumatic stress disorder (PTSD) and associated conditions that people may experience after this event.
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
Ursano, Robert J., 1947-; Donaldson, Sam, 1934-
2001-09-18
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Psychological and Behavioral Issues Healthcare Providers Need to Know when Treating Patients Following a Radiation Event
"An attack using radiation will create uncertainty, fear, and terror. Following the detonation of a Radiation Dispersal Device (RDD) the management of acute psychological and behavioral responses will be as important as the treatment of RDD-related injuries and illnesses. Radiation is a dreaded threat, usually seen as catastrophic and fatal. Radiation is invisible, odorless and unknown. These ingredients stimulate worst-case fantasies. People must rely on health care providers and scientists to determine whether or not a person has been contaminated. Radiation exposure may not be manifest immediately. The health effects of radiation can be delayed in time, not only affecting those exposed but also future generations. Those who have been exposed or anticipate possible exposure feel a sense of vulnerability, anxiety, and a lack of control. The common lack of consensus among experts can increase public fear and anger."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress
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Evidence-Based Management for Acute Stress Disorder (ASD)
"Acute Stress Disorder (ASD) is characterized by dissociative symptoms (e.g. detachment, derealization, or amnesia) during or after exposure to a traumatic event followed promptly by symptoms of re-experiencing, avoidance/ numbing, and hyperarousal from two days to a maximum of four weeks after the traumatic exposure. While not the only disorder seen acutely after exposure to traumatic events, ASD is quite common. The American Psychiatric Association and the U.S. Department of Veterans Affairs Office of Quality and Performance have published Practice Guidelines for the treatment of ASD."
Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress