DEEP
Center
Copyright © 2004: All Rights Reserved
Disaster Behavioral Health Awareness
Training for Health Care Professionals
James M. Shultz MS, PhD
Zelde Espinel MD, MA, MPH
Raquel E. Cohen MD, MPH
Jorge R. Insignares MD
Lisa Rosenfeld MPH
DEEP Center
University of Miami
School of Medicine
Brian W. Flynn EdD
Rear Admiral, USPHS (Ret)
Assistant Surgeon
General (Ret)
Jon A. Shaw MD, MS
Department of Psychiatry
University of Miami
School of Medicine
Robert J. Ursano MD
Director, Center for the Study of
Traumatic Stress
Uniformed Services University of the Health Sciences
Joseph A. Barbera MD
Director
Institute for Crisis, Disaster, and
Risk Management
The George Washington University
Mauricio Lynn MD
Abdul Memon MD
S. Shai Gold
Jackson Memorial Medical Center
University of Miami
School of Medicine
DISASTER BEHAVIORAL HEALTH AWARENESS TRAINING FOR HEALTH CARE PROFESSIONALS
HOSPITAL AS A PATIENT CARE PROVIDER:
Patient Care
Strategies
Expand surge capacity
Conduct behavioral triage
Conduct behavioral intervention
Manage contamination, isolation, and quarantine
Maintain quality patient care
Support patient families
Meet special population needs
Provide culturally-competent care
Communicate with the public
Plan
Prepare & Mitigate
Pre-event
Train Drill
Respond
Event
Recover
Post-event
Evaluate Activate Restore Evaluate
Patient Care Strategies II
Key Concepts
Manage contamination, isolation, and quarantine
Maintain ongoing quality patient care
Patient Care
Strategies
Expand surge capacity
Conduct behavioral triage
Conduct behavioral intervention
Manage contamination, isolation, quarantine
Maintain quality patient care
Support patient families
Meet special population needs
Provide culturally-competent care
Communicate with the public
Plan
Prepare & Mitigate
Pre-event
Train Drill
Respond
Event
Recover
Post-event
Evaluate Activate Restore Evaluate
Goal: Manage
Special Contingencies
Plan for Special Contingencies
Potentially-exposed patients
Patients selected for:
Decontamination
Isolation
Manage Special Contingencies —
Potentially-exposed Patients
Potentially-exposed Patients
Provide full registration for all victims.
Provide written information after decontamination, triage, and initial treatment, including agent-specific information.
Provide information as it becomes available:
Patient care information
Test results
Credible event information
Emphasize the positive actions being taken.
Source: Barbera & McIntyre,2003, Jane’s Mass Casualty Handbook: Hospital
Potentially-exposed Patients
Monitor patients under observation for delayed symptoms.
Enroll discharged patients in a surveillance system.
Provide behavioral health evaluation and referral if indicated.
Provide written information on normal reactions to stress and community resources.
Source: Barbera & McIntyre,2003, Jane’s Mass Casualty Handbook: Hospital
Manage Special Contingencies —
Patients Needing Decontamination
Behavioral Goal:
Decrease hyperarousal
Decrease anxiety and fear
Strategies:
Explain procedure
Remove activities from public view
Permanent Decon Area
Jackson Memorial Medical Center, Miami, FL
Post-Decontamination Triage Area
Jackson Memorial Medical Center, Miami, FL
Manage Special Contingencies —
Patients Needing Isolation
“Virtual visit” to the hospital during the SARS outbreak,
Hong Kong, 2003
Public Health
Disease Containment
Quarantine:
Compulsory physical separation, including restriction of movement, of populations or groups of healthy people who have been potentially exposed to a contagious disease , or efforts to segregate these persons within specified geographic areas.
Source: Barbera et al., 2001
Public Health
Disease Containment
Isolation:
Separation and confinement of individuals known or suspected (via signs, symptoms, or laboratory criteria) to be infected with a contagious disease , to prevent them from transmitting disease to others.
Source: Barbera, et al., 2001; Gostin 2000
Public Health
Disease Containment
Quarantine
Possible infection with contagious disease
Isolation
Confirmed infection or contagious disease
Behavioral Health Implications of Isolation/Quarantine
Behavioral Goals
Reduction of psychological distress
Compliance with containment measures
Stressors
Separation from loved ones
Fear of impending illness
Fear of death
Stigma
Social isolation
Behavioral Health Implications of Isolation/Quarantine
Strategies
Provide basic needs
Provide information as it becomes available
Maintain communication with loved ones
Provide access to media
Provide psychoeducation
Provide compassionate/empathic care
Provide behavioral health support
In Hong Kong and Singapore:
Mandatory quarantines implemented in large residential areas
50% of the population fled before quarantine could be enforced
In Canada:
Voluntary “shielding” strategy implemented
Extensive public education
Home visits by doctors
Worked well
Source: Pilch, 2004
Citizens instructed to remain at home for several days or weeks
Self-imposed measure to contain or minimize an epidemic
Education, information, food, and access to home health care provided
Alternative to quarantine
Source: Pilch, 2004
Maintains normal routines
Keeps families together
Decreases traffic flow
Minimizes patient surge
Targets delivery of health services to persons developing symptoms
Minimizes restrictions on civil liberties
Source: Pilch, 2004
Behavioral Health Perspective:
Manage Contamination,
Isolation, and Quarantine
When dealing with special contingencies due to contamination or infection…
Plan for the behavioral needs of patients who are exposed or require decontamination or isolation.
Patient Care
Strategies
Expand surge capacity
Conduct behavioral triage
Conduct behavioral intervention
Manage contamination, isolation, and quarantine
Maintain quality patient care
Support patient families
Meet special population needs
Provide culturally-competent care
Communicate with the public
Plan
Prepare & Mitigate
Pre-event
Train Drill
Respond
Event
Recover
Post-event
Evaluate Activate Restore Evaluate
Goal: Maintain Ongoing
Inpatient Care
Maintaining Ongoing
Inpatient Care
“In a massive disaster, many chronically ill patients could lose access to their physicians or settings where they usually receive care or obtain medications.”
“In a disaster event, care for hospitalized patients may deteriorate.”
Source: JCAHO, 2003
Plan for Maintaining Care for
Existing Patients
Prepare to optimize care for inpatients
Prepare for early discharge
Prepare for patient transport
Prepare for “graceful degradation” of care
Plan for Graceful Degradation
Treat and board patients in hallways.
Ration care and personnel contact as needed.
Provide protection from legal actions due to unavoidable delivery of substandard care during declared emergencies.
Source: JCAHO, 2003
Track patients within the hospital and across the community to achieve the highest-possible quality care and reunite family members
Behavioral Health Perspective:
Maintain Quality Patient Care
While accommodating a surge of incoming patients during a terrorist event…
Hospitals must maintain ongoing quality care for current patients and carefully manage degradation of care.