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8 - Assessment and management of medical-surgical disaster casualties

from Part III - Clinical care and interventions

Published online by Cambridge University Press:  09 August 2009

By
R. James Rundell
Edited by
Robert J. Ursano ,
Carol S. Fullerton ,
Lars Weisaeth  and
Beverley Raphael
R. James Rundell
Affiliation:
Professor of Psychiatry Mayo Clinic College of Medicine 200 First Street, SW, West 11 Rochester, MN 55905, USA
Robert J. Ursano
Affiliation:
Uniformed Services University of the Health Sciences, Maryland
Carol S. Fullerton
Affiliation:
Uniformed Services University of the Health Sciences, Maryland
Lars Weisaeth
Affiliation:
Universitetet i Oslo
Beverley Raphael
Affiliation:
University of Western Sydney
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Summary

Introduction

Having medical or surgical injuries or conditions following a disaster or terrorist attack increases the likelihood a psychiatric condition is also present. Fear of exposure to toxic agents can drive many times more patients to medical facilities than actual terrorism-related toxic exposures. Existing postdisaster and post-terrorism algorithms consider predominantly medical and surgical triage and patient management. There are few specific empirical data about the potential effectiveness of neuropsychiatric triage and treatment integrated into the medical-surgical triage and management processes (Burkle, 1991). This is unfortunate, since there are lines of evidence to suggest that early identification of psychiatric casualties can help decrease medical-surgical treatment burden, decrease inappropriate treatments of patients, and possibly decrease long-term psychological sequelae in some patients (Rundell, 2000). Physicians and mental health professionals involved in disaster/terrorism response planning should understand the importance of considering behavioral symptoms within the context of concurrent medical-surgical assessment and treatment (Rundell, 2003). Effective medical-psychiatric differential diagnosis and adequate attention to public risk communication lessen the risk of medical or psychiatric misdiagnoses, and decrease the odds that healthcare systems may be overwhelmed (Rundell & Christopher, 2004). This chapter will identify how postdisaster patient triage and management can incorporate behavioral/psychiatric assessment and treatment, merging behavioral and medical approaches in the differential diagnosis and early management of common psychiatric syndromes among medical-surgical disaster or terrorism casualties.

Keywords

antidepressant medicationsdepressionmedical-surgical disasterpostdisaster patientpublic educationrisk communicationpsychiatric assessmentpsychiatric syndromesterrorism
Type
Chapter
Information
Textbook of Disaster Psychiatry , pp. 164 - 189
Publisher: Cambridge University Press
Print publication year: 2007

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