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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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References

Abramova, F. A., Grinberg, L. M., Yampolskaya, O. V. & Walker, D. H. (1993). Pathology of inhalational anthrax in 42 cases from the Sverdlovsk outbreak of 1979. Proceedings of the National Academy of Sciences of the United States of America, 90, 2291–2294.Google Scholar
Alexander, D. A. & Klein, S. (2003). Biochemical terrorism: too awful to contemplate, too serious to ignore: subjective literature review. British Journal of Psychiatry, 183, 491–497.Google Scholar
American College of Surgeons (2004). Advanced Trauma Life Support® for Doctors – Student Course Manual, 7th edn. Chicago, IU.: American College of Surgeons.
American Heart Association. (2002). Advanced Cardiac Life Support. Dallas, Tex.: American Heart Association.
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn., Text revision. Washington, D.C.: American Psychiatric Publishing.
Arnon, S. S., Schecter, R. & Inglesby, T. V. (2001). Botulinum toxin as a biological weapon: medical and public health management. Journal of the American Medical Association, 285, 1059–1070.Google Scholar
Bartone, P. T., Wright, K. M. & Radke, A. (1994). Psychiatric effects of disaster in the military community. In Military Psychiatry: Preparing in Peace for War, eds. Jones, F. D., Sparacino, L. R., Wilcox, V. L. & Rothberg, J. M.. Washington, D.C.: TMM Publications.
Benedek, D. M., Holloway, H. C. & Becker, S. M. (2002). Emergency mental health management in bioterrorism events. Emergency Medicine Clinics of North America, 20, 393–407.Google Scholar
Blacher, R. (1987). Brief psychotherapeutic interventions for the surgical patient. In The Psychological Experience of Surgery, ed. Blacher, R. S.. New York: John Wiley and Sons.
Bleich, A., Gelkopf, M. & Solomon, Z. (2003). Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Israel. The Journal of the American Medical Association, 290, 612–620.Google Scholar
Breitbart, W. & Lintz, K. (2002). Psychiatric issues in the care of dying patients. In The American Psychiatric Publishing Textbook of Consultation-Liaison Psychiatry, 2nd edn., eds. Wise, M. G. & Rundell, J. R.. Washington, D.C.: American Psychiatric Publishing.
Bryant, R. A., Sackville, T., Dang, S. T., Moulds, M. & Guthrie, R. (1999). Treating acute stress disorder: an evaluation of cognitive behavior therapy and supportive counseling techniques. The American Journal of Psychiatry, 156, 1780–1786.Google Scholar
Burkle, F. M. (1991). Triage of disaster-related neuropsychiatric casualties. Emergency Medicine Clinics of North America, 9, 87–105.Google Scholar
Butler, T. (1995). Yersinia species. In Principles and Practice of Infectious Diseases, eds. Mandell, G. L., Bennett, J. E. & Dolin, R.. New York: Churchill Livingstone.
Cadigan, F. D. (1982). Battleshock, the chemical dimension. Journal of the Army Medical Corps, 128, 89–92.Google Scholar
Cassem, N. H. (2004). End of life issues: principles of care and ethics. In Massachusetts General Hospital Handbook of General Psychiatry, 5th edn., ed. Stern, T. A.. Philadelphia, Pa.: Elsevier.
CDC. (2000). Biological and chemical terrorism: strategic plan for preparedness and response. Recommendations of the CDC Strategic Planning Workgroup. Morbidity and Mortality Weekly Report, 49 (Suppl), RR–4.Google Scholar
CDC. (2001a). Update: investigation of bioterrorism-related anthrax and adverse effects from antimicrobial prophylaxis. Morbidity and Mortality Weekly Report, 50, 973.Google Scholar
CDC. (2001b). Update: investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antimicrobial therapy. Morbidity and Mortality Weekly Report, 50, 909–919.Google Scholar
CDC. (2001c). Vaccinia (Smallpox) vaccine. Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, 50 (Suppl), RR–10.Google Scholar
CDC. (2002). Use of anthrax vaccine in response to terrorism: supplemental recommendations of the advisory committee on immunization practices. Morbidity and Mortality Weekly Report, 51, 1024–1025.Google Scholar
CDC. (2003a). Recommendations for using smallpox vaccine in a pre-event vaccination program. Morbidity and Mortality Weekly Report, 52, 1–16.Google Scholar
CDC. (2003b). Mass trauma casualty predictor. Centers for Disease Control Emergency Preparedness and Response Website, updated March 17, 2003. http://www.bt.cdc.gov/masscasualties/predictor.asp.
Christopher, G. W., Cieslak, T. J., Pavlin, J. A. & Eitzen, E. M. (1997). Biological warfare: a historical perspective. Journal of the American Medical Association, 278, 412–417.Google Scholar
Clauw, D. J., Engel, C. C., Aronowitz, R.et al. (2003). Unexplained symptoms after terrorism and war: an expert consensus statement. The Journal of Occupational and Environmental Medicine, 45, 1040–1048.Google Scholar
Cloak, N. L. & Edwards, P. (2004). Psychological first aid: emergency care for terrorism and disaster survivors. Current Psychiatry Online, 3, 1–8.Google Scholar
Committee on Environmental Health and Committee on Infectious Diseases. (2000). Chemical-biological terrorism and its impact on children: a subject review. Pediatrics, 105, 662–670.
Currier, G. W., Allen, M. H., Bunney, E. B.et al. (2004). Updated treatment algorithm. The Journal of Emergency Medicine, Supplemental Issue, 27, S25–S26.Google Scholar
Dennis, D. T., Inglesby, T. V., Henderson, D. A.et al. (2001). Tularemia as a biological weapon: medical and public health management. Journal of the American Medical Association, 285, 2763–2773.Google Scholar
DiGiovanni, C. (1999). Domestic terrorism with chemical or biological agents: psychiatric aspects. The American Journal of Psychiatry, 156, 1500–1505.Google Scholar
Everly, G. S. & Mitchell, J. T. (2001). America under attack: the “10 Commandments” of responding to mass terror attacks. International Journal of Emergency Mental Health, 3, 133–135.Google Scholar
Fenner, F. (1988). Smallpox and its Eradication. Geneva: World Health Organization.
Franz, D. R., Jahrling, P. B., Friedlander, A. M.et al. (1997). Clinical recognition and management of patients exposed to biological warfare agents. Journal of the American Medical Association, 278, 399–411.Google Scholar
Fullerton, C. S., Brandt, G. T. & Ursano, R. J. (1996). Chemical and biological weapons: silent agents of terror. In Emotional Aftermath of the Persian Gulf War: Veterans, Families, Communities, and Nations, eds. Ursano, R. J. & Norwood, A. E.. Washington, D.C.: American Psychiatric Press.
Galea, S., Ahern, J., Resnick, H.et al. (2002). Psychological sequelae of the September 11 terrorist attacks in New York City. The New England Journal of Medicine, 346, 982–987.Google Scholar
Grinstad, B. (1964). BC Warfare Agents. Stockholm: Forsvarets Forskningsanstalt.
Grob, D. & Harvey, A. M. (1953). The effects and treatment of nerve gas poisoning. American Journal of Medicine, 14, 52–63.Google Scholar
Heath, D. F. (1961). Organophosphorus Poisons. New York: Paragon Press.
Henderson, D. A., Inglesby, T. V., Bartlett, J. G.et al. (1999). Smallpox as a biological weapon: medical and public health management. Journal of the American Medical Association, 281, 2127–2137.Google Scholar
Hobbs, J., Kittler, A., Fox, S., Middleton, B. & Bates, D. W. (2004). Communicating health information to an alarmed public facing a threat such as a bioterrorist attack. Journal of Health Communication, 9, 67–75.Google Scholar
Holloway, H. C., Norwood, A. E., Fullerton, C. S., Engel, C. C. & Ursano, R. J. (1997). The threat of biological weapons: prophylaxis and mitigation of psychological and social consequences. The Journal of the American Medical Association, 278, 425–427.Google Scholar
Ihlenfeld, J. T. (2003). Precepting student nurses in the intensive care unit. Dimensions of Critical Care Nursing, 22, 204–207.Google Scholar
Inglesby, T. V., Dennis, D. T., Henderson, D. A.et al. (2000). Plague as a biological weapon: medical and public health management. Journal of the American Medical Association, 283, 2281–2290.Google Scholar
Jones, F. D. (1995). Neuropsychiatric casualties of nuclear, biological, and chemical warfare. In War Psychiatry, eds. Jones, F. D., Sparacino, L. R., Wilcox, V. L., Rothberg, J. M. & Stokes, J. W.. Washington, D.C.: TMM Publications.
Keim, M. & Kaufmann, F. (1999). Principles for emergency response to bioterrorism. Annals of Emergency Medicine, 34, 177–182.Google Scholar
Marshall, S. L. A. (1979). Bringing Up the Rear: A Memoir. San Rafal, Calif.: Presidio Press.
Meselson, M., Guillemin, J. G., Hugh-Jones, M.et al. (1994). The Sverdlovsk anthrax outbreak of 1979. Science, 226, 1202–1207.Google Scholar
Miller, E. (1944). Neurosis in War. New York: Macmillan.
Nocera, A. & Garner, A. (1999). Australian disaster triage: a colour maze in the Tower of Babel. Australia and New Zealand Journal of Surgery, 69, 598–602.Google Scholar
Papaparaskevas, J., Houhoula, D. P., Papadimitrious, M.et al. (2004). Ruling out Bacillus anthracis. Emerging Infectious Diseases, 10, 1–6.Google Scholar
Perry, R. D. & Fetherston, J. D. (1997). Yersinia pestis – etiologic agent of plague. Clinical Microbiology Review, 10, 35–66.Google Scholar
Perry, S. W., Difede, J., Musngi, G., Frances, A. J. & Jocobsberg, L. (1992). Predictors of posttraumatic stress disorder after burn injury. American Journal of Psychiatry, 149, 931–935.Google Scholar
Raison, C. L., Pasnau, R. O., Fawzy, F. I. et al. (2002). Surgery and surgical subspecialties. In The American Psychiatric Publishing Textbook of Consultation – Liaison Psychiatry, 2nd edn., eds. Wise, M. G. & Rundell, J. R.. Washington, D.C.: American Psychiatric Publishing.
Rundell, J. R. (2000). Psychiatric issues in medical-surgical disaster casualties: a consultation-liaison approach. Psychiatric Quarterly, 71, 245–258.Google Scholar
Rundell, J. R. (2003). A consultation-liaison psychiatry approach to disaster/terrorism victim assessment and management. In Terrorism and Disaster: Individual and Community Mental Health Interventions, eds. Ursano, R. J., Fullerton, C. S. & Norwood, A. E.. New York: Cambridge University Press.
Rundell, J. R. & Baine, D. (2002). The first OEF patients evacuated to Landstuhl Regional Medical Center. Journal of the U.S. Army Medical Department, 8–02–10, 6–13.Google Scholar
Rundell, J. R. & Christopher, G. W. (2004). Differentiating manifestations of infection from psychiatric disorders and fears of having been exposed to bioterrorism. In Bioterrorism, eds. Ursano, R. J. & Norwood, A. E.. New York: Cambridge University Press.
Rundell, J. R. & Ursano, R. J. (1996). Psychiatric responses to war trauma. In Emotional Aftermath of the Persian Gulf War, eds. Ursano, R. J. & Norwood, A. E., Washington, D.C.: American Psychiatric Press.
Rundell, J. & Wise, M. G. (2000) Medical conditions associated with psychiatric disorder. In New Oxford Textbook of Psychiatry, eds. Gelder, M. G., Lopez-lbor, J. J. & Andreasen, N. C., pp. 1157–1168. New York: Oxford University Press.
Shuster, J. L., Breitbart, W. & Chochinov, H. M. (1999). Psychiatric aspects of excellent end-of-life care. Psychosomatics, 40, 1–4.Google Scholar
Stern, J. (1999). The prospect of domestic bioterrorism. Emerging Infectious Diseases, 5, 517–522.Google Scholar
Stuart, J., Ursano, R. J., Fullerton, C. S., Norwood, A. E. & Murray, K. (2003). Belief in exposure to terrorist agents: reported exposure to nerve/mustard gas by Gulf War Veterans. Journal of Nervous and Mental Disease, 191, 431–436.Google Scholar
Tucker, J. B. (1997). National health and medical services response to incidents of chemical and biological terrorism. Journal of the American Medical Association, 278, 362–368.Google Scholar
Ursano, R. J. & Rundell, J. R. (1994). The prisoner of war. In Military Psychiatry: Preparing in Peace for War, eds. Jones, F. D., Sparacino, L. R., Wilcox, V. L. & Rothberg, J. M., Washington, D. C.: TMM Publications.
Ursano, R. J., Fullerton, C. S. & Norwood, A. E. (1995). Psychiatric dimensions of disaster: patient care, community consultation, and preventive medicine. Harvard Review of Psychiatry, 3, 196–200.
Ursano, R. J., Fullerton, C. S. & Norwood, A. E. (2003). Terrorism and Disaster: Individual and Community Mental Health Interventions. Cambridge: Cambridge University Press.
Ursano, R. J., Norwood, A. E. & Fullerton, C. S. (2004). Bioterrorism: Psychological and Public Health Interventions. Cambridge: Cambridge University Press.
Wessely, S., Rose, S. & Bisson, J. (1999). Brief psychological interventions (“debriefing”) for treating immediate trauma-related symptoms and the prevention of posttraumatic stress disorder (Cochrane Review). In The Cochrane Library. Oxford: Update Software Ltd.
Wharton, M., Strikas, R. A., Harpaz, R.et al. (2003). Recommendations for using smallpox vaccine in a pre-event vaccination program. MMWR Recommendations and Reports, 52 (RR07), 1–16.Google Scholar
Wise, M. G. & Rundell, J. R. (2005). Special consultation-liaison settings and situations. In Concise Guide to Consultation-Liaison Psychiatry, 5th edn., eds. Wise, M. G. & Rundell, J. R.. Washington, D.C.: American Psychiatric Press.
World Health Organization. (1970). Health Aspects of Chemical and Biological Weapons. Geneva: World Health Organization.
Yori, G. (2002). Posttraumatic stress disorder after terrorist attacks: a review. The Journal of Nervous and Mental Disease, 190, 118–121.Google Scholar

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