Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-23T05:06:45.997Z Has data issue: false hasContentIssue false
  • English
  • Français

The Mass Casualty Incident in Turin, 2017: A Case Study of Disaster Responders’ Mental Health in an Italian Level I Hospital

Published online by Cambridge University Press:  20 June 2019

Valeria Caramello Open the ORCID record for Valeria Caramello [Opens in a new window] ,
Leticia Bertuzzi ,
Fulvio Ricceri ,
Umberto Albert ,
Giuseppe Maina ,
Adriana Boccuzzi ,
Francesco Della Corte  and
Merritt C Schreiber
Valeria Caramello*
Affiliation:
Emergency Department, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
Leticia Bertuzzi
Affiliation:
Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy Laboratoire Adaptations Travail Individu, Université Paris Descartes, Paris, France
Fulvio Ricceri
Affiliation:
Department of Biological and Clinical Sciences, University of Turin, Italy Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy
Umberto Albert
Affiliation:
Rita Levi Montalcini Department of Neuroscience, University of Turin, Italy San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
Giuseppe Maina
Affiliation:
Rita Levi Montalcini Department of Neuroscience, University of Turin, Italy San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
Adriana Boccuzzi
Affiliation:
Emergency Department, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
Francesco Della Corte
Affiliation:
Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy
Merritt C Schreiber
Affiliation:
Department of Clinical Pediatrics, Los Angeles Biomedical Research Institute, Harbor University of California at Los Angeles Medical Center, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
*
Correspondence and reprint requests to Valeria Caramello, Medicina d’Urgenza AOU San Luigi Gonzaga regione Gonzole 10, 10043 Orbassano (TO), Italy (e-mail: [email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To assess the psychological impact of a mass casualty incident (MCI) in a subset of personnel in a level I hospital.

Methods:

Emergency department staff responded to an MCI in June 2017 in Turin, Italy by an unexpected sudden surge of casualties following a stampede (mass escape). Participants completed the Psychological Simple Triage and Rapid Treatment Responder Self-Triage System (PsySTART-R), which classified the potential risk of psychological distress in “no risk” versus “at risk” categorization and identified a range of impacts aggregated for the population of medical responders. Participants were administered a questionnaire on the perceived effectiveness of management of the MCI. Two months later, the participants were evaluated using the Hospital Anxiety and Depression Scale (HADS), the Kessler Psychological Distress Scale (K6), and the Posttraumatic Stress Disorder Checklist (PCL-5).

Results:

The majority of the responders were classified as “no risk” by the PsySTART-R; no significant differences on HADS, K6, and PCL-5 were found in the participants grouped by the PsySTART-R categories. The personnel acquainted to work in emergency contexts (emergency department and intensive care unit) scored significantly lower in the HADS than the personnel usually working in other wards. The number of positive PsySTART-R criteria correlated with the HADS depression score.

Conclusions:

Most of the adverse psychological implications of the MCI were well handled and averted by the responders. A possible explanation could be related to factors such as the clinical condition of the victims (most were not severely injured, no fatalities), the small number of casualties (87) brought to the hospital, the event not being considered life-threatening, and its brief duration, among others. Responders had mainly to cope with a sudden surge in casualties and with organizational issues.

Keywords

mass casualty incidentdisaster respondersmental health triagePsySTARTresponder self-triage system
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 13 , Issue 5-6 , December 2019 , pp. 880 - 888
Copyright
Copyright © 2019 Society for Disaster Medicine and Public Health, Inc. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Lopes, CB, Gotway Crawford, C, Eriksson, C, et al. Psychological distress, depression, anxiety, and burnout among international humanitarian aid workers: a longitudinal study. PLoS One. 2012;7(9):e44948. doi: 10.1371/journal.pone.0044948CrossRefGoogle Scholar
Firth-Cozens, J. A perspective on stress and depression. In: Cox, J, King, JA. Understanding Doctors’ Performance. Oxford: Radcliffe Publishing; 2006: 22–25.Google Scholar
Firth-Cozens, J. Individual and organisational predictors of depression in general practitioners. Br J Gen Pract. 1998;48:1647–1651.Google Scholar
Kroenke, K, Spitzer, RL, Williams, JBW, et al. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146:317–325.CrossRefGoogle Scholar
Iversen, A, Rushforth, B, Forrest, K. How to handle stress and look after your mental health. BMJ. 2009;338:1139–1144.CrossRefGoogle ScholarPubMed
Kay, M, Mitchell, G, Clavarino, A, et al. Doctors as patients: a systematic review of doctors’ health access and the barriers they experience. Br J Gen Pract. 2008;58:501–508.CrossRefGoogle ScholarPubMed
Bennett, J, O’Donovan, D. Substance misuse by doctors, nurses and other healthcare workers. Curr Opin Psychiatry. 2001;14:195–199.CrossRefGoogle Scholar
Brooke, D, Edwards, G, Andrews, T. Doctors and substance misuse: types of doctor, types of problem. Addiction. 1993;88:655–663.CrossRefGoogle Scholar
Shanafelt, TD, Boone, S, Tan, L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377–1385.CrossRefGoogle ScholarPubMed
Shanafelt, TD, Bradley, KA, Wipf, JE, et al. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136(5):358–367.CrossRefGoogle Scholar
Lu, DW, Dresden, S, McCloskey, C, et al. Impact of burnout on self-reported patient care among emergency physicians. West J Emerg Med. 2015;16(7):996–1001. doi: 10.5811/westjem.2015.9.27945CrossRefGoogle ScholarPubMed
Gleichgerrcht, E, Decety, J. Empathy in clinical practice: how individual dispositions, gender and experience moderate empathic concern, burnout and emotional distress in physicians. PLoS One. 2013;8(4):e61526. doi: 10.1371/journal.pone.0061526CrossRefGoogle ScholarPubMed
Gibson, D. The gaps in the gaze in South African hospitals. Soc Sci Med. 2004;59(10):2013–2024. doi: 10.1016/j.socscimed.2004.03.006CrossRefGoogle ScholarPubMed
de Oliveira, GS Jr, Chang, R, Fitzgerald, PC, et al. The prevalence of burnout and depression and their association with adherence to safety and practice standards: a survey of United States anesthesiology trainees. Anesth Analg. 2013;117(1):182–193. doi: 10.1213/ANE.0b013e3182917da9CrossRefGoogle ScholarPubMed
Dewa, CS, Loong, D, Bonato, S, et al. How does burnout affect physician productivity? A systematic literature review. BMC Health Serv Res. 2014;14:325. doi: 10.1186/1472-6963-14-325CrossRefGoogle ScholarPubMed
Shanafelt, TD, Balch, CM, Bechamps, G, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995–1000. doi: 10.1097/SLA.0b013e3181bfdab3CrossRefGoogle ScholarPubMed
Misiolek, A, Gorczyca, P, Misiolek, H, et al. The prevalence of burnout syndrome in Polish anaesthesiologists. Anaesthesiol Intensive Ther. 2014;46(3):155-116. doi: 10.5603/AIT.2014.0028Google ScholarPubMed
Arigoni, F, Bovier, PA, Sappino, A. Trend in burnout among Swiss doctors. Swiss Med Wkly. 2010;140:w13070. doi: 10.4414/smw.2010.13070Google ScholarPubMed
Pejušković, B, Lečić-Toševski, D, Priebe, S, et al. Burnout syndrome among physicians - the role of personality dimensions and coping strategies. Psychiatr Danub. 2011;23(4):389–395.Google ScholarPubMed
Figley, CR, ed. Compassion Fatigue: Coping With Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. New York: Brunner/Mazel; 1995:1–20.Google Scholar
Gleichgerrcht, E, Decety, J. The relationship between different facets of empathy, pain perceptions and compassion fatigue among physicians. Front Behav Neurosci. 2014;8:243. doi: 10.3389/fnbeh.2014.00243CrossRefGoogle ScholarPubMed
McHolm, F. Rx for compassion fatigue. J Christ Nurs. 2006;23(4):12–19.CrossRefGoogle ScholarPubMed
Cardozo, BL, Salama, P. Mental Health of Humanitarian Aid Workers in Complex Emergencies. Sharing the Front Line and the Back Hills: Peacekeepers, Humanitarian Aid Workers and the Media in the Midst of Crisis. Amityville, NY: Baywood Publishing; 2002:242–255.Google Scholar
Connorton, E, Perry, MJ, Hemenway, D, et al. Humanitarian relief workers and trauma- related mental illness. Epidemiol Rev. 2012;34:145–155. doi: 10.1093/epirev/mxr026CrossRefGoogle ScholarPubMed
Khashaba, EO, Mona, AFE-S, Ibrahim, AA-W, et al. Work-related psychosocial hazards among emergency medical responders (EMRs) in Mansoura City. Indian J. Community Med. 2014;39(2):103–110.CrossRefGoogle Scholar
Galea, S, Nandi, A, Vlahov, D. The epidemiology of post-traumatic stress disorder after disaster. Epidemiol Rev. 2005;27:78–91.CrossRefGoogle Scholar
Armagan, E, Engindeniz, Z, Devay, AO, et al. Frequency of post-traumatic stress disorder among relief force workers after the tsunami in Asia: do rescuers become victims? Prehosp Disaster Med. 2006;21(3):168–172.CrossRefGoogle ScholarPubMed
Zvolensky, MJ, Kotov, R, Schechter, CB, et al. Post-disaster stressful life events and WTC-related posttraumatic stress,depressive symptoms, and overall functioning among responders to the World Trade Center disaster. J Psychiatr Res. 2015;61:97–105.CrossRefGoogle ScholarPubMed
Wang, H, Jin, H, Nunnink, SE, et al. Identification of post traumatic stress disorder and risk factors in military first responders 6 months after Wen Chuan earthquake in China. J Affect Disord. 2011;130(1-2):213–219.CrossRefGoogle Scholar
Alexander, DA, Wells, A. Reactions of police officers to body handling after a major disaster: a before and after comparison. Br J Psychiatry. 1991;159:547–555.CrossRefGoogle Scholar
Brewin, CR, Holmes, EA. Psychological theories of posttraumatic stress disorder. Clin Psychol Rev. 2003;23(3):339–376.CrossRefGoogle ScholarPubMed
Olff, M, Langeland, W, Gersons, BP. The psychobiology of PTSD: coping with trauma. Psychoneuroendocrinology. 2005;30(10):974–982.CrossRefGoogle ScholarPubMed
Taylor, AJ, Frazer, AG. The stress of post-disaster body handling and victim identification work. J Human Stress. 1982;8(4):4–12.CrossRefGoogle ScholarPubMed
Sloan, I, Rozensky, RH, Kaplan, L, et al. A shooting incident in an elementary school: effects of worker stress on public safety, mental health, and medical personnel. J Trauma Stress. 1994;7(4):565–574.CrossRefGoogle Scholar
Morgan, PM. The psychological impact of mass casualty incidents on first responders: a systematic review. J Emerg Manag. 2016;14(3):213–226. doi: 10.5055/jem.2016.0287CrossRefGoogle ScholarPubMed
Shirley, PJ. Manders clinical review: the role of the intensive care physician in mass casualty incjdents: planning, organization and leadership. Crit Care. 2008;12:214. doi: 10.1186/cc6876CrossRefGoogle Scholar
Robertson-Steel, I. Evolution of triage systems. Emerg Med J. 2006;23:154–155.CrossRefGoogle ScholarPubMed
Atto 98/CSR 5/8/2014. Definizione degli standard qualitativi, strutturali, tecnologici e quantitativi relativi all’assistenza ospedaliera. Italian Law D Lgs. 70/2015Google Scholar
mhGAP module Assessment Management of Conditions Specifically Related to Stress. WHO I2013 SBN: 978 9 24 1505932. http://www.who.int/mental_health/emergencies/mhgap_module_management_stress/en/. Accessed September, 2018.Google Scholar
National Child Traumatic Stress Network, National Center for PTSD. SAMHSA Skills for Psychological Recovery: Field Operations Guide 2010. www.nctsn.org/sites/default/files/assets/pdfs/spr_complete_guide.pdf. Accessed April 16, 2019.Google Scholar
Schreiber, MD, Yin, R, Omaish, M, et al. Snapshot from Superstorm Sandy: American Red Cross mental health risk surveillance in lower New York State. Ann Emerg Med. 2014;64(1):59–65.CrossRefGoogle ScholarPubMed
King, ME, Schreiber, MD, Formanski, SE, et al. A brief report of surveillance of traumatic experiences and exposures after the earthquake-tsunami in American Samoa, 2009. Disaster Med Public Health Prep. 2013;7(3):327–331. doi: 10.1001/dmp.2012.11CrossRefGoogle ScholarPubMed
Mace, SE, SharieSff, G, Bern, A, et al. Pediatric issues in disaster management, part 3: special healthcare needs patients and mental health issues. Am J Disaster Med. 2010;5(5):261–274.CrossRefGoogle ScholarPubMed
Sylwanowicz, L, Schreiber, M, Anderson, C, et al. Rapid triage of mental health risk in emergency medical workers: findings from Typhoon Haiyan. Disaster Med Public Health Prep. 2017;1:1–4. doi: 10.1017/dmp.2017.37Google Scholar
Van der Auwera, M, Debacker, M, Hubloue, I. Monitoring the mental well-being of caregivers during the Haiti-earthquake. PLoS Curr. 2012;4:e4fc33066f1947.CrossRefGoogle ScholarPubMed
Sijbrandij, M, Farooq, S, Bryant, RA, et al. Problem Management Plus (PM+) for common mental disorders in a humanitarian setting in Pakistan: study protocol for a randomised controlled trial (RCT). BMC Psychiatry. 2015;15:232.CrossRefGoogle Scholar
Zigmond, AS, Snaith, RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–370.CrossRefGoogle ScholarPubMed
Kessler, RC, Barker, PR, Colpe, LJ, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatr. 2003;60(2):184–189.CrossRefGoogle ScholarPubMed
Blevins, CA, Weathers, FW, Davis, MT, et al. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress. 2015;28:489–498. doi: 10.1002/jts.22059CrossRefGoogle ScholarPubMed
Sakuma, A, Takahashi, Y, Ueda, I, et al. Post-traumatic stress disorder and depression prevalence and associated risk factors among local disaster relief and reconstruction workers fourteen months after the Great East Japan Earthquake: a cross-sectional study. BMC Psychiatry. 2015;15:58.CrossRefGoogle ScholarPubMed
Shrestha, R. Post-traumatic stress disorder among medical personnel after Nepal earthquake, 2015. J Nepal Health Res Counc. 2015;13(30):144–148.Google ScholarPubMed
Bonanno, GA, Galea, S, Bucciarelli, A, et al. What predicts psychological demographics, resilience after disaster? the role of resources, and life stress. J Consult Clin Psychol. 2007;75(5):671–682.CrossRefGoogle ScholarPubMed
Peninsulas Emergency Medical Services Council and Tidewater Emergency Medical Services Council. Hampton Roads Mass Casualty Incident Response Guide 2005. www.peninsula.vaems.og. Accessed September, 2018.Google Scholar
De Boer, J. Definition and classification of disasters: introduction of a disaster severity scale. J Emerg Med. 1990;8:591–595.CrossRefGoogle ScholarPubMed
Perrin, MA, DiGrande, L, Wheeler, K, et al. Differences in PTSD prevalence and association risk factors among World Trade Center Disaster rescue and recovery workers. Am J Psychiatry. 2002;164(9):1385–1394.CrossRefGoogle Scholar
North, CS, Tivis, L, McMillen, JC, et al. Psychiatric disorders in rescue workers after Oklahoma City Bombing. Am J Psychiatry. 2002;159(5):857–859.CrossRefGoogle ScholarPubMed
Eriksson, CB, Bjork, JP, Larson, LC, et al. Social support, organizational support, and religious support in relation to burnout in expatriate humanitarian aid workers. Ment Health Relig Cult. 2009;12:671–686.CrossRefGoogle Scholar
Salas, E, DiazGranados, D, Klein, C, et al. Does team training improve team performance? a meta-analysis. Hum Factors. 2008;50(6):903–933.CrossRefGoogle ScholarPubMed
Gallardo, AR, Djalali, A, Foletti, M, et al. Core competencies in disaster management and humanitarian assistance: a systematic review. Disaster Med Public Health Prep. 2015;9(4):430–439.CrossRefGoogle Scholar
Schreiber, M. Anticipate Plan Deter. http://dhs.lacounty.gov/wps/portal/dhs/ems/DisasterMedicalServices. Accessed April 16, 2019.Google Scholar
Supplementary material: File

Caramello et al. supplementary material

Table S1

Download Caramello et al. supplementary material(File)
File 15.3 KB