APNA 28th Annual Conference Session 4018: October 25, 2014

Transcription

1 Boston Marathon Bombings Disaster Mental Health Response: Role, Recovery & Resilience CHRISTINE TEBALDI, MS, PMHNP, BC Conflict of Interest This presenter has no conflicts of interest This speaker will not be discussing off label uses Objectives Describe the characteristics and phases of disasters Describe a full disaster operation Identify the primary psychological consequences of a disaster Tebaldi 1

2 DISASTER RECOVERY FRAMEWORK National Disaster Recovery Framework DISASTER National Disaster Recovery Framework, FEMA, 2011 (1) National Disaster Recovery Framework PREPAREDNESS Pre-disaster recovery planning Mitigation planning & implementation Capacity and resilience-building Partnership building Review of protocols and plans for services to meet emotional and health care needs National Disaster Recovery Framework, FEMA, 2011 (1) Tebaldi 2

3 National Disaster Recovery Framework SHORT-TERM Mass Care / Sheltering Debris safety clear primary roads Business temporary infrastructure Emotional / Psychological identify those who would benefit from counseling or behavioral health services Public Health / Health Care provide emergency medical care Mitigation activities: assess and understand risks & vulnerabilities National Disaster Recovery Framework, FEMA, 2011 (1) National Disaster Recovery Framework INTERMEDIATE Housing interim Debris / Infrastructure removal & restoration Business reestablish Emotional / Psychological engage support networks for ongoing care Public Health / Health Care ensure continuity of care through temp facilities and services Mitigation Activities rebuilding back even stronger National Disaster Recovery Framework, FEMA, 2011 (1) National Disaster Recovery Framework LONG-TERM Housing permanent Infrastructure rebuild Business revitalization Emotional / Psychological follow up for ongoing counseling, behavioral health & case mgt Public Health / Health Care Reestablish disrupted health care facilities Mitigation Activities implement mitigation strategies National Disaster Recovery Framework, FEMA, 2011 (1) Tebaldi 3

4 Disaster Management Continuum Planning & Preparedness Mitigation Response Recovery Evaluation 2005 University of Rochester (2) MASSACHUSETTS PREPAREDNESS & RESPONSE (SHORT-TERM & INTERMEDIATE) Massachusetts Emergency Preparedness Multiple partners Federal State City/Town/Municipality EMS/Fire/Law Enforcement Hospitals Community Emergency Response Teams (CERT) Medical Reserve Corps (MRC) Community Mental Health and Emergency Response Programs/Organizations American Red Cross (ARC) Volunteer Organizations Active in Disaster (VOAD) Many more!! Tabletop Exercise & Drills Emergency Response Plans Memorandums of Understanding (MOUs) Tebaldi 4

5 Boston Marathon Background A longstanding annual event in Massachusetts organized by the Boston Athletic Association (BAA) and held on Patriots Day (a statewide holiday in honor of the battles of Concord and Lexington celebrated in April each year) The 117 th Running took place on April 15, 2013 A planned emergency Multiple organizations with activated with Emergency Operations Centers with liaisons on the course Medical Tents along the course co-operated by BAA and Red Cross Large Medical Tents at the end of the course for acute stabilization and triage EMS and Local Hospital plans activated secondary to potential runner health issues Volunteer availability call down Situational Awareness Monday April 15, 2013 Excellent weather for the race Top Finishers: completed in under 2.5 hrs and before noon Average level of runner health issues Medical Tents get busier as the day goes on 2:50 pm one explosion in front of Marathon Sports on Boylston St 10 seconds later a second explosion in front of the Forum Restaurant three were killed and more than 260 men, women and children with serious physical injuries Approx 5,600 runners were unable to complete the race New York Times, 4/15/13 Aerial image from Pictometry International Tebaldi 5

6 Proficient Preparedness & Immediate Reactions Within moments, the crowd s initial panic was replaced by purposeful action, as bystanders ran to, rather than from, the horror to help the injured. Law-enforcement and emergency medical services (EMS) personnel swiftly converged on the scene. Within minutes, ambulances began transporting the most critically injured to nearby hospitals. Kellerman & Pelleg, New England Journal of Medicine, May 2013 (3) Responding to Disaster: Who Gets Involved, How, When, and Why? All disasters begin and end at the LOCAL level. Marathon Bombing Response: Rapid Action All pre-activated entities shifted into response mode State Agencies HHS, MEMA, DPH, DMH, ME, MOVA Boston Public Health Commission Medical Intelligence Center America Red Cross Boston Teaching Hospitals (COBITH) State & Federal Law Enforcement Offices of Boston Mayor and Governor BAA and more Tebaldi 6

7 Marathon Bombing Response: Early Activities Acute medical intervention and stabilization Reunification / Hospital-based family assistance Mass Care / Feeding Disaster Mental Health Public Messaging & Education Triage and Coordination of services Presence at public and private memorials Outreach at Boylston St, Copley Square and Watertown Scaling of a Disaster Response American Red Cross (4) American Red Cross Congressional Charter Carry on a system of national and international relief in time of peace and apply the same in mitigating the sufferings caused by pestilence, famine, fire, floods, and other great national calamities, and to devise and carry on measures for preventing the same Aids emergency management in providing food, shelter, health and mental health services, blood and blood products for disaster victims Responds at the local, regional, and national levels 96% volunteer led Tebaldi 7

8 Red Cross Early Response Numbers 46,829 meals & snacks served 3,574 mental health contacts made 3,107 relief items distributed 305 Red Cross staff & volunteers assigned to the operation (including 67+ Disaster Mental Health Professionals) 1 Family Assistance Center opened for 15 days 11 agencies assisting in the Family Assistance Center, 41 families assisted (145 individuals) with financial grants 466 Safe and Well registrations for those separated from family on Marathon Monday 4 Reception Centers opened for those seeking services from the American Red Cross 26 days the Red Cross Regional Disaster Operations Center was open 26 Red Cross emergency response vehicles activated throughout Greater Boston 315 MBTA car cards & bus shelter signs with Red Cross coping messaging 540 mentions on twitter in one week by those spreading Red Cross messages on 78 memorials, vigils, & community gatherings 7 Emergency Operations Centers & Call Centers were supported 38 runners on Team Red Cross who ran the Boston Marathon April Boston Marathon First Aid stations operated by Red Cross Family Assistance Center Multi-agency Resource Center ARC, BPHC, MOVA, States Attorney, FBI and many more Allows clients to receive services in a timely and coordinated manner and protects them from the media Prevents duplication of services and resources Supports coordinated advocacy related to service needs Lockdown: A secondary impact Thursday April 18: 10:30pm: Officer Collier is shot on MIT campus Suspects car-jack a citizen in Cambridge Friday April 19: 1:30am: Police surround the suspects in Watertown - 1 st suspect is killed 4:30am: Police tell residents in Watertown to shelter-in-place Shelter-in-place order is extended to 7 cities (over 1 million residents) 8:45pm: 2 nd suspect is captured in Watertown Tebaldi 8

9 Disaster Mental Health Response Continues Outreach and triage Education Advising leaders on response activities and communications Staffing Call Centers Multiple coordinated service meetings Presence at multiple FAC and community events Supporting victims and families through various transitions Returning to the bombing sites Moving of the Temporary Memorial Virtual Family Assistance Center PSYCHOLOGICAL IMPACT OF DISASTER: TRIAGE & INTERVENTION Common Reactions to Disaster Centers for Disease Control - Coping with a Traumatic Event (5) Tebaldi 9

10 Emotional Response to Disaster 2005 University of Rochester (2) (Adapted from Zunin/Meyers) Coping Tips & Public Education Collaboration with ARC and MBTA Psychological Impact of Disaster Many people are resilient The most common outcome Over 50% of population resilient after 9/11 On average, 30-40% of direct victims of disaster will experience one or more disorders such as PTSD, depression or anxiety Children emerge with greater risk 5-10% of people in the community-at-large 10-20% of responders are at risk Early intervention reduces risk Galea, S., Nandi, A., & Vlahov, D. (2005) 2005; 2011 American Red Cross (6) Tebaldi 10

11 Psychological First Aid (PFA) Help individuals across the lifespan in immediate aftermath of disaster and terrorism. Reduce the initial distress caused by traumatic events and Foster short- and long-term adaptive functioning and coping. Evidence-informed PFA is supported by disaster mental health experts as the acute intervention of choice when responding to the psychosocial needs of individuals affected by disaster and terrorism. systematic empirical support is still required; however, because many of the components have been guided by research, there is consensus among experts that these components provide effective ways to help survivors manage post-disaster distress and adversities, and to identify those who may require additional services. Psychological First Aid: Field Operations Guide, 2 nd Edition (7) PFA Core Actions Contact and Engagement Safety and Comfort Stabilization (if needed) Information Gathering: Current Needs and Concerns Practical Assistance Connection with Social Supports Information on Coping Linkage with Collaborative Services Psychological First Aid: Field Operations Guide, 2 nd Edition (7) Red Cross Three-Element Intervention Strategy The aim is to alleviate immediate emotional distress and mitigate long-term consequences Element #1: Identification of Mental Health Needs: Individual psychological triage using a validated tool called PsySTART TM Mental Health Triage System Mental health surveillance Element #2: Promotion of Resilience and Coping: Enhance Psychological First Aid Psychoeducation Community resilience support and training Element #3: Targeted Interventions: Secondary assessment and referrals Crisis intervention Advocacy Reference: American Red Cross Disaster Mental Health Handbook, October 2012 (8) 2012 American Red Cross, 2012 (8) Tebaldi 11

12 LONG-TERM RECOVERY Recovery & Evaluation After Action sessions and reports Routine meetings with partner agencies Updated plans and MOUs Support to the Virtual Family Assistance Center which transitioned to Resilience Center with paid staff navigators from MOVA Long-term Recovery Partner agencies remain engaged Grant Application to Antiterrorism Emergency Assistance Program (AEAP) grant administered by the U.S. Department of Justice to fund Resilience Center New Initiatives Patient Connection MOU with BAA Planning for 2014 Marathon started in Sept 2013! Tebaldi 12

13 Emotional Response to Disaster: Recovery & Reconstruction (Adapted from Zunin/Meyers) 2005 University of Rochester (2) Resilience & Recovery: 1 Year Later C.Tebaldi, 4/15/ Planning and Participation 1 Year Tribute staffed with mental health volunteers 2014 Marathon 26 Medical Stations co-led by BAA and Red Cross Education sessions prior to event Extensive planning and collaboration Increased media attention Mental Health Volunteers At BAA 5K, Expo, with each medical team on Marathon Monday Supported Team Red Cross Staffed Reception Centers in the event of course disruption Tebaldi 13

14 The Finish Line C.Tebaldi, 4/21/2014 References & Resources (1) National Disaster Recovery Framework Strengthening Disaster Recovery for the Nation, FEMA, September available at: (2) Disaster Mental Health: A Critical Response Training Course, University of Rochester Medical Center & New York State Office of Mental Health (2005) (3) Peleg K, Kellermann AL, Peleg, K. Lessons from Boton. New Enhancing hospital. N Engl J Med 2013; 368;21: (4) Disaster Services Overview, American Red Cross (2011; revised 2012) (5) Coping with a Traumatic Event. Centers for Disease Control available at: (6) Foundations of Disaster Mental Health Training Course, American Red Cross (2005; revised 2011) (7) National Child Traumatic Stress Network and National Center for PTSD, Psychological First Aid: Field Operations Guide, 2 nd Edition. July, 2006 (8) Disaster Mental Health Handbook ; Disaster Services 2012 The American National Red Cross Tebaldi 14