Examples of Major Disasters

Presented by Mrs. Rosalie Kwong Sr. Clinical Psychologists Certified Traumatologist Corporate Clinical Psychology Services

Examples of Major Disasters Nov 96 : Fire Incident of Garley building Jan 97: Top One Karaoke Fire Incident April 97: Mei Foo Fire Incident Jan 98: Electric Road Fire Incident Jan 98: City Bus overturn Incident Feb 98: Kam Sheung Road Coach Accident May 98: Shipwreck Accident Aug 99: Aircraft overturn Sept 01: 911 Mar 03: SARS Dec 04: Tsunami Nov 05: WTO

Fire Incidents Garley building Nov 96 Top One Karaoke Jan 97 Mei Foo April 97

Traffic Accidents (1998) Bus overturn Coach Accident Ship wreck

Aircraft overturn (1999)

911 (2001)

SARS (2003)

Tsunami (2004)

WTO (2005)

Victims Hospitalized/ discharged victims Families/ relatives of the victims/deceased Rescuers/ emergency personnel

Objectives of Disaster Management (Psychological Services) Primary Goals Mitigate impact of event Facilitate normal recovery processes Restoration to adaptive function

Phases of Disaster Impact Phase Remedy / Honeymoon Phase (Week - Months) Disillusionment Phase Warning or Threat Phase Rescue / Heroic Phase (Immediate Aftermath) Inventory Phase Reconstruction / Recovery Phase (Continue for years)

Intervention Timeline Incident Crisis Intervention Counseling Psychotherapy Hospitalization Rehab

Implementation mechanisms I. 1996/97 II. 1999/20 III. 2001 IV. 2002- present Civil Disaster Management Committee (CDMC) (Clinical Psychology Services) Network among CPs Chairman, Chief Coordinator Disaster Psychosocial Services Teams (DPST) Chief Coordinator, HAHO Trainer Oasis Center for Personal Growth & Crisis Intervention Center Director Critical Incident Support Teams (CIST) Clinical Director

Psychological Management of Disaster I. Civil Disaster Management Committee (Clinical Psychology Services) II. Disaster Psychosocial Services Teams 1. Hospitalized / Discharged Victim 2. Family members / Bereaved relatives III. Oasis Center for Personal Growth & Crisis Intervention Rescuers / Emergency Personnel IV. Critical Incident Support Teams HA Staff

I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC) Network among clinical psychologists working in different clusters (not only those working in acute general hospitals) Better coordination of clinical psychology Services in the event of a major disaster Coordinators: Clinical psychologists/ senior clinical psychologists Civil disaster contingency plan (clinical psychology service)

I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC) Objectives: To minimize the severity and duration of emotional trauma To prevent development of further mental disturbance

I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC) Scope of Services Consultation on therapeutic intervention Psycho diagnostic assessment Psychological intervention Group support session Group debriefing Development of psycho educational materials Training Liaison with other agencies

I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC) Psycho educational materials 1.Trauma Victims (Adult, Children) Chinese & Eng versions 2. Bereaved Relatives (Adult, Children, Staff) Chinese & Eng versions

I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC) 3. Emergency personnel- Critical Incident Stress Management Request Forms Oasis website : http://www.ha.org.hk/oasis

I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC) Training 1. Workshops on Disaster Psychosocial Services e.g. Pre-incident Preparation Phases of disaster Impact of disaster Assessment of the needs of survivors Management of disaster victims/ families Service Guidelines

Assessment Forms Disaster Psychosocial Services Record Form Incident : Date : Assessment Checklists For Disaster Victims Name : ID No. Sex : F M Age : Marital Status : S M D W Education : Nil P S U P Contact No. : Address : Physical Injury : Mental Condition : Major Concern : Social Support : Services Rendered : Action Plan : Referral : Prepared by (Rank ) A. Acute Symptoms Affective Dimension 1. Affective Flooding e.g. panicked, enraged 2. Affective Numbness e.g. absence of emotional responsiveness, reduction in awareness of the surrounding Congnitive Dimension Trauma Factors 1. Memory Impairment e.g. inability to recall personal 1. information Life threatening danger, extreme violence, or sudden death of others 2. Concentration Difficulties e.g. train of thought is often 2. interrupted Personal injury 3. Denial e.g. demand the dead relative gets up and returns home 3. Loss of Loved ones 4. Ruminations & Intrusions e.g. obsess with the details, repet the same 4. Injury of loved ones answered questions 5. 5. Extreme loss or destruction of their homes normal lives, and community Guilt and Hopelessness e.g. self-blame and expressed suicidal thoughts 6. Exposure to traumatic sights, sounds, or experiences Physiological Dimension 1. High Arousal Level e.g. flushed, sweating C. Trauma Risk Factors 7. Witness of mass destruction or death 8. Histories of prior exposure to trauma 2. Somatic Discomfort e.g. dizziness, palpitation Support Behavioural Dimension 1. Low levels of emotional / social support or high levels of social demand 1. Withdrawal & Avoidance e.g. turn away from people 2. Regression e.g. speak and act like a child Coping 3. Aggression to self or others 1. Coping via avoidance, self-blame, or rumination 2. Coping via substance abuse Comorbidity Severe Moderate Mild 1. Previous experience of adverse life events 2. Eventful developmental history and family instability 3. Prior psychiatric / severe emotional disturbance 4. History of substance abuse 5. History of suicidal attempt 6. Major life stressors (e.g. divorce, job loss, financial losses) 7. Prior significant loss (e.g. death of a loved one in the past year), unresolved bereavement 8. Loss of job 9. Toxic contamination 10. Serving as an emergency worker (e.g. police, fire, healthcare, professionals, emergency workers) 11. Elderly Risk Factors 1. Having young Children 2. Low socio economic status Severe Moderate Mild Grief Risk Factors (Adult) 3. Unemployed or with financial difficulties 4. Presence of rage 5. Blaming others 6. Blaming self 7. Poor social Support 8. Inadequate coping skills 9. Multiple losses 10. Prior psychiatric / severe emotional disturbance

I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC) 2. Training for HA staff who are required to provide direct services to disaster victims or their relatives e.g. Acute grief handling Breaking bad news Understanding critical incident stress

I. Civil Disaster Management Committee (Clinical Psychology Services) Liaison with other agencies Indirect peripheral victims Victims without physical injury Who are in need of psychological treatment Referral to other relevant agencies for FU services SWD NGOs Universities: Psychological services unit

II. Disaster Psychosocial Services Teams (DPST) (14 Acute General Hospitals) Cluster HAHO HKEC HKWC KCC KEC KWC NTEC NTWC Hospitals - PYNEH QMH, RHTSK QEH TKOH, UCH CMC, KWH, PMH,YCH AHNH, NDH, PWH TMH

II. Disaster Psychosocial Services Teams (Coordinators) Cluster Hospitals HAHO - HKEC PYNEH HKWC QMH RHTSK KCC QEH KEC TKOH KWC NTEC Ms. Rosalie Kwong Department PS&O Ms. Jeanie Ngan Clin. Psy. Dr. Amy Fung Clin. Psy. Mr. Tse Heung Sang Ms. Mary Lee Mr. S. Y. Li MSW Clin. Psy. Psychological Spiritualf Reh. Center UCH Ms. Tsoi Yuen-kan MSS PMH Ms. Kitty Siu PSD KWH Ms. Lee Mee-ling Florence MSS YCH Ms. Kitty Fu MSS CMC Dr. Kitty Wu Clin. Psy. PWH Ms. Tam Chui-king MSSU Mr. Victor Tam MSW AHNH NTWC Name NDH Ms. Terry Wu PR&PAS TMH Ms. Ide Chan Clin. Psy.

II. Disaster Psychosocial Services Teams (DPST) Members: Clinical Psychologists Medical Social Workers Pastoral care workers Chaplains Patient relation officers Community nurses etc.

II. Disaster Psychosocial Services Teams Disaster Psychosocial Services Team (DPST) (MSWs, Clinical Psychologists, Chaplains, Pastoral Care Workers, PROs, Nurses, etc ) Initial Assessment Immediate Intervention Identification of Patient at Risk FU Referral

II. Disaster Psychosocial Services Teams Scope of services (Psycho social spiritual care) Assessment Crisis intervention Assisting in help Desk Bereavement counseling Spiritual care, sacramental services, religious services/rituals Follow up services (including home based Fu visits) Making referral Consultation services to other health care workers Liaison with other departments

Implementation mechanisms I. Civil Disaster Management Committee (CDMC) (Clinical Psychology Services) II. Disaster Psychosocial Services Teams (DPST) III. IV. Oasis Center for Personal Growth & Crisis Intervention Psychological services for staff Critical Incident Support Teams (CISTs) Crisis Intervention Emergency Personnel

Hidden Victims Emergency personnel Health care workers Secondary/ Tertiary victims Vicarious traumatization Empathy : suffering and distress Exposure Normal reaction to abnormal situation

Impact: Individual Level Physical Symptoms: Headaches, fatigue, dizziness, etc. Behavioural Symptoms: sleeping difficulty, avoidance behaviours, poor appetite, loss of interest in work, substance abuse, etc. Cognitive Symptoms: Sense of detachment, recurrent thoughts or dreams of the incident, poor concentration, difficulty in making decisions, etc. Emotional Symptoms: Depressed mood, anxiety, irritation, hypervigilance, etc. Possibility of developing PTSD

Impact: Organizational Level absenteeism U.S. : lost workdays per nonfatal assault = 5 work performance sense of organizational commitment staff turnover number of accidents at work long-term treatment cost

Post-incident Support Proper support to staff: Standard of care

Care for staff Care for Patients

Service Providers III. Oasis Center for Personal Growth & Crisis Intervention Corporate Clinical Psychologists Psychological services to HA staff Psychological Wellness Website: http://www.ha.org.hk/oasis

III. Oasis Center for Personal Growth & Crisis Intervention Scope of Services Scope of Services Personal Development Crisis Intervention 1. Direct Clinical Services 2. Crisis intervention-- psychological first aid 3. Professional Training 4. Research/ Stress Audit 5. Consultation Services 6. Personal Development Programs 7. Oasis at Workplace 8. Development of Resources 9. Volunteer Services 10. Facilities of Oasis: bookstore, resources Library

III. Oasis Center for Personal Growth & Crisis Intervention Crisis intervention-- psychological first aid 1. Contingency Plans of Major Critical incidents Psychological services for staff (e.g. SARS, WTO, Avian Flu Pandemic) 2. Phases of intervention: Pre-event Stage Event Stage Post-Event Stage 3. Pre-incident training: Psychological preparedness 4. Critical Incident Stress Management (CISM): various intervention approaches

IV. Critical Incident Support Teams Different hospitals Psychological First Aid Staff volunteers from different disciplines (e.g. physicians, nurses, allied health professionals, administrative, support services,) Trained under the Critical Incident Stress Management model Peer-led support system Supported by Corporate Clinical Psychology Services

Critical Incident Support Team Physicians, Nurses, AH SSP, Admin P Assessment Intervention Oasis (Corporate Clinical Psy Services)

Critical Incident Support Teams (CIST) 緊急事故 支援小組 聯網 醫院 小組人數 聯絡專員 東區尤德夫人那打素醫院 26 Ms Ann Chan 律敦治醫院 18 Ms Kwok Wai Han 瑪嘉烈醫院 21 陳貴芳小姐 Ms Pamela Chan 同路人 廣華醫院 東華三院黃大仙醫院 31 劉洪漪小姐 Ms Liu Hung-yee 心聆夥伴 聖母醫院 明愛醫院 21 Ms Florena Yau 同仁共濟 仁濟醫院 8 Ms Grace Wan HKE 心聆之友 KWC 聆心薈 KEC 靈實醫院 19 朱懿芬小姐 Ms Josephine Chu 知心友 NTW 青山醫院 博愛醫院 小欖醫院 屯門醫院 29 何鈺瑩小姐 Ms Maicy Ho 陽光行動 NTE 雅麗氏何妙齡那打素醫院 大埔醫院 40 談德榮先生 Mr Victor Tam 緊急事故 支援小組 威爾斯親王醫院 28 招潔萍小姐 Ms Canice Cheiu 何沛儀小姐 Ms Becky Ho 晴心苗圃 沙田醫院 沙田慈氏護養院 白普理寧養中心 16

Crisis Intervention Services Model of Critical Incident Stress Management (CISM) (Everly & Mitchell, 1997, 1999) A comprehensive integrated, multi-component continuum approach to crisis intervention

I. Pre-Exposure Scope of Services Formulation of CISM team Stress Education II. During Traumatic Exposure On Scene Support Services

Scope of Services III. Post Stress Intervention 1. Crisis Mx Plan/ Strategic Response to Crisis Assess service needs Psychological triage Set expectations Advice and plan suitable crisis intervention services

Scope of Services 2. Individual crisis intervention 3. Small group crisis intervention a. Defusing b. Critical Incident Stress Debriefing (CISD)

Scope of Services 4. Large group crisis intervention a. Demobilizations b. Crisis Management Briefings 5. Consultation

It helps to build up a harmonious atmosphere among staff The group meeting can relieve my anxiety I can get professional advice from the facilitator It is good for my mental health I realise that I am not alone Feedback from Staff I do not have to face the problem alone Members can know more about each other s feeling It helps to understand the impact of this incident on my psychological well being

Psychological Services for Other Government Personnel Lan Kwai Fong Incident (firefighters, ambulance men) Aircraft overturn (air traffic controllers) Immigration Tower Incident (officers) Tsunami (government personnel)

Psychological Services for Other Government Personnel Immigration Dept. Hong Kong Police Force Auxiliary Medical Services Civil Aid Services Hospital Authority Department of Health Government Information Service Security Bureau Social Welfare Department

Consultation to management Group Crisis Intervention (Critical Incident Stress Debriefing) Psycho education class Individual follow up Scope of Services (For Government Personnel) Psycho educational material on Coping with Critical Incident Stress

Scope of Services (For victims and their relatives) Consultation to management Client advocate Supportive therapy Grief counselling Provision of additional resources