Hospital disaster preparedness: Mental and behavioral health interventions for infectious disease outbreaks and bioterrorism incidents
Keywords:Hospital, disaster, infectious disease outbreak, mental health, behavioral health
Background: Despite an increasing reliance on outpatient clinics and other ambulatory care facilities, traditional hospitals play a crucial role in the US healthcare system. They provide emergency services on a walk-in basis and are staffed to address issues related to triage. In an era of heightened concern over bioterrorism and a potential influenza pandemic, hospital preparedness for responding to infectious disease outbreaks is essential. During such outbreaks, mental and behavioral health problems may constitute an important part of the demand placed on hospitals. There is now sufficient clinical experience regarding such problems, and tested recommendations are available for hospitals to implement in disaster planning and practice.
Objective: This paper summarizes available liter-ature addressing hospital preparedness for mental and behavioral health interventions in the event of an infectious disease outbreak and identifies the barriers to improvement.
Methods: A systematic literature review using the MEDLINE database was carried out. Additional arti-cles were selected from the references of the identified sources, and Web sites of relevant agencies and organizations were searched.
Results: The review indicates that little literature documents recent hospital performance in or readiness for disaster mental and behavioral health interventions. The available evidence suggests a poor state of hospital readiness for providing such interventions. The problems related to financing such preparedness are likely contributors to this finding and must be overcome if improvements are to be made.
Conclusions: More research is needed to categori-cally examine the preparedness of hospitals for mental
and behavioral health interventions during times of disaster.
World Health Organization: Avian Influenza, Including Influenza A (H5N1), in Humans: WHO Interim Infection Control Guideline for Health Care Facilities. Manila, Philippines: World Health Organization Regional Office for the Western Pacific, 2006.
Centers for Disease Control and Prevention: Avian Influenza (Bird Flu): Current Situation. Atlanta, GA: Centers for Disease Control and Prevention, 2006.
Knobler SL, Mack A, Mahmoud A, et al. (eds.): The Threat of Pandemic Influenza: Are We Ready? Washington, DC: National Academies Press, 2005.
Crosse M: Testimony before the Committee on Government Reform, House of Representatives: Influenza Pandemic Challenges in Preparedness and Response. Washington, DC: United States Government Accountability Office, 2005.
Fetter JC: Psychosocial response to mass casualty terrorism: Guidelines for physicians. Prim Care Companion J Clin Psychiatry. 2005; 7(2): 49-52.
Ursano RJ, Cerise FP, Demartino R, et al.: The impact of disasters and their aftermath on mental health. Prim Care Companion J Clin Psychiatry. 2006; 8(1): 4-11.
Committee on Responding to the Psychological Consequences of Terrorism, Butler AS, Panzer AM, et al. (eds.): Preparing for the Psychological Consequences of Terrorism: A Public Health Strategy. Washington, DC: National Academy of Sciences, 2003.
Milsten A: Hospital responses to acute-onset disasters: A review. Prehospital Disaster Med. 2000; 15(1): 32-45.
DiGiovanni C Jr: Domestic terrorism with chemical or biological agents: Psychiatric aspects. Am J Psychiatry. 1999; 156(10): 1500-1505.
Okumura T, Suzuki K, Fukuda A, et al.: The Tokyo subway sarin attack: Disaster management, Part 1: Community emergency response. Acad Emerg Med. 1998; 5(6): 613-617.
Okumura T, Suzuki K, Fukuda A, et al.: The Tokyo subway sarin attack: Disaster management, Part 2: Hospital response. Acad Emerg Med. 1998; 5(6): 618-624.
Okumura T, Suzuki K, Fukuda A, et al.: The Tokyo subway sarin attack: Disaster management, Part 3: National and international responses. Acad Emerg Med. 1998; 5(6): 625-628.
Centers for Disease Control and Prevention: Rapid assessment of injuries among survivors of the terrorist attack on the World Trade Center—New York City, September 2001. MMWR Morb Mortal Wkly Rep. 2002; 51(1): 1-5.
Howell JM, Mayer TA, Hanfling D, et al.: Screening for inhalational anthrax due to bioterrorism: Evaluating proposed screening protocols. Clin Infect Dis. 2004; 39(12): 1842-1847.
Donahue SA, Lanzara CB, Felton CJ, et al.: Project Liberty: New York’s crisis counseling program created in the aftermath of September 11, 2001. Psychiatr Serv. 2006; 57(9): 1253-1258.
Ursano RJ, Fullerton CS, Norwood AE (eds.): Terrorism and Disaster: Individual and Community Mental Health Interventions. Cambridge, England: Cambridge University Press, 2003.
Ritchie EC, Watson PJ, Friedman MJ (eds.): Interventions Following Mass Violence and Disasters. New York: The Guilford Press, 2006.
Agency for Healthcare Research and Quality: Pediatric Terrorism and Disaster Preparedness: A Resource for Pediatricians. Agency for Healthcare Research and Quality Web site. Available at www.ahrq.gov/research/pedprep/. Accessed March 7, 2007.
National Center for Posttraumatic Stress Disorder: Early Mental-Health Intervention for Disasters. US Department of Veterans Affairs Web site. Available at www.ncptsd.va.gov/facts/ disasters/ fs_treatment_disaster.html. Accessed March 7, 2007.
Benedek DM: Acute stress disorder and post traumatic disorder in the disaster environment. In Ursano RJ, Fullerton CS, Weisaeth L, et al. (eds.): Textbook of Disaster Psychiatry. London: Cambridge University Press (in press).
Grieger TA, Fullerton CS, Ursano RJ, et al.: Acute stress disorder, alcohol use, and perception of safety among hospital staff after the sniper attacks. Psychiatr Serv. 2003; 54(10): 1383-1387.
Fullerton CS, Ursano RJ, Reeves J, et al.: Perceived safety in disaster workers following 9/11. J Nerv Ment Dis. 2006; 194(1): 61-63.
Qureshi K, Gershon RR, Sherman MF, et al.: Health care workers’ ability and willingness to report to duty during catastrophic disasters. J Urban Health. 2005; 82(3): 378-388.
Koh D, Lim MK, Chia SE, et al.: Risk perception and impact of Severe Acute Respiratory Syndrome (SARS) on work and personal lives of healthcare workers in Singapore: What can we learn? Med Care. 2005; 43(7): 676-682.
Robertson E, Hershenfield K, Grace SL, et al.: The psychosocial effects of being quarantined following exposure to SARS: A qualitative study of Toronto health care workers. Can J Psychiatry. 2004; 49(6): 403-407.
Sim K, Chua HC: The psychological impact of SARS: A matter of heart and mind. CMAJ. 2004; 170(5): 811-812.
Nickell LA, Crighton EJ, Tracy CS, et al.: Psychosocial effects of SARS on hospital staff: Survey of a large tertiary care institution. CMAJ. 2004; 170(5): 793-798.
Zhang L, Wang J, Feng Z, et al.: The responses of nursing system to the outbreak of SARS in general hospital. Chin Med J (Engl). 2003; 116(6): 834-837.
Braun BI, Wineman NV, Finn NL, et al.: Integrating hospitals into community emergency preparedness planning. Ann Intern Med. 2006; 144(11): 799-811.
Muller AG: Rebuilding in New Orleans. One hospital struggles with more indigent care, staffing shortages. Mod Healthc. 2006; 36(1): 21.
National Council on Disability: The Needs of People with Psychiatric Disabilities During and After Hurricanes Katrina and Rita: Position Paper and Recommendations. Washington, DC: National Council on Disability, 2006.
Federal report documents extensive discrimination against Katrina evacuees with psychiatric disabilities. Psychiatr Serv. 2006; 57(9): 1350-1351.
US Government Accountability Office: Hurricane Katrina: Status of Hospital Inpatient and Emergency Departments in the Greater New Orleans Area. Washington, DC: US Government Accountability Office, 2006.
Weisler RH, Barbee JG, Townsend MH: Mental health and recovery in the Gulf Coast after Hurricanes Katrina and Rita. JAMA. 2006; 296(5): 585-588.
World Health Organization: Consensus Document on the Epidemiology of Severe Acute Respiratory Syndrome (SARS). Manila, Philippines: World Health Organization Department of Communicable Disease Surveillance and Response, 2003.
American Hospital Association Section for Metropolitan Hospitals: Proceedings for the National Symposium on Hospital Disaster Readiness. Washington, DC: American Hospital Association, 2002.
Braun BI, Darcy L, Divi C, et al.: Hospital bioterrorism preparedness linkages with the community: Improvements over time. Am J Infect Control. 2004; 32(6): 317-326.
Niska RW, Burt CW: Bioterrorism and mass casualty preparedness in hospitals: United States, 2003. Adv Data. 2005; (364): 1-14.
Kaji AH, Lewis RJ: Hospital disaster preparedness in Los Angeles County. Acad Emerg Med. 2006; 13(11): 1198-1203.
Hick JL, Hanfling D, Burstein JL, et al.: Health care facility and community strategies for patient care surge capacity. Ann Emerg Med. 2004; 44(3): 253-261.
The Chartis Group: Prepared to Care: The 24/7 Role of America’s Full-service Hospitals. Washington, DC: American Hospital Association, 2006.
US Health Resources and Services Administration: National Bioterrorism Hospital Preparedness Program (NBHPP). US HHS Health Resources and Services Administration Web site. Available at www.hrsa.gov/bioterrorism/. Accessed December 10, 2006.
Larkin GL, Claassen CA, Emond JA, et al.: Trends in U.S. emergency department visits for mental health conditions, 1992 to 2001. Psychiatr Serv. 2005; 56(6): 671-677.
Jackson CT, Covell NH, Shear KM, et al.: The road back: Predictors of regaining preattack functioning among Project Liberty clients. Psychiatr Serv. 2006; 57(9): 1283-1290.
Gershon RR, Qureshi KA, Sepkowitz KA, et al.: Clinicians’ knowledge, attitudes, and concerns regarding bioterrorism after a brief educational program. J Occup Environ Med. 2004; 46(1): 77-83.
Center for the Study of Traumatic Stress: Psychological First Aid: How You Can Support Well-Being in Disaster Victims. Disaster Response Education and Training Project, Center for the Study of Traumatic Stress. Available at www.centerforthestudyoftraumaticstress.org/downloads/CSTS_Psych1stAid.pdf. Accessed March 7, 2007.
Benedek DM, Ursano RJ, Fullerton CS, et al.: Responding to workplace terrorism: Applying military models of behavioral health and public health response. Journal of Workplace Behavioral Health. 2006; 21(3/4): 21-33.
Carmona RH: The science of surge: An all-hazard approach is critical to improving public health preparedness. Acad Emerg Med. 2006; 13(11): 1097.
Agency for Healthcare Research and Quality: Bioterrorism and Other Public Health Emergencies: Altered Standards of Care in Mass Casualty Events. Washington, DC: US Department of Health and Human Services, 2005.
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