Primary intervention for memory structuring and meaning acquisition (PIMSMA): Study of a mental health first-aid intervention in the ED with injured survivors of suicide bombing attacks


  • Shaul Schreiber, MD
  • Ornah T. Dolberg, MD
  • Gabriel Barkai, MD
  • Einat Peles, PhD
  • Agnes Leor, MD
  • Elena Rapoport, MD
  • Jeremia Heinik, MD
  • Miki Bloch, MD



PTSD, suicide bombing, terror attack, memory structuring, mental-health first aid, emergency department


Objective: To assess the impact of a structured intervention, the “primary intervention for memory structuring and meaning acquisition” (PIMSMA) performed randomly in the emergency department with survivors of suicide bombing attacks, on their mediumterm mental health outcome.
Design: Follow up and assessment 3-9 months postinjury, and 24 months thereafter.
Setting: A tertiary referral general hospital in Tel Aviv, Israel.
Participants: Injured survivors of 9 suicide bombing and suicide shooting, men and women aged 16-72 at the time of the incident.
Main outcome measures: Diagnosis of posttraumatic stress disorder (PTSD) was made using the Hebrew validated version of the DSM-IV SCID-PTSD rating scale. Other psychiatric symptoms were assessed using the following rating scales: impact of event scale (IES), Hamilton rating scale for depression (HAM-D) and for anxiety (HAM-A), and the Pittsburgh sleep quality index (PSQI). Effects of PIMSMA and PTSD level of psychological distress were analyzed using ANOVA and for change over time for continuous variables repeated measured multivariate analyses was performed, and for categorical variables nonparametric-related sample McNemar. Logistic regression for variable associated with PTSD was performed.
Results: Out of 213 eligible injured survivors evacuated to our ER, 129 were retrieved 3-9 months after the incident, and 53 were available for assessment 2 years later. Multivariate analyses for being PTSD vs non-PTSD at the first evaluation, being hospitalized OR = 5.6 (95 percent CI 1.1-27.6) and treated OR = 24.5 (95 percent CI 2.8-200) were the only predictors, with no effect (p = 0.9) for PIMSMA vs other supportive intervention. Predictor for PTSD at the second evaluation were IES severity score at first evaluation OR = 1.1 (95 percent CI 1.04-1.2).
Conclusion: The PIMSMA approach is as good as the nonspecific supportive treatment performed routinely in the ED with all survivors of traumatic events of any origin. Further studies are needed to establish valid, evidence-based treatment approaches for the acute aftermath of exposure to severe potentially traumatic events.

Author Biographies

Shaul Schreiber, MD

Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel).

Ornah T. Dolberg, MD

Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel).

Gabriel Barkai, MD

Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel).

Einat Peles, PhD

The Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Isreal (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel).

Agnes Leor, MD

Child & Adolescent Psychiatric Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel).

Elena Rapoport, MD

Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel).

Jeremia Heinik, MD

Margoletz Psychogeriatric Center, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel).

Miki Bloch, MD

Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel).


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How to Cite

Schreiber, MD, S., O. T. Dolberg, MD, G. Barkai, MD, E. Peles, PhD, A. Leor, MD, E. Rapoport, MD, J. Heinik, MD, and M. Bloch, MD. “Primary Intervention for Memory Structuring and Meaning Acquisition (PIMSMA): Study of a Mental Health First-Aid Intervention in the ED With Injured Survivors of Suicide Bombing Attacks”. American Journal of Disaster Medicine, vol. 2, no. 6, Nov. 2007, pp. 307-20, doi:10.5055/ajdm.2007.0040.