Interventions to improve the psychological well-being of healthcare workers in disasters, pandemics, and mass casualty events


  • Romeo Fairley, MD, MPH
  • Sharon E. Mace, MD
  • Kathy Lehman-Huskamp, MD
  • Leah Gustafson Ista, MD, MSPH
  • Jennie Wang, DO, MPH
  • Lillian Lockwood, MD
  • Joshua Weil, MD
  • Carl H. Schultz, MD, FACEP



disaster medicine, mental health, resilience, first responder


Objectives: This information paper will describe the current research and recommendations for improving healthcare worker’s (HCW) mental health. Individual and organizational goals will be outlined with items broken up into the time frames of predisaster, during a disaster, and post-disaster.

Methods: A team of subject matter experts reviewed the current literature utilizing a search of PubMed, Google Scholar, relevant article reference lists, and subject matter interviews.

Results: Thirty-six distinct recommendations were identified and distributed into the time frames of predisaster, during a disaster, and post-disaster. Twenty-one of these are pertaining to organizational goals and factors. Fifteen recommendations are identified for individual HCWs.

Conclusions: Additional institutional and government policies supporting the protection of HCW’s mental health are required to reduce the stigma and fear, preventing frontline workers from seeking help with the psychological effects of disasters, mass casualty incidents, and pandemics. Further research dealing with ways to ameliorate the negative effects of the stress related to the duties and responsibilities of HCWs, which are exacerbated by disasters, is needed.

Author Biographies

Romeo Fairley, MD, MPH

Department of Emergency Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas

Sharon E. Mace, MD

Professor of Medicine, Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University; Director of Research, Emergency Services Institute; Director of Research, Department of Emergency Medicine, Cleveland Clinic, Cleveland, Ohio

Kathy Lehman-Huskamp, MD

Associate Professor, Pediatric Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina

Leah Gustafson Ista, MD, MSPH

Emergency Medicine Physician, Altru Health System, Grand Forks, North Dakota

Lillian Lockwood, MD

Emergency Medicine, Colmery-O’Neil Veterans Affairs Medical Center, Topeka, Kansas

Joshua Weil, MD

Emergency Medicine, The Permanente Medical Group, Kaiser Hospital Santa Rosa, Santa Rosa, California

Carl H. Schultz, MD, FACEP

Professor Emeritus of Emergency Medicine and Public Health, UC Irvine School of Medicine; EMS Medical Director, Orange County Health Care Agency, Irvine, California


Wright HM, Griffin BJ, Shoji K, et al.: Pandemic-related mental health risk among front line personnel. J Psychiatr Res. 2021; 137: 673-680.

Giorgi G, Lecca LI, Alessio F, et al.: COVID-19-related mental health effects in the workplace: A narrative review. Int J Environ Res Public Health. 2020; 17(21): 7857.

Brooks SK, Dunn R, Amlôt R, et al.: Protecting the psychological wellbeing of staff exposed to disaster or emergency at work: A qualitative study. BMC Psychol. 2019; 7(1): 78.

Minihan E, Gavin B, Kelly BD, et al.: COVID-19, mental health and psychological first aid. Ir J Psychol Med. 2020; 37(4): 259-263.

Schreiber M, Cates D, Formanski S, et al.: Maximizing the resilience of healthcare workers in multi-hazard events: Lessons from the 2014-2015 Ebola response in Africa. Mil Med. 2019; 184(Suppl. 1): 114-120.

Wisnivesky JP, Teitelbaum SL, Todd AC, et al.: Persistence of multiple illnesses in world trade center rescue and recovery workers: A cohort study. Lancet. 2011; 378(9794): 888-897.

Benedek DM, Fullerton C, Ursano RJ: First responders: Mental health consequences of natural and human-made disasters for public health and public safety workers. Annu Rev Public Health. 2007; 28: 55-68.

Shanafelt TD, Ripp J, Brown M, et al.: Caring for health care workers during crisis, creating a resilient organization. 2020.

Kane L: Medscape National Physician Burnout & Suicide Report 2020: The generational divide. 2020. Available at Accessed January 25, 2023.

Pollock A, Campbell P, Cheyne J, et al.: Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: A mixed methods systematic review. Cochrane Database Syst Rev. 2020; 11(11): Cd013779.

Barello S, Palamenghi L, Graffigna G: Burnout and somatic symptoms among frontline healthcare professionals at the peak of the Italian COVID-19 pandemic. Psychiatry Res. 2020; 290: 113129-113129.

Epstein RM, Krasner MS: Physician resilience: What it means, why it matters, and how to promote it. Acad Med. 2013; 88(3): 301-303.

Sotile WM, Fallon RS, Simonds GR: Moving from physician burnout to resilience. Clin Obstet Gynecol. 2019; 62(3): 480-490.

Restauri N, Sheridan AD: Burnout and posttraumatic stress disorder in the coronavirus disease 2019 (COVID-19) pandemic: Intersection, impact, and interventions. J Am Coll Radiol. 2020; 17(7): 921-926.

Ebell MH, Siwek J, Weiss BD, et al.: Strength of recommendation taxonomy (SORT): A patient-centered approach to grading evidence in the medical literature. Am Fam Physician. 2004; 69(3): 548-556.

Mahmoud NN, Rothenberger D: From burnout to well-being: A focus on resilience. Clin Colon Rectal Surg. 2019; 32(6): 415-423.

Maunder RG, Leszcz M, Savage D, et al.: Applying the lessons of SARS to pandemic influenza: An evidence-based approach to mitigating the stress experienced by healthcare workers. Can J Public Health. 2008; 99(6): 486-488.

Nukui H, Midorikawa S, Murakami M, et al.: Mental health of nurses after the Fukushima complex disaster: A narrative review. J Radiat Res. 2018; 59(Suppl_2): ii108-ii113.

Umeda M, Chiba R, Sasaki M, et al.: A literature review on psychosocial support for disaster responders: Qualitative synthesis with recommended actions for protecting and promoting the mental health of responders. Int J Environ Res Public Health. 2020; 17(6): 2011.

Quitangon G: Managing distress in health care workers during COVID-19: Lessons from a disaster trauma lens. Psychiatric Times. 2020; 37(10).

Nguyen J, Liu A, McKenney M, et al.: Impacts and challenges of the COVID-19 pandemic on emergency medicine physicians in the United States. Am J Emerg Med. 2021; 48: 38-47.

Lim R, Aarsen KV, Gray S, et al.: Emergency medicine physician burnout and wellness in Canada before COVID19: A national survey. CJEM. 2020; 22(5): 603-607.

Kenardy J: The current status of psychological debriefing. BMJ. 2000; 321(7268): 1032-1033.

Rock LK, Rudolph JW, Fey MK, et al.: “Circle up”: Workflow adaptation and psychological support via briefing, debriefing, and peer support. NEJM Catal Innov Care Deliv. 2020; 1(5).

Bozdag˘ F, Ergün N: Psychological resilience of healthcare professionals during COVID-19 pandemic. Psychol Rep. 2021; 124: 2567-2586.

Rieckert A, Schuit E, Bleijenberg N, et al.: How can we build and maintain the resilience of our health care professionals during COVID-19? Recommendations based on a scoping review. BMJ Open. 2021; 11(1): e043718.

Baskin RG, Bartlett R: Healthcare worker resilience during the COVID-19 pandemic: An integrative review. J Nurs Manag. 2021; 29: 2329-2342.

Labrague LJ: Psychological resilience, coping behaviours and social support among health care workers during the COVID-19 pandemic: A systematic review of quantitative studies. J Nurs Manag. 2021; 29: 1893-1905.

Schreiber M: Personal Interview, February 2022.

Dyrbye LN, West CP, Sinsky CA, et al.: Medical licensure questions and physician reluctance to seek care for mental health conditions. Mayo Clin Proc. 2017; 92(10): 1486-1493.

Jones S, Agud K, McSweeney J: Barriers and facilitators to seeking mental health care among first responders: “Removing the darkness.” J Am Psychiatr Nurs Assoc. 2020; 26(1): 43-54.

Knaak S, Mantler E, Szeto A: Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthc Manage Forum. 2017; 30(2): 111-116.

American College of Emergency Physicians: Joint statement, supporting clinician health in the post-COVID pandemic era. 2020.

Network NCTS: Psychological first aid. Available at Accessed January 25, 2023.

Bisson JI, Tavakoly B, Witteveen AB, et al.: TENTS guidelines: Development of post-disaster psychosocial care guidelines through a Delphi process. Br J Psychiatry. 2010; 196(1): 69-74.

Watkins LE, Sprang KR, Rothbaum BO: Treating PTSD: A review of evidence-based psychotherapy interventions. Front Behav Neurosci. 2018; 12: 258-258.



How to Cite

Fairley, MD, MPH, R., S. E. Mace, MD, K. Lehman-Huskamp, MD, L. G. Ista, MD, MSPH, J. Wang, DO, MPH, L. Lockwood, MD, J. Weil, MD, and C. H. Schultz, MD, FACEP. “Interventions to Improve the Psychological Well-Being of Healthcare Workers in Disasters, Pandemics, and Mass Casualty Events”. American Journal of Disaster Medicine, vol. 17, no. 3, Sept. 2022, pp. 189-95, doi:10.5055/ajdm.2022.0433.




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