Psychologist Alma Elder, PhD, walked around the disaster site at Connecticut's Fort Trumbull and surveyed the damage from a chemical weapons attack: Piles of rubble lay strewn about, with survivors buried beneath. An "alphabet soup" of agencies stood on hand with search dogs at the ready. Responders in hazmat suits cordoned off areas.

The whole scene looked frighteningly real. Good thing it wasn't.

As coordinator of Connecticut's arm of APA's Disaster Response Network (DRN)--an organization that includes volunteer APA members who offer psychological assistance to victims, Red Cross workers and other responders during a crisis--Elder was one of hundreds of psychologists who participated in a weeklong national anti-terrorism drill in April called TOPOFF 3. The TOPOFF exercise--which stands for "top officials"--included a simulated mustard gas attack at Fort Trumbull and a simulated biological attack in New Jersey where an unidentified virus was released. People began arriving at local hospitals complaining of flu-like symptoms.

Designed to test the nation's anti-terror and emergency response services, TOPOFF 3 cost $16 million and involved more than 10,000 people, from federal officials in the United States, Canada and England, to volunteers acting as victims at disaster sites.

Response teams, police and hospitals treated the event as a real terrorist attack--treating patients, quarantining sites, performing search and rescue missions and searching for evidence to track down the perpetrators. In addition to regional coordination in New Jersey and Connecticut, U.S. Department of Homeland Security officials monitored the drill's activities from a central command center in Washington, D.C.

TOPOFF 3 is the third anti-terror drill of its kind. The first TOPOFF, held in 2000, had a simulated chemical attack in Portsmouth, N.H., and a simulated anthrax attack in Denver. The second exercise, in 2003, simulated a dirty bomb and biological terrorist attacks in Seattle and Chicago.

But April's drill differed noticeably from its predecessors by involving a greater number of psychologists, including many from the DRN, among its teams of responders to the attack sites and also behind the scenes coordinating disaster mental health responders. "The opportunity to participate through our partnership with the American Red Cross in response efforts with agencies such as the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention shows the important contribution psychology can have in disaster situations," says Marguerite Schroeder, APA's DRN director. APA's DRN program is administered through the Practice Directorate.

During TOPOFF 3, "The DRN program participated daily on conference calls with Red Cross and governmental agencies, and implemented procedures used to communicate with and mobilize volunteers," Schroeder says.

Providing psychological perspectives

The Red Cross has had a formal disaster mental health program since the early 1990s and includes a large cadre of volunteer psychologists with disaster relief training. It invited the DRN to participate in the most recent TOPOFF.

"I suggested the more formal involvement of APA at the national level for TOPOFF 3, as the mental health associations have played a large role in recruiting licensed mental health professionals in natural disasters and during the tragic events on September 11, 2001," says Susan Hamilton, PhD, the senior associate for disaster mental health at the Red Cross and the agency's disaster mental health program lead during TOPOFF 3. "Mental health professionals who are trained in disaster response are enormously important and their role has gained greater attention since 9/11."

For TOPOFF 3, the Red Cross only tapped a fraction of its 4,500 trained mental health volunteers and simulated use of the rest, which would be available during a real attack, says Merritt Schreiber, PhD, the mental health lead for the American Red Cross Disaster Mental Health effort in TOPOFF 3. In his role, Schreiber coordinated Red Cross national mental health efforts from the Red Cross Disaster Operations Center at its national headquarters in Washington, D.C. There, he stayed in touch with Red Cross disaster mental health workers on site in New Jersey and Connecticut to ensure mental health volunteers were available to everyone who needed them. Schreiber was also in contact with the DRN Office at APA.

The services the Red Cross Disaster Mental Health program provides to disaster victims and Red Cross workers, include mental health screening, informal assessment and triage, emotional support, advocacy, problem-solving, crisis intervention and education.

For example, Elder coordinated with psychologists working at family assistance centers during the April TOPOFF. In an actual disaster, people would look for missing family members at these centers. During TOPOFF, participants acting as family members did the same thing: Volunteers collected key information, such as the missing person's physical description, and conveyed it to local hospitals to assist in the search. In the meantime, psychologists were available to work on difficult cases, helping to calm individuals too upset to provide information on their missing family members.

"Mental health assistance is critical for handling people who may be safe, but who are frightened and who can't find their loved ones," Elder says. "In this situation, hospitals can become inundated. Providing mental health assistance to these people can be a way to help them slow down and balance their emotions with more rational information and establish ways to cope."

In New Jersey, psychologist Ray Hanbury, PhD, the state's DRN coordinator, was part of a special response team conducting initial assessments at triage areas and command centers as part of an interdisciplinary effort to address the physical, mental and environmental health concerns of affected communities.

"This drill demonstrated the need to have psychologists trained in early intervention models and in psychological sequelae of terrorism," Hanbury says.

Cool, calm and coordinated

During TOPOFF, the Red Cross unveiled innovations that could improve access to mental health information during an attack, Schreiber says.

It and the Centers for Disease Control and Prevention jointly launched a Web site for the drill that provided information in real time on shelter locations. It also offered strategies, such as techniques to manage children's reactions to the events, and resources, such as a link to APA's online information on resilience--at the APA Help Center.

The Red Cross also launched a pilot program called PsyStart, a rapid triage tool and incident management system for mental health response in mass casualties. Using the system, mental health professionals at various sites were able to send information on risk factors from victims to a Red Cross emergency operations center. The center was used to plot that triage data onto a map that allowed Red Cross officials to see where high-risk individuals and populations were located in real time and match resources to those triaged levels of risk.

"It's a tremendous aid in helping the Red Cross manage the mental health aspects of an incident," says Schreiber, also the Orange County Psychological Association DRN coordinator in California. "The information can inform our immediate response and help in the long-term planning for an at-risk population."

Department of Homeland Security (DHS) officials are reviewing the drill and will report on which aspects of the nation's anti-terror and disaster response efforts worked well and which others still need improvement. DHS will release findings sometime in the fall. A fourth TOPOFF drill is tentatively planned for 2007.

Schroeder says APA's DRN program hopes to continue participation in the drills to be prepared to offer the best possible assistance to the public.