Learning how to calm public panic in the event of a chemical attack

By Scott Sleek
Monitor staff

After a terrorist released nerve gas into a Tokyo subway system in 1995, 5,000 people overwhelmed emergency rooms seeking treatment, but not many of them actually were medically harmed by the attack. Most were suffering severe anxiety or other psychological reactions. Many mistakingly believed they were exposed.

The Tokyo incident demonstrated the acute need for psychological services in the aftermath of terrorists? use of biological or chemical agents. The Cold War specter of global nuclear war has been replaced by the threat of an anthrax bomb dropped in the middle of an airport or train station or radioactive dust released into a subway system. Unlike natural disasters, these weapons are ominously invisible and strike without warning. They can send people into a unique, confused panic once they learn of their exposure.

'Evidence that the tornado or hurricane has come and gone is pretty unambiguous,' says Paul Ofman, PhD, an expert in disaster mental health services and assistant to the director at the U.S. Department of Veterans Affairs Medical Center in New York City. 'But when it?s something that contaminates the air you breathe, where people don?t really know what?s going on, there?s much more distress. What is it? Where did it happen? When will it end? What are the long-term effects? All those questions raise the risk for panic.'

Ofman and other psychologists are in the forefront of an embryonic national effort to prepare for this modern form of terrorism?and the unique emotional pandemonium it can arouse. They?re helping disaster relief organizations, such as the Federal Emergency Management Agency (FEMA) and the U.S. Department of Defense, develop appropriate response protocols that include ample mental health services for both victims and rescuers. In fact, psychologists were actively involved in a recent federally sponsored conference, held in Denver, on preparation for disasters involving weapons of mass destruction.

Most importantly, they?re helping disaster-response teams learn how to keep public alarm under control, so that rescue efforts can run more smoothly and effectively.

Terrifying possibilities

The federal government and other terrorism watchdogs offer some grim projections about the threat of biological or chemical terrorism. Some envision terrorists releasing the deadly Ebola virus in an airport, dumping radioactive waste in a train station or a chemical weapon released at a national convention.

Fears were heightened earlier this year when FBI agents in Las Vegas arrested two men suspected of possessing anthrax for use as a weapon. Anthrax is simple and inexpensive to produce, and just a minute amount can be fatal.

The psychological tumult that can result from a terrorist attack can hamper medical personnels? efforts to treat people who truly need emergency medical attention, disaster-response experts say. So psychologists and other mental health specialists have begun identifying specific roles they can play in the response to these terrorist attacks, in a way that allows medical personnel to do their job. Those duties include:

? Diagnostic assistance. Psychologists can help rescue teams distinguish between people who are actually suffering from the exposure and those who may simply be having a psychosomatic reaction to the incident.

'In a biological attack, for example, rescuers need help determining if someone is having a stress reaction or a reaction to the virus or toxin,' explains Gerard Jacobs, PhD, director of the Disaster Mental Health Institute at the University of South Dakota. 'Sometimes the reactions are very similar and can be very confusing. Some people are categorized as infected when they?re just having a panic attack.'

? Information dissemination. Psychologists, trained in effective communication skills, can develop the most calming and reassuring ways to keep the public informed about the terrorist event, says Brian W. Flynn, EdD, director of program development, special populations and projects for the Center for Mental Health Services. Often people are more dismayed by what they don?t know than they are by bad news, he explains. Information delivered in a timely and sensitive way may prevent them from assuming the worst, he says.

Psychologists say they also are well-trained to disseminate the information in culturally sensitive ways, which can be extremely useful in disasters that occur in ethnically diverse regions.

? Acute intervention. Prac-titioners can provide practical assistance and unobstrusive counseling to victims, their family members and rescue workers at disaster sites and nearby relief centers, says Julian Ford, PhD, deputy executive director of the U.S. Department of Veterans Affairs (VA) National Center for Post-traumatic Stress Disorder. One of their primary objectives is to help people cope with intense, albeit normal stress reactions to the event, to help prevent full-blown psychological disorders, Ford says. Rescue workers and medical personnel also need the help of mental health professionals to calm people experiencing severe agitation, he says.

Psychologists who are experts in disaster response say mental health professionals also need to be involved in preparation efforts, not just the crisis response. Most importantly, psychologists can suggest rescue protocols that can lessen the risk of adverse emotional reactions among patients, says Ofman, who is also leads disaster mental health services for the American Red Cross in New York state.

Take, for example, the decontamination process for people externally contaminated with radioactive materials, he says. The decontamination, which often involves rinsing with soap and water, must be done in a nonporous area. Some medical crews often seek to set up decontamination sites in autopsy rooms. From a technical point of view, that might be the best location. But what will the psychological consequences be for the victims?

'Imagine having a person who comes in for decontamination and is wheeled into a room labeled ?autopsy room,?' he says. 'And all around him are autopsy instruments and people wearing protective suits. The potential for agitation or panic is very, very great.

'So you need mental health professionals, who know about trauma and typical responses to traumatic situations, to help set up protocols for managing these situations.'

Psychologists also need to be on hand to provide counseling to the rescue workers, who may also be distressed about the possibility that they?ve been exposed to the dangerous agent, says Julian Ford, who conducts disaster-response research for the U.S. Department of Veterans Affairs? National Center for Post-Traumatic Stress Disorder.

Practicing for the worst

Psychologists are already involved in preparation efforts. The theme of the National Disaster Medical System?s annual conference, held in April in Denver, focused on preparing for weapons of mass destruction. The conference included a full mental health track, organized by Ford and CMHS? Flynn.

'We basically addressed how disaster mental health comes into play in nuclear, biological and chemical warfare and terrorist acts,' says Jacobs, who attended the conference and also is actively involved in APA?s Disaster Response Network. 'We were led through scenarios of how these weapons work, and how likely they are to be used here in the United States.'

Meanwhile, federal agencies such as the VA and the Public Health Service, as well as organizations such as the American Red Cross, have been training mental health professionals to respond effectively to man-made disasters.

In April, for example, the VA and the U.S. Department of Defense held a two-day training program at the Fort Gordon Army base in Georgia. The training included a simulated disaster?an explosion that released airborne toxins. It was the first exercise of its type full-scale simulation of a medical and mental health response to a incident involving a weapon of mass destruction, says Ford, who coordinated a mental health leadership training session for the exercise.

Psychologists and other counselors were on hand to help medical personnel manage the participants playing the role of 'psychiatric casualties'?people who were severely traumatized by the accident. They also provided profession and personal consultation to rescue workers who needed help coping with the stress of situation, he says.

'The training went very well, and the simulation was excellent,' Ford says. 'The mental health professionals were very organized and helpful. Medical staff said they were there when needed, constantly available to manage psychiatric casualties?which the medical people are often very frightened of and uncertain how to deal with.'

Mental health services also were a big component of a VA-led radiological-disaster drill held in 1996 at the VA medical center in San Juan, Puerto Rico. Mental health staff worked on planning the scenario and the protocols to be used and provided services to 'victims' and 'response teams,' says Ofman, who served as a faculty member in the drill.

Another big task in preparing for biological and chemical terrorism is getting the general citizenry aware of the threat, so they?re better prepared to deal with it, psychologists say. And that?s a lofty objective: Most people, including psychologists, don?t like to hear about a horrifying danger that at this point remains largely theoretical.

As Flynn put it in a recent speech, the possibility of chemical or biological terrorism forces everyone 'to face our own vulnerabilities, our own limitations, our most primal fears, and break down the denial that allows us to live our daily lives.'