Insight Matters
Fall 2005

Disaster Responses in a Season of Disasters
by James Wasserman, M.D., Chair, Ad Hoc Committee on Disaster Mental Health

Hurricanes, Floods, Earthquakes, Tsunamis, Tornados: it appears to be a season of multiple disasters. We have thousands of people homeless and displaced all over the world. Here, in the United States, it appears we have not even been able to recover from one disaster when another strikes. Citizens of Louisiana and Mississippi are evacuated all over the US in what best can be called a Diaspora. When disaster strikes the American Psychiatric Association is in contact with individuals all over the world through the APA Disaster Response Committee lead by Antonia Ng, MD.

In September I had the privilege of attending the APA Component Meeting of the Disaster Response Committee. There we heard about hurricane Katrina and the horrible events that occurred during and in the aftermath.

Dr. Harold Ginsburg, Chairman of the Louisiana Psychiatric Medical Society's Disaster Response Committee, spoke to us at length about his experiences. He stood before us in borrowed clothes, and living in an evacuation camp near Jackson Mississippi. He discussed how Louisiana simply failed to act when they could and did not even follow their own emergency evacuation plans. Dr. Ginsburg talked about how you can lose perspective when you are both a responder and a victim. You are a casualty. His final thoughts that we can all take with us is that the problems that arise tend not to be high tech. They tend to be "oh gosh", common sense issues.

In the aftermath of Hurricane Katrina, the Louisiana Chapter simply ceased to exist according to Dr. Ginsburg. There wasn't even anyone to contact to see about restoring it. Records are gone. It brings home to all of us that whether as individuals, in our practices or as medical organizations, we need to have a disaster plan. This includes important files, communication plans, and evacuation sites. I know. I had some two thousand patient files stored on the Gulf Coast, in Gulfport Mississippi. I still have no idea what happened to them! One reason to take care of personal, practice, and organizational emergency plans is that it allows us all to be better able to respond to a disaster. It is easier to take care of others if we know we have acted to care for ourselves and those we care for.

We are all involved. There are many evacuees in Ohio, many know people who were involved and many experience traumatic response just from the repeated twenty-four hours a day, seven days a week visual reporting in the news media. Watch all the media reporting on the dangers for bird flu and comparisons to the 1917 epidemic, and you are witnessing the power of the press to inflict trauma. It isn't that the threat is not there; it is just that it has not happened. At some point the reporting begins to cause traumatic responses by itself. As psychiatrists we need to be aware of the responses and help people cope with the fear. Should there be an epidemic, then we will be challenged to respond as a professional society and further as advisors to community leaders.

At the component meeting, a number of recommendations were discussed most of which we can either collaborate with or develop ourselves:

The APA needs to support training and understanding of Disaster Psychiatry including Acute Traumatic Disorder and Post Traumatic Stress Disorder. I recently gave such a lecture to the house staff at Riverside Methodist Hospital here in Columbus, which was very well received. We need to teach such topics in medical school.

There is a need for the District Branches to develop their own disaster response plans and for them to assist members to develop their plans.

After a disaster, the APA needs to assist in the rebuilding of District Branches affected, to assist in the rebuilding of practices and to collaborate with local professional associations.

A suggestion was made to develop a web-based course on Complicated Grief, as this certainly will be a long-term issue for many of the people in a major disaster.

There needs to be a communication system established about how the APA, District Branches and individuals communicate in a disaster. How do we coordinate?

It is important to remember that, as psychiatrists, we are a resource and need to act as consultants is a disaster.

We need to urge authorities to consider the problems inherent in a major disaster. Patients were without their medications, Alcoholics went into withdrawal, and individuals on methadone maintenance went into withdrawal. All were homeless and isolated. The elderly had no support or stability. Emergency supplies do not currently provide for any of these needs.

There is now a direct link on the OPA web site to the APA disaster web site, which has invaluable information and links. The CDC also has excellent information and disaster related forums.

The OPA is a member of the Ohio All Hazards Response Group and provides professional input for the planning and actuation of a response to a disaster.

The OPA Disaster Committee is working with the APA to review our plans and how we can communicate with the membership in times of disaster.

I would like to receive any reports of members as to their experiences with the disasters this summer and their encounters with the evacuees. Also we are recruiting members for the OPA Disaster Committee, especially from those Local Chapters that do not have representation.

Any comments or suggestions you have regarding the activity of the Disaster Committee and the OPA are welcome. The can be sent to opadisaster@aol.com.

Jim Wasserman, MD
Distinguished Life Fellow
Chairman, OPA Disaster Committee

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