Insight Matters
Fall, 2001

OPA Reactivates Disaster Committee

Following in the aftermath of the terrorist attack on September 11, 2001, an interdisciplinary interagency statewide committee, Disaster Integration and Planning for Mental Health in Ohio, was formed to work with non-mental health disaster crisis planning structure/organizations, to formulate a seamless, timely mental health disaster plan for Ohio. A key component was missing: the psychiatric plan within the larger mental health disaster plan. On October 3, 2001, Ohio Psychiatric Association President Robert Ronis asked Marion Sherman to chair an OPA disaster committee, due to Dr. Ronis' determination of the need for the committee, and Dr. Sherman's membership on the state interagency disaster committee. The Disaster Committee of the OPA was commissioned, to develop the psychiatric internal structure and link to the larger disaster/crisis response structures locally and nationally.

Goals and Objectives
The first goal was to develop disaster committee membership. Working with the OPA Executive Council, a committee was assembled with volunteers from multiple local chapters to provide statewide geographic representation. The committee communicates status of disaster preparedness/response internally to OPA membership/Executive Council, and externally to APA.

The second goal was to determine Ohio psychiatry resources available in case of disaster. A survey was designed and sent to all OPA members to determine crisis response resources in Ohio. Remarkably, within three weeks, 149 surveys (about 15%) had been returned, initiating:
• Call-down list of volunteers interested in receiving crisis training and helping in future disasters in any of three zones: 1) local communities, 2) within Ohio, 3) outside of Ohio within the U.S.;
• Duration of psychiatric disaster service availability for volunteers (Options of two days, five days, one week, ten days, two weeks or more);
• Disaster preparedness of volunteers, per completion of 12 hour American Red Cross Crisis Response training (ARC), 3 hour American Red Cross Introduction to Disasters, NOVA crisis training, or Critical Incident Stress Debriefing/Management (CISM).

The third goal was to promote disaster education and training in Ohio, with a mechanism to:
• Inform members regarding disaster preparedness in Ohio;
• Communication to members regarding training for disaster debriefing and crisis counseling, including the following courses: ARC Crisis, ARC Intro. to Disasters, NOVA, CISM;
• Develop CME programming, chapter rounds, potential speakers/topics for OPA members;
• Formulate recommendation to psychiatric training programs for required disaster curriculum;
• Educate community in disaster preparedness to enhance secondary prevention during disaster.

The fourth goal was to develop a structure for communicating resources and other disaster response entities during a disaster/aftermath, to:
• Describe imminent linkage during disaster with other disaster response bodies;
• Link direct psychiatric services to primary and secondary victims during disaster;
• Design community education for secondary prevention during disaster;
• Enhance the OPA web site to include relevant disaster information and references, including treatment and triage, disaster type, deployment instructions, links to other disaster information;
• Develop media package/"sound bites" for distribution and use during disaster.

Mental Health Disaster Plan
In formulating a mental health disaster plan for implementation, the phases of disaster must be considered separately. One may conceptualize the spectrum of disaster mental health disaster planning divided into four phases:
• Preattack / Precrisis Phase
• Disaster Phase I: Acute Event Management (hours to days)
• Disaster Phase II: Short-term (less than one month)
• Disaster Phase III: Long-term: Consequence Management and Reconstruction

Preattack/ Precrisis Phase planning addresses threat assessment, prevention, and psychological preparedness of primary target and emergency medical services. Threat assessment must define distinct disaster types: terrorism act, chronic terrorism, bioterrorism, natural disaster, and war. The plan must design should specifically address each type, as there are differences in the first line responders, pattern of destruction, burden of morbidity and mortality, timeline, and psychological sequela.

Prevention in this phase includes many parts, such as: linking groups: ODMH, ADAMH, NAMI, OPA, MHA, ODE, ODOH, ODJFS; assisting in community development of disaster plans; educating public; designing mental health disaster web with links; promoting training in disaster mental health; involving mental health personnel in local and state disaster drills.

Psychological preparedness of primary target and emergency medical services requires a designed focus of intervention (age appropriate- child, adult, geriatric; culturally appropriate; population appropriate) for each disaster type. Preparedness also requires communication plan, establishment of credentials for media experts, listing of media experts, creation of "sound bites" outlines, establishment of credentials for each provider resource, and creation of resource lists.

Disaster Phase I involves acute event management (within hours to days). Threat assessment should include definition of the focus of this phase, symptoms, and coping mechanisms. Psychological preparedness includes design of a mechanism for community education for secondary prevention during disaster/aftermath; listing of credentialed providers (including mental health, teachers, ministers); and activation of media package.

Phase I action response should include both an action plan for linkage of direct mental health services to primary and secondary victims during disaster/aftermath, and a focus of intervention for each disaster type, including: triage/demobilization, crisis management briefings, defusing, individual crisis debriefing, and crisis counseling. Training for "informal" providers (including in educational institutions, faith-based settings) should be addressed as well.

Disaster Phase II involves short-term disaster management (less than one month). Threat assessment again defines the focus of the phase. Psychological preparedness/Secondary prevention describes usage of media resources, and formulation of credentialed provider lists. Phase II action response planning describes the focus and identifies signs, symptoms, and diagnoses for this phase (e.g. acute stress disorder/anxiety/mood/psychosis).

Disaster Phase III spans the long-term timeframe (more than one month), during which consequence management and reconstruction occur. In this phase, threat assessment includes defining of the focus of phase, symptoms (e.g.. frustration, anxiety, grief, disillusionment, mourning, depression), diagnoses (e.g. PTSD/anxiety/mood/ psychotis); and coping mechanisms. Psychological preparedness/secondary prevention/action response requires planned usage of media resources and credentialed providers specific to Phase III.

Future
On September 11, 2001, the terrorists dealt a mighty blow to our fellow colleagues, their families, friends, and patients in New York, New Jersey, Maryland, Virginia, Connecticut, Washington D.C., and Pennsylvania. The Ohio Psychiatric Association extends our most heartfelt condolences to those wounded in this horrific act. We send our hopes that wounded healers may continue to find the strength to continue their healing for themselves and their patients. As we face new challenges across the country in war, bioterrorism or disaster acts, we will need to continue to learn how to conquer each new foe. Planning structure, education, communication, and relationship are the tools that we are using in Ohio to move forward.

Marion Sherman, M.D.
Chair, Ad Hoc Committee on Disaster Psychiatry

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