Insight Matters
Summer, 2003

Disaster Training Results in Action Plan
by Marion Sherman, M.D., Chair, Ad Hoc Committee on Disaster Mental Health

In the last Insight Matters, we promised to present the physician action plan created by the participants at the April FEMA disaster mental health training, and to follow up with updates on participants' questions and requests:

1. A request for a "brief bi-monthly or quarterly e-mail of status of volunteer initiative" was made. For those who did not attend the training but who wish to be included on the disaster mental health email, feel free to request inclusion at the address Shermanme@mhmail.mh.state.oh.us. This will continue to expand the cadre of those preparing to assist Ohioans in case disaster strikes, and allow you an avenue for further information. This email update will serve to continue the OPA commitment to disaster mental health training, organization, linkage, and education.

2. Participants requested notification acknowledging them as Disaster Volunteers. The Ohio Disaster Card will assist in this registry function. Currently, we are waiting for legislation that will authorize the Bureau of Motor Vehicles to issue these cards. The initial card is designed to register physicians, physicians assistants, pharmacists, nurses, and independent licensed mental health professionals. The State Medical Board of Ohio has agreed upon the criteria, along with the licensing boards for social work, clinical counseling, and psychology, to round out the independent professional mental health disaster volunteer registry.

3. A request was made for "a clear call to action e.g. specifics of EMA/MH status by county so we know how/who to contact in our locale." We are working to make this list available by web access.

The draft action plan for psychiatrists in disaster mental health follows:

1. Establish relationships:
Meet pre-disaster and plan ongoing partnerships; establish roles & responsibilities with each partner. Leaders ask "How can we help?" as well as "This is how we can help."
Primary Partnerships to begin contact with may include:
- County EMA Directors
- Fire/Rescue / Law Enforcement / Hospitals / EMA / EMS / FEMA / Red Cross
- Mental Health Boards / Mental Health Agencies (e.g. NetCare)
- Children's Guidance / Children's Svcs./ Foster Care Agencies / Buckeye Ranch
- Utility providers / Shelters / Hotels / Chamber of Commerce / ODMH
- Media (TV, Radio, Newspapers) / Quilters, Songwriters, Artists, Dance
- Schools - public & private / School Board / PTA / Colleges/Univ/ Faculty
- General community / Employers / My CEO / My system
- City and County Commissioners / Health Dept./ NG / Local Govt/Local Politicians
- Local voluntary service organizations (e.g. Rotary, Kiwanis)
- NOVA/CISM / First Link/ Faith-based / Churches / Salvation Army
- Family Support Svces Social Service Agencies (e.g., Cath., Luth.)
- OPA / OSMA/ Medical Associations / MHA / NAMI / Advocacy organizations

Secondary Partnerships expand to include:
- National Guard / Army Reserve / Coast Guard / Military / VA / Court
- Med. Schools / Dept. of Psychiatry / Social Workers / Nursing / Counselor / Pharmacy
- Preschool (church, private, Healthy Start - 0-3)
- Interpreters: ASL and languages / minority assoc
- Charities (e.g. United Way, Humane Society)
- Veterinarian Services / HAM Radio / Transportation (Bus, Rail, Airlines)
- Other professional organizations / Individual Providers / EMT/ER physicians
- Area Agency on Aging / Senior Centers / Neighborhood Associations
- Retail/ Major corporations/ Grocers & Restaurateurs

2. Get Trained: Disaster MH (FEMA) training is a good place to start; opportunities for training for trainers may emerge in Ohio as well. Look at the following aspects:
- Personal fit: media, field work, consultation/liaison, education/training/written materials/communication, local provider agency clinical work
- Role(s) of physicians - OPA
- Obtain Community Knowledge: demographics, ethnic groups, special pops.
- Maintain Updated knowledge of training guidelines from state for physician volunteers - PPVC
- Develop Disaster Education Resources: FEMA slides, SAMHSA DTAC, Talking points

3. Recruit/Train /Educate Others/ Locals for Long-Term Planning:
- Assist in mental health training for volunteers (MH), psychiatry, psychology, paraprofessionals, fire, EMS, police
- Consult to all of above
- Media - talking points, point person, ongoing links with reframing.
- Educate public
- Find ways to inform regarding emotional & behavioral response to disaster; During/immediately after; unreality of immediacy vs. working through anniversary "event" including media impact (e.g. grieve v celebrate)
- Schools/Senior Citizens/Special Populations: triage, educate, consult, become involved in post-disaster projects

4. Link to OPA plan
- Disaster email
- Disaster Committee communications
- Insight Matters
- Explore OPA/APA web resources

5. Define the Structure/ Your Plan
- Design your personal plan; compare notes with others
- Practice Disaster: Participate in mock disasters EMA drills, HEIC drills, Other mock: CMHC, OPA, School disaster drills, ARC course "Masters of Disaster"
- Disaster Registry/credentialing: obtain your Disaster Card when available

6. Disaster Response
- Be prepared, flexible, competent, and ready to listen well.
- Work with ODMH disaster coordinator to write a local grant for monies following a disaster
- Inform & update media; work through established point person
- On site, EMA/Red Cross makes the call. Work with them, in predetermined roles to deploy volunteers to assigned sites to assess & recommend treatment, defuse safety forces on site to keep volunteers/disaster relief working, debrief victims/staff, crisis triage on site, refer to community MH providers, work/clinical supervision, training/mentoring/education, assist with ongoing reallocation/specialization; in cases of repeat trauma, one may need to deal with prior trauma.
- Work with family centers, community supports, referred psychiatric patients

7. Plan administrative issues
- Learn about your Leave of Absence/Coverage options
- Obtain your workplace Policies and Procedures
- Calculate your financial situation to determine availability up front
- Determine your current liability insurance coverage for disasters vs. FEMA coverage
- Learn about extent and limitations of Good Samaritan coverage

This is a start for the individual action plans for psychiatrists designing their personalized approach to preparing professionally for disaster. Again we thank you for participating in the February and April disaster mental health trainings, and we look forward to providing more information to you, as well as the opportunity for additional psychiatrists to receive training. As we continue to define our roles and responsibilities in mental health disaster response in Ohio, disaster planning, preparation, and building relationships with key partners remain vital components to building for a safer tomorrow.

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