homeland security forum responses(215)

Class,

This week we will evaluate the effectiveness of the process of primary care management for behavioral reactions during a weapons of mass destruction (WMD) incident in the United States. The course of behavioral reactions to an attack involving WMD is predictable (Lacy & Benedek, 2003, p. 394). When in groups, people may experience “mass panic, acute outbreaks of medically unexplained symptoms, and chronic cases of medically unexplained physical symptoms”, while individuals may experience “psychiatric disorders such as posttraumatic stress disorder” (Lacy & Benedek, 2003, p. 394). However, each behavioral reaction to WMD attacks, whether in groups or individual responses, have been studied for the appropriate primary care management. The U.S. continues to improve upon primary care management preparedness in the case of a WMD attack. I believe the U.S. is somewhat prepared for primary care management during a WMD incident; however, some improvements could be made.

In situations of mass panic, it is difficult to train individuals to react rationally, such as not becoming paralyzed or socially unorganized; however, primary care providers (PCPs) anticipate mass panic as “a common problem after a devastating attack” (Lacy & Benedek, 2003, p. 395). As suggested, providing accurate knowledge to the public regarding the attack is the best way to reduce mass panic (Lacy & Benedek, 2003, p. 395). Unfortunately, the other option is to provide advanced training and disaster simulation to the public, which, in my opinion, is nearly impossible to do. The U.S. government and PCPs cannot provide the public advanced training and disaster simulation exercises for every possible situation that may occur. Instead, mass media communication is used to educate the public and “promoting responsible behaviors” (Lacy & Benedek, 2003, p. 395). In the case of WMD related attacks, PCPs are prepared to “mitigate barriers” and respond to “psychosocial consequences” (Eisenman et al., 2005, p. 772). “Since the September 11, 2001, and subsequent anthrax attacks, substantial federal funds have been devoted to improving the health care system's capacity to detect and respond to a chemical, biologic, radiologic, or nuclear (CBRN) weapon attack” (Eisenman et al., 2005, p. 772). PCPs are prepared to triage patients to provide the best primary care management possible. Unfortunately, people become noncompliant with public health recommendations. In the 2001 anthrax attack, 30,000 people were offered the prophylactic antibiotics, because it is known that unexposed patients “may present with somatic symptoms mimicking exposure symptoms” (Eisenman et al., 2005, p. 773).

Some of the improvements that need to be made would help PCPs overcome barriers in delivering mental health care in a CBRN event. “Leaders in primary care should improve linkages with local, state, and federal mental health and public health agencies” (Eisenman et al., 2005, p. 773). Coordination between teams to maximize use of existing resources would improve primary care management. Similarly, as previously mentioned, disaster planning cannot be given to the public; however, disaster planning and training should be given to PCPs about ways to respond to emotional and behavioral responses during a WMD attack (Eisenman et al., 2005, p. 774). Finally, there are “critical knowledge gaps” that should be identified and remedied by PCPs and “different service sectors that will operate in a CBRN event” (Eisenman et al., 2005, p. 774). Communication continues to be one of the biggest issues in responding to emergency situations; therefore, breaking communication barriers between all response units would improve the skills and speed at which primary care management is provided.

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Resources

Eisenman, D.P., Stein, B.D., Tenielian, T.L., & Pincus, H.A. (2005). Terrorism’s psychological effects and their implications for primary care policy, research, and education. J Get Intern Med, 20(8): 772-776.

Lacy, T.J., & Benedek, D.M. (2003). Terrorism and Weapons of Mass Destruction: Managing the behavioral reaction in primary care. Southern Medical Journal, 94(4): 394-399.