Psychosocial care to affected citizens and communities in case of CBRN incidents: a systematic review

Preparing railway stakeholders against CBRNe threats through better cooperation with security practitioners

This paper presents partial results from the Horizon2020 PROACTIVE project, following a set of literature reviews and surveys conducted with first responder organisations and rail security experts. Qualitative and quantitative data from two surveys are being presented. The results provide an overview of the CBRNe (Chemical, Biological, Radiological, Nuclear and explosive) preparedness and response capabilities of railway stakeholders and how these relate to a wider context represented by CBRNe first responders. The results highlight a set of challenges as well as five core skills that railway staff need to develop or improve: 1) understand the specific characteristics of the CBRNe threat, 2) develop basic response measures, 3) cooperate with authorities and train with specialised first responders, 4) improve public awareness about this threat, and 5) optimise crisis communication. In line with these, project PROACTIVE will further help update rail crisis management plans with practical recommendations concerning the CBRNe threat.

Advancing and translating knowledge: a systematic inquiry into the 2010-2020 mental health and psychosocial support intervention research evidence base

BACKGROUND AND STUDY OBJECTIVES

MHPSS is increasingly seen as a critical component to effective and responsible humanitarian programming. This review examines the extent to which MHPSS research generated since 2010 has contributed to the public health evidence base and how this has influenced and impacted programming and policy in humanitarian settings.

METHODS

This mixed-method study included a scoping literature review (n = 50) and a consultation process with qualitative key informant interviews (n = 19) and online survey responses (n = 52) to identify the facilitating and inhibiting factors for the two areas of inquiry and to understand the broader context in which knowledge is generated and taken up. The interviews were thematically analysed and the survey responses were descriptively analysed.

RESULTS

The review identified a rapidly growing evidence base that has evaluated a range of MHPSS interventions. However, few studies examined long-term impacts of interventions, there was limited direct evidence on outcomes for children and adolescents and whole family approaches, and there were minimal replications of the same approach that could test efficacy across settings and population groups. A general shift was identified in the consultation process away from a focus on disorder towards the more positive aspects of wellbeing. However, there remained a mismatch in many studies included in the literature review, whereby the interventions were broad, community-based but the outcome measures used still focused on changes in symptoms of mental disorders.

CONCLUSION

The evidence base for MHPSS has grown significantly over the last 10 years. However, several knowledge gaps remain, as does the divide between research and practice. Moving forward, MHPSS intervention research needs to be more responsive to the needs on the ground.

The Effect of Risk Communication on Public Behavior to Non-Conventional Terrorism-Randomized Control Trial

Non-conventional terrorism (NCT) incorporates an extended dimension of uncertainty that can lead to fear among the public. Health officials have an unsubstantiated assumption that thousands will seek treatment in hospitals following NCT. This study aims to examine public behavioral intentions in the case of NCT and the effect of risk communication on intents. An online randomized controlled trial was conducted among 1802 adult participants in Israel. Threat perception and behavioral intent before and after exposure to hypothetical NCT scenarios were assessed stratified to the type of media, exposure to rumors, and risk communication. The majority (~64%) of participants are aware of the NCT threat. Almost half (45%) of participants indicated a "high" or "very high" chance of seeking medical attention following an NCT incident. Regression analysis suggests that the odds of participants exposed to risk communication to report an elevated intent of seeking medical attention were 0.470 (95% CI: 0.359, 0.615) times that of participants not exposed to risk communication, χ² = 30.366, p < 0.001. The findings demonstrate the importance of effective risk communication in reducing undesired public behavior during NCT crises. Efforts must be invested to create a robust risk communication infrastructure to allow the proper management of possible NCT incidents.

Exploring the non-technical competencies for on-scene public health responders in chemical, biological, radiological, and nuclear emergencies: a qualitative study

Objectives

The purpose of this study was to define and delineate specific non-technical competencies for first-line public health responders in Chemical, Biological, Radiological, and Nuclear (CBRN) emergencies in China.

Study design

A qualitative study was conducted in China involving interviews with key informants in the field of health response to CBRN disasters.

Methods

One-on-one in-depth interviews were carried out with 20 participants, including expert members of National Medical Response Teams for CBRN disasters, officials at emergency management authorities, and scholars of academic institutions related to CBRN emergency. Interviews were recorded using audio equipment, transcribed, and coded into codable passages as per grounded theory using NVivo software. Themes were identified within the transcriptions by using thematic analysis.

Results

A total of 159 codable passages were produced. Eight domains of non-technical core competencies were identified: (1) situation awareness, (2) communication skills, (3) collaboration, (4) resource management, (5) task management, (6) cultural competency, (7) austere environment skills, and (8) physical stamina.

Conclusions

The study identified a variety of competencies for on-scene public health responders in CBRN emergencies. The findings of this study could specifically benefit development of strategy and improvement of content of education and training. Further research that involves input from the disaster response community at large is needed for the validation of these competencies.

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Non-technical competencies affect performance of health response to Chemical, Biological, Radiological, and Nuclear (CBRN) disasters.

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Austere environment skills and physical stamina are priority non-technical competencies for on-site public health responders in CBRN events.

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Effective CBRN health emergency training should integrate and synchronize courses based on non-technical/technical competency.

Mental health and psychosocial support programmes for adults in humanitarian emergencies: a systematic review and meta-analysis in low and middle-income countries

BACKGROUND

Humanitarian emergencies are a major global health challenge with the potential to have a profound impact on people's mental and psychological health. Effective interventions in humanitarian settings are needed to support the mental health and psychosocial needs of affected populations. To fill this gap, this systematic review synthesises evidence on the effectiveness of a wide range of mental health and psychosocial support (MHPSS) programmes delivered to adults affected by humanitarian emergencies in low and middle-income countries (LMICs).

METHODS

A comprehensive search of 12 electronic databases, key websites and citation checking was undertaken in 2015 and updated in May 2018. We included controlled trials published in English from 1980. We extracted data and assessed risk of bias prior to performing a meta-analysis using random effects models. When meta-analysis was not used, we narratively described individual trial effect sizes using forest plots.

RESULTS

Thirty-five studies were included. Overall, MHPSS programmes show benefits in improved functioning and reducing post-traumatic stress disorder. There are also indications from a limited pool of evidence that cognitive-behavioural therapy and narrative exposure therapy may improve mental health conditions. Other psychotherapy modalities also showed a positive trend in favour of MHPSS programmes for improving several mental health outcomes.

CONCLUSION

In addition to MHPSS programme for improving mental health outcomes in adults affected by humanitarian emergencies in LMICs, there is also a need to generate robust evidence to identify potential impact on broader social dimensions. Doing so could aid the future development of MHPSS programmes and ensure their effective implementation across different humanitarian contexts in LMICs. Future research on MHPSS programmes which focus on basic services and security, community and family programmes, their cost-effectiveness and mechanisms of impact could also strengthen the MHPSS evidence base to better inform policy and practice decision-making in humanitarian settings.

PROTOCOL REGISTRATION NUMBER

CRD42016033578.

The organization of post-disaster psychosocial support in the Netherlands: a meta-synthesis

Background: Despite numerous calls for a more evidence-based provision of post-disaster psychosocial support, systematic analyses of post-disaster service delivery are scarce. Objective: The aim of this review was to evaluate the organization of post-disaster psychosocial support in different disaster settings and to identify determinants. Methods: We conducted a meta-synthesis of scientific literature and evaluations of post-disaster psychosocial support after 12 Dutch disasters and major crises between 1992 and 2014. We applied systematic search and snowballing methods and included 80 evaluations, as well as grey and scientific documents. Results: Many documents focus on the prevalence of mental health problems. Only a few documents primarily assess the organization of post-disaster psychosocial support and its determinants. The material illustrates how, over the course of two decades, the organizational context of post-disaster psychosocial support in the Netherlands has been influenced by changes in legislation, policy frameworks, evidence-based guidelines, and the instalment of formal expertise structures to support national and local governments and public services. Recurring organizational issues in response to events are linked to interrelated evaluation themes such as planning, training, registration, provision of information and social acknowledgement. For each evaluation theme, we identify factors helping or hindering the psychosocial support organization during the preparedness, acute and recovery phases. Conclusions: The meta-synthesis illustrates that psychosocial service delivery has grown from a monodisciplinary to a multidisciplinary field over time. Suboptimal interprofessional collaboration poses a recurring threat to service quality. Despite the development of the knowledge base, post-disaster psychosocial support in the Netherlands lacks a systematic and critical appraisal of its functioning. Further professionalization is coupled with the strengthening of evaluation and learning routines.

Demographic transition and factors associated with remaining in place after the 2011 Fukushima nuclear disaster and related evacuation orders

INTRODUCTION

Demographic changes as a result of evacuation in the acute phase of the 2011 Fukushima nuclear disaster are not well evaluated. We estimated post-disaster demographic transitions in Minamisoma City-located 14-38 km north of the nuclear plant-in the first month of the disaster; and identified demographic factors associated with the population remaining in the affected areas.

MATERIALS AND METHODS

We extracted data from the evacuation behavior survey administered to participants in the city between July 11, 2011 and April 30, 2013. Using mathematical models, we estimated the total population in the city after the disaster according to sex, age group, and administrative divisions of the city. To investigate factors associated with the population remaining in place after the disaster, a probit regression model was employed, taking into account sex, age, pre-disaster dwelling area, and household composition.

RESULTS

The overall population decline in Minamisoma City peaked 11 days after the disaster, when the population reached 7,107 people-11% of the pre-disaster level. The remaining population levels differed by area: 1.1% for mandatory evacuation zone, 12.5% for indoor sheltering zone, and 12.6% for other areas of the city. Based on multiple regression analyses, higher odds for remaining in place were observed among men (odds ratio 1.72 [95% confidence intervals 1.64-1.85]) than women; among people aged 40-64 years (1.40 [1.24-1.58]) than those aged 75 years or older; and among those living with the elderly, aged 70 years or older (1.18 [1.09-1.27]) or those living alone (1.71 [1.50-1.94]) than among those who were not.

DISCUSSION

Despite the evacuation order, some residents of mandatory evacuation zones remained in place, signaling the need for preparation to respond to their post-disaster needs. Indoor sheltering instructions may have accelerated voluntary evacuation, and this demonstrates the need for preventing potentially disorganized evacuation in future nuclear events.

The Association Between Disaster Vulnerability and Post-disaster Psychosocial Service Delivery Across Europe

This study confirms that the developmental stage of post-disaster psychosocial support planning and delivery systems in Europe is associated with countries' level of disaster vulnerability. Lower vulnerability is accompanied by more evolved planning and delivery systems. Countries in north, west and central regions have more developed planning and delivery systems and lower vulnerability levels than those in the south, southeast and east. The highest proportion of variance in vulnerability is located at the regional level, most of the variance in planning and delivery systems is at the individual level. Possible implications and chances for the optimization of psychosocial services are discussed.

Breast cancer patient delay in Fukushima, Japan following the 2011 triple disaster: a long-term retrospective study

Background

Little information is available concerning how patient delay may be affected by mass disasters. The main objectives of the present study are to identify whether there was a post-disaster increase in the risk of experiencing patient delay among breast cancer patients in an area affected by the 2011 triple disaster in Fukushima, Japan, and to elucidate factors associated with post-disaster patient delay. Sociodemographic factors (age, employment status, cohabitant status and evacuation status), health characteristics, and health access- and disaster-related factors were specifically considered.

Methods

Records of symptomatic breast cancer patients diagnosed from 2005 to 2016 were retrospectively reviewed to calculate risk ratios (RRs) for patient delay in every year post-disaster compared with the pre-disaster baseline. Total and excessive patient delays were respectively defined as three months or more and twelve months or more from symptom recognition to first medical consultation. Logistic regression analysis was conducted for pre- and post-disaster patient delay in order to reveal any factors potentially associated with patient delay, and changes after the disaster.

Results

Two hundred nineteen breast cancer patients (122 pre-disaster and 97 post-disaster) were included. After adjustments for age, significant post-disaster increases in RRs of experiencing both total (RR: 1.66, 95% Confidence Interval (CI): 1.02–2.70, p < 0.05) and excessive patient delay (RR: 4.49, 95% CI: 1.73–11.65, p < 0.01) were observed. The RRs for total patient delay peaked in the fourth year post-disaster, and significant increases in the risk of excessive patient delay were observed in the second, fourth, and fifth years post-disaster, with more than five times the risk observed pre-disaster. A family history of any cancer was the only factor significantly associated with total patient delay post-disaster (odds ratio: 0.38, 95% CI: 0.15–0.95, p < 0.05), while there were no variables associated with delay pre-disaster.

Conclusions

The triple disaster in Fukushima appears to have led to an increased risk of patient delay among breast cancer patients, and this trend has continued for five years following the disaster.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-017-3412-4) contains supplementary material, which is available to authorized users.

Mass Casualty Decontamination Guidance and Psychosocial Aspects of CBRN Incident Management: A Review and Synthesis

INTRODUCTION

Mass casualty decontamination is an intervention employed by first responders at the scene of an incident involving noxious contaminants.  Many countries have sought to address the challenge of decontaminating large numbers of affected casualties through the provision of rapidly deployable temporary showering structures, with accompanying decontamination protocols.  In this paper we review decontamination guidance for emergency responders and associated research evidence, in order to establish to what extent psychosocial aspects of casualty management have been considered within these documents. The review focuses on five psychosocial aspects of incident management: likely public behaviour; responder management style; communication strategy; privacy/ modesty concerns; and vulnerable groups.

METHODS

Two structured literature reviews were carried out; one to identify decontamination guidance documents for first responders, and another to identify evidence which is relevant to the understanding of the psychosocial aspects of mass decontamination.  The guidance documents and relevant research were reviewed to identify whether the guidance documents contain information relating to psychosocial issues and where it exists, that the guidance is consistent with the existing evidence-base.

RESULTS

Psychosocial aspects of incident management receive limited attention in current decontamination guidance.  In addition, our review has identified a number of gaps and inconsistencies between guidance and research evidence.  For each of the five areas we identify: what is currently presented in guidance documents, to what extent this is consistent with the existing research evidence and where it diverges.  We present a series of evidence-based recommendations for updating decontamination guidance to address the psychosocial aspects of mass decontamination.

CONCLUSIONS

Effective communication and respect for casualties' needs are critical in ensuring decontamination is completed quickly and effectively.  We identify a number of areas requiring further research including: identifying effective methods for communicating in an emergency; better understanding of the needs of vulnerable groups during decontamination; effective training for emergency responders on psychosocial issues, and pre-incident public education for incidents involving emergency decontamination.  It is essential that the psychosocial aspects of mass decontamination are not neglected in the pursuit of solely technical solutions.

Social isolation and cancer management after the 2011 triple disaster in Fukushima, Japan: A case report of breast cancer with patient and provider delay

Breast cancer patients may present with patient delay or experience provider delay-2 factors which can lead to a late-stage diagnosis and poor prognosis. Mass disasters drastically change social structures, and have the potential to contribute to these delays. However, there is little information available on patient and provider delay related to cancer after disasters. In March 2011, an earthquake, followed by a tsunami and nuclear accident struck Fukushima, Japan. In July 2014, a 59 year-old Japanese widow, living alone, presented to our hospital with a lump and pain in her right breast, which had originally appeared in April 2011 and continuously deteriorated for 3 years and 3 months. She was diagnosed with stage IIIB right breast cancer. Detailed history revealed that she was exposed to social isolation in the aftermath of the disasters due to evacuation of her friends and daughter. Although she regularly saw her general practitioner, she did not disclose her breast symptoms for 1 year and 5 months, at which time she was falsely diagnosed with intercostal neuralgia. She did not seek further medical attention for the breast symptoms for another 1 year and 10 months, despite multiple clinic visits for unrelated reasons. The present disasters, particularly the nuclear disaster, seem to have led to the social isolation of local residents, reducing their opportunities to discuss health concerns with others and seek subsequent medical attention.This case highlights that social isolation may contribute to patient and provider delay in breast cancer patients, as accentuated in this disaster setting.

Alcohol use disorder due to social isolation after a nuclear disaster in Fukushima

It is well-known that a nuclear disaster causes health problems including cancer, however, information on mental disorders linked to a nuclear disaster is limited. On 11 March 2011, there was a serious nuclear power plant accident in Fukushima, Japan. Subsequently, in October 2012, a 78-year-old man living 31 km from the plant was admitted to the hospital with head trauma. This was his third physical trauma since the nuclear accident. A thorough interview revealed that his alcohol intake had increased after the disaster, suggesting that his injuries might be related to alcohol use. The diagnosis of alcohol use disorder was established based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. He had been exposed to social isolation after evacuation of his neighbourhood. Using education and intervention, he was successfully treated. We should recognise that a nuclear disaster might cause social isolation among the elderly, leading to mental disorders and alcohol use disorder. Early diagnosis and intervention might be beneficial for individuals presenting the above symptoms.

Post-disaster psychosocial support and quality improvement: A conceptual framework for understanding and improving the quality of psychosocial support programs

This article is original in that it addresses post-disaster psychosocial support programs from a quality-improvement perspective, not from the traditional viewpoint of mental health services. Based on a combination of renowned quality models, a framework is sketched that offers chances to better understand and optimize the quality of post-disaster psychosocial service delivery. The quality is reflected in the program's structure, process, and outcome. Moreover, quality can be expressed in scores per criterion (i.e. need centeredness, effectiveness, safety, timeliness, efficiency, and equity) that are proposed to be related to the "attitude" (more passive or active) toward affected people. When quality and attitude are combined in a 2-D parabolic model, psychosocial support is preferably found in the middle of the attitude-axis (high quality); extremely passive or active positions are to be avoided (low quality). Well-timed assessments of structure, process, and outcome aspects, and associations between them, will help planners, providers, and evaluators understand if the optimum is reached, as well as provide guidance for quality improvement.

Mental health consequences of chemical and radiologic emergencies: a systematic review

This article reviews the literature pertaining to psychological impacts in the aftermath of technological disasters, focusing on the immediate psychological and mental health consequences emergency department physicians and first responders may encounter in the aftermath of such disasters. First receivers see a wide spectrum of psychological distress, including acute onset of psychiatric disorders, the exacerbation of existing psychological and psychiatric conditions, and widespread symptomatology even in the absence of a diagnosable disorder. The informal community support systems that exist after a natural disaster may not be available to communities affected by a technological disaster leading to a need for more formal mental health supportive services.