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Zhao F, Zhao C, Bai S, Yao L, Zhang Y. Triage Algorithms for Mass-Casualty Bioterrorism: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20065070. [PMID: 36981980 PMCID: PMC10049471 DOI: 10.3390/ijerph20065070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To understand existing triage algorithms, propose improvement measures through comparison to better deal with mass-casualty incidents caused by bioterrorism. STUDY DESIGN Systematic review. METHODS Medline, Scopus and Web of Science were searched up to January 2022. The studies investigating triage algorithms for mass-casualty bioterrorism. Quality assessment was performed using the International Narrative Systematic Assessment tool. Data extractions were performed by four reviewers. RESULTS Of the 475 titles identified in the search, 10 studies were included. There were four studies on triage algorithms for most bioterrorism events, four studies on triage algorithms for anthrax and two studies on triage algorithms for mental or psychosocial problems caused by bioterrorism events. We introduced and compared 10 triage algorithms used for different bioterrorism situations. CONCLUSION For triage algorithms for most bioterrorism events, it is necessary to determine the time and place of the attack as soon as possible, control the number of exposed and potentially exposed people, prevent infection and determine the type of biological agents used. Research on the effects of decontamination on bioterrorism attacks needs to continue. For anthrax triage, future research should improve the distinction between inhalational anthrax symptoms and common disease symptoms and improve the efficiency of triage measures. More attention should be paid to triage algorithms for mental or psychosocial problems caused by bioterrorism events.
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Affiliation(s)
- Feida Zhao
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
| | - Chao Zhao
- Center for Biosafety Research and Strategy, Tianjin University, Tianjin 300072, China
| | - Song Bai
- Evaluation and Optimization of Health Emergency Response Capacity, Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
| | - Lulu Yao
- Emergency Medicine, Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
| | - Yongzhong Zhang
- Epidemiology and Health Statistics, Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China
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Gouweloos J, Dückers M, te Brake H, Kleber R, Drogendijk A. Psychosocial care to affected citizens and communities in case of CBRN incidents: a systematic review. ENVIRONMENT INTERNATIONAL 2014; 72:46-65. [PMID: 24684819 DOI: 10.1016/j.envint.2014.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 02/14/2014] [Accepted: 02/18/2014] [Indexed: 06/03/2023]
Abstract
Disasters are associated with a substantial psychosocial burden for affected individuals (including first responders) and communities. Knowledge about how to address these risks and problems is valuable for societies worldwide. Decades of research into post-disaster psychosocial care has resulted in various recommendations and general guidelines. However, as CBRN (chemical, biological, radiological, nuclear) events form a distinctive theme in emergency planning and disaster preparedness, it is important to systematically explore their implications for psychosocial care. The aim of this study is to answer two questions: 1). To what extent does psychosocial care in the case of CBRN events differ from other types of events? 2). How strong is the scientific evidence for the effectiveness of psychosocial care interventions in the context of a CBRN event? A systematic literature review was conducted. Searches were performed in Medline, PsychINFO, Embase and PILOTS. Studies since January 2000 were included and evaluated by independent reviewers. The 39 included studies contain recommendations, primarily based on unsystematic literature reviews, qualitative research and expert opinions. Recommendations address: 1) public risk- and crisis communication, 2) training, education and exercise of responders, 3) support, and 4) psychosocial counselling and care to citizens and responders. Although none of the studies meet the design criteria for effectiveness research, a substantial amount of consensus exists on aspects relevant to CBRN related psychosocial care. Recommendations are similar or complementary to general post-disaster psychosocial care guidelines. Notable differences are the emphasis on risk communication and specific preparation needs. Relevant recurring topics are uncertainty about contamination and health effects, how people will overwhelm health care systems, and the possibility that professionals are less likely to respond. However, the lack of evidence on effectiveness makes it necessary to be careful with recommendations. More evaluation research is absolutely needed.
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Affiliation(s)
- Juul Gouweloos
- National Knowledge and Advice Centre for Psychosocial Care Concerning Critical Incidents, Partner in Arq Psychotrauma Expert Group, Nienoord 5, 1112XE Diemen, The Netherlands.
| | - Michel Dückers
- National Knowledge and Advice Centre for Psychosocial Care Concerning Critical Incidents, Partner in Arq Psychotrauma Expert Group, Nienoord 5, 1112XE Diemen, The Netherlands.
| | - Hans te Brake
- National Knowledge and Advice Centre for Psychosocial Care Concerning Critical Incidents, Partner in Arq Psychotrauma Expert Group, Nienoord 5, 1112XE Diemen, The Netherlands.
| | - Rolf Kleber
- Utrecht University, Department of Clinical & Health Psychology, PO Box 80140, 3508 TC, Utrecht, The Netherlands; Arq Psychotrauma Expert Group, Nienoord 5, 1112XE Diemen, The Netherlands.
| | - Annelieke Drogendijk
- National Knowledge and Advice Centre for Psychosocial Care Concerning Critical Incidents, Partner in Arq Psychotrauma Expert Group, Nienoord 5, 1112XE Diemen, The Netherlands.
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Gurwitch RH, Kees M, Becker SM, Schreiber M, Pfefferbaum B, Diamond D. When Disaster Strikes: Responding to the Needs of Children. Prehosp Disaster Med 2012; 19:21-8. [PMID: 15453156 DOI: 10.1017/s1049023x00001448] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractWhen a disaster strikes, parents are quick to seek out the medical advice and reassurance of their primary care physician, pediatrician, or in the case of an emergency, an emergency department physician. As physicians often are the first line of responders following a disaster, it is important that they have a thorough understanding of children's responses to trauma and disaster and of recommended practices for screening and intervention. In collaboration with mental health professionals, the needs of children and families can be addressed. Policy-makers and systems of care hold great responsibility for resource allocation, and also are well-placed to understand the impact of trauma and disaster on children and children's unique needs in such situations.
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Affiliation(s)
- Robin H Gurwitch
- Department of Pediatrics, University of Oklahoma Health Sciences Center for Terrorism and Disaster Branch, Oklahoma City, Oklahoma 73117, USA.
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Bourgeois SL, Doherty MJ. Bioterrorism and biologic warfare. Oral Maxillofac Surg Clin North Am 2009; 17:299-330, vii. [PMID: 18088788 DOI: 10.1016/j.coms.2005.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Biologic agents have been used throughout history to influence battles. Recently, biologic agents have been used as terrorist weapons. A review of the history of biologic weapons and a medical overview of the Centers for Disease Control and Prevention Category A and B agents is provided, including history, pathogenesis, clinical presentation, microbiology/virology, diagnosis, treatment, and each agent's use or potential use as a weapon. Background information on public health issues surrounding bioterrorism and the role of oral and maxillofacial surgeons in a bioterrorist event also is provided.
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Affiliation(s)
- Sidney L Bourgeois
- Department of Oral and Maxillofacial Surgery, National Capital Consortium, National Naval Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
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Prioritizing care during the acute phase: the prominent role of basic psychosocial life support. Prehosp Disaster Med 2008; 23:s49-54. [PMID: 18935959 DOI: 10.1017/s1049023x00021245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The issue of basic psychosocial life support during and after disasters is important. People who are affected by disasters can experience severe distress and may need psychosocial support. However, there still are many questions about service design and effectiveness of psychosocial support. During the process of the Targeted Agenda Program, "Prioritizing Care during the Acute Phase: The Prominent Role of Basic Psychosocial Life Support", a team of experts reached consensus on some important issues concerning psychosocial first aid, civil participation, and risk communication. The experts come from many different backgrounds, which supports the notion that psychosocial care deserves special attention within disaster relief programs involving all disciplines and all responsibilities.
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Hawley SR, Hawley GC, Romain TS, Ablah E. Quantitative Impact of Mental Health Preparedness Training for Public Health Professionals. Biosecur Bioterror 2007; 5:347-52. [DOI: 10.1089/bsp.2007.0031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Suzanne R. Hawley
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Wichita
| | - Gary C. Hawley
- Robert J. Dole Medical Center, Department of Veterans Affairs, Wichita
| | - Theresa St. Romain
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Wichita
| | - Elizabeth Ablah
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Wichita
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Preparing Medical Personnel to Work a Chemical or Biological Incident: a ‘Readiness and Resiliency’ Model. Psychiatr Ann 2007. [DOI: 10.3928/00485713-20071101-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hawley SR, Hawley GC, Ablah E, St Romain T, Molgaard CA, Orr SA. Mental health emergency preparedness: the need for training and coordination at the state level. Prehosp Disaster Med 2007; 22:199-204; discussion 205-6. [PMID: 17894213 DOI: 10.1017/s1049023x00004659] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The coordination and integration of mental health agencies' plans into disaster responses is a critical step for ensuring effective response to all-hazard emergencies. PROBLEM In order to remedy the current lack of integration of mental health into emergency preparedness training, researchers must assess mental health emergency preparedness training needs. To date, no recognized assessment exists. The current study addresses this need by qualitatively surveying public health and allied health professionals regarding mental health preparedness in Kansas. METHODS Participants included 144 professionals from public health and allied fields, all of whom attended one of seven training presentations on mental health preparedness. Following each presentation, participants provided written responses to nine qualitative questions about preparedness and mental health preparedness needs, as well as demographic information, and a program evaluation. Survey questions addressed perceptions of bioterrorism and mental health preparedness, perceptions about resource and training needs, as well as coordination of preparedness efforts. RESULTS Overall, few respondents indicated that they felt their county or community was prepared to respond to an attack. Respondents felt less prepared for mental health issues than they did for preparedness issues in general. The largest proportion of respondents reported that they would look to a community mental health center or the state health department for mental health preparedness information. Most respondents recognized the helpfulness of interagency coordination for mental health preparedness, and reported a willingness to take an active role in coordination. CONCLUSIONS The current study provides important data about the gaps regarding mental health preparedness in Kansas. This study demonstrates the present lack of preparedness and the need for coordination to reach an appropriate level of mental health preparedness for the state. These findings are the first step to implementing effective distribution of information and training.
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Affiliation(s)
- Suzanne R Hawley
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine--Wichita, 67214-3199, USA.
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O'Boyle C, Robertson C, Secor-Turner M. Nurses' beliefs about public health emergencies: fear of abandonment. Am J Infect Control 2006; 34:351-7. [PMID: 16877103 DOI: 10.1016/j.ajic.2006.01.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Revised: 01/06/2006] [Accepted: 01/09/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Since the events of September 11, 2001, subsequent anthrax mailings, world political events, and natural disasters such as Hurricane Katrina and the recent tsunami, public health emergencies including bioterrorism events are viewed as realistic possibilities. Public health emergencies would stress the current health care system. OBJECTIVE The objective was to identify beliefs and concerns of nurses who work in hospitals designated as receiving sites during public health emergencies. METHODS A qualitative study using focus groups with a total of 33 hospital nurses in 2003 was used. Audiotapes were analyzed, and codes, categories, and a theme were identified. RESULTS Fear of abandonment was the overarching theme. Nurses believed that clinical settings would be chaotic, without a clear chain of command, and with some colleagues refusing to work. Limited access to personal protective equipment, risk of infection, unmanageable numbers of patients, and possibly being assaulted for their personal protective equipment resulted in the sense that they would be in unsafe clinical environments. Loss of freedom to leave the hospital and fears that hospitals would not provide treatment to nurses who become ill as a result of caring for patients contributed to the sense of abandonment. CONCLUSION Although these nurses worked in hospitals with comprehensive public health emergency plans, they believed that they would not have readily accessible material and human resources to cope with a bioterrorism event. Readiness plans should include a systematic assessment of nurses' concerns. Health care readiness plans should incorporate focused interventions to improve safety, a sense of control, and facilitate coping in public health emergencies.
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Affiliation(s)
- Carol O'Boyle
- University of Minnesota, School of Nursing, Minneapolis, 55455, USA.
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Abstract
Perceived poisoning may manifest in numerous ways; however, all cases share certain characteristics. All are fostered by the wide availability of unreliable information about chemical safety, poor understanding of scientific principles, and ineffective risk communication. Although this problem is still incompletely understood, some approaches have been demonstrated to be useful, such as education about risk, appropriate reassurance, and empathy on the part of the practitioner. Successful management may curtail the spread or exacerbation of symptoms, whereas unsuccessful treatment may cause the problems to escalate, with detrimental effects on both society and patient.
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Affiliation(s)
- Kristine A Nañagas
- Division of Medical Toxicology, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46206-1367, USA.
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Stein BD, Tanielian TL, Eisenman DP, Keyser DJ, Burnam MA, Pincus HA. Emotional and behavioral consequences of bioterrorism: planning a public health response. Milbank Q 2004; 82:413-55, table of contents. [PMID: 15330972 PMCID: PMC2690224 DOI: 10.1111/j.0887-378x.2004.00317.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Millions of dollars have been spent improving the public health system's bioterrorism response capabilities. Yet relatively little attention has been paid to precisely how the public will respond to bioterrorism and how emotional and behavioral responses might complicate an otherwise successful response. This article synthesizes the available evidence about the likely emotional and behavioral consequences of bioterrorism to suggest what decision makers can do now to improve that response. It examines the emotional and behavioral impact of previous "bioterrorism-like" events and summarizes interviews with experts who have responded to such events or conducted research on the effects of community-wide disasters. The article concludes by reflecting on the evidence and experts' perspectives to suggest actions to be taken now and future policy and research priorities.
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Affiliation(s)
- Bradley D Stein
- RAND Corporation, 1700 Main Street, Santa Monica, CA 90407, USA.
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Hall MJ, Norwood AE, Fullerton CS, Ursano RJ. Preparing for bioterrorism at the state level: report of an informal survey. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2002; 72:486-91. [PMID: 15792034 DOI: 10.1037/0002-9432.72.4.486] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Members of 18 states' departments of mental health were interviewed about their plans for managing the psychosocial impacts of a bioterrorism event. Questions were developed from recommendations of an international conference on planning for bioterrorism ("Planning for bioterrorism," 2000). Information derived from the survey highlights the need for, and the importance of, mental health consultation to the state's planning process. Familiarity with the unique psychological and behavioral consequences of a bioterrorism event in contrast to natural disasters is essential. Realistic training scenarios that incorporate likely psychosocial impacts and appropriate mental health response must be developed.
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Affiliation(s)
- Molly J Hall
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA
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