Hospital Disaster Plans Must Indude a Strong Mental Health Component. (Lessons from Sept. 11)

Article excerpt

On the morning of Sept. 11, 2001, Dr. Fuad Issa strolled through his neighborhood in the Virginia suburbs of Washington, D.C., with his wife. Their placid mood was shattered when they returned home to find a frantic message on the answering machine about the terrorist attack that had just struck the Pentagon.

Dr. Issa, medical director of psychiatric and addiction services at the Virginia Hospital Center, Arlington, immediately called the head nurse on his unit to say he was on his way in and asked her to get a copy of the hospital's disaster plan for him.

He soon confronted a big shock: The disaster plan of Virginia Hospital Center-the designated receiving hospital for Pentagon medical emergencies-had no protocol for handling the severe psychological stress of disaster victims, coworkers, family members, rescue personnel, or hospital staff.

Dr. Issa also was surprised to learn that no other facility in the region had a disaster plan that adequately addressed mental health issues.

"Even the person I talked to at St. Vincent s Hospital in New York told me their disaster protocol was the same as everyone else's. It had no provisions for psychiatric care," Dr. Issa said in an interview with CLINICAL PSYCHIATRY] NEWS.

So Dr. Issa and several colleagues made sure that their hospital's revised disaster plan addressed mental health care. "It serves not only patients and their families, but health care providers in the hospital," he said.

On Sept. 11, Dr. Issa was joined at the hospital by the head nurse, a clinical nurse specialist, and two fellow psychiatrists. One of these physicians had been an Army doctor for 8 years, and Dr. Issa had been a medical officer in the army of his own country; Syria, for 3 years before moving to the United States. Both would draw on their experience with military medicine-specifically, treating large-scale trauma-in the days to come.

As wounded workers began arriving, the five members of this ad-hoc psychiatric team identified themselves to the hospital's command center and arranged to see every victim who entered the facility; They set up a treatment site at the opposite end of the hospital from the emergency room, so that the patients, family members, rescue workers, and government personnel who gathered there wouldn't crowd the emergency room.

Every patient with minor injuries was directed to the team for a brief psychological intervention, a standard postdisaster "debriefing" session, before discharge. More seriously injured patients who were admitted to the hospital were seen for a similar intervention at their bedsides. ER staffers also were told to call on this team if they encountered a psychiatric emergency among the terrorists' victims. They made only one such call on Sept. 11. In fact, Dr. Issa thinks the hospital's ER treated only 44 patients.

The psychiatric team was indebted to several workers from CrisisLink, a local telephone crisis intervention service, who had a longstanding relationship with the Virginia Hospital Center and 'just showed up to help," he said. Those workers manned a bank of phones.

More help arrived from the Pentagon- representatives of the Marines, Army; Air Force, and Navy-who set up communication links to the crash site and relayed information to relatives and friends.

In the days right after the attack, the psychiatric team followed up on all the patients they had seen on Sept. …