The recent terrorist attacks in the United States of America and the widespread fears of anthrax poisoning and spreading of smallpox that followed, raise the question of how New Zealand health professionals might respond to the casualties were similar events to occur here. The matter has often been raised before, but now the new Director of the Ministry of Civil Defence and Emergency Management is determined to have it addressed. As a start, this paper draws on international expertise and local experience to outline the kind of psychological first-aid service that should be made available to disaster casualties. In clinical justification it holds middle ground on the efficacy of such intervention between the advocates and the critics, lists the particular topics about which interveners should be informed, sketches the essentials of their involvement, and asserts that some conditions will require specialist treatment. It accepts that the implementation of the proposal would require further discussion with the relevant professional societies, voluntary agencies, and the statutory bureaucracies that have responsibility for dealing with other aspects of trauma and social disruption.
The events in New York and Washington on 11 September 2001 left around 3 000 dead on the sites where the three planes crashed and many thousands of people in stages of grief and shock throughout the country. Teams of crisis responders swung swiftly into action, locating themselves conveniently in available spaces, alerting their networks to the problems to be addressed, and calling for `restraint, patience, preparation, and professionalism' (September 11 Updates, 2002). In short time leading educationalists, clinical practitioners, public authorities, and trauma relief organisations updated websites, and some mounted a series of one-day transitional courses to upgrade the knowledge of recent recruits.
Several official and unofficial agencies were involved with the counselling response, and the full weight of their commitment has yet to be known. But in the first eight weeks after the event throughout America, the Red Cross alone had 135,800 mental health and grief contacts. Soon more detailed information should be available about the kind of problems presented around the impact and the recoil stages of the attacks. On the organisational side, trained mental health volunteers on the sites worked long hours, and in their state of marginal fatigue they did not receive kindly the reminder of a sceptic that they were accountable, scientifically and clinically, for their work--especially when the media took up the issue. Nor did they appreciate the spontaneous offers of help from unknown clinicians whom they described disparagingly as `trauma tourists' for being in a heightened state of arousal and displaying the well-known signs of the convergence phenomenon with an uncontrollable impulse to be at `ground zero'.
For their part the trained reinforcements brought in from neighbouring States were annoyed to find that even in such an emergency their professional credentials had to be checked before they could lend a hand. Others en route were frustrated by the unavoidable air transport delays caused by the fears of further terrorist attacks, and by the typical `hurry up and wait' orders they received. But on reflection some realised that they had a useful role to fill at home without being at the epicentre of the disaster. They came to see that their existing clients might be dependent on them for help in dealing with the ramifications of the terrorist attack on the nation, and that new clients might be referred to them for grief, anxiety and depressive reactions associated vicariously with the event.
For those on site, questions arose as to what kind of agency intervention model they were better to adopt--either that of American Red Cross, or Critical Incident Stress Management, or Green Cross, or an amalgam--and what kind of debriefing system should be provided, and how soon after the event. …