Prevention and management of panic in personnel facing a chemical threat--lessons from the Gulf War

Enduring beliefs about effects of gassing in war: qualitative study

OBJECTIVES

To discover the content of enduring beliefs held by first world war veterans about their experience of having been gassed.

DESIGN

Collection and thematic analysis of written and reported statements from a sample of veterans about gassing.

SUBJECTS

103 veterans with a war pension.

RESULTS

Twelve themes were identified, which were related to individual statements. The systemic nature of chemical weapons played a key part in ideas and beliefs about their capacity to cause enduring harm to health. Unlike shrapnel or a bullet that had a defined physical presence, gas had unseen effects within the body, while its capacity to cause damage was apparent from vesicant effects to skin and eyes. The terror inspired by chemical weapons also served to maintain memories of being gassed, while anti-gas measures were themselves disconcerting or a source of discomfort.

CONCLUSIONS

Chronic symptoms and work difficulties maintained beliefs about the potency of chemical weapons. In the period after the war, gas continued to inspire popular revulsion and was associated with a sense of unfairness.

Viewpoint: Terrorism and Dispelling the Myth of a Panic Prone Public

Governments and commentators perceive the public to be prone to panic in response to terrorist attacks--conventional or involving chemical, biological or radiological weapons. Evidence from five such incidents suggests that the public is not prone to panic, although people can change their behaviours and attitudes to reduce the risk of themselves being exposed to a terrorist incident. Behavioural responses may be divided into acts of omission, such as not making unnecessary journeys, and acts of commission, such as taking prophylactic medication despite the inherent risk of side effects. Evidence suggests that the public are aware of these differences, and tend to adopt responses proportionate to the risk. Drawing upon the literature in the social and natural sciences, our discussion encompasses differing risk perceptions of terrorist threats and consequences of attacks. How do fear and anxiety interact with behavioural responses to amplify or attenuate perceptions that can be modified through risk communication undertaken by authorities?

Biochemical terrorism: too awful to contemplate, too serious to ignore: subjective literature review

BACKGROUND

It is important not to foster unnecessary public anxiety with regard to the risk of a biochemical terrorist incident, but the authorities need to consider their response strategy, particularly with regard to mental health issues.

AIMS

To describe the likely effects of a terrorist incident involving biochemical agents and to identify important response issues.

METHOD

Literature survey.

RESULTS

Observations following conventional terrorist incidents and other major trauma, including biochemical and nuclear accidents, suggest that a biochemical terrorist incident would have widespread public effects. The mental health services should play a major role in designing an effective multi-disciplinary response, particularly with regard to the reduction of public anxiety, identifying at-risk individuals and collaborating with medical and emergency services, as well as providing care for those who develop post-traumatic psychopathology.

CONCLUSIONS

We should not feel helpless in the face of a biochemical threat; there is considerable knowledge and experience to be tapped. A well-designed, well-coordinated and rehearsed strategy based on empirical evidence will do much to reduce public anxiety and increase professional confidence.

Preparing hospitals for toxicological mass casualties events

OBJECTIVE

For most hospital staffs, treatment of chemical casualties presents an obscure and even frightening situation. We report our unique experience from hospital drills in order to improve hospital preparedness for patient management under mass casualty conditions involving hazardous chemicals.

SETTING

Twenty-one major hospitals in Israel.

INTERVENTIONS

A unique hospital deployment plan for the management of chemical casualties was developed, and hospitals were required to have a full chemical practice drill every 3 to 5 yrs. These drills were designed as realistically as possible, and all included the use of personal protective equipment, decontamination, and treatment of simulated patients. Twenty-five percent of these patients, simulating children and adults, required intensive care and ventilation support. Hospitals were inspected and reviewed on the quality of treatment given and the overall continuity of care as well as on their administrative performance.

RESULTS

Between 1986 to 1994, 30 full chemical practice drills were conducted in 21 major hospitals. Each drill included treatment of 100 to 400 simulated patients. The lessons from the hospital drills are described and were incorporated in the proposed revised hospital deployment plan. All hospitals significantly improved their ability to respond appropriately to these incidents.

CONCLUSIONS

The level of preparedness for a chemical mass casualty scenario should be established according to the existing threat and the available resources. The proposed plan can serve as a basis for hospital planning and staff training worldwide, thus facilitating optimal care in the event of an incident involving toxic chemicals. A cost-effective scale for hospital preparation levels according to the existing threat is suggested.