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Psychological After Shocks

Vol. 6 •Issue 19 • Page 32
Psychological After Shocks

Still fresh in her mind, a mental health nurse talks about the lessons learned from 9/11

Five years ago I stood in a classroom on the top floor of Coney Island Hospital, where I've practiced mental health for 24 years. Of all things, I was lecturing to new employees about workplace violence. Our hospital overlooks southern Brooklyn, and the Manhattan skyline is in our view.

We were following the news about a plane hitting the World Trade Center and watched as the towers collapsed to the ground and the huge plume of smoke was visible, looking like the pictures we see about the atomic bomb dropping on Hiroshima.

What I have found in the 5 years since 9/11 is that we must anticipate any disaster, natural or manmade to ensure we are ready and capable of handling any emergency. No one in the organization is expendable, and the mental health issues both clinicians and their patients face after a disaster require coordinated, collaborative preparedness plans.

Protecting Mental Health

Recently, the behavioral health department at Coney Island Hospital formed an interdisciplinary committee to develop a "mental health surge capacity plan." The focus of this committee was spawned by the questions posed by the city's Department of Health and Mental Hygiene about how the mental health of patients and employees would be met in future disasters.

This plan becomes a vital extension of the hospital's emergency preparedness plan. It coordinates the emotional support services needed for employees to continue to work during an emergency. It is intended to ensure employees who are needed for patient care during an emergency get their emotional needs and concerns met.

For example, along with the human resources department, we plan to develop a hotline for loved ones to call in and let a spouse, parent or significant other know they are alright. This information would then be relayed to the worker, who could continue to perform work, without the stress of worrying about a loved one.

The hospital also will offer workers the opportunity to have family, especially children, come to the facility to be under the same roof with their working parents. If it were not possible for families to be reunited, a resource guide comprised of community services available in the zip codes where our employees live would help families get to programs where they would be safe and taken care of. These are just a few services we have begun to coordinate.

In addition to disaster preparedness, the mental health team would be available during and after any disaster to ensure employees get the emotional support and services they may need to perform in their roles. We would continually assess for posttraumatic stress disorder (PTSD) and other stress-related illnesses.

Personal Readiness

We know healthcare workers can only perform as well as the support they receive for their own well-being. And while the hospital can ensure certain tools are available to employees and patients to address their mental health needs after a disaster, certain elements of preparedness are required of each employee.

We learned this firsthand from our own experiences during 9/11. For example, I was unable to get home to my children on 9/11 because the Verrazano-Narrows Bridge was closed, and I was committed to staying and assisting with grief and trauma counseling here at the hospital. But like many others, I realized I had not planned for this type of emergency situation. My family didn't have a game plan if I had to stay at work indefinitely.

As a result of such experiences, we now encourage all employees to engage in readiness preparations with their family and loved ones.

Employees — especially those who commute some distance to work — need to have a preparedness plan in place that their family has rehearsed. Phone numbers for children's schools and parents' nursing homes should be kept in an accessible place both at work and home. Numbers of evacuation sites should be included in the family's plan. And contact people out of state are also important resources in case local phone lines go down; they can act as a relay system.

Consider using recommendations in the "Take Care New York" campaign. It suggests items some may not have considered: packing essentials (money, flashlights, copies of important papers, food, water and clothing for a few days) into an evacuation bag and finding accommodations for pets.

Everyone in the family needs to know where the evacuation bag is and what role they play in the evacuation plan. In crisis situations, it's just as easy to freeze and not react to the situation as it is to mobilize (i.e., the "fight-or-flight" mechanism). Rehearsing your response will be invaluable.

For example, as a mother of school-age children, I now have designees in my neighborhood and in another state to help my children in case of emergency. I made sure these additional people are on the contact information cards at my children's school, and I have the school's evacuation sites and numbers in my wallet and posted in my office.

Continuing Education

There is still a great need for those of us in hospital and mental health services to continue our education in crisis, trauma and communications. We are the ones our colleagues turn to for a reassuring word or act in an emergency. It is our obligation to continue to learn from tragedies such as 9/11 so we can continue to provide the professional care and support needed in an emergency.

The New York State Nurses Association offers guidelines on how to become involved in local emergency response through Nurse-Response. Visit http://register.nysna.org/ for more details.

Training also is available for mental health nurses who want to learn more about how to help the public and each other in the event of a major disaster. See Resources for additional information.

As we mourn the fifth anniversary of 9/11 and the loss of life, we recognize we have used this unforeseen event to motivate our professional practice and strategic planning for future disasters. This is the forward-thinking we all should employ when remembering disasters such as 9/11, rather than dwelling on "if only" and "what if."

Resources

Crisis Counseling Training and Assistance Program Guidance — copies available from the Center for Mental Health Services, part of the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration, at http://www.mentalhealth.samhsa.gov/cmhs/EmergencyServices/progguide.asp or 800-789-2647.

Disaster Mental Health Services: A Guidebook for Clinicians and Administrators — http://www.ncptsd.va.gov/publications/disaster/index.html

National Disaster Mental Health Training Program — http://www.ncptsd.va.gov/about/training/ndmh_training.html; or contact training coordinator Bruce Young, LCSW, at 650-493-5000, press 1, then ext. 22494, or e-mail bhh@icon.palo-alto.med.va.gov

PTSD Information Line — 802-296-6300 or e-mail ncptsd@ncptsd.org

Training Manual for Mental Health and Human Service Workers in Major Disasters — copies available at SAMHSA's National Mental Health Information Center, PO Box 42557, Washington, DC 20015; 800-789-2647; (TDD) 866-889-2647; www.mentalhealth.samhsa.gov

Marianne Howard-Siewers is director of behavioral health at Coney Island Hospital, Brooklyn, NY. Coney Island Hospital is part of the New York City Health and Hospitals Corp.

Mental Health Nursing Post-9/11

Recently, I interviewed some of my nurse colleagues at Coney Island Hospital to see what impact 9/11 has had on them. Here's a snapshot of what two of them had to share.

Privilege to Help

Edie Tucker, MA, RN, clinical specialist in the assertive community treatment program, still tears when recalling the "privilege" she felt spending time with victims' families.

Days after the collapse, the psychiatric nurse accompanied family members of dead and missing people on a boat that sailed into the New York Harbor to view the site. She remembers the strength and courage these families demonstrated at this tragic time in their lives.

"It remains amazing to me the degree of compassion and humanity that people can exhibit in the face of travesty," Tucker said. "We need to maintain this energy to better help us in prevention, awareness and promoting a rational philosophy on an everyday basis."

The events of 9/11 also inspired her to maintain her crisis and trauma competence. When healthcare professionals in the New York area are asked to volunteer time with victims of catastrophic events, Tucker is available to help.

Crisis Counseling

John Zabatta, MSN, RN, head nurse on our mobile crisis team, has continued to support his crisis and trauma background by participation in educational training opportunities, offered by the New York City Department of Health and Mental Hygiene in conjunction with the state and New York City Fire Department.

He was trained in crisis counseling and continues to work with clients who experience posttraumatic stress disorder (PTSD) in the wake of 9/11 and other disasters.

Geared for first responders, the training Zabatta attended impacts the hospital's mobile crisis team – a major support to the community during any disaster. It is the arm of the hospital that reaches out to the community and works closely with our emergency preparedness committee to meet the mental health needs of those seeking help.

"When 9/11 first occurred, we all anticipated the crisis team would be inundated with calls. Ironically, that was not the case. The atmosphere in southern Brooklyn grew eerily silent," Zabatta said.

"However, as the weeks and months passed, we began to receive more and more calls from people in the community who were experiencing classic symptoms of PTSD.

"It was at that point, when, as a unit, the harsh reality of 9/11 had set in."

Working with the community post 9/11, the mobile crisis team has now expanded its role beyond providing crisis counseling during a disaster.

"Due to the failures associated with Hurricane Katrina, it has become incumbent upon us to be able to educate our population by establishing and maintaining accurate lists of key FEMA [Federal Emergency Management Association], FEMA-supported programs, and state contacts that can assist the survivor in obtaining accurate, detailed and official information about their individual case," Zabatta said.

In addition, the mobile team offers tips on how to deal effectively with FEMA and other organizations.

– Marianne Howard-Siewers, MS, RN,BC, HPCN




     

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