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There was bad news and good news in Dr. Dan Garza’s keynote address at the ABHM annual conference in July. The New York chapter of the Association of Behavioral Healthcare Management attracted about 60 members and other professionals to its annual Management Institute, held this year at St. Vincent’s Medical Center in Greenwich Village. They heard an unsettling report, with great specificity, of the various disasters that could befall New York in a covert terrorist attack such as poison gases, lethal germs, deadly radiation, all of which would make great demands on the health care delivery system and on mental health care services in particular. Dr. Garza, who is chair of the clinical committee for disaster psychiatry outreach and assistant clinical professor of psychiatry at Mount Sinai Hospital, said that behavioral and psychological casualties of such events are forecast to be four times the medical casualties. The stealth nature of these attacks is such that they become apparent only after affected individuals begin manifesting symptoms. Because the site and source of the disaster may be unknown, stress and fear can pervade the population leading to a variety of psychological disorders. In this scenario, hospital emergency personnel, including psychiatric caregivers, are the disaster’s first responders.

The good news is that much research, study, and training have gone into preparing for these kinds of eventualities and disasters in general. Disaster Psychiatry Outreach (DPO) was founded by four psychiatrists in 1998, works collaboratively with Mount Sinai School of Medicine’s Psychiatry Department, and has enlisted 600 volunteer psychiatrists who are at the ready to bring psychiatric care to victims at disaster sites. DPO psychiatrists have conducted mental health screenings, referrals, and long-term treatment to 9,000 workers and volunteers who participated in the rescue and recovery effort at the World Trade Center bombsite. More recently, DPO has dispatched three teams of volunteers to Sri Lanka to assist in the response to the tsunami.

In establishing the basis for disaster psychiatric care practice, Dr. Garza and his colleagues have formulated key definitions and practice guidelines.

- Terrorism is defined as actions undertaken to achieve a political or ideological goal through a threat or action that creates terror or horror. The fear and horror objectives of terrorism go direct to the human psyche and threaten its stability.

- Stress is a disturbance on one’s state of physical or psychological equilibrium brought about by a disturbance in the world around you.

The nearer one is to the disaster sight, the greater and the more dangerous the stress.

- Trauma is a stress that overcomes one’s ability to cope and reassert mental equilibrium. It is the condition in which stress threatens serious mental disorders.

- Disaster is a trauma that overwhelms not only the individual, but also the whole community. It is unpredictable and has the added factors of fear and horror when it is an act of terrorism.

The DPO has analyzed the psychological impact of disasters around the world in gathering its database of disaster statistics: Chernobyl, Hurricane Andrew, Swissair and EgyptAir airline crashes, Surat India floods, El Salvador and San Salvador earthquakes in addition to terrorist attacks. The 1995 serin gas attack in the Japanese subway is indicative of the pattern of psychological fallout after a terror-disaster. There were twelve fatalities, but 5500 people visited 98 hospitals in the days that followed. Only 1,046 were admitted. The others can be considered psychological casualties. In the months and years that followed, 60% of the patients who had been treated in the hospitals were found to have persistent PTSD (post-traumatic-stress-disorder) symptoms that lasted longer than their physical symptoms. The analysts concluded that persons who have been through a terrorist attack might suffer “a modified form” of PTSD for many years after the event.

Dr. Garza’s presentation made the hard facts of this subject bearable. Knowing his organization has addressed every aspect of preparation was reassuring to an audience who themselves may be called upon to respond.

The 10th Annual Behavioral Healthcare Management Institute is a production of the Association of Behavioral Healthcare Management, New York chapter, and its president, Mark Gustin is senior associate director of Kings County Hospital Center in Brooklyn. In addition to Dr. Garza’s keynote address, the following presentations made up the Institute program: