In review of our course materials this week, we are introduced to several excellent theories aiding our understanding in the survivors’ experience in coping after disaster events. The complex nature of disasters results in reactions manifested in many ways including psychological, biological, and social. The architect of modern-day positive psychology, Dr. Martin Seligman, speaks to the foundational basis of the psychological approach in his Ted Talk, The New Era of Positive Psychology. In considering the insights Dr. Seligman applies to the field of psychology, we may find useful applications to addressing concerns unique to disaster psychology.

After reviewing the course materials for the week including the Ted Talk and the Scenario Module 2, choose to answer questions from either the Health & Social Services section or the Public Information and Warning section.  Once you have chosen a section, you must respond to at LEAST three questions in your main post response.  Be sure to clearly identify which questions you are answering in your main post.  At LEAST two of your peer responses must be to someone who chose a different set of questions than you did for your main post.  Any additional peer responses can be to either someone who chose the same question set or a different question set than you did for your main post.  

Health & Social Services

1. What is Phase 2 of disaster psychology, and how would it apply to the current situation that is occurring in Bobsville and Disaster County?

2. What types of traumatic stressors might the citizens and 911 operators encounter because of the current situation? What special considerations might come up relevant to dispatchers and other first responders?

3. What actions could be used from Psychological First Aid to support the 911 dispatchers? Why?

4. What are the strengths of Psychological First Aid for this event?

Public Information and Warning & Infrastructure Systems

6. Name at least 3 different entities that would be responsible for providing equal access to effective communication to deliver credible, actionable, culturally, and linguistically appropriate, and accessible messages to the citizens of Bobsville and Disaster County?  What are examples of the types of messages each on of them might relay?

7. Why should the mental health community be involved in developing actionable messaging for the public and responders?

8. How could emergency management utilize and support the mental health community in identifying impacts to the citizens with the loss of critical infrastructure systems, including housing, stores, financial facilities, roadways, etc.?

Reference

Seligman, M. (2004). Martin Seligman: The new era of positive psychology [Video file]. Retrieved from https://www.ted.com/talks/martin_seligman_on_the_state_of_psychology

Transcript Scenario Module 2

May 1, 2021, 7:30 am. It is a chilly and clear Wednesday morning. The wind is from the northeast, moving towards the southwest at one (1) mile per hour.

In Bobsville, Oklahoma, located in Carol County, traffic is experiencing delays on the interstate as commuters drive to their work destinations. Many vehicles are backed up on the interstate, causing commuters to be late for work and school.

Near I-58 and Oklahoma State Route 323 in the vicinity of the Nuclear Power Plant, law enforcement has established a checkpoint as a result of the DHS and E-ISAC alerts received the day before. The checkpoint is the source of the traffic delays that are occurring in Carol County and Bobsville.

In Bobsville, without warning, a bright flash comes from the direction of the interstate followed by a loud explosion. The resulting fireball and mushroom cloud are visible for many miles. Many windows in the north end of town near the highway are blown out and violently hurl shattered glass. For this scenario, Bobsville is three (3) miles from the location of the explosion.

Morning commuter traffic in Bobsville and Carol County is interrupted, and a large number of accidents occur as car windows are blown out and drivers looking directly at the blast are temporarily blinded.

The explosion has brought many people out of their homes and businesses, and they can see that something is burning as there is smoke billowing in the sky.

• Fire and Law Enforcement

Fire and Law Enforcement agencies start to receive notifications of the explosion and are dispatched to the scene.

• First Responders

First responders experience difficulties with their two-way communication devices as the explosion has impacted the public safety communication towers. 

• Communications

Cell phone, television and radio communications have also been interrupted and are working sporadically or not working at all.

Key Issues

• Some sort of a blast has occurred in Disaster County, Oklahoma.
• First responders have been dispatched to the incident scene; however, they are unaware of what type of blast has occurred.
• Communications systems have been interrupted and have some level of degradation, or they are not working.
• Emergency Management is attempting to communicate with first responders to get updated accurate information to implement/provide appropriate or additional protective action measures.

Natural disasters are inevitable.  There are environmental factors, such as climate change, that influence the number of natural disasters.  Emergency management and communities have to be prepared for natural disasters.

Please answer the following questions:

1. What natural disaster is your local community at highest risk?
2. Considering this information, what are the triage, mass casualty care, and public health challenges involved in a response to this disaster?
3. If you have experience in natural disaster response, please share your stories and insights

Disasters and Mental Health

Disasters and emergencies are stressful for many people including survivors, families, rescue workers, communities, etc.  According to the Substance Abuse and Mental Health Services Administration (2017), “When people experience a disaster, they may experience a variety of reactions, many of which are natural responses to difficult situations.”

Discussion Questions:

Considering the Simulation Exercise Explosion in Bobsville, please answer the following questions:

1. What could be the potential psychological consequences of this traumatic event for Bobsville and General County residents?
2. What are the potential planning interventions that public health, hospitals, and elected leaders should be looking at to support the mental health needs of the citizens?
3. Are there any particular concerns or immediate issues related to children’s mental health in this disaster situation?
4. Are there any particular concerns or immediate issues related to first responsders’ mental health in this disaster situation?

TAP 34: Disaster Planning Handbook for Behavioral Health Service Programs | SAMHSA Publications and Digital Products

Traumatic Incident Stress | NIOSH | CDC

Simulation Exercise Scenario:

The Next Two Days – Population and Environmental Impacts

May 1, 2021, at 8:30 AM, fire and law enforcement personnel responding to the incident scene are aware that an explosion has occurred that is not normal, and they have suspected that it is a nuclear explosion. They are detecting high levels of radiation, and it appears that some sort of nuclear explosion has occurred. There is a small mushroom cloud in the area.

The Incident Commander (IC) has asked for additional mutual aid resources. The IC is requesting the Oklahoma National Guard 63^rd Civil Support Team (CST) be deployed immediately along with other neighboring response organizations.

• By noon, the public, facilities, and hospitals receive notice to begin evacuating out of the Dangerous Fallout (DF) zone.
• Many citizens have self-evacuated and are leaving Bobsville for a more secure environment.

May 1, 2021, at 9:00 AM, Bunnyville hospital initiated START triage as soon as victims began arriving at the hospital. Bunnyville hospital reports many citizens arriving at the emergency room without any physical impacts, but they demonstrate significant psychological effects. Bunnyville Hospital is already overwhelmed with victims who have presented with severe injuries. They have implemented START triage for all patients to include those with psychological or mental health issues. Bunnyville hospital is separating the physically injured and are placing the mental health patients in a holding area and are classifying them as green or delayed patients.

May 1, 2021, at 1:00 PM, Incident Command recommends the local college gymnasium be utilized as a temporary casualty collection point. This site offers sufficient space allocation, brick structure for shielding, accessibility, and amenities needed to support a casualty collection point.

May 1, 2021, 2:00 PM, a meeting is held with elected leaders, public health officials, hospital leadership, law enforcement, and community advocates/leaders.

• The discussion is about high public anxiety over radiation and diminished understanding of the associated risks and protective actions implemented.
• There is increased demand for messaging and information even at points distant from the incident.
• Elevated behavioral health impacts already exist within the impacted population as public fear of radiation has resulted in many concerned, healthy citizens seeking medical assistance.  
• If not mitigated radiological fear, and mental health issues will quickly add to the already overwhelmed limited medical facilities. Medical facilities impacted by the concerned yet healthy citizens will continue to affect capability and capacity to assist the sick and wounded.

By May 1, 2021, at 3:00 PM, patient fatalities have exceeded the capacity of the hospital morgue and the county medical examiner’s office.

Bobsville receives notice that a crude 1kt (kiloton) nuclear device appears to be the cause of the detonation. Currently, there is no information available as to who is responsible.

May 2, 2021, 8:00 AM, the Governor of the State of Oklahoma has prioritized the following response mission actions:

• Lifesaving,
• Life-sustaining,
• Mental health,
• Property protection,
• Other measures intended to neutralize the immediate threat to life, environment, and property to achieve community stabilization.

The State of Oklahoma has also activated multiple units of the National Guard to respond to the impacted area of Bobsville.

• Activated National Guard will provide mass care, critical transportation, and evacuation support resources to the community. Additionally, at the request of the Bobsville Incident Management Team Incident Commander, the Governor has requested any National Guard medical personnel with a background in mental health treatment or psychological first aid to be activated.
• The National Guard is also assisting with scene security, and several additional Civil Support Teams (CST) have been requested and are en-route from other locations. The CST teams will support monitoring operations until other Federal agencies have arrived on the scene.

The State of Oklahoma has asked for assistance from the National Disaster Medical System with Disaster Mortuary Operation Response Teams (DMORT) to assist with identification, evidence collection and decontamination of deceased victims.

Mass Care of citizens, responders and domestics pets is a priority, and some agencies have already begun to arrive and have established mass care functions at Reception Care Centers (RCC).

• Decontamination needs for mass care will place additional constraints on responder resources. In some cases, decontamination standards will need to be adjusted to allow entry and reentry into shelters or RCC’s.
• Planning has begun for short and long-term domestic contamination migration issues due to unmonitored and uncontrolled movement of people, household pets and service animals, and transportation conveyances outward from the Bobsville, which could cause cascading challenges across multiple jurisdictions. GCPHD has begun to implement different surveillance methods to identify and track victims/patients/citizens that may have been exposed to radiation.
• Additionally, GCPHD has implemented surveillance systems to track individuals who may be presenting with mental health issues.
• Children continue to be sheltered-in-place at schools and have been anxious to be reunited with their parents and parents with their children.  Some parents have not yet been located, which has created some complexities. 
• Some individuals did not receive the evacuation order. First responders have been attempting to locate all citizens still sheltering-in-place to be evacuated and relocated to [preidentified] Reception and Care Center (RCC) locations outside the hazard zone.

Environmental assessments and consequences have been evaluated and may include contamination of ground and water systems (natural and distributed).

• Residual radioactivity in the environment (e.g., waterways, livestock, forests, agricultural land, and wildlife) may affect the food supply and drinking water.
• Stormwater runoff may contaminate retention basins, stormwater management systems, and larger waterways, affecting drinking water.

Key Issues

• During these 48 hours, hospital EDs and community health center clinics are above surge capacity.
• A Casualty Collection Point is established at the college.
• Residents, schools, and other locations have been sheltering-in-place but now have been instructed to begin evacuation procedures.
• Civil Support Teams have arrived and are providing technical expertise to Incident Command.
• Mental health issues and psychological first aid requirements for citizens are overwhelming the health care infrastructure.
• Children are in the process of being reunited with located parents/guardians.
• Bobsville and General County have begun to receive medical assets, food and evacuation assistance coordinated through the first responders, National Guard, the American Red Cross, state and local public health agencies.

Discussion Questions:

Based on the information provided, participate in the discussion concerning the issues raised in Week 6. Identify any additional requirements, critical issues, decisions, or questions.

1. What are the public health and medical agencies, short-term, intermediate, and long-term priorities?
2. What federal agencies should be requested or might automatically respond to this incident?

What Do I Do In A Nuclear Emergency? | NRC.gov

Emergency Classification | NRC.gov

How Can I Prepare For A Radiological Emergency? | NRC.gov

Simulation Exercise Scenario:

Immediate Response and the First Two Hours

May 1, 2021, 7:40 AM – Fire and law enforcement units respond to the incident scene. They are careful to approach the incident scene as the incident scene is near the nuclear power plant.

First responders can visually view a mushroom cloud in the area of the incident scene as they make their approach to the incident.

• Upon arrival, the first responding EMS units start to size up the scene from a safe distance. They see many cars on fire on the roadway, there are victims from the explosion on the ground and walking around looking for help.
• Fire and Law Enforcement units realize that the explosion is not at the nuclear power plant but at the law enforcement checkpoint established that morning.
• Fire and EMS are attempting the activation of mutual aid assistance from other departments in the area.
• Fire, EMS, and Law Enforcement reach out to emergency management and the local hospitals as best as possible and inform them that an explosion with a Mass Casualty Incident (MCI) has occurred.
• Minutes later, emergency management and hospital facilities receive information from first responders arriving on the scene recommending emergency management send a shelter-in-place protective action to Bobsville and General County communities. There is a potential that this is some sort of nuclear detonation.  Bobsville Emergency Management puts out an immediate notification instructing citizens to Shelter-in-Place due to an explosion with unknown hazards until further notice.

Bobsville emergency management sends out the following message:

Citizens of Bobsville – there has been a potential nuclear detonation near the nuclear power plant, and Bobsville emergency management is implementing the following protective action:

Shelter-in-Place immediately to minimize time spent near a radioactive source. The less time exposed to the source of radiation, the lower the dose received.

Maximize the distance from a radioactive source. The farther one is from the source of radiation, the lower the dose received.

Shielding yourself from the outside – Shielding means having something that will absorb radiation (such as concrete) between yourself and the source of the radiation. Keep as much protection between oneself and the source as possible.

• Bobsville Emergency Operations Center has been activated and is being staffed by assigned personnel, elected, and appointed leaders.
• The General County Health Department has requested that surveillance systems be initiated both in the county and in Bobsville and at any established evacuation sites.

• EMS and Fire first responders located at the scene are reporting a significant number of injuries as traffic was at a standstill at the Law Enforcement checkpoint in and around SR-323 and I-58.
• EMS and Fire first responders are starting to establish zones around the event. EMS is beginning to provide care to victims that are furthest away from the blast location. EMS providers are reporting various levels of injuries and must decide who and what type of treatment they can provide.

During the first two hours of the event, Bunnyville General Hospital emergency department (ED) begins receiving patients by Personal Operated Vehicle (POV) with a spectrum of injury types and severity, including eye, blast, thermal burns, heat, and fire injuries.  Medical assets are limited and rapidly becoming scarce.

Key staff have not shown up to work at critical infrastructure locations in Bobsville; some reside in General County and have not reported to work.  Staff members want to leave their employment locations, including Bunnyville General Hospital, to find family members in General County or at schools, workplaces, and homes. Most of the population are fearful and anxious.

Community health centers are receiving an increasing number of calls and self-presenting patients that do not want to wait for treatment in what appears to be overcrowding at the Bunnyville hospital emergency department.

Responders report a plume is headed in a southwesterly direction and is starting to enter portions of Bobsville.

Key Issues

• First responders see a mushroom cloud coming from the area of the explosion.
• Upon arrival at the incident scene, first responders see many victims and immediately implement notifications for an MCI.
• Victims are being treated at the incident site.
• A Shelter-In-Place protective action has been issued to the community of Bobsville.
• Hospitals and community health centers in the General County and Bobsville region begin experiencing patient surge within two hours of the event. 
• Patients are presenting with a variety of injuries with varying severity from the blast and resulting infrastructure destruction.
• The public, medical staff and patients are fearful, frantic, and anxious.
• A plume is moving towards Bobsville.

Discussion Questions:

Based on the information provided, participate in the discussion concerning the issues raised in Week 5. Identify any additional requirements, critical issues, decisions, or questions you may have at this time.

1. How will public health, EMS and hospital partners ensure the information received will be sufficient to inform decision-makers regarding immediate lifesaving and life-sustaining activities? 
2. What system(s) should be utilized by EMS and Fire personnel as they arrive on the scene and start sorting and treating patients?

radcover2 (fema.gov)

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5 triage lessons learned from the Boston Marathon Bombing (ems1.com)