When Disaster Strikes: Responding to the Needs of Children

Abstract

Abbreviations: WMD = weapons of mass destruction DSR = disaster somatization reaction TDB = Terrorism and Disaster Branch NCTSN = National Child Traumatic Stress Network AbstractWhen a disaster strikes, parents are quick to seek out the medical advice and reassurance of their primary care physician, pediatrician, or in the case of an emergency, an emergency department physician. As physicians often are the first line of responders following a disaster, it is important that they have a thorough understanding of children's responses to trauma and disaster and of recommended practices for screening and intervention. In collaboration with mental health professionals, the needs of children and families can be addressed. Policy-makers and systems of care hold great responsibility for resource allocation, and also are well-placed to understand the impact of trauma and disaster on children and children's unique needs in such situations. Gurwitch RH, KeesM, Becker SM, Schreiber M, Pfefferbaum B, Diamond D: When disaster strikes: Responding to the needs of children. Prehosp Disast M«/2004;19(l):21-28. IntroductionEmergency medicine is a relatively new specialization dating only from the early 1960s. In fact, the American Medical Association rejected the initial application for emergency medicine as a medical specialty, citing no need for organization and certification. Finally, in 1979, the American Board of Emergency Medicine was recognized as a conjoint specialty 1 with the charge to assess and to stabilize all individuals presenting to an emergency department. Since its inception, the responsibilities of emergency medicine physicians have continued to evolve. At the beginning of the 20th century, medical personnel were involved in the treatment of several large-scale, medical epidemics affecting physical health, such as poliomyelitis, rubella, and diphtheria. With the dawn of the 21st century, new threats to the health and safety of children have emerged. In the United States, the domestic terrorist attack in Oklahoma City and the large-scale, coordinated, terrorist attacks of 11 September 2001 have added a new facet to all areas of medicine, including disaster mental health. The ongoing threats of chemical, biological, radiological, and nuclear attacks (weapons of mass destruction (WMD)), as well as conventional weapons (e.g., explosives) have underlined the need for disaster planning and preparedness. As physicians and other health professionals design and modify disaster and crisis plans, the inclusion of plans for disaster mental health issues, particularly related to children, also must be incorporated.Medical professionals are an important point of contact for children and families during or following a catastrophic event. Immediately after an event, children may be seen in triage or emergency department settings. Later, parents may bring their children to pediatricians or consult with the family physi-

Emergency Department Staff Preparedness for Mass Casualty Events Involving Children

“…It is imperative that they possess adequate knowledge and skill in the care of pediatric trauma management, as well as the emotional readiness and social support needed to allow them to perform their tasks. 3,9,12 Research shows that when a large-scale event involving children occurs, the primary concern of health care workers is their commitment toward their own children and family members; 8 their concerns about their safety make it difficult for them to perform their duties. They may be far away from their children and families and in the midst of a crucial task, rendering them unable to make alternative arrangements for their children.…”

Earthquakes and children: The role of psychologists with families and communities.

“…As in other natural disasters, children are a particularly vulnerable population (Gurwitch, Kees, Becker, Schreiber, Pfefferbaum & Diamond, 2004; Johnston & Redlener, 2006; Norris, Friedman, & Watson, 2002; Williams, Alexander, Bolsover, & Bakke, 2008). However, as contrasted with natural disasters that have advance warning during which there is time for families to unite and evacuate, earthquakes can cause a particularly high number of injuries and deaths, as well as destruction to community facilities and critical health infrastructure (La Greca & Prinstein, 2002; Mirhashemi, Ghanjal, Mohebbi, & Moharamzad, 2007).…”

“…Dose-response effects have been related to factors such as severity of personal life threat, personal injury, injury or death of a family member or friend, directly observing the injury and death of others, feeling trapped or unable to escape, separation from parent, and damage to or destruction of one's home (Gurwitch et al, 2004; Proctor et al, 2007). Perceptions of life threat predict to post-trauma symptoms, even in low casualty disasters (La Greca, Silverman, Vernberg, & Prinstein, 1996).…”

“…The disaster literature highlights the importance of avoiding pathologizing anticipated ‘normal’ reactions to terrifying events while still identifying those children suffering severe mental disorders (Gurwitch et al 2004; Jones, 2008). Experts on disaster management and mental health debate whether a focus on clinical symptoms and psychiatric categories detracts attention from the needs of the society-at-large (Belfer, 2006; Williams et al, 2008).…”

“…More generally, children's manifestations of symptoms following a disaster vary across different developmental stages (Gurwitch et al, 2004; Murray, 2006; Vogel & Vernberg, 1993). For very young children who cannot verbally describe their internal states, post-trauma stress might best be recognized through trauma themes in their play, loss of developmental skills, and disturbances in sleeping and eating.…”