Responding to Terrorism: Recovery, Resilience, Readiness (Part 4)
Readiness for future attacks demands continuous planning for the
unimaginable. The anthrax attacks following 9-11 highlighted the
challenges of preparing for a new kind of warfare that includes
biological and chemical attacks. What lessons from past disasters
can help guide future emergency planning?
"We don't know what we don't know." This is
the first thing to remember when a strike occurs, according to
Stephen Mayberg, Ph.D., director of the California Department
of Mental Health. Every disaster is unique, he said, whether it
is natural or man-made. Experience with earthquakes has taught
that even with the best preparation, responders should be prepared
for some chaos and uncertainty. "There's a lot you figure out
as you go along," he said.
Don't expect things to work. Dr. Mayberg added
that in a physical disaster, responders should anticipate the
failure of vital services such as phones and electricity and have
Bioterrorist events are different from natural disasters.
They're less predictable and more drawn out; losses are human,
not material; and while the "worst it can get" tends to be obvious
in a fire or flood, the low point is less clear when the agent
of disaster is biological, according to Dr. DeMartino. Not knowing
when to expect things to improve heightens stress. These factors
intensify feelings of loss of control and can reduce public confidence
in the agencies designated to protect against and deal with disaster.
Preparation itself is stressful. This is especially
true when the threats are insidious. When the onset of an attack
is invisible, as it is with anthrax, or the agents are easily
obtainable, as are many chemical agents, new worries complicate
the preparations for a possible attack.
Identifying victims of bioterrorism is challenging.
Minor symptoms of other illnesses like the flu may initially mirror
those of a biological attack. Emergency plans should include preparing
for rapid identification of potentially dispersed casualties.
Biological and chemical attacks call on a different
set of first responders. In the early hours and days
of a biological or chemical attack, first responders typically
are not police and firefighters, according to Martha B. Knisely,
M.A., District of Columbia Mental Health director. Based on her
recent experience dealing with the anthrax crisis in the Nation's
capital, she told listeners that "our first responders were lab
technicians, mental health workers, public health workers, pharmacists,
and physicians." Emergency planning needs to include these professionals.
Government can help. In an emergency, Government
agencies provide consistency, structure, reassurance, and authority,
Dr. Mayberg has found. "When you rush in to help, you need legitimate
identification and a defined role," he said.
Communications are critical. Officials can
help the public manage fear by describing threats clearly and
accurately, outlining what is being done and what the public can
do, and promoting realistic expectations of public agencies, Dr.
Plan for a marathon. As with all emergency
responders, mental health and substance abuse workers should pace
themselves for the long haul when terrorism strikes, Dr. Mayberg
counseled. "Compassion fatigue" and burnout are common among crisis
Build on the current knowledge base for the future.
Paul Puccio, of the New York State Office of Alcoholism
and Substance Abuse Services, spoke for many participants when
he said, "This conference was tremendous in terms of giving us
a framework we can build upon. But I suspect that most of the
state teams . . . came away with the understanding that we need
to learn a lot more and develop a lot more."
Based on feedback from the summit, SAMHSA will assess and respond
to states' requests for technical assistance and will hold
a series of regional meetings to follow up on state plans.
"Many of the words we've heard over these days remind us why we
do what we do," Mr. Curie told the conference. "They help us move
forward along these unmarked roadways since September 11, so we
can be prepared to help others. How we act—not just react—in
the coming weeks and months will help millions of our fellow Americans
who are struggling with the new definition of normal."
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