Pediatric Terrorism and Disaster Preparedness: A ... - PHE Home

these roles, they should work closely and collaborate with a number of individuals and
agencies to ensure that the psychological impact of mass violence is addressed.
The first and foremost response to mass events is both directed and performed by the
government and its agents. These are usually under the auspices of law enforcement, fire
personnel, and/or emergency medical services, which are typically managed by an
Incident Command System (ICS). Mental health early responders should have preexisting
relationships with the ICS to perform their duties effectively. In most States and
other jurisdictions, ICS staff members meet regularly to ensure efficient operation when
needed. During episodes of mass violence, mental health providers need to be part of the
ICS staff whenever possible. The pre-existing relationship with emergency response
commanders permits more expeditious access to affected individuals and for the
community’s psychological needs to be considered consonant with emergency responses.
In addition, when mental health providers are members of the ICS, access to and
allocation of resources for mental health crisis responders in situations of mass violence
improves. Situating providers in the most useful locations, ensuring the flow of needed
information and communications, and preventing well-intended, but inexperienced and
unlinked clinicians from arriving en masse in an attempt to provide services are essential
to lessen the general confusion and chaos that accompany disasters.
A useful way of defining and understanding a traumatic response is that the affected
individual experiences the loss of both internal and external control. Therefore,
maximizing organization and structure is a necessary prerequisite in providing mental
health crisis response and early intervention. Mental health crisis models are best
equipped to achieve this organization and structure when they are firmly rooted in the
ICS.
Crisis Response for Children and Families
Unfortunately, there is no clear empirical evidence for the effectiveness of any crisis
response intervention. In fact, the frequently used and previously heralded Critical
Incident Stress Debriefing or Management (CISD or CISM) strategies have not
demonstrated effectiveness, and in some studies they have proved detrimental. Indeed, it
has been recommended that compulsory debriefing of victims of trauma should cease.
However, it is possible that an alternative method of early crisis intervention may be
helpful for assisting people who may be recently traumatized. The following
recommendations and guidelines for early intervention strategies are based on evidence
from research on the risk factors for PTSD as well as some intervention research. Thus,
they provide an empirical foundation for appropriate and useful approaches to assist
potentially traumatized individuals.
Currently, there is no evidence that global intervention for all trauma survivors serves a
function in preventing subsequent psychopathology. However, there is consensus that
providing comfort, information, and support and meeting the immediate practical and
emotional needs of affected individuals can help people cope with a highly stressful
event. This intervention should be conceptualized as supportive and noninterventional but
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