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Workforce Resilience and Performance
in the Face of Disasters, Terrorism, and Emerging Health Threats
Dori B. Reissman, M.D., M.P.H.CDR, U.S. Public Health Service
Senior Advisor for Disaster Mental Health and Terrorism
CDC’s National Center for Injury Prevention and Control
PHP Conference Feb 23, 2005
Session Organization Dori B. Reissman, M.D., M.P.H.
“Integrating Workforce and Organizational Resilience into the Response Culture of Public Health”
Kathleen Kowalski Trakofler, Ph.D.“Pragmatic Approaches to Creating Workforce
and Organizational Resilience in Public Health Emergency Operations
Explain to decision makers the need to anticipate and integrate behavioral and social needs into advance planning efforts to optimize medical and public health systems of care
Address workplace policy and programmatic design to promote resilience amongst public health responders
Learning Objectives
Grants to State Health Departments Exercise indicators will include behavioral
and mental health components to build local capacity (public health readiness)
Grant guidance includes language to anticipate and integrate behavioral aspects and mental health needs and services for populations exposed to traumatic events
Fear-Inducing Factors in Emerging Biological Events
Biological agent is invisible & odorless Biological agent may be contagious Biological agent may cause death or
severe health problemsMany casualties, widespreadAccess to effective treatmentNo available treatment
Hall, M., Norwood, A., Ursano, R., & Fullerton, C. (2003). The psychological impacts of bioterrorism. Biosecurity and Bioterrorism, 1, 139-44.
Fear-Inducing Factors in Emerging Biological Events
Cause of the event may not be familiar, which breeds “magical” thinking
Public information is inadequate or conflictingUncertainty about how to avoid sicknessUncertainty about where to get help
Hall, M., Norwood, A., Ursano, R., & Fullerton, C. (2003). The psychological impacts of bioterrorism. Biosecurity and Bioterrorism, 1, 139-44.
Substantial investments are spent in search of the best treatment strategy, but relatively little
attention is paid evaluating emotional and behavioral reactions to mass dispensing
Issues That Need to Be Addressed Surge in public demand for medical attention Public’s concern about exposure and safety Incomplete knowledge as events unfold Conflicting expert opinion about treatment Perceived mismatch of governmental action and
public expectations Reluctance to follow health directives
Flu Shot Demand Rises
Sharply
In Colorado, Flu Outbreak
In Colorado, Flu Outbreak Has Killed at Least 5
Has Killed at Least 5 ChildrenChildren
Shortage of Flu Shots Prompts Rationing Vaccine Being Reserved For Highest-Risk Patients
ANTHRAXANTHRAX
1971 U.S. civilian vaccination stopped
2003
38,257 civilians vaccinated
1971 U.S. civilian vaccination stopped
2003
38,257 civilians vaccinated
(as of 8/8/03)
PUBLIC HEALTHPUBLIC HEALTH
72 total U.S. cases 37 lab-confirmed 35 suspect or probable
72 total U.S. cases 37 lab-confirmed 35 suspect or probable
Honeymoon(Community Cohesion)
Honeymoon(Community Cohesion)
WarningWarningThreatThreat
Pre-disasterPre-disaster
“Heroic”“Heroic”
(Coming to
Terms)
Working Through G
rief
(Coming to
Terms)
Working Through G
rief
Reconstruction A New Beginning
Reconstruction A New Beginning
DisillusionmentDisillusionment
Trigger Events and Anniversary Reactions
Trigger Events and Anniversary Reactions
ImpactImpact
InventoryInventory
[Zunin & Meyers]
Phases of Natural Disaster
TimeDays Years
Florida Hurricane Season 2004
Mass fatalities: preserved with dry ice on grounds of Wat (temple) Yan Yao in Takuapa, Thailand.
2004 Indian Ocean Tsunami
2004 Indian Ocean Tsunami:Health-Related Infrastructure Loss in Banda Aceh
Damage to the lab equipment at the Provincial Hospital
Damage outside Meuraxa Hospital
Psychological Consequences of Disasters and Terrorism (R. Ursano, 2002)
These can apply to responders, not just victims.
Usual Sources of Stress on Deployment
Role ambiguity Clarity of tasking Matching skills with tasks Team cohesion Comfort with hazardous exposure Communication protocols
2. Usual Stresses for Responders Autonomy and clearance
Intense local needs for information (media and health officials) that cannot await clearance delay
Database issues, linkage between epidemiology, laboratory, and environmental sampling
Laboratory specimen tracking, reporting
3. Usual Stresses for Responders
Resources/equipment shortages Command and control ambiguities Re-integration barriers
Coworkers had to pick up your work… or no one did and it is overwhelming
Lack of understanding or appreciation for what you have been through
Domestic/family conflict
Endpoints for Evaluation (Agency) Workforce productivity (re-integration) Intra-agency collaboration Interagency coordination (local response plans)
Rules of engagement and integration with constituent partners
Workforce absenteeism (post-event) Command and control strategies (e.g., ICS/UCS) Workforce morale
Endpoints for Evaluation (Individual) Quality of life
Sense of satisfaction with home, work, friends, family, health, hobbies
Existential or world view Functional capacity
Social, family, and occupational rolesBehavioral adaptation and copingThinking and planning skills
Workplace Resilience Program Formal needs assessment Key leadership and service provider training Developing curricula and support tools to
launch a program for deployable staff Assuring infrastructure to provide event-
response and post-response intervention services (including surge capacity)
Why does this matter? Preservation of personnel assets for
emergency response Time, energy, and cost of workforce training
Preparedness improves response readiness and may hasten recovery Mission success Effective re-integration to “day job” Minimize loss of productivity and work
absenteeism Possibility of post-traumatic growth
Potential individual and agency gains
Acknowledgements 2005 Operation Earthquake Mental Health and Resilience Team, CDC
Emergency Operations Academic & Specialty Centers for Public Health Preparedness Disaster Mental Health Institute of South Dakota American Psychological Association American Psychiatric Association Carter Center Mental Health Program
Defense Threat Reduction Agency (DOD) The National Center for Post-Traumatic Stress Disorder (Dept of Veterans
Affairs) The National Child Traumatic Stress Network Potomac Institute/National Defense University RAND Corporation (a non-profit institution) Uniformed Services University of the Health Sciences, Dept of Psychiatry US Dept of Health and Human Services
CDC Substance Abuse and MH Services Administration National Institute of Mental Health Health Resources Service Administration