Bushfire mass casualty — stepped disaster mental health response (MEQ)

(i) Phases and exposure. Disaster psychiatry supports preparedness, impact/response, early recovery, and reconstruction. At 36 hours: integrate with emergency command; PFA; risk triage; medication continuity; family reunification support; staff welfare. Exposure gradient: direct threat/injury/bereavement greater than secondary responder exposure greater than community disruption/media; plan resources by dose of exposure.^[1][10]

(ii) Spectrum and epidemiology. Most show early distress; many recover (Bonanno trajectories). ASD/PTSD when trauma clusters persist; depression and grief common; SMI may relapse when scripts/housing lost. Anchors: Norris synthesis; Neria dose-response PTSD review; Beaglehole natural-disaster meta-analysis; Bryant Black Saturday residual morbidity in high-impact communities alongside majority resilience. Do not quote a single false-precision universal prevalence.^[1][2][3][9]

(iii) Immediate care; CISD. Promote Hobfoll five elements: safety, calming, efficacy, connectedness, hope. Deliver PFA (engagement, safety/comfort, stabilisation, information, practical help, social connection, coping info, linkage). Do not mandate single-session CISD for all exposed — Cochrane review finds no useful PTSD prevention effect and possible harm relative to control.^[4][5][6]

(iv) Stepped definitive care. Watchful waiting for recovering people; skills-based help if distress persists; individual TF-CBT or EMDR for chronic PTSD (Bisson Cochrane). If SSRI indicated: sertraline 25–50 mg orally daily, titrate toward 50–200 mg; monitor GI effects, sexual dysfunction, early activation/suicidality. Treat depression, substance use, and SMI in parallel; restore practical resources.^[7][8][10]

(v) Pitfalls and disposition. Pitfalls: mandatory CISD; pathologising all survivors; ignoring secondary stressors; child interpreters; lost psychotropics; long-term benzodiazepine defaults; inventing emergency statute numbers. Special populations: children, older adults, perinatal, SMI, first responders, Indigenous/rural. Disposition: shelter/field to primary care to specialist trauma/crisis to inpatient if high risk. Plan long-term follow-up for high-impact zones.^[3][9][10]