Psych · Public and community psychiatry — disaster and mass casualty psychiatry
Disaster and mass casualty psychiatry
Also known as Disaster mental health · Mass casualty behavioural health · Psychological first aid PFA · Critical incident stress debriefing CISD · MHPSS emergency psychiatry · Bushfire flood terrorism mental health · Hobfoll five essential elements · Disaster psychiatry surge
Exam-exhaustive fellowship reference on disaster and mass casualty psychiatry — exposure gradients, normal distress versus disorder, Hobfoll five elements, Psychological First Aid versus mandatory debriefing, stepped triage and treatment of ASD/PTSD/depression/grief, first-responder and child care, and regional MHPSS architecture. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Active suicidal intent, plan, or high-lethality attempt in a shelter or field setting — same-day senior review, means restriction, documented safety plan
- Mandatory single-session CISD debriefing of all exposed people as 'prevention' — not evidence-based and may harm
- Loss of psychotropic continuity for pre-existing SMI during displacement — replace scripts early
- Using children as interpreters in multilingual disaster settings for risk or consent
- Ignoring medical injury, TBI, or substance withdrawal while labelling all arousal as 'PTSD'
- Freelancing outside emergency command safety protocols in an active hazard zone
Meet the patient
A community nurse refers a 44-year-old farmer three weeks after a bushfire took his closest neighbour's house and the fence line he had worked since childhood. He is not sleeping, startles at the sound of a helicopter, and cannot face the burnt paddock. He has drunk most evenings to get to sleep, and has run out of his olanzapine because the script burned with the kitchen drawer.[16][18]
Two questions follow this patient for years: is this normal distress or disorder? and what should the system have done in the first 72 hours? Disaster psychiatry exists to answer both, soberly and in the right phase.[6][8]
References18ShowHide
- [1]Norris FH, Friedman MJ, Watson PJ, et al. 60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981-2001 Psychiatry, 2002.PMID 12405079
- [2]Norris FH, Friedman MJ, Watson PJ 60,000 disaster victims speak: Part II. Summary and implications of the disaster mental health research Psychiatry, 2002.PMID 12405080
- [3]Galea S, Ahern J, Resnick H, et al. Psychological sequelae of the September 11 terrorist attacks in New York City N Engl J Med, 2002.PMID 11919308
- [4]Neria Y, Nandi A, Galea S Post-traumatic stress disorder following disasters: a systematic review Psychol Med, 2008.PMID 17803838
- [5]Goldmann E, Galea S Mental health consequences of disasters Annu Rev Public Health, 2014.PMID 24159920
- [6]Bonanno GA, Brewin CR, Kaniasty K, et al. Weighing the costs of disaster: consequences, risks, and resilience in individuals, families, and communities Psychol Sci Public Interest, 2010.PMID 26168411
- [7]Beaglehole B, Mulder RT, Frampton CM, et al. Psychological distress and psychiatric disorder after natural disasters: systematic review and meta-analysis Br J Psychiatry, 2018.PMID 30301477
- [8]North CS, Pfefferbaum B Mental health response to community disasters: a systematic review JAMA, 2013.PMID 23925621
- [9]Hobfoll SE, Watson P, Bell CC, et al. Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence Psychiatry, 2007.PMID 18181708
- [10]Rose S, Bisson J, Churchill R, Wessely S Psychological debriefing for preventing post traumatic stress disorder (PTSD) Cochrane Database Syst Rev, 2002.PMID 12076399
- [11]Forbes D, Lewis V, Varker T, et al. Psychological first aid following trauma: implementation and evaluation framework for high-risk organizations Psychiatry, 2011.PMID 21916629
- [12]Shultz JM, Forbes D Psychological First Aid: Rapid proliferation and the search for evidence Disaster Health, 2014.PMID 28228996
- [13]Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults Cochrane Database Syst Rev, 2013.PMID 24338345
- [14]Brady K, Pearlstein T, Asnis GM, Baker D, et al. Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial JAMA, 2000.PMID 10770145
- [15]Brewin CR, Andrews B, Valentine JD Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults J Consult Clin Psychol, 2000.PMID 11068961
- [16]Bryant RA, Waters E, Gibbs L, et al. Psychological outcomes following the Victorian Black Saturday bushfires Aust N Z J Psychiatry, 2014.PMID 24852323
- [17]Kõlves K, Kõlves KE, De Leo D Natural disasters and suicidal behaviours: a systematic literature review J Affect Disord, 2013.PMID 22917940
- [18]Norwood AE, Ursano RJ, Fullerton CS Disaster psychiatry: principles and practice Psychiatr Q, 2000.PMID 10934746