Disaster and mass casualty psychiatry — structured clinical viva

Systems role. Embed under incident command; medical triage first; mental health provides PFA, risk assessment, SMI medication continuity, staff support, and stepped referral — not freelancing in hazard zones.[8]

Epidemiology. Heterogeneous elevated morbidity (Norris); PTSD dose-response (Neria); intentional mass violence epicentre effects (Galea); resilience common (Bonanno); natural disasters increase distress/disorder (Beaglehole); Black Saturday residual need in high-impact communities (Bryant).[1][2][7]

Early intervention. Hobfoll: safety, calming, efficacy, connectedness, hope. PFA operationalises early support. Mandatory single-session CISD is not supported for PTSD prevention (Rose Cochrane).[3][4]

Treatment. For persistent PTSD: individual TF-CBT/EMDR (Bisson). Sertraline 25–50 mg orally daily, titrate 50–200 mg with monitoring if medication indicated. Assess suicide risk despite mixed population suicide patterns after natural disasters.[5][6]