Terrorism and Weapons of Mass Destruction: Managing the Behavioral Reaction in Primary Care

Timothy J. Lacy, MD, David M. Benedek, MD

Disclosures

South Med J. 2003;96(5) 

In This Article

Abstract and Introduction

Any terrorist attack using weapons of mass destruction will result in substantial psychological trauma and stress. Primary care and emergency clinics will likely see patients who have stress-related emotional or physical symptoms, or exacerbations of preexisting health concerns. Significant psychological and behavioral reactions to an attack with weapons of mass destruction are certain, include both group and individual reactions, and will follow a predictable course. Possible group reactions include mass panic, acute outbreaks of medically unexplained symptoms, and chronic cases of medically unexplained physical symptoms. Possible individual reactions include psychiatric disorders such as posttraumatic stress disorder, which occurs in approximately 30% of people exposed to extreme trauma. Most people have symptoms of arousal that are normal reactions to abnormal events and that resolve with rest, reassurance, support, and education. Mandatory debriefings are not recommended, and medications may be used when more conservative measures are not sufficient.

Weapons of mass destruction (WMD) are used to kill large numbers of people, destroy large amounts of property, achieve political goals, and create terror, chaos, and social disruption. WMD include biologic or chemical agents, nuclear weapons, conventional bombs contaminated with radioactive materials, large conventional or "truck" bombs, and surprising sources such as hijacked airplanes. Significant psychological and behavioral reactions to such an attack are predictable. Primary care and emergency clinics will likely see many patients who have stress-related emotional or physical symptoms, or exacerbations of preexisting health concerns that will stress the health care delivery system. For example, after the Tokyo sarin attack, 5,510 people sought medical attention at more than 200 hospitals and clinics in Tokyo within several hours of the incident. Approximately 25% of those seen were hospitalized; the remainder had no signs of exposure and were sent home.[1] Medical and rescue personnel may experience impaired performance and have a high rate of "burn-out" related to stress, fatigue, and resisting treatment for themselves as they did after the Oklahoma City bombing.[2]

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