title: Prioritizing "psychological" consequences for disaster preparedness and response: a framework for addressing the emotional, behavioral, and cognitive effects of patient surge in large-scale disasters.
abstract: While information for the medical aspects of disaster surge is increasingly available, there is little guidance for health care facilities on how to manage the psychological aspects of large-scale disasters that might involve a surge of psychological casualties. In addition, no models are available to guide the development of training curricula to address these needs. This article describes 2 conceptual frameworks to guide hospitals and clinics in managing such consequences. One framework was developed to understand the antecedents of psychological effects or "psychological triggers" (restricted movement, limited resources, limited information, trauma exposure, and perceived personal or family risk) that cause the emotional, behavioral, and cognitive reactions following large-scale disasters. Another framework, adapted from the Donabedian quality of care model, was developed to guide appropriate disaster response by health care facilities in addressing the consequences of reactions to psychological triggers. This framework specifies structural components (internal organizational structure and chain of command, resources and infrastructure, and knowledge and skills) that should be in place before an event to minimize consequences. The framework also specifies process components (coordination with external organizations, risk assessment and monitoring, psychological support, and communication and information sharing) to support evidence-informed interventions.
authors.affiliation: RANDCorporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA. lisa_meredith@rand.org
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Meredith
authors.forename: David P
authors.initials: DP
authors.lastname: Eisenman
authors.forename: Terri
authors.initials: T
authors.lastname: Tanielian
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Taylor
authors.forename: Ricardo
authors.initials: R
authors.lastname: Basurto-Davila
authors.forename: James
authors.initials: J
authors.lastname: Zazzali
authors.forename: Dickson
authors.initials: D
authors.lastname: Diamond
authors.forename: Barbara
authors.initials: B
authors.lastname: Cienfuegos
authors.forename: Sandra
authors.initials: S
authors.lastname: Shields
mesh_terms: D000223:Adaptation, Psychological; D003071:Cognition; D003142:Communication; D003479:Curriculum; D004189:Disaster Planning / Q000379:methods* / Q000706:statistics & numerical data; D004190:Disasters / Q000706:statistics & numerical data; D004644:Emotions; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology; D006301:Health Services Needs and Demand; D006801:Humans; D012066:Relief Work / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012944:Social Support; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology; D014481:United States