Responding to Terrorism: Recovery, Resilience, Readiness (Part 4)

Readiness

Readiness for future attacks demands continuous planning for the unimaginable. The anthrax attacks following 9-11 highlighted the challenges of preparing for a new kind of warfare that includes biological and chemical attacks. What lessons from past disasters can help guide future emergency planning?

• "We don't know what we don't know." This is the first thing to remember when a strike occurs, according to Stephen Mayberg, Ph.D., director of the California Department of Mental Health. Every disaster is unique, he said, whether it is natural or man-made. Experience with earthquakes has taught that even with the best preparation, responders should be prepared for some chaos and uncertainty. "There's a lot you figure out as you go along," he said.

• Don't expect things to work. Dr. Mayberg added that in a physical disaster, responders should anticipate the failure of vital services such as phones and electricity and have backup plans.

Dr. Robert DeMartino

• Bioterrorist events are different from natural disasters. They're less predictable and more drawn out; losses are human, not material; and while the "worst it can get" tends to be obvious in a fire or flood, the low point is less clear when the agent of disaster is biological, according to Dr. DeMartino. Not knowing when to expect things to improve heightens stress. These factors intensify feelings of loss of control and can reduce public confidence in the agencies designated to protect against and deal with disaster.

• Preparation itself is stressful. This is especially true when the threats are insidious. When the onset of an attack is invisible, as it is with anthrax, or the agents are easily obtainable, as are many chemical agents, new worries complicate the preparations for a possible attack.

• Identifying victims of bioterrorism is challenging. Minor symptoms of other illnesses like the flu may initially mirror those of a biological attack. Emergency plans should include preparing for rapid identification of potentially dispersed casualties.

• Biological and chemical attacks call on a different set of first responders. In the early hours and days of a biological or chemical attack, first responders typically are not police and firefighters, according to Martha B. Knisely, M.A., District of Columbia Mental Health director. Based on her recent experience dealing with the anthrax crisis in the Nation's capital, she told listeners that "our first responders were lab technicians, mental health workers, public health workers, pharmacists, and physicians." Emergency planning needs to include these professionals.

• Government can help. In an emergency, Government agencies provide consistency, structure, reassurance, and authority, Dr. Mayberg has found. "When you rush in to help, you need legitimate identification and a defined role," he said.

• Communications are critical. Officials can help the public manage fear by describing threats clearly and accurately, outlining what is being done and what the public can do, and promoting realistic expectations of public agencies, Dr. DeMartino explained.

• Plan for a marathon. As with all emergency responders, mental health and substance abuse workers should pace themselves for the long haul when terrorism strikes, Dr. Mayberg counseled. "Compassion fatigue" and burnout are common among crisis workers.

• Build on the current knowledge base for the future. Paul Puccio, of the New York State Office of Alcoholism and Substance Abuse Services, spoke for many participants when he said, "This conference was tremendous in terms of giving us a framework we can build upon. But I suspect that most of the state teams . . . came away with the understanding that we need to learn a lot more and develop a lot more."

Captain Carol Coley, M.S., of SAMHSA's Center for Substance Abuse Treatment, provided behavioral health trauma services at the former World Trade Center site. "I have returned home a different person, a stronger person," she said. "I have a reinforced view of the kindness and dedication that can be exhibited by others in times of crisis. Regrettably, I also have a vision seared into my brain of the horror that can be created by a few terrorists."

Based on feedback from the summit, SAMHSA will assess and respond to states' requests for technical assistance and will hold a series of regional meetings to follow up on state plans.

"Many of the words we've heard over these days remind us why we do what we do," Mr. Curie told the conference. "They help us move forward along these unmarked roadways since September 11, so we can be prepared to help others. How we act—not just react—in the coming weeks and months will help millions of our fellow Americans who are struggling with the new definition of normal."

« See Part 1: Responding to Terrorism: Recovery, Resilience, Readiness

« See Part 2: Responding to Terrorism: Recovery, Resilience, Readiness

« See Part 3: Responding to Terrorism: Recovery, Resilience, Readiness

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