Terrorism & Public Health Response- by Dr. Rajan R Patil

8/7/2019 Terrorism & Public Health Response- by Dr. Rajan R Patil

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Title

TERRORISM- A MODERN STRESS AGENT:

A PUBLIC HEALTH RESPONSE TO MITIGATE PSYCHOLOGICAL

CONSEQUENCE OF TERRORISM.

Author

Rajan R Patil,

Affiliation

School of Public Health , SRM University, Chennai.

Correspondence:

Dr. Rajan R Patil

Division of EpidemiologySchool of Public Health

SRM University

Potheri, Kattankulathur - 603203Greater Chennai,

INDIA.

Cell: 9445811610 & 9025378036

Email : [email protected]
mailto:[email protected]:[email protected]


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IntroductionAn Epidemiological view of Terrorism in India

Our country has been plagued with many disease earlier, and today Terrorism is anemerging disease, and Terrorism is a modern day scourge. if so, 30 years is good

enough time in the life of a nation to be convinced that this epidemic is not a self

limiting in nature

Terrorism being deadly Virus- an emerging disease- which has got hold its foot in India

since 1980s and has evolved from being regional endemic disease in Punjab and Kashmir

a few years ago, to now assuming full fledged epidemic proportion- spreading across

India- Andhra Pradesh, Tamilnad, Bangalore-IISc, Sankat Mohchan Temple-UP,Bombay etc. Just do spot mapping of this epidemic, and you know the extensive

geographic expansion of this virus. Also note its increasing pathogenecity and Virulence,

translating into increasing Case Fatality Ratio- The evolution and adaptation of this

terrorist virus and its success has been fantastic in Indiaso far. (thanks to their

increased sophistication of their attack).

Indian Epidemic should be viewed in the context of ongoing Global pandemic of

terrorism in Lebanon, palestein, North Korea, Afganistan, Srilanka etc.

Uniqueness of epidemiology of Terrorism

1. In Infectious Disease epidemic- The disease causing Agent, its spread, population

at risk, susceptibility and resultant morbidly & Mortality can be localized within adefinable geographic boundary. In terrorism its almost boundary less.

2. In terrorism, physical injury is only a small proportion of its overall health impact.

Major burden is mental health morbidity

3. The modern disease causing vector- TV medium- carrying the horrific visual

beyond the place of terrorist attack. One is equally susceptibility to the mentalinjury caused by the horrific visuals like my friends in

Bombay. In effect it is boundary less. So where do my interventions start andend?

4. In ID epidemic, therapeutic intervention is warranted while the epidemic is goingon. In terrorism therapeutic intervention are required (mental health-psychosocial)


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after terrorist attack has taken place and intervention may need to continue up to

six months after the attack e.g. to manage PTSD etc.

The Context

Terrorism a modern day scourge and its high time for us to have in place Public Health

Strategies to counter adverse health impact of terrorism which will go long way inreducing morbidity & morality related to terrorism.

Israel is a synonym (for many) a role model for counter terrorism offensive. But historyhas shown that flamboyant military offensives in various countries in Viatnam,

Afganistan, Irag or Leabanon etc all have had very limited successes.

1. Can Terrorism be brushed aside by the health groups as the usual law and orderproblem with a foreign affairs dimension?

2. Should the Health Professionals be contented by leaving the response to terrorismArmy, IB, police, journalists.etc.

3. Could some thing be done to address the adverse health impact of Terrorism?

It is well documented that there are specific public health problems arising due toterrorism. It is important to have a well structured public health response to terrorism

with appropriate public health components i.e., preventive, curative and promotivemeasures to tackle health impact following terrorist attack.

THE COMPONENTS OF PUBLIC HEATH RESPONSESTRATEGIESTO TERRORISM.

PRE-TERRORIST ATTACK

1. Identifying terrorist hot spots (like seismic zoning)2. Behavioural(Suspicious) Surveillance in public placesrailway , Air ports, Temples etc3. Hospital contingency plans preparation4. Annual Mockdrills managing mass causalities in very highrisk zones at least5. Training


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DURING TERRORIST ATTACK (FIRST 5 HRS)

1. Establishing Incident command system2. Emergency Medical Team Deployment3. Mass Casualty incident Management

4. On Site and Off Site Triage of injured and serious victims5. Conveyor belt Transport of ambulances6. Coordination with Police, firefighter, NGOs & Local authorities.7. Psych-Social workers deployment8. Burnout issues in first responders

POST TERRORIST ATTACK (2ND DAY UP TO 6 MONTHS)

Can this be under taken when the NEXT Terrorist Attack takes place?

This phase is most important from Public Mental Health point of view,and this is where the health groups need to intervene the most Afterdisaster tourist have left place. The need for Continued psycho-socialcouselling and establishing Mental Health Surveillance System

Public Health Interventions and Strategies :

The following arevthe major areas of public health concern andsuggested public health interventions and strategies [1,2]

Media management especially sensationalization andcensoring of horrific visuals

In short, among those adults who directly experienced loss orwitnessed a terrorist event, there exists a dose response relationshipbetween post-traumatic distress and exposure to televised terrorism-related material whereas this dose relationship does not appear amongthose adults not directly affected by terrorism. It does appear,however, that news consumption is related to temporary increases inanxiety in the general adult public.

However, terrorism is not only about life threat to single individuals, oreven a small group of persons, but is designed to instill fear in societyat large. Thus, in addition to those who experience the effects ofterrorism first-hand, there are collateral effects. Persons who are not inproximity to the target of where the terrorist event occurred, orpersons who were not directly affected by the loss of someoneimportant to them, can also be affected in terms of mental health


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outcomes, particularly since such events often receive repeatedcoverage on television and other media outlets. One of the gaps in ourknowledge concerns whether the mental health consequences inpersons indirectly exposed to terrorism are qualitatively orquantitatively different from those who have been directly exposed.

High Risk Groups - Establishing Mental Health Surveillance

Whereas the typical public health approach to terrorism would focus onthe impact of this event on the majority of persons exposed, theliterature is clear that only a proportion of persons exposed to anygiven traumatic event suffer long-term symptoms. These findings raisethe question of what factors mediate risk and resilience. On the basisof retrospective studies, those at greatest risk for developing PTSD

following a traumatic event are persons with a family history of mentalillness prior exposure to trauma and certain pre-existing personalitytraits such as proneness to experiencing negative emotions and havingpoor social supports.

Clarify that negative health behaviors, which may increase during timeof stress (ie, smoking, unhealthy eating, excessive drinking), constitutea greater health hazard than the hazards likely to stem frombioterrorism.

Support to Children

Children gauge threats based on caregiver responses. Since terrifiedparents are terrifying to children, parents can moderate or mediate thepropagation of terror as a vector for the spread of fear to children.Calm and functional parents, teachers, and other adults can reassurechildren. In addition, it is not clear whether the same pharmacologicagents used for post-trauma syndromes in adults should be used inchildren. A major gap in our knowledge is that there is virtually no

In addition to the 'dose' or degree of exposure to the event, theamount of family support available during the experience and in theaftermath of trauma, the amount of life disruption, and the degree ofsocial disorganization are important predictors of mental healthsymptoms


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The Differential Effects of Terrorism in Groups at Special Riskfor Exposure

It is not clear whether persons who function in occupations as firstresponders to terrorism and trauma (police officers, firefighters, EMT

workers) are at greater risk due to increased exposure, or lesser risk,due to constitutional protective factors and prior training and specificrole-related duties, than do random citring the scale of terrorism, andits potential to impact on whole communities, there is a need toinvestigate the capacity to train individuals, or even communities, tominimize the effects of terrorism.

Effect of Public Health Education and Media

The roles of the mass media, the web, and other public education tools

may be helpful in alleviating public distress. It may be that in thosewho are at risk for developing psychopathology, specificrecommendations for minimizing exposure to media following terroristattacks may be indicated. More than this, it may be possible toarticulate guidelines for the types of communications that will be leastlikely to precipitate or augment symptomatology in the public. Withoutsystematic study of these issues, it is unwarranted to make suchrecommendations.

TERRORISM AND THE RISK OF PSYCHOPATHOLOGY ANDDISABILITY

Pathologic Response?

In the days following 9/11, the majority of people in the US reportedproblems sleeping and concentrating, irritability, nightmares,distressing thoughts about the event, or distress at reminders of theevent but 5-8 weeks after the attacks, most had recovered from initialsymptoms. The important question raised by these findings is whether

the initial symptoms observed constituted a clinical syndromerequiring treatment, or was rather, a reflection of normal acute,transient distress not requiring intervention.

Risk Communication in Special, High-Risk Groups


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While most terrorist attacks do not cause extensive loss of life, thepsychological impact of terrorist acts and threats can be widespread.While the reactions of the general public can range from mild tomoderate after an adjustment it is important to understand andprevent extreme and dangerous responses in a minority that may

include transient panic, retaliatory attacks on local minority groups,nonadherence to medical or other recommendations

CONCLUSIONS

1. Terrorist acts produce devastating injuries, destruction, anddeath. However, their ultimate goal is psychological: to create aclimate of fear, uncertainty, and vulnerability. The psychologicaleffects of terrorism are central to the political goals of the

perpetrators.

2. Psychological effects exert strong and persistent effects onimportant neurobiologic systems. This is why a neurobiologicperspective is essential to the development of knowledge aboutthe effects of terrorism.

3. Following a terrorist attack, persons will be fearful, anxious, anddistressed for a few weeks to months but the vast majority will prove resilient.

4. A significant minority of those affected by terrorism will needmental health treatment because they develop long-term anddisabling disorders, most notably PTSD. Others may developdepression or increase their use of alcohol or other addictivedrugs. For this subgroup, the resource utilization will be veryhigh.

5. The risk of developing a long-term mental illness is based on twointeracting factors: (1) the directness and severity of a person'sexposure to the terrorist event and (2) the degree of personalsusceptibility. The more directly a person is affected by a

terrorist act, the greater is the risk of developing post-traumaticpsychopathology. However, research shows that some peopleare more susceptible than others because of genetic differences,as well as other factors (eg prior history of traumatization).

Reference


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1. Rachel Yehuda et al. Pathological Responses to Terrorism.

Neuropsychopharmacology (2005) 30, 1793,1805. doi:10.1038/sj.npp.1300816;

published online 13 July 2005

2. The Impact of Terrorism on Brain, and Behavior: What We Know and What WeNeed to Know. Neuropsychopharmacology (2005) 30, 1773,1780.

doi:10.1038/sj.npp.1300817; published online 13 July 2005

Terrorism & Public Health Response- by Dr. Rajan R Patil

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