To further make the best use of limited resources, the authors say that broad-based primary interventions, such as psychological debriefings, might be a lower priority than implementing potentially more effective "secondary prevention" measures, which seek to reduce long-term ill outcomes.
In particular, EMTs could be asked to responsibly distribute sedatives to manage short-term anxiety-related symptoms. But the authors say that policies would need to be developed to expand the list of those authorized to prescribe such drugs, as they are at present strictly regulated by federal law.
The authors note that sedatives were distributed in New York City immediately after the Sept. 11, 2001, terrorist attacks.
The authors also recommend that planners focus on ethical challenges likely to arise when assisting the mentally disabled during and after a disaster. These challenges may be partially addressed by adopting a "crisis standard of care" consistent with guidelines from the Institute of Medicine, they say.
Special attention should be given to assisted-living and long-term care facilities that house many residents with significant cognitive impairment, such as dementia. If these people are forced to evacuate, they may not fully comprehend the crisis and may be at risk for extreme emotional distress.
Hence, disaster-preparedness training for first-responders should also include information about how to interact with such individuals in a way that respects their dignity, the authors say.
More broadly, criteria for priority setting and the allocation of scarce resources can be based on objective factors, such as the likelihood of response to int
|Contact: Michael Pena|
Johns Hopkins Medical Institutions