Resources for Dealing with Stress Brought on by Terrorist Attacks

ACEP's Well-Being Committee provides information and helpful links

Emergency physicians may be resilient and professional, but we are not immune to stress related disorders. Acute Stress Disorder and Posttraumatic Stress Disorder are well-recognized entities for which there are diagnostic criteria.

Even if we don't experience a clinical stress related condition, we have all been affected by the horrific events of September 11, 2001. ACEP's Well-Being Committee has a history of service to the membership, as evidenced by the ACEP publication Wellness for Emergency Physicians. In an effort to help us deal with the emotional consequences of the recent attacks on America, committee member Dr. Richard Goldberg has prepared the following article.

The Terrorist Attacks: Dealing With the Emotional Consequences
Richard Goldberg, MD, FACEP
Well-Being Committee
American College of Emergency Physicians

The terrible events of September 11, 2001 have deeply impacted us all and will continue to do so for an indefinite period of time. It is to be expected that many of us will encounter, if not directly experience, symptoms of post-traumatic stress in the weeks and months ahead.

Post-traumatic stress disorder (PTSD) refers to a prolonged, sometimes permanent, abnormal emotional reaction to a traumatic event. Primary characteristics of PTSD include the following:

• Exposure to a sufficiently disturbing event
• A continual re-experiencing of the event in thoughts, dreams, or daily life
• An avoidance of any stimuli associated with the event
• A sense of numbness of one's own emotions
• Cognitive, emotional, physical, or behavioral signs and symptoms that were not present before the event and that have lasted longer than one month

Associated symptoms often include loss of memory of important aspects of the event, loss of interest in activities previously enjoyed, feelings of detachment and estrangement from others, loss of loving feelings toward others, sleep disturbances, difficulty concentrating, intense irritability, and loss of emotional control.

A variety of resources are available for the management of post-traumatic stress. The concept of critical incident stress debriefings (CISD) has evolved over the past 20 years based on the combined experiences of military, police, emergency medical services, and disaster personnel.

The two main goals of CISD are to lessen the impact of distressing critical incidents on personnel exposed to them and accelerate recovery from such events before stress reactions occur. The debriefings are formal group meetings that emphasize ventilation of emotion and discussion of other reactions to a traumatic event. Other modalities of treatment include less structured individual or group counseling sessions.

Most communities now have a variety of resources capable of providing assistance for post-traumatic stress. Community hospitals often have employee assistance programs that can be used for debriefing purposes. Formal CISD teams also may be available through local EMS agencies, fire and police agencies, and local Red Cross chapters.

Additional resources:
If you want to network with, or speak to a colleague, contact the American College of Emergency Physicians' Practice Management Department, P. O. Box 619911, Dallas, Texas 75261-9911 (800-798-1822, ext., 3234). They will put you in contact with another emergency physician who is experienced in these areas.

www.ptsd.va.gov/
The National Center for Post Traumatic Stress Disorder: Check out the new link to "Disaster Mental Health: Dealing with the After Effects of Terrorism" and "Information for Clinicians." The NCPTSD was originally founded under what is now the Department of Veterans Affairs but has expanded it scope to the public at large.

www.psychiatry.org
The American Psychiatric Organization: The site has several readily accessible disaster psychiatry and coping links.

www.apa.org
The American Psychological Association: APA Help Center. Recovering Emotionally from Disasters.

www.mentalhealth.org
The Center for Mental Health Services of the Department of Health and Human Services: Click on "Mental Health: Disaster Mental Health Services."

www.icisf.org
The International Critical Incident Stress Foundation, Inc: A nonprofit foundation (formerly called the American Critical Incident Stress Foundation) with bilingual information. Click on "Attack on the USA: CISM Information."