Blast Injuries • • • • • • • • • personnel asneeded: Provide psychologicalfirstaid(PFA) topatients, family members,andemergency response Initial Management • • • • Clinical Presentation care.patient Cliniciansshouldtakeallreportsofphysical, emotional, cognitive, reactionsseriously. andbehavioral Most fearanddistressreactionsarenormal, expected, usingprinciplesofgoodpsychological andcanbemanaged symptoms resulting from continuedexposure todeathanddevastation. Emergency responders andotherhealthcare providers mayalsoexperiencepsychological aboutlovedones;andthewitnessingofhorrificfrighteningscenes.of knowledge factors, fromorlack offamilymembersandfriends; separation ordeath including ofselfand/orinjury injury oflongtermpsychologicalsymptoms.rates The leveloffearanddistressafterabombingdependsonseveral confusion. disasters, Incomparisontonatural withhigher intentionalmasscasualtyeventsareassociated Intentional masscasualtyeventssuchasbombingsaredesignedtocausedeath, destruction, fear, and Background Bombings andMentalHealth be happening next be happening Provide familymemberswith accurate, timely, will andwhat status aboutpatient andcredibleinformation services follow-up Link withappropriate/needed tocope regardingsignsofdistressandhow andeducation Provide information Provide practicalassistance totalkabouttheeventasthismayintensifysymptoms patient Avoid encouraging regardingcurrentneedsandconcerns information Gather Stabilize, asnecessary Provide/ensure safetyandsecurity Establish contactandengagement being distant, judgmental, orover-controlling. Abuse ofsubstancesand/oralcoholisalsoacommonsymptom. reactions,hypervigilance/startle withdrawal, isolation/social distrust, irritability, feelingrejectedorabandoned, reactions:Behavioral sleepproblems, easily, crying excessiveactivity level, increasedconflictswithothers, indecisiveness, worry, span, shortenedattention loss, memory unwantedmemories, orself-blame. things,trouble concentrating/remembering difficultymakingdecisions, questioning spiritualbeliefs, disorientation, Cognitive reactions: confusion/disorganization, recurringdreamsornightmares, withthedisaster, preoccupation guilt/self-doubt, unpredictablemoodswings, emotionalnumbness, affect. flat or inappropriately Emotional reactions: depression/sadness, irritability/anger/resentment, anxiety/fear, despair/hopelessness, headache, worseningchronicconditions, complaints, somatic orracing heartbeat. Physical reactions: fatigue/exhaustion, gastrointestinaldistress, tightening inthroat/chest/stomach,

Bombings and Mental Health Bombings and Mental Health June 2009 • • • Disposition • • • • • • • Address emergency responseasneeded: personnelconcerns • • • • • • • • • Refer toabehavioralhealthspecialistwhenthefollowingsignsoccur: • • • Initial Management(continued) specialist forongoingcare illness, including psychosis, severeanxiety, anddepression, shouldbereferredtoamentalhealth exhibitcontinuingsignsofdistress,Individuals andfamiliesthat andthoseexhibitingsignsofmental than thosewhodonot Individuals whobelongtostrongsocialnetworks, such asfamiliesandfaithcommunities, tendtodobetter however, toallpatients, shouldbemade available families, referral services andemergency responsepersonnel Most fear and distress reactions are normal and will resolve without the intervention of a mental health specialist; ofstressandfearsinyourfamilyresultingfromwork/role Be aware Seek helpfromamentalhealthspecialistifnecessary Provide PFA asneeded systemtoidentifystress Use abuddy Enforce breaks Identify physical, emotional, cognitive, signsinselfand coworkers, andbehavioral andpracticeself-care ofpersonalstressvulnerabilitiesinemergencyBe aware responders Domestic violence: child, spouse, elder, oranimalabuse useofalcoholordrugs Problematic Suicidal orhomicidalthoughtsplans Inability tocareforoneself: orbathe, doesnoteat fromothers, isolated tasksofdailyliving orunabletomanage withideasorthoughts preoccupation Psychosis: hearing voices, are not there, seeing things that out of touch with reality, appearing or excessive reason, fornoapparent crying orwithdrawal Severe depression: hopelessnessanddespair, unrelentingfeelingsofworthlessnessorguilt, frequent environment asunreal, ortimedistortion Dissociation: emotionaldisconnection, senseofseeingselffromanotherperspective, seeingthe intrusive thoughts High anxietyandhyper-arousal: highlyagitated, unabletosleep, frequentnightmares, flashbacks, or Disorientation: date, inabilitytoknow location, orrecentevents andchaplains ofhospitalsocialservices Optimize services increases distress whereseparation andotherpatients ofpediatric Minimize separation fromdistressingsignsandsounds away Provide familymembersaquietlocation This fact sheet is part of a series of materials developed bytheCentersforDiseaseControl This factsheetispartofaseries ofmaterials and Prevention(CDC)onblast injuries. For moreinformation, visitCDConthe Web at: www.emergency.cdc.gov/BlastInjuries. 202792-A