Transcript the best laid plans: will they work in a real crisis?

THE BEST LAID PLANS:
PREPARING FOR A
PANDEMIC
J. Barry Mascari, Ed.D., LPC, LCADC
DRCC(NJ)
Kean University (NJ)
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I had a little bird, Its name was Enza.
opened the window And in-flu-enza.
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Ring-around-the rosie, pockets full of
posie, ashes, ashes, we all fall down
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1918 children’s jump rope rhyme
Bubonic Plague children’s rhyme
Camus, The Plague
I
4 THINGS COUNSELORS
SHOULD KNOW
1.
2.
3.
4.
5.
There will be a pandemic
There will be many deaths
Counselors will be needed to help people cope with
illness, death, mistrust, and scarcity
The delivery system for counselors may have to be
altered
Counselors will simultaneously serve as caregivers to
family members and others
1. There will be a pandemic
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A new virus subtype with little immunity in the
population
That can replicate in humans
Transmitted from one human to another efficiently
to cause community wide outbreaks
World Health Organization
PANDEMIC
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Epidemic - when the observed number of cases exceeds the
expected number of cases of a given disease in a given time
period
Pandemic - when an epidemic spreads rapidly across many
geographic locations (different countries or continents)
 10 pandemics in 300 years
 3-4 times every 100 years
 Spanish Flu 1918 (H1N1)
 Asian Flu 1957 (H2N2)
 Hong Kong Flu 1968 (H3N2) [1 to 4 Million deaths]
 Recent - HIV/AIDS, SARS, West Nile Virus
 H5N1?
 Swine Flu 2009 (H1N1)?
QuickTime™ and a
decompressor
are needed to see this picture.
Pandemic is not
a Seasonal Flu
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Infects 15-50% of population
All ages are at risk
Severe illness and high death rate
Effective vaccine may not be available for 4-6 months after onset
Effectiveness of antiviral drugs is unknown
Drugs in short supply
Avian Flu (H5N1)
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Epidemic in migratory birds and poultry
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Bird-to-human (or human to human?) infection
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Identified in 1997 in Asia
Vietnam, Cambodia, Thailand, Indonesia, Russia, Azerbaijan,
Egypt, India, Iraq, Laos, Nigeria, Turkey
Mammals: pigs, domestic cats, tigers
Air travel increases pandemic risk
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reaching all continents in three months vs. sea travel of 1918
2. There will be many deaths
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Current world-wide death rates from H5N1 approach 50%
US - 200 Million infected (66% of population)
90,000-207,000 deaths
 314,000-713,000 hospitalized
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NJ - most densely populated state
nearly half of the population in 1/3 of state near NYC
 Expect 8,000 deaths (5,700 in hospitals) - 1% rate
 41,000 hospital admissions
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Spanish Flu of 1918:
The Great Flu
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200 Million to 1 Billion infected
50 Million to 100 Million died
20-40 year old population suffered most deaths (not just
elderly and children, or at risk)
In 2 years, nearly half the world was infected (3 waves)
3. Counselors will be needed to help
people cope with illness, death,
mistrust, fear, and scarcity
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Fear and anxiety common in health crisis
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Contagious fear in groups
Perceived threat may be greater than real threat
Large group irrational actions, potentially disruptive to
leaders
Stress, fear leads to somatic complaints -more health care
sought
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“...understanding and managing the public’s
psychological and behavioral reactions to an
unexpected outbreak of infectious disease are
integral to successful response and
containment.”
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CIA (2003). SARS: Lessons learned from the first epidemic of the
21st Century
5. Counselors will simultaneously serve
as caregivers to family members and
others
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Safety: physical and emotional preparation
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Connectedness
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Increased risk of contracting illness
stay attached - phone, internet, video
Efficacy: don’t let crisis destroy inner resources to help
selves
Resilience
Vicarious traumatization
ATTITUDES QUIZ (1 No - 5 Yes)
1.
2.
3.
4.
5.
6.
7.
8.
It’s always better to avoid a crisis if you can
People usually make their own crises
Crises just happen, often there is nothing you can do to
prevent them
It takes about 3 months to recover from bereavement
It is best to try to take your mind off things if you are
upset
There is always something to be learned from a crisis
Once a person is very anxious or depressed, there is not
much they can do about it themselves
If someone is experiencing horrifying ‘flashbacks’ to a
crisis event, it means they are suffering from PTSD
QUIZ (continued)
9. Professional health workers generally know how to
handle a crisis
10. You are more likely to have an accident following a
stressful event
11. Professional help is usually needed if someone has had a
severely stressful event
12. After most crises, it is best to get things back to normal
ASAP
13. It’s just a matter of luck if you get the right kind of help
during a crisis
14. Crisis is what happens when your emotions get out of
control.
PEOPLE DON’T PLAN
TO FAIL…
THEY FAIL TO PLAN!!!!
PLANNING
Who calls whom?
 Who is on charge of what?
 How fast can we mobilize our team?
 What if we need help? Whom can we call?
 How to avoid confusion:
 Read
 Write a policy
 Write clear procedure (steps to follow)
 Rehearse
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Planning is more than a document…
 The
plan in relation to other plans (Red
Cross, FEMA, etc.)
 Not just the deployment of a response
 Considering the effects on caregivers
 Always have a Plan B? C?
 Practice…
Determining Expected Degree of Trauma
Oates, M. D. (1988)
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WHO
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STUDENT
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WHERE
At school (4)
 Local community (2)
 Other (1)
GRAND TOTAL_______
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Popular/well known (6)
Other (3)
TEACHER
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Popular/well known (4)
Under 32 yrs. old (2)
Not well known (1)
HOW
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Murder/suicide (6)
Accident (3)
Natural causes
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Unexplained (4)
Short-term illness (3)
Long-term illness (2)
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DEGREE OF TRAUMA
12+ High
 8-11 Moderate
 0-7 Low
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KEYS TO AN EFFECTIVE
RESPONSE
 SUPPORT
 CONTROL
 STRUCTURE
Normal
people experiencing a
normal response to an abnormal
situation
AFTERMATH
 Emotional ventilation within 24 - 48
hours
 It takes a chunk out of you…
87% affected emotionally
93% felt debriefing was
necessary
 Debriefing procedures
 Response plans for the future
Non-Anxious
presence
Connection
with others
Self-care
Skills
building
Self-validated
caregiving
RESOURCES
FEMA: www.fema.gov
 FEMA for kids: www.fema.org/kids/
 NEA: www.nea.org/crisis/resources
 Red Cross: www.redcross.org
 ACA: www.counseling.org
 U.Colorado: www.colorado.edu/cspv/
 Sidran Institute: www.sidran.org/trauma
 CDC flu: http://www.cdc.gov/h1n1flu/index.htm
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Web Resources
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http://realage.typepad.com/avian_flu/
http://www.birdflubreakingnews.com/ Breaking news
http://virus.stanford.edu/uda/
http://www.pandemicflu.gov US Govt. Pandemic site
http:///www.who.int/csr/disease/influenza/en/
http://www,pandemicflu.gov/plan/tab3.html Family planning guide
http://www.pandemicflu.gov/plan/tab4.html Business guide
http://www.who.int/csr/en/ WHO Epidemic & Pandemic site
www.cdc.gov/flu/pandemic CDC/P Pandemic Influenza Worldwide
Preparedness