Transcript Psychological Effects of Radiation Injury

IX. EMERGENCY EXPOSURE SITUATION
IX.8.1 Medical Management of Radiation
Injuries
Psychological Effects of Radiation Injury
IAEA
International Atomic Energy Agency
Contents
• Introduction
• Medical consequences of radiation
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accidents
Psychological consequences of radiation
accidents
What is psychological stress caused by the
accident?
What can we do about stress?
Management of psychological effects
IAEA
Introduction
• Importance of psychological impact of radiation
accidents underestimated in past
• Psychosocial effects may far outnumber any direct
health effects
• Reactions to nuclear and radiological accidents
similar
• Role of scientific community, and physicians in
particular, in influencing public perception of risk and addressing psychological consequences of
accidents
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Medical Consequences of Radiation
Accidents
• Health effects directly related to radiation
exposure
• Deterministic
• Stochastic
• Health effects indirectly related to radiation
exposure
• Caused by accident
• Caused by intervention
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Reasons of Stress Reactions at
Radiation Accidents
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Unknown threat
Can not be felt
Long term consequences of radiation
Conflicting information in mass media
Speculation of “radiation theme” by politicians
Lack of education of general public, physicians and
other professionals
• Inadequate actions of official authorities on
mitigation of consequences of radiation accidents
for general public
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What is Psychological Stress Caused
by Accident?
• Normal reaction to abnormal event
• Unusually strong psychological and
emotional reactions which could interfere
with ability to function during or after
accident
• Can become post traumatic stress disorder
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What is Psychological Stress Caused by
Accident?
• New diagnostic entity “chronic environmental
stress disorder” proposed
• Principal characteristics:
• apathy, asthenia, diminished interest and
“learned helplessness”
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Early stress reactions
• Physiological
• Cognitive
• Emotional
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Early Physiological Stress Reaction
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Nausea
Muscle tremors
Sweating
Dizziness
Chills
Increased heart rate
Increased blood pressure
Hyperventilation
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Early Cognitive Stress Reaction
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Confusion
Difficulty in making decisions
Impaired thinking
Difficulty problem solving
Memory loss
Calculation difficulties
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Early Emotional Stress Reaction
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Anxiety
Anger
Fear
Irritability
Sense of guilt
Feeling overwhelmed
Grief
Hopelessness
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Late Stress Reactions
• Physiological
• Cognitive
• Emotional
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Late Physiological Stress Reactions
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Fatigue
Increased use of alcohol and drugs
Exaggerated startle response
Sleep disturbance
Development of somatic disease
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Late Cognitive Stress Reactions
• Decreased attention span
• Poor concentration
• Memory problems
• Flashbacks
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Late Emotional Stress Reactions
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Feeling abandoned
Resentment
Feeling alienation
Autism
Numbness
Depression
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What Can We Do About Stress?
• Accidents can not be predicted
BUT
Psychological reaction to radiation accident
could be mitigated using different programs:
• Preventive program
• Action program during an accident
• Action program after an accident
IAEA
Preventive Program
• Increase of population literacy in the field of
radiation influences
• Introduction of special course in formation
for medical and paramedical staff, police,
firemen
IAEA
Action Program During an Accident
• provide timely, clear information to general
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public and specialists
single trusted spokesperson
organization of medical aid station
determination of order and ways of
evacuation
provide psychological assistance
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Management of Psychological
Consequences After an Accident
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medical response
psychological assistance
social adaptation
material support of the state
long term rehabilitation programs of victims
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Psychological Stress of Relocation
• Correct calculation of a dose of radiation
influence
• It is required to weigh all pro and contra
• Negative impact on mental well being
• Elderly people especially likely to suffer
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How to Reduce Psychological Effects
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Have ongoing information program
Give clear, simple and timely advice
Provide consistent advice and assessment
Use international guidance
Ensure protective action justified
Correct false information
Social support and education
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Requirements for Warning Message
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Accurate, timely and complete
Clear
Simple
Sufficient
Concrete
Consistent
Frequently repeated
Provided through multiply channels
IAEA
Psychological Support in Different Types
of Accident
Accident
Psychological support is needed for:
Affected
victims
General
public
Emergency
responders
Nuclear (reactor)
Yes
Yes
Yes
Criticality
Yes
Yes
Yes
Involving lost/stolen sources
Yes
Yes
Not always
Transportation
Yes
Yes
Not always
Yes, if any
Yes
Not always
Laboratory accidents
Yes
No
No
Result of use/misuse of industrial sources
Yes
No
No
Medical misadministration in diagnosis and therapy
Yes
No
No
Nuclear power satellite re-entry
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Psychological Stress of Injured
Individuals
• Patient needs
• Comfort, relief of
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symptoms
Stability and
authoritative support
Information
Concern
Hope
Control
Stimulation
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• Patient problems
• Overly scientific
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approach
Repeated tests,
examinations
Photographs
Reactions of others
Too many “experts”
Too much media
attention
Psychological Support of Emergency
Responders
• Provide instructions BEFORE an event
• Should have necessary knowledge about
irradiation effects
• Should be psychologically prepared to work in
stress conditions
• Periodic control of state of health of emergency
responders, made by physicians, psychologists
(psychotherapists);
• Medico psychological rehabilitation of emergency
responders, if necessary
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During an Event
• Provide an initial briefing on the following
questions:
• Mission tasks
• Hazards
• Radiation protection
• Contamination control
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During an Event (Continued)
• Provide adequate rest
• Care, attention (show concern)
• Provide guidance
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Immediately After, and Continuing as
Necessary
• Provide debriefing sessions
• Provide counseling as needed
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Medical Staff Problems
• Fear / anxiety
• Isolation by others
• Lack of knowledge (medical treatment, long
term effects, etc.)
• New experience:
• Interactions with “experts,” public officials,
reporters, etc.
• Loss of autonomy (activities may be
monitored/managed by authorities)
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Supporting Mental Health
• Role of The Physician in Supporting Mental Health
and Reducing The Patient’s Anxieties
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One physician in charge
Keep patient and patient’s family informed. Be honest
Encourage self-help and family support
Assure patient privacy
Discuss tactics of dialogue with a patient and his
relatives with psychologist
• Provide psychological comfort when transferring the
patient to other hospitals
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What Must We Do After a Radiation
Accident ?
• Truthful explanation of early and delayed effects of
a radiation accident for all categories of involved
people
• Provision of correct explanation of social and
economic compensations for victims
• Provision of qualified supervision over delayed
health effects of radiation accident of involved
people and population with attraction of
international experts
• Work with mass media
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Mitigation of Psychological Consequences
• One of the functional requirements
• Applicable for all planning categories
• Should be performed by facility, local or
national level of response
• Depending on planning category
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Conclusion
• Psychological effects – more important in
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current situation
What is stress caused by accident?
What can we do about stress?
Management of psychological effects
Psychological support in different types of
accidents
Mitigation of psychological consequences
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