New developments in the area of

                            Disasters Assistance

                         R.E.Cohen MD, MPH-2006

 

New areas of knowledge

Increased investigation in the effect of stressors on the brain physiology: Based on findings of the changes in homeostasis the response, labeled stress response, presents an array of physiologic adaptations that ultimately resets the process toward establishing a return to balance.  The best-studied secretions of the adrenal glands, epinephrine and glucocorticoids, which are secreted during stress response mobilize energy for muscles, increase cardiovascular tone and turn off nonessential activities.  The final effect of this “cascade” is to mobilize the organism for survival.  The imbalance of neurotransmitters produces many different observable behavioral expressions, which are sometimes categorized as “normal reactions to an abnormal situation”, or pathological expressions to intense stress.  This area of research is being investigated and many questions are being raised following massive traumas worldwide.  This differentiating has important ramifications in term of prognosis and appropriate treatment of all biologic functions the degree and duration of the stressor will produce an acute or chronic reaction. Variables that influence outcome:

*few opportunities to process frustration

*lack of social support

*loss of control and sense of helplessness

*pessimistic outlook

Relation between biologic changes and adaptation: The limbic system is an important organ for adaptation.  One of its structures-the amigdala-functions as a sensor of threat and in turn mobilizes many of the neural path that controls coping behavior.  It also communicates with the frontal lobes of the brain to make judgment calls and incoming information as to the degree of danger.  This continuous awareness of our environment is coordinated and finally monitored by the limbic structure.

Another important concept flows from the memory traces that will be imprinted in the synapses of the hippocampus-another structure where memory traces are recorded- following the traumatic effects of the disaster.  Investigations are producing findings that painful, chronic memories may affect and atrophy this structure.

Focus on resiliency and adaptation: Increasing awareness is being focused on the survival and coping strength of individuals as we search for intervention methods.  Resiliency is defined as important process of adaptation in the face of adversity.  Most individuals have differing degrees of coping abilities but it can be strengthened by the following interventions and guidance:

*Stay active and participate in the decisions affecting your life

*Become aware of healthy schedules in spite of the chaos-sleep, eat, relaxation, use of assistance

*Try to deal with problems taking each day at a time

*Try to reframe painful memories

*During crisis episodes accept help and try to analyze how problems can be interpreted from different perspective

The role of genetics in coping: Investigations are identifying certain genes that code for the receptors of the neurotransmitters.  They may change or alter the processes of synthesis or degradation of biologic substances affecting mechanisms that impact or influence behavior.  Coping behavior varies from individual to individual due to the interplay between early, past experiences and genetic inheritance which will in turn influence how one responds to stressful environments produced by the disaster.  Sequelae left by the loss (bereavement), chronicity, and intensity of the trauma will be differentiated by the interplay of nature and nurture in the final results

 

DIFFERING CATEGORIES OF REACTIONS AND DX

The opportunity to identify survivors and their reaction to disaster traumatic effects has increased both by the research following man-made and natural disasters.  Many of the expectations of pathology sequelae are being questioned and new findings are beginning to emerge.

The categories of normal reactions to catastrophic stressors are being recognized as well as the more clinical significant of acute stress reaction or PTSD.  The identification of some manifestation of the clinical diagnosis either in the acute or chronic stages as more significant than others as far as pathology is being identified.  Many studies are clarifying the pre-disaster personality types or previous clinical diagnosis that may make the individual more vulnerable to the effects of the disaster trauma. (See studies by North;Shalev)

Although attention has been focused on the traumatic symptomatology the different levels of depression, anxiety and addiction has not received the same attention from new investigations even though their prevalence may be larger in numbers.

TREATMENT MODALITIES

*Interactive methodology

The interventions used in assisting survivor’s range from the behavioral-cognitive to the psychodynamic models.  The intervention differs whether they are utilized in the acute phase-First –Aid type-to the longer, supportive models. A theoretical approach is being presented which states that we need to question whether ventilating the emotions and dredging the memories of the traumatic event is beneficial to the survivor.  The underlying issue is whether these memories should be repressed instead so as not to reinvigorate the intense stimuli to the limbic system in the brain and so let these memories fade through the natural capacity of the brain to return to a homeostatic balance with time and support.  This area is still open for further inquire.

*Controversy over the range of “debriefing” methods

The “debriefing” and “critical incident” methods among others used for disaster workers became universally accepted in the past.  New investigations are being published questioning their expected results (preventing PTSD or other pathologies). Researchers are attempting to design studies that will demonstrate whether or not debriefing decreases pathological morbidity. Further studies need to be replicated due to the fact that many professionals are using the group ventilation, remembering, sharing, and learning processes differentially. 

USE OF THECNOLOGY TO TRAIN

*Multimedia *Training at a distance – The technology advancement in curriculum design and computer use is beguiling to communicate professional content that can be used to prepare or train post disaster workers through the Webb

*Instant communication for consulting and problem-solving-This method is available to consortium of professionals worldwide.