Workforce Resilience and Performance

in the Face of Disasters, Terrorism, and Emerging Health Threats

Dori B. Reissman, M.D., M.P.H.CDR, U.S. Public Health Service

Senior Advisor for Disaster Mental Health and Terrorism

CDC’s National Center for Injury Prevention and Control

PHP Conference Feb 23, 2005

Session Organization Dori B. Reissman, M.D., M.P.H.

“Integrating Workforce and Organizational Resilience into the Response Culture of Public Health”

Kathleen Kowalski Trakofler, Ph.D.“Pragmatic Approaches to Creating Workforce

and Organizational Resilience in Public Health Emergency Operations

Explain to decision makers the need to anticipate and integrate behavioral and social needs into advance planning efforts to optimize medical and public health systems of care

Address workplace policy and programmatic design to promote resilience amongst public health responders

Learning Objectives

Grants to State Health Departments Exercise indicators will include behavioral

and mental health components to build local capacity (public health readiness)

Grant guidance includes language to anticipate and integrate behavioral aspects and mental health needs and services for populations exposed to traumatic events

Fear-Inducing Factors in Emerging Biological Events

Biological agent is invisible & odorless Biological agent may be contagious Biological agent may cause death or

severe health problemsMany casualties, widespreadAccess to effective treatmentNo available treatment

Hall, M., Norwood, A., Ursano, R., & Fullerton, C. (2003). The psychological impacts of bioterrorism. Biosecurity and Bioterrorism, 1, 139-44.

Fear-Inducing Factors in Emerging Biological Events

Cause of the event may not be familiar, which breeds “magical” thinking

Public information is inadequate or conflictingUncertainty about how to avoid sicknessUncertainty about where to get help

Hall, M., Norwood, A., Ursano, R., & Fullerton, C. (2003). The psychological impacts of bioterrorism. Biosecurity and Bioterrorism, 1, 139-44.

Substantial investments are spent in search of the best treatment strategy, but relatively little

attention is paid evaluating emotional and behavioral reactions to mass dispensing

Issues That Need to Be Addressed Surge in public demand for medical attention Public’s concern about exposure and safety Incomplete knowledge as events unfold Conflicting expert opinion about treatment Perceived mismatch of governmental action and

public expectations Reluctance to follow health directives

Flu Shot Demand Rises

Sharply

In Colorado, Flu Outbreak

In Colorado, Flu Outbreak Has Killed at Least 5

Has Killed at Least 5 ChildrenChildren

Shortage of Flu Shots Prompts Rationing Vaccine Being Reserved For Highest-Risk Patients

ANTHRAXANTHRAX

1971 U.S. civilian vaccination stopped

2003

38,257 civilians vaccinated

1971 U.S. civilian vaccination stopped

2003

38,257 civilians vaccinated

(as of 8/8/03)

The FearThe Fear

PUBLIC HEALTHPUBLIC HEALTH

72 total U.S. cases 37 lab-confirmed 35 suspect or probable

72 total U.S. cases 37 lab-confirmed 35 suspect or probable

Honeymoon(Community Cohesion)

Honeymoon(Community Cohesion)

WarningWarningThreatThreat

Pre-disasterPre-disaster

“Heroic”“Heroic”

(Coming to

Terms)

Working Through G

rief

(Coming to

Terms)

Working Through G

rief

Reconstruction A New Beginning

Reconstruction A New Beginning

DisillusionmentDisillusionment

Trigger Events and Anniversary Reactions

Trigger Events and Anniversary Reactions

ImpactImpact

InventoryInventory

[Zunin & Meyers]

Phases of Natural Disaster

TimeDays Years

Florida Hurricane Season 2004

Mass fatalities: preserved with dry ice on grounds of Wat (temple) Yan Yao in Takuapa, Thailand.

2004 Indian Ocean Tsunami

2004 Indian Ocean Tsunami:Health-Related Infrastructure Loss in Banda Aceh

Damage to the lab equipment at the Provincial Hospital

Damage outside Meuraxa Hospital

Psychological Consequences of Disasters and Terrorism (R. Ursano, 2002)

These can apply to responders, not just victims.

Usual Sources of Stress on Deployment

Role ambiguity Clarity of tasking Matching skills with tasks Team cohesion Comfort with hazardous exposure Communication protocols

2. Usual Stresses for Responders Autonomy and clearance

Intense local needs for information (media and health officials) that cannot await clearance delay

Database issues, linkage between epidemiology, laboratory, and environmental sampling

Laboratory specimen tracking, reporting

3. Usual Stresses for Responders

Resources/equipment shortages Command and control ambiguities Re-integration barriers

Coworkers had to pick up your work… or no one did and it is overwhelming

Lack of understanding or appreciation for what you have been through

Domestic/family conflict

Endpoints for Evaluation (Agency) Workforce productivity (re-integration) Intra-agency collaboration Interagency coordination (local response plans)

Rules of engagement and integration with constituent partners

Workforce absenteeism (post-event) Command and control strategies (e.g., ICS/UCS) Workforce morale

Endpoints for Evaluation (Individual) Quality of life

Sense of satisfaction with home, work, friends, family, health, hobbies

Existential or world view Functional capacity

Social, family, and occupational rolesBehavioral adaptation and copingThinking and planning skills

Workplace Resilience Program Formal needs assessment Key leadership and service provider training Developing curricula and support tools to

launch a program for deployable staff Assuring infrastructure to provide event-

response and post-response intervention services (including surge capacity)

Why does this matter? Preservation of personnel assets for

emergency response Time, energy, and cost of workforce training

Preparedness improves response readiness and may hasten recovery Mission success Effective re-integration to “day job” Minimize loss of productivity and work

absenteeism Possibility of post-traumatic growth

Potential individual and agency gains

Acknowledgements 2005 Operation Earthquake Mental Health and Resilience Team, CDC

Emergency Operations Academic & Specialty Centers for Public Health Preparedness Disaster Mental Health Institute of South Dakota American Psychological Association American Psychiatric Association Carter Center Mental Health Program

Defense Threat Reduction Agency (DOD) The National Center for Post-Traumatic Stress Disorder (Dept of Veterans

Affairs) The National Child Traumatic Stress Network Potomac Institute/National Defense University RAND Corporation (a non-profit institution) Uniformed Services University of the Health Sciences, Dept of Psychiatry US Dept of Health and Human Services

CDC Substance Abuse and MH Services Administration National Institute of Mental Health Health Resources Service Administration