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Utility of Fear Severity and Individual Resilience Scoring as a Surge Capacity, Triage Management Tool during Large-Scale, Bio-Event Disasters

Published online by Cambridge University Press:  28 June 2012

H.Stefan Bracha  and
Frederick M. Burkle Jr.
H.Stefan Bracha*
Affiliation:
National Center for Post-Traumatic Stress Disorder, Pacific Islands Division, Department of Veterans Affairs, Pacific Islands Health Care System, Spark M. Matsunaga Medical Center, Honolulu, Hawaii, USA Asia-Pacific Center for Biosecurity, Disaster and Conflict Research, Asia-Pacific Institute for Tropical Medicine and Infectious Disease, Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii, Honolulu, USA
Frederick M. Burkle Jr.
Affiliation:
Asia-Pacific Center for Biosecurity, Disaster and Conflict Research, Asia-Pacific Institute for Tropical Medicine and Infectious Disease, Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii, Honolulu, USA Harvard Humanitarian Initiative, Harvard School of Public Health, Boston, Massachusetts, USA
*
H. Stefan Bracha, MD Pacific Islands Division National Center for post-traumatic stress disorder Department of Veterans Affairs Pacific Islands Health Care System Spark M. Matsunga Medical Center 3375 Koapaka Street, Suite I-560 Honolulu, HI 96819 USA
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Abstract

Threats of bioterrorism and emerging infectious disease pandemics may result in fear-related consequences. If left undetected and untreated, fearbased signs and symptoms may be extremely debilitating and lead to chronic problems with a risk of permanent damage to the brain's locus coeruleus and stress response circuits. The triage management of susceptible, exposed, and infectious victims seeking care must be sensitive and specific enough to identify individuals with excessive levels of fear in order to address the nuances of fear-based symptoms at the initial point of contact. These acute conditions, which include hyper-vigilant fear, are managed best by timely and effective information, rapid evaluation, and possibly medications that uniquely address the locus-coeruleus-driven noradrenalin over-activation. It is recommended that a Fear and Resilience (FR) Checklist be included as an essential triage tool to identify those most at risk. The use of this checklist facilitates an enhanced capacity to respond to limitations brought about by surge capacity requirements. Whereas the utility of such a checklist is evident, predictive validity studies will be required. In addition to identifying individuals who are emotionally, medically, and socially hypo-resilient, the fear and resilience Checklist simultaneously identifies individuals who are hyper-resilient and can be asked to volunteer, and thus, rapidly expand the surge capacity.

Keywords

bio-eventsbioterrorismdisastersdisaster planningfearfear scoringpandemic influenzaresiliencesurge capacitytriage
Type
Editorial Review
Information
Prehospital and Disaster Medicine , Volume 21 , Issue 5 , October 2006 , pp. 290 - 296
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2006

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