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When the SARS-Cov2 virus hit the New York and New Jersey metropolitan area in Spring 2020, hospitals and hospital workers were hit hard with a new unknown pathogen that either killed people or made them very ill. There were large numbers of severely ill patients that strained resources. Hospital workers had extraordinary stress with multiple additional patients, the need to use personal protective equipment (PPE) in short supply, and faced with a pathogen that had no treatments beyond care and support initially.
We surveyed our hospital workers in late Spring 2020 to identify the main stressors and find out what measures were helpful. An online anonymous survey included questionnaires about sleep, mood, outside stressors, helpful measures, and how they coped generally. All levels of hospital workers were surveyed. Resources were provided to all respondents.
Over 240 individuals responded to the survey; most respondents were women (76%). ‘Workplace stressors’ topped the chart for 98 of our respondents. The worst workplace stressor that was cited was ‘irritable workforce,’ but ‘lack of ‘protocols’ and ‘shortage of PPE’ were also cited as stressors. ‘Other’ (not described) and ‘taking care of an ill relative’ were rated highly. Those who had ‘symptoms everyday:’ Anhedonia (loss of pleasure or interest), 13%; feeling down and hopeless, 12%; sleep disturbance, 41%; low energy, feeling tired, 29%; appetite disturbance, 26%; poor concentration and attention, 15%. Respondents told us what resources they used and what was most helpful; exercise was most frequently cited as helpful.
Lessons Learned and Discussion
Various resources for formal and informal mental health support were provided to all respondents at the time of survey. Our hospital mounted its own response with support services, as did our medical school and university. A "warm line" was available through the Department of Psychiatry from late March 2020; tip sheets and online groups were widely circulated; State Department of Health provided resources. There were formal peer support sessions and workers helped each other. Medical students provided child care, shopping, and transport. We learned that extra support for workers and more frequent rest and recharge time are important. A weekly "town hall" was instituted and a weekly update about the hospital and support in healthy activities are widely circulated to employees. Those with active PTSD (some were very disturbed by the number of deceased patients) were referred to professional providers. Hospitals need to be ready to deal with epidemics and pandemics more effectively in order to mitigate stress and support workers. Being prepared, not just with equipment, but with protocols in how to proceed should another pandemic come. We learned that listening to workers is important. Workers also need to know how valued they are.
Department of Psychiatry, New Jersey Medical School
The development of medical school courses on medical responses for disaster victims has been deemed largely inadequate. To address this gap, a 2-week elective course on Terror Medicine (a field related to Disaster and Emergency Medicine) has been designed for fourth year students at Rutgers New Jersey Medical School in Newark, New Jersey (USA). This elective is part of an overall curricular plan to broaden exposure to topics related to Terror Medicine throughout the undergraduate medical education.
A course on Terror Medicine necessarily includes key aspects of Disaster and Emergency Medicine, though the converse is not the case. Courses on Disaster Medicine may not address features distinctively associated with a terror attack. Thus, a terror-related focus not only assures attention to this important subject but to accidental or naturally occurring incidents as well.
The course, implemented in 2014, uses a variety of teaching modalities including lectures, videos, and tabletop and hands-on simulation exercises. The subject matter includes biological and chemical terrorism, disaster management, mechanisms of injury, and psychiatry. This report outlines the elective’s goals and objectives, describes the course syllabus, and presents outcomes based on student evaluations of the initial iterations of the elective offering.
All students rated the course as “excellent” or “very good.” Evaluations included enthusiastic comments about the content, methods of instruction, and especially the value of the simulation exercises. Students also reported finding the course novel and engaging.
An elective course on Terror Medicine, as described, is shown to be feasible and successful. The student participants found the content relevant to their education and the manner of instruction effective. This course may serve as a model for other medical schools contemplating the expansion or inclusion of Terror Medicine-related topics in their curriculum.
ColeLA, NatalB, FoxA, CooperA, KennedyCA, ConnellND, SugalskiG, KulkarniM, FeravoloM, LambaS. A Course on Terror Medicine: Content and Evaluations. Prehosp Disaster Med. 2016;31(1):98–101.
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