With its large amount of citations and a wide variety of sources, we can extrapolate that this research article was made with a good deal of time and care. There are even citations to other works by Galea, but it appears that the only original research done for the article was interviewing responders and patients.
The main focus of the article is mental health issues resulting in the aftermath of a major disaster. Mental health is rarely discussed in these types of environments but persists long after the dust has settled and the houses rebuilt. This article seeks to explore the current state of mental health care in disaster environments.
It has been cited 39 times as of 10/23 according to google scholar, the majority of these being disaster/mental health related articles.
Dr. Emily Goldmann graduated from the University of Michigan with her PhD in Epidemiology and Columbia University with a Bachelor’s in economics and Chinese. Dr. Goldmann is currently a clinical assistant Professor of Global Public Health at New York University. “I am currently on the faculty of NYU's College of Global Public Health, in the Division of Social Epidemiology. My current research focuses on the intersection between physical and mental health in older adults, specifically trajectories of depressive symptoms following stroke. I also have a strong interest in the characterization, prevention, and treatment of mental illness in low-resource settings globally. I currently teach a master's level course in global mental health and an introductory course in epidemiology to undergraduate students.” (LinkedIn profile)
Dr. Sandro Galea graduated from University of Toronto with his MD, Harvard with a MPH, and Columbia with a DPH. Dr. Galea works as a physician and epidemiologist at Boston University School of Public Health. “In his scholarship, Dr Galea is centrally interested in the social production of health of urban populations, with a focus on the causes of brain disorders, particularly common mood-anxiety disorders and substance abuse. He has long had a particular interest in the consequences of mass trauma and conflict worldwide, including as a result of the September 11 attacks, Hurricane Katrina, conflicts in sub-Saharan Africa, and the American wars in Iraq and Afghanistan. ” (Boston University Biography)
Psychological first aid (PFA) administration is the main focus of the emergency response solution.
PFA has eight main action items to administration:
Contact and engagement, safety and comfort, stabilization, information gathering: current needs and concerns, practical assistance, connection with social supports, information on coping, and linkage with collaborative services. (nctsn.org)
This past spring break (2016), on a Monday night while at home, I responded to a motor vehicle accident as a Good Samaritan. The accident happened at approximately 19:00 hours on my street in Blackstone, Massachusetts. My father was on our front porch when he heard a car barreling down our back country road which has a long straight away before taking a sharp turn. Before the impact he knew that the driver would not anticipate the curve fast enough at the speed he was traveling. Sure enough, there was a loud bang and the sound of a car rolling over, which I could hear from inside the house (approximately ¼ mile from crash).
I grabbed both of my personal first aid kits and a flashlight while my father called emergency services. I walked to scene with my father and younger brother. I sped walked and arrived at the crash site first.
The vehicle was a ‘90s sedan that went straight into a telephone pole, which broke like a toothpick, and rebounded backwards and flipped 90 degrees on its left side. Parts of the car, tools, and glass were on ground, airbags deployed. There was a car seat in back, and for a moment I thought a child but it was just clothing. Front right tire was up inside front passenger compartment. Hazards flashing. Driver window was rolled down. No people in the car.
My brother and father directed traffic on either end of the crash site. They almost certainly prevented at another crash by a car who didn’t see the accident but saw my brother flag them down with his light.
I saw man standing 20’ from crash site, talking to people in a gold SUV. When I arrived I start asking medical questions and the people in the SUV leave – they were by standards who pulled up but left after I started taking over. The man in question appeared to be a lower/middle class white/Hispanic, male in his 30s. He was driving an older car with lots of tools in the back which were now all over the road. Our neighborhood is a small country community and I know he was not from our neighborhood. I assumed he was some kind of mechanic, bases on tools in car. He was wearing dirty jeans and stained hoodie. He was definitely a blue-collar worker. He may have been from downtown Blackstone which is largely lower middle class and blue collar, or he may have been from Woonsocket, Rhode Island, which is known as “the Detroit of Rhode Island”.
As I tried to obtain basic medical information from the patient, it was apparent he had an altered mental status, and did not appear to understand fully what was going on. I am not certain if it was alcohol and/or drugs as for safety reasons I did not get close enough to the patient/suspect to tell. He was ambulatory and verbal. The interesting part of our conversation was to the best of my ability as follows:
“Are you sure you’re okay? Umm yeah. Are you hurt anywhere? I’m fine. [I did visual inspection of patient using flashlight which revealed no major injuries other than minor cuts from airbag]. [He starts to edge away from scene]. You should wait for ems to check you out. Wait, you’re right! I might die?! You appear to be okay externally but things like internal bleeding, and a full assessment could reveal other problems. Naaaa [turns and starts to walk away down street]”
I attempted to convince the patient to wait on scene but he was going through several mode swings during my interactions with him from fear, anxiety, agitation, and anger. While I was talking to the patient, the first officer from the neighboring town arrived on a motor cycle. I informed the officer at the scene of the situation about the patient/suspect fleeing the scene. The officer took note of it and continued to work to secure the crash site. Another officer arrive from my town from the west. I informed the same and he stated that he would need me to make a witness statement and proceeded to the crash site. A third and fourth officer arrived together the same time as two ambulances (indicated because of rollover) from the east. One of them told me again that they would need a witness statement.
I met back up with my dad and brother who were no longer needed to control traffic with law enforcement on scene. Neighbors had started coming out to see the commotion. We were all talking near the scene while waiting for officers. Finally one of the officers asked another officer if he should go look for the suspect. He left approximately 20 minutes after my last contact. I never spoke with the arriving EMS as they came from the east and I was on the west of the accident but officers told them that the patient was missing. Eventually multiple officers and cars were out looking for patient/suspect but was not found as far as I am aware. I finally was given the chance to give my testimony which, to the best of my knowledge, mirrors this report. After reading out loud in front of the officer and my father and brother to confirm accuracy, the officer asked me something very strange. First, he asked me to add what the suspect was wearing (which I had forget to include), but then he also asked me to state that I saw the suspect drive into the telephone pole and that I smelled alcohol on the patients breath. Neither of these things were what I told any of the officers and ran counter to my testimony as written. I include the suspect’s clothing description but I did not add the second mention and stated that I had not witnessed those things. After my report I left the scene with my brother and father.
Some of the policies and procedures relevant to this case were: scene safety, dealing with aggressive/combative patients, and HIPPA did not apply to me as a bystander so I gave full testimony including medical status to the officers.
After reflecting on the education I received and didn't receive, there are a few things that would have allowed me to be better prepared for this incident. How do I convince patients to stay on scene? When do you give up? I wish my EMT class was a little better scene on safety training. Being distracted by the emergency at hand, I did not truly take into account the fact that the power lines were live and drooping with half of the telephone poll pulling on them. Only supported by the next and previous poll but not drooping more than 3’ from normal, more than 15’ from ground, and 10’ above vehicle. Reflecting on it, I did not really consider the threat as I should have, and neither did the officers on scene. I don’t understand why it took so long for police to search for the suspect who could have had major medical issues. Should I have followed suspect/patient alone? When is a citizen arrest allowed/appropriate? Should I have asked for the badge number of the officer who asked me to misrepresent the truth on an eye witness testimony? What is the process to do that anyway? If I had the answers to these questions I feel I may have been able to provide better assistance, but then again perhaps not.
External data/studies as well as interviews with doctors, responders, and patients on the ground were used to produce the arguments used in the article.
1) "These studies can help us understand what factors are associated with different courses of mental illness, which can help us identify the most vulnerable populations and inform tailored interventions"
2) "Psychological first aid (PFA) has become the preferred post-disaster intervention, with three goals: Secure survivors’ safety and basic necessities (e.g., food, medical supplies, shelter), which promotes adaptive coping and problem solving; reduce acute stress by addressing post-disaster stressors and providing strategies that may limit stress reactions; and help victims obtain additional resources that may help them cope and regain feelings of control."
3) “Exposure to disasters has been associated with a variety of mental health consequences. Although the majority of individuals cope well in the face of a disaster, a substantial proportion experience some psychological impairment, and a smaller proportion will go on to develop mental disorders.”
1) I did more research into our role and mental health in the EMS system as EMTs. I found this article to be particularly insightful: Managing Psychiatric Emergencies (http://www.emsworld.com/article/10931747/managing-psychiatric-emergencies).
2) Bettering and improving EMS care by bypassing EDs and transporting patients to mental hospitals.
(http://epmonthly.com/article/pilot-project-trains-ems-to-bypass-the-ed-with-mental-health-patients/)
3) Learned about FEMAs policies and programs for mental health following a disaster in the U.S. (https://www.fema.gov/recovery-directorate/crisis-counseling-assistance-training-program)
1) Past—the past is used as a guide to the future. Past research is used in the article such as from the Vietnam War.
2) Present—PTSD and MMD are explored in detail in areas that have been effected by it.
3) Future-- post-disaster plans and planning to better administer Psychological First Aid (PFA).