Behavioral Health Triage in Disaster Settings
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Behavioral Health Triage in Disaster Settings

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2. Behavioral Health Triage in Disaster Settings Lawrence Hipshman, MD MPH. Disaster Mental Health Triage Triage is for normal people responding to abnormal situations, andPeople with pre-existing mental health dysfunction or predispositions responding to abnormal situations . 3
Behavioral Health Triage in Disaster Settings

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1. Behavioral Health Triage in Disaster Settings Lawrence Hipshman, MD MPH Oregon DMAT (OR-2) Oregon Health & Science University 3181 SW Sam Jackson Road Portland Oregon 97239 hipshmal@ohsu.edu 503 494 4222

2. 2 Behavioral Health Triage in Disaster Settings Lawrence Hipshman, MD MPH Disaster Mental Health Triage Triage is for normal people responding to abnormal situations, and People with pre-existing mental health dysfunction or predispositions responding to abnormal situations

3. 3 (Physical) Triage Purpose: Sort, prioritize casualties according to need Matches victims with available resources May need different triage method / goal in recovery v. acute phase (e.g.., use more traditional assessment / case finding processes / disposition Behavioral Health Triage in Disaster Settings Lawrence Hipshman, MD MPH

4. 4 Behavioral Health Triage in Disaster Settings Lawrence Hipshman, MD MPH (Physical) Triage Principle: Continuous process Greatest good for greatest number Minimize death and suffering Direct resources to those likely to benefit Use no resources if little/ no survival chance

5. 5 Behavioral Health Triage in Disaster Settings Lawrence Hipshman, MD MPH Priorities in Physical Triage: First (Red): life threatening / urgent care/ priority transport Second (Yellow): significant injuries but stable / or no expectation of survival / would use too many resources Third (green): walking wounded, not need ambulance /hospital not required ?PSYCHOLOGICAL CASUALTIES HERE? Deceased (Black or White)

6. 6 Behavioral Health Triage in Disaster Settings Lawrence Hipshman, MD MPH Possible definition/ purpose for Behavioral Health Disaster Triage: (acute) To restore psychological and social functioning of individuals and communities; limiting the occurrence and severity of adverse impacts of disaster related mental health problems (e.g., PTSD, substance use, depression) (wish that we could) Steury S, Parks J: NASMHMD, State Mental Health Authorities? Response to Terrorism, August 14 2003, Medical Directors Council, 9th Technical Paper Very ambitious. Triage does not restore as such, but to the extent that it starts a process to link the person into the resource. Unfortunately we know not much about limiting the occurrence and/or severity. Very ambitious. Triage does not restore as such, but to the extent that it starts a process to link the person into the resource. Unfortunately we know not much about limiting the occurrence and/or severity.

7. 7 Behavioral Health Triage in Disaster Settings Lawrence Hipshman, MD MPH Triage is ongoing is several locales: At disaster site: In ED: 1st Gulf War: (Karsenty et al 1991) only 22% of 1000 ED attendees had direct injury 1995 Sarin Gas Attack: (Obhu et al 1997) 4000 to ED for tx w/o signs of exposure

8. 8 Behavioral Health Triage in Disaster Settings Lawrence Hipshman, MD MPH Existing Emergency Medicine Triage Schemes I: Mental Health Triage Scale Goals: consistent w. National Triage Scale reduce ED waiting / transit times improve assessment skills Smart D, Pollard, C & Walpole, B: Mental health triage in emergency medicine Australian and New Zealand Journal of Psychiatry; 33?(1) 57, February 1999

9. 9 Behavioral Health Triage in Disaster Settings Lawrence Hipshman, MD MPH MHTS: Category 2: violent, aggressive or suicidal, danger to self or others, police escort Category 3: very distressed or psychotic, likely to deteriorate, situational crisis, danger to self or others Category 4: long-standing semi-urgent mental health disorder, supporting agency present Category 5: long-standing non-acute mental health disorder, no support agency present Reportedly reduced wait time, reduced ?not wait?, educed transit times, ?more consistent admissions rates by urgency, good integration into general emergency department.Reportedly reduced wait time, reduced ?not wait?, educed transit times, ?more consistent admissions rates by urgency, good integration into general emergency department.

10. 10 Behavioral Health Triage in Disaster Settings Lawrence Hipshman, MD MPH Existing Emergency Medicine Triage Schemes II: Centre for Mental Health Triage is for those who are: distressed, acutely affected, demonstrate disturbed mental state, heightened arousal, ongoing disturbed behavior, ongoing cognitive impairments (dissociation, decreased concentration, memory) Purpose is to ensure psychological safety.


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