Caring for the Marathon Caregivers

Professional Matters

Vital Signs April 2014 - Professional Matters - Marathon Caregivers

This month, my colleague and friend John Herman, an MGH psychiatrist who directs Partners’ Employee Assistance Program, shares memorable reflections with us on the impact of the Boston Marathon bombing on the staff of his institution. Impressively, MGH provided a safety net for a small number of distressed individuals, while setting a positive tone that helped most involved staff members to pull themselves together and do their jobs. I continue to ponder his observation that none of the 30 staff members assisted by the MGH EAP were physicians. 
— Steve Adelman, M.D., Director, Physician Health Services

Vital Signs April 2014 - John Herman
John B. Herman, M.D.

Monday April 15, 2013, 2:54 p.m. a text message from an ever-vigilant friend: “I heard something happened at the marathon… something about an explosion… did you?”

Another Internet prank?

Within seconds the chorus of emergency pagers vibrated:

“Explosions heard at Marathon finish line.”

Minutes later the hospital began receiving victims at an unprecedented pace. Focusing only on their clear and present duties, the emergency room staff was shielded from the bombing’s unknowns, uncertainties, and speculations. Those would come later.

In the hours and days following the bombing, attention turned to addressing the emotional and psychological impact of the bombing on victims, their families, and our own staff. For staff, there was a sense of deep relief and satisfaction that their years of careful preparation had produced a well-choreographed response.

Debriefings Effective

To encourage thoughtful personal reflection, Employee Assistance Program staff and trauma psychiatry specialist Naomi Simon, M.D., director of the MGH Center for Anxiety and Traumatic Stress Disorders led highly effective debriefings for the clinical units most closely involved with the care of bombing victims. To help staff distinguish normal and expected anxiety from more pathologic conditions, Dr. Simon said it best: “If you are not a bit freaked out by this experience, your brain isn’t working.”

Nevertheless, we anticipated that a small fraction of staff responders would eventually develop the need for skilled clinical intervention. We created a triage process, which successfully prevented an indiscriminate flood of referrals from saturating the limited availability of specialists we knew would be called upon to treat victims, finish-line witnesses, and first responders in the coming weeks.

Consistent with this estimate, only one or two of the 21 employees requesting help from the EAP for bombing-related issues required further evaluation. Since the bombing, our department’s outpatient Post-traumatic Stress Disorder group has evaluated around 30 patients. None of these were physician responders.

Coping with the Aftermath

Arieh Shalev, M.D., is currently professor of psychiatry at NYU and a leader in creating best practices for managing patients, families, and medical staff in the aftermath of terrorist attacks. For many years, Dr. Shalev oversaw the psychological response to terrorist attacks at Jerusalem’s Hadassah Medical Center.

His evidence-based advice seems softly homespun and eminently practical. Dr. Shalev observed that, if unchecked, widespread and repeated reminders of an isolated terrorist attack create a kind of emotional echo chamber, heightening emotional vigilance and disrupting a community’s sense of safety. Dr. Shalev dispenses a strong and healing psychological antidote to the impact of terrorist attacks: return to your home and to your work, to your family and friends; endeavor to resume life sustained by safe places and familiar faces, where life’s normal routines can at once proceed and reassure.

Schwartz Center Rounds

Responding to the needs of marathon bombing caregivers, The Schwartz Center for Compassionate Healthcare sponsored a series of citywide special Schwartz Center Rounds exclusively for hospital staff, first responders, and medical tent volunteers. Held last fall, these sessions were quite moving in both their content and in the pervasive sense of shared achievement for jobs well done. Encouraged by the success of those sessions, the Schwartz Center has planned psychiatric first aid for caregivers for mid-April. (See related article)

In the days following that Monday’s bombing and Friday’s citywide shutdown, the “where were you when?” stories were widely and excitedly shared by the citizens of Boston and particularly among hospital staff who were directly involved in the clinical care of victims. By week two the frequency and intensity of these reflections began to fall. Steadily, healthily, routine life in Boston resumed.

—John B. Herman, M.D.

Dr. Herman is the Associate Chief of Psychiatry at Massachusetts General hospital and medical director for the Partners HealthCare Employee Assistance Program.

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