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Psychological reaction in members of medicine rescue team for Wenchuan earthquake in 2008 and its management
आऋऑऎऊࣽईࣜऋंࣜ उँऀअࣿࣽईࣜ ࣿऋईईँःँएࣜऋंࣜऌईࣽ
Journal of Medical Colleges of PLA 25 (2010) 98-102
www.elsevier.com/locate/jmcpla
Psychological reaction in members of medicine rescue team for Wenchuan earthquake in 2008 and its management Pan Zhulin1*, Le Yan2 1
Department of Medical Affairs, No.85 Hospital of PLA , Shanghai 200052, China
2
Department of Medical Affairs, No. 411 Hospital of PLA, Shanghai 200081, China Received 11 February 2010; accepted 25 March 2010
Abstract This paper reviews the rescue experience of our medical rescue team during the relief of Wenchuan earthquake in 2008 in Sichuan province, China, and analyzes the psychological reaction of team members. Based on the rescuers’ distinctive psychological reaction in different phases of the rescue operation, we aims to propose measures for administration of the team in order to better fulfill the rescue duties and provide references for future medical service in non-war operations such as an earthquake relief. Keywords: Earthquake relief; Medical service; Psychological reaction; Managerial strategies
1. Introduction
or killed in our group. When facing a sudden disaster, the medical team members were under enormous
On the next day after May 12
th
Wenchuan
psychological pressure, which may lead to a variety of
earthquake in 2008 in Sichuan province, China, our
physiological
hospital selected 65 members to establish a relief team;
summarized the psychological responses of medical
and at 2 p.m. on May 14th 2008, carrying the whole set
teams in different stages, and we also analyzed the
of medical equipment, our team was sent to Shifang
organizing and managing measures of the team for the
City, Sichuan province by a helicopter. At the end of the
field medical staff, hoping to provide useful references
st
rescue mission (July 21 ), no team member was injured *
Corresponding author.
E-mail address: [email protected] (Pan Z.)
and
psychological
reactions.
for future medical support in non-war operations.
We
99
Pan Zhulin et al./ Journal of Medical Colleges of PLA 25 (2010) 98-102
in these phases are distinctive.
2. Rescue operation 3.1. The first phase Our team set up a field medical center after we had arrived at our area of mission. Till 4 p.m. July 19th,
3.1.1. Sense of responsibility
2008, we treated 13,733 patients (including 1,738 soldiers),
performed
38
major
operations,
and
Sense of responsibility was the instinctive
hospitalized 271 patients. A total of 591 batches of
psychological reaction after our rescue team landed on
rescuers (3,832 person-times) were sent to the 8 most
the struck area. When the rescuers realized the severity
devastated towns and 32 villages of Shifang City. And
of the devastation, they were all willing to work in the
2
the medical relief covered a total of 12,276 km and
most
dangerous
areas,
and
some
even
wrote
treated a total of 31,152 earthquake victims. Meanwhile,
volunteering letters with their own blood to the
we also provided medical service to 2,200 officers and
command department to show their determination.
soldiers, printed 13,000 health handbooks, and held health-related lecture for 1,200 soldiers. Totally we
3.1.2. Sense of shock
provided 20 kinds of medicines worth of 470,000 RMB.
Collapsed houses, dead bodies and severely injured victims could be seen everywhere, which
3. Psychological reactions in three rescuing
greatly shocked the rescuers. The rescuers were moved
phases[1]
to tears when they were watching the live show of the most strong-minded boy ever in Sichuan.
The medical relief operation could be roughly divided into three phases according to the change of
3.1.3. Sense of guilty
cases with external injuries or wound disease. The first phase: from the beginning of the earthquake to the
Due to transportation limitations, we were not able
seventh day after earthquake; the second phase: from
to rush to the heavily devastated areas in the first time
the eighth day to the thirtieth day after earthquake; the
even though we tried to get there by helicopter, thus we
third phase: a month after the earthquake. We mainly
missed the best rescuing time. After we arrived at our
focused on the emergent rescue in villages and at the
task area, we found some victims had already died due
victims’ homes in the first phase, on epidemic
to delayed rescue. Meanwhile, the medical team arrived
prevention in the second phase, and the third stage was
earlier was not very professional, which caused cases of
to provide medical support for the army. The
medical malpractice. A sense of guilty rose in our team
psychological reactions of the medical team members
members, which made us greatly dismayed and
100
Pan Zhulin et al./ Journal of Medical Colleges of PLA 25 (2010) 98-102
depressed.
eating conditions also made the team member easier to lose their temper. Some rescuers suffered depression
3.2. The second phase
and anxiety of different extents.
3.2.1. Sense of accomplishment
3.3. The third phase
We had a sense of accomplishment as we felt we
3.3.1. Sense of emptiness
were doing our rescue duty. More victims were cured and the recovered began to rebuild their homes. There
In this phase we mainly provided medical service
were no epidemics in our task area, the victims
to the army men. And with the recovery of local
gradually returned to their normal track of life, and the
medical organizations, we seldom received local
local government as well as civilian organizations
victims. So our task was greatly decreased; and a sense
offered their timely support and efforts; all these gave
of emptiness rose among the rescuers and some
the rescuers a sense of accomplishment.
surgeons even did embroidery to keep the flexibility of their hands.
3.2.2. Sense of fear 3.3.2. Sense of anxiety On our way to the task area, we could be hit by aftershock at any time, which bringing a sense of fear to
At this phase the rescuers were not allowed to
the team members. The rescuers all felt nervous when
leave their barracks as they wished.
Family
they were on an ambulance to provide first aid. If a
problems such as children education and spouse job
landslide or an aftershock happens, there would be no
rose among the rescue team members. Quite a few
place for us to hide, as right below us was steep cliffs.
rescuers felt anxious and unwillingly vented their anger
Sometimes the rescuers could not return to their camp
on their colleagues. There were even quarrels over
and had to spend the nights in hazardous areas, which
trifles.
also caused panic and worry. 3.3.3. Post traumatic stress disorder [2-3] 3.2.3. Unaccustomed to the environment A
catastrophic
earthquake
usually
causes
Our medical team had to scattered to various
tremendous casualty, which makes the survived feel
locations to provide treatments at this stage. The
horrified and suffer great trauma. The psychological
rescuers could not take shift on time. Meanwhile,
crises mainly include the following: disordered thinking,
unfamiliarity with the surroundings and poor living or
losing control of temper, and affective disorder. With
Pan Zhulin et al./ Journal of Medical Colleges of PLA 25 (2010) 98-102
101
the decrease of their work load, these psychological
unnecessary injury or even death, not to mention to
crises may burst out in the rescuers in the forms of
provide first aid to the victims. So the team leaders
cognitive, emotional and behavioral activities, such as
should keep calm and take the responsibility to calm
easy irritability, tiredness, headache, absent-mindedness,
the rescuers. And the leaders have to help the rescuers
loss of appetite, and the abuse of alcohol. One extreme
to realize medical equipment can not be transported in
example was that some rescuers began to sing the
time when the roads are blocked. Carrying limited
moment when he got up and kept on singing in the rest
medicine and equipment is far from enough. So at that
of the day. And some rescuers chose to sit alone for
moment it is best to cure the local victims instead of
quite a long time.
rushing to the most devastated areas.
4. Counter measures
4.2. To provide psychological assistance and pull through the dangerous stage of disease and epidemic
The medical rescuers can present with distinctive
prevention
physical, psychological and behavioral reactions when facing a sudden disaster. Their possible physical and
The second phase is the most dangerous period for
psychological status should be considered before they
medical rescuers because they have to go to the villages
carry out their upcoming rescue task. The psychological
and homes to promote epidemic prevention. The
reactions of the rescuers were scarcely documented
aftershock might occur at any time. Therefore it is
both at home and abroad, and most of the researches
better to mainly focus on the following aspects: (1) To
focused on the psychological reaction of the disaster
strengthen the communication, especially to keep up
victims [4-5]. Thus how to effectively manage the
with the current status of transportation and the
rescuers’ psychological reaction is discussed in this
surroundings. (2) To strengthen political propaganda.
paper. The followings are the counter measures we
The rescuers’ sense of accomplishment and the local
propose for different phases of the rescue operation.
residents’ support encourage the rescuers to combat fear and effectively fulfill their duties. (3) To make rescue
4.1. To effectively regulate the rescuer’s emotion in
plan. In the poor-condition areas, it is better to shorten
emergence
the work shift and arrange backbone cadres to fulfill the duties. Meanwhile, the leader focused on providing
The first phase is often very busy and it is quite
material supply and encouraging the rescuers.
understandable for the medical rescuers to provide first aid in eagerness. But at this phase the roads might be
4.3. To prevent psychological crisis and provide
blocked and it is impossible and unsafe to go to the
medical service[6-8]
most devastated areas. Any blind action may cause
102
Pan Zhulin et al./ Journal of Medical Colleges of PLA 25 (2010) 98-102
The third phase is the toughest period for medical
3.
Yehuda R, McFarlane AC. Conflict between current
service. As the psychological reactions of some
knowledge about posttraumatic stress disorder and its
rescuers became more obvious, they were facing the
original conceptual basis. Am J Psychiatry 1995; 152(12):
problem of how to fulfill their rescue duties. In order to
1705–1713.
carry on the rescue mission, we applied the following
4.
San Blise ML. Crisis intervention: aftershocks in the
methods: (1) To fully solve the rescuers’ personal
quake zone. J Psychosoc Nurs Ment Health Serv 1994;
problems. During this period, our leaders tried their
32(5): 29-30.
best to help every rescuer, which is of great significance
5.
Chapman K, Arbon P. Are nurses ready? Disaster
for stabilizing the rescue team. (2) To organize the
preparedness in the acute setting. Australas Emerg Nurs J
rescuers to participate in team activities. Recreational
2008; 11(3):135-144.
and sport activities reduced their pressure, making them
6.
Stein DJ, Gureje O. Depression and anxiety in the
feel relaxed. (3) To relive the rescuers’ stress disorder
developing world: is it time to medicalise the suffering?
by applying psychological intervention.
Lancet 2004; 364 (9430): 233–234. 7.
References
Stein DJ, Ipser JC, Seedat S. Pharmacotherapy for post-traumatic
stress
disorder
(PTSD).
Cochrane
Database Syst Rev 2006; (1): CD002795. 1.
Hodgkinson PE, Stewart M. Coping with catastrophe – a handbook
of
post-disaster
psychosocial
aftercare.
London: Routledge, 1991. 2.
Stein DJ, Seedat S, Iversen A, et al. Post-traumatic stress disorder: medicine and politics. Lancet 2007; 369(9556): 139–144.
8.
Bradley R, Greene J, Russ E, et al. Multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry 2005; 162(2): 214–227. (Editor Lu Renmin)
Journal of Medical Colleges of PLA 25 (2010) 98-102
www.elsevier.com/locate/jmcpla
Psychological reaction in members of medicine rescue team for Wenchuan earthquake in 2008 and its management Pan Zhulin1*, Le Yan2 1
Department of Medical Affairs, No.85 Hospital of PLA , Shanghai 200052, China
2
Department of Medical Affairs, No. 411 Hospital of PLA, Shanghai 200081, China Received 11 February 2010; accepted 25 March 2010
Abstract This paper reviews the rescue experience of our medical rescue team during the relief of Wenchuan earthquake in 2008 in Sichuan province, China, and analyzes the psychological reaction of team members. Based on the rescuers’ distinctive psychological reaction in different phases of the rescue operation, we aims to propose measures for administration of the team in order to better fulfill the rescue duties and provide references for future medical service in non-war operations such as an earthquake relief. Keywords: Earthquake relief; Medical service; Psychological reaction; Managerial strategies
1. Introduction
or killed in our group. When facing a sudden disaster, the medical team members were under enormous
On the next day after May 12
th
Wenchuan
psychological pressure, which may lead to a variety of
earthquake in 2008 in Sichuan province, China, our
physiological
hospital selected 65 members to establish a relief team;
summarized the psychological responses of medical
and at 2 p.m. on May 14th 2008, carrying the whole set
teams in different stages, and we also analyzed the
of medical equipment, our team was sent to Shifang
organizing and managing measures of the team for the
City, Sichuan province by a helicopter. At the end of the
field medical staff, hoping to provide useful references
st
rescue mission (July 21 ), no team member was injured *
Corresponding author.
E-mail address: [email protected] (Pan Z.)
and
psychological
reactions.
for future medical support in non-war operations.
We
99
Pan Zhulin et al./ Journal of Medical Colleges of PLA 25 (2010) 98-102
in these phases are distinctive.
2. Rescue operation 3.1. The first phase Our team set up a field medical center after we had arrived at our area of mission. Till 4 p.m. July 19th,
3.1.1. Sense of responsibility
2008, we treated 13,733 patients (including 1,738 soldiers),
performed
38
major
operations,
and
Sense of responsibility was the instinctive
hospitalized 271 patients. A total of 591 batches of
psychological reaction after our rescue team landed on
rescuers (3,832 person-times) were sent to the 8 most
the struck area. When the rescuers realized the severity
devastated towns and 32 villages of Shifang City. And
of the devastation, they were all willing to work in the
2
the medical relief covered a total of 12,276 km and
most
dangerous
areas,
and
some
even
wrote
treated a total of 31,152 earthquake victims. Meanwhile,
volunteering letters with their own blood to the
we also provided medical service to 2,200 officers and
command department to show their determination.
soldiers, printed 13,000 health handbooks, and held health-related lecture for 1,200 soldiers. Totally we
3.1.2. Sense of shock
provided 20 kinds of medicines worth of 470,000 RMB.
Collapsed houses, dead bodies and severely injured victims could be seen everywhere, which
3. Psychological reactions in three rescuing
greatly shocked the rescuers. The rescuers were moved
phases[1]
to tears when they were watching the live show of the most strong-minded boy ever in Sichuan.
The medical relief operation could be roughly divided into three phases according to the change of
3.1.3. Sense of guilty
cases with external injuries or wound disease. The first phase: from the beginning of the earthquake to the
Due to transportation limitations, we were not able
seventh day after earthquake; the second phase: from
to rush to the heavily devastated areas in the first time
the eighth day to the thirtieth day after earthquake; the
even though we tried to get there by helicopter, thus we
third phase: a month after the earthquake. We mainly
missed the best rescuing time. After we arrived at our
focused on the emergent rescue in villages and at the
task area, we found some victims had already died due
victims’ homes in the first phase, on epidemic
to delayed rescue. Meanwhile, the medical team arrived
prevention in the second phase, and the third stage was
earlier was not very professional, which caused cases of
to provide medical support for the army. The
medical malpractice. A sense of guilty rose in our team
psychological reactions of the medical team members
members, which made us greatly dismayed and
100
Pan Zhulin et al./ Journal of Medical Colleges of PLA 25 (2010) 98-102
depressed.
eating conditions also made the team member easier to lose their temper. Some rescuers suffered depression
3.2. The second phase
and anxiety of different extents.
3.2.1. Sense of accomplishment
3.3. The third phase
We had a sense of accomplishment as we felt we
3.3.1. Sense of emptiness
were doing our rescue duty. More victims were cured and the recovered began to rebuild their homes. There
In this phase we mainly provided medical service
were no epidemics in our task area, the victims
to the army men. And with the recovery of local
gradually returned to their normal track of life, and the
medical organizations, we seldom received local
local government as well as civilian organizations
victims. So our task was greatly decreased; and a sense
offered their timely support and efforts; all these gave
of emptiness rose among the rescuers and some
the rescuers a sense of accomplishment.
surgeons even did embroidery to keep the flexibility of their hands.
3.2.2. Sense of fear 3.3.2. Sense of anxiety On our way to the task area, we could be hit by aftershock at any time, which bringing a sense of fear to
At this phase the rescuers were not allowed to
the team members. The rescuers all felt nervous when
leave their barracks as they wished.
Family
they were on an ambulance to provide first aid. If a
problems such as children education and spouse job
landslide or an aftershock happens, there would be no
rose among the rescue team members. Quite a few
place for us to hide, as right below us was steep cliffs.
rescuers felt anxious and unwillingly vented their anger
Sometimes the rescuers could not return to their camp
on their colleagues. There were even quarrels over
and had to spend the nights in hazardous areas, which
trifles.
also caused panic and worry. 3.3.3. Post traumatic stress disorder [2-3] 3.2.3. Unaccustomed to the environment A
catastrophic
earthquake
usually
causes
Our medical team had to scattered to various
tremendous casualty, which makes the survived feel
locations to provide treatments at this stage. The
horrified and suffer great trauma. The psychological
rescuers could not take shift on time. Meanwhile,
crises mainly include the following: disordered thinking,
unfamiliarity with the surroundings and poor living or
losing control of temper, and affective disorder. With
Pan Zhulin et al./ Journal of Medical Colleges of PLA 25 (2010) 98-102
101
the decrease of their work load, these psychological
unnecessary injury or even death, not to mention to
crises may burst out in the rescuers in the forms of
provide first aid to the victims. So the team leaders
cognitive, emotional and behavioral activities, such as
should keep calm and take the responsibility to calm
easy irritability, tiredness, headache, absent-mindedness,
the rescuers. And the leaders have to help the rescuers
loss of appetite, and the abuse of alcohol. One extreme
to realize medical equipment can not be transported in
example was that some rescuers began to sing the
time when the roads are blocked. Carrying limited
moment when he got up and kept on singing in the rest
medicine and equipment is far from enough. So at that
of the day. And some rescuers chose to sit alone for
moment it is best to cure the local victims instead of
quite a long time.
rushing to the most devastated areas.
4. Counter measures
4.2. To provide psychological assistance and pull through the dangerous stage of disease and epidemic
The medical rescuers can present with distinctive
prevention
physical, psychological and behavioral reactions when facing a sudden disaster. Their possible physical and
The second phase is the most dangerous period for
psychological status should be considered before they
medical rescuers because they have to go to the villages
carry out their upcoming rescue task. The psychological
and homes to promote epidemic prevention. The
reactions of the rescuers were scarcely documented
aftershock might occur at any time. Therefore it is
both at home and abroad, and most of the researches
better to mainly focus on the following aspects: (1) To
focused on the psychological reaction of the disaster
strengthen the communication, especially to keep up
victims [4-5]. Thus how to effectively manage the
with the current status of transportation and the
rescuers’ psychological reaction is discussed in this
surroundings. (2) To strengthen political propaganda.
paper. The followings are the counter measures we
The rescuers’ sense of accomplishment and the local
propose for different phases of the rescue operation.
residents’ support encourage the rescuers to combat fear and effectively fulfill their duties. (3) To make rescue
4.1. To effectively regulate the rescuer’s emotion in
plan. In the poor-condition areas, it is better to shorten
emergence
the work shift and arrange backbone cadres to fulfill the duties. Meanwhile, the leader focused on providing
The first phase is often very busy and it is quite
material supply and encouraging the rescuers.
understandable for the medical rescuers to provide first aid in eagerness. But at this phase the roads might be
4.3. To prevent psychological crisis and provide
blocked and it is impossible and unsafe to go to the
medical service[6-8]
most devastated areas. Any blind action may cause
102
Pan Zhulin et al./ Journal of Medical Colleges of PLA 25 (2010) 98-102
The third phase is the toughest period for medical
3.
Yehuda R, McFarlane AC. Conflict between current
service. As the psychological reactions of some
knowledge about posttraumatic stress disorder and its
rescuers became more obvious, they were facing the
original conceptual basis. Am J Psychiatry 1995; 152(12):
problem of how to fulfill their rescue duties. In order to
1705–1713.
carry on the rescue mission, we applied the following
4.
San Blise ML. Crisis intervention: aftershocks in the
methods: (1) To fully solve the rescuers’ personal
quake zone. J Psychosoc Nurs Ment Health Serv 1994;
problems. During this period, our leaders tried their
32(5): 29-30.
best to help every rescuer, which is of great significance
5.
Chapman K, Arbon P. Are nurses ready? Disaster
for stabilizing the rescue team. (2) To organize the
preparedness in the acute setting. Australas Emerg Nurs J
rescuers to participate in team activities. Recreational
2008; 11(3):135-144.
and sport activities reduced their pressure, making them
6.
Stein DJ, Gureje O. Depression and anxiety in the
feel relaxed. (3) To relive the rescuers’ stress disorder
developing world: is it time to medicalise the suffering?
by applying psychological intervention.
Lancet 2004; 364 (9430): 233–234. 7.
References
Stein DJ, Ipser JC, Seedat S. Pharmacotherapy for post-traumatic
stress
disorder
(PTSD).
Cochrane
Database Syst Rev 2006; (1): CD002795. 1.
Hodgkinson PE, Stewart M. Coping with catastrophe – a handbook
of
post-disaster
psychosocial
aftercare.
London: Routledge, 1991. 2.
Stein DJ, Seedat S, Iversen A, et al. Post-traumatic stress disorder: medicine and politics. Lancet 2007; 369(9556): 139–144.
8.
Bradley R, Greene J, Russ E, et al. Multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry 2005; 162(2): 214–227. (Editor Lu Renmin)