Lessons of terror

US academic Patricia Levy draws on practical lessons from her experience in Israel to show how social and health services in the US could better respond to the threat of terrorist attack.

The terrorist attack on the World Trade Centre and the Pentagon occurred this week two years ago. Watching the horrific scenes on television, I experienced, as a former medical social worker from Israel, a feeling of deja vu.

I have learned through first-hand experience that victims of terrorism have deep feelings of helplessness and shock that they could have been killed or maimed for life.

Psychologically, the mind cannot grapple with the fact of having become targeted because of one’s innocence. There is also the overwhelming stress of the possible loss of loved ones, friends, and associates. An ongoing sense of trauma can culminate in experiencing post-traumatic stress syndrome, accompanied by permanent socio-economic effects on victims and their families. An immediate community response is necessary and, in the longer term, support by social workers is critical.

In Israel, relationships have been set up between community health centres, welfare offices, emergency medical teams, hospitals and the police and military. Certain types of wounded (for example, head wounds) are taken to specified medical facilities providing acute and specialised care services. Children are taken to a specialised children’s hospital.

Medical social work staff who are off duty come into the hospital as soon as they hear of an incident. Some staff an information centre that has been set up. Others join emergency room and operating room personnel. Still others go to their regularly assigned wards to wait for hospitalised victims to arrive. A phone and fax system are set up with outside lines going to the emergency medical services at the scene of the attack, to the police and military, and to the welfare agencies. Inside the hospital, a centralised software programme lists new patients by number, names if known, and any other critical details.

The information centre usually includes a public reception area, a waiting lobby for patients’ families, friends, and relatives, and a crisis line to answer public enquiries regarding loved ones. After an attack, hospital social workers aim to create an environment of safety where they can conduct group work with 30 or 40 people who were present at the time of the attack. A debriefing focusing on recounting of events can encourage participants to express feelings of confusion, powerlessness, guilt or outrage.

A major goal is to aid victims and loved ones to use their own coping mechanisms to reduce stress. Professional intervention techniques might also include breathing exercises, appropriate touching, holding, and giving opportunities for clients to regain a sense of control.

It is important for communities to “practise, practise, practise” to be prepared to deal with the sudden crisis of a terrorist attack. This also means being ready to facilitate immediate response emergency systems and to have in place staff debriefing mechanisms.Also there is a need to follow-up with outreach in the community for patients and families experiencing secondary effects who require further referrals to appropriate resources.

Most US communities have a disaster system in place. However, trying to respond to a colour code (yellow one day, orange the next) does not provide the average citizen with any sense of security or direction of what to do, when to do it, and where to go. Education of communities combined with a joint plan of action between agencies can help to combat terrorists’ goals of instilling fear, vulnerability and panic. An interdisciplinary response team with skills in crisis intervention, counselling skills, who know how to conduct debriefing, and who have been taught to cope with their own needs will be prepared to take control when needed most.

Patricia Levy is assistant professor, department of sociology and social work, Fort Hays State University, Kansas.

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