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Disaster Med Public Health Prep. 2011 Mar;5(1):73-80. doi: 10.1001/dmp.2010.47. Epub 2010 Nov 24.
While information for the medical aspects of disaster surge is increasingly available, there is little guidance for health care facilities on how to manage the psychological aspects of large-scale disasters that might involve a surge of psychological casualties. In addition, no models are available to guide the development of training curricula to address these needs. This article describes 2 conceptual frameworks to guide hospitals and clinics in managing such consequences. One framework was developed to understand the antecedents of psychological effects or "psychological triggers" (restricted movement, limited resources, limited information, trauma exposure, and perceived personal or family risk) that cause the emotional, behavioral, and cognitive reactions following large-scale disasters. Another framework, adapted from the Donabedian quality of care model, was developed to guide appropriate disaster response by health care facilities in addressing the consequences of reactions to psychological triggers. This framework specifies structural components (internal organizational structure and chain of command, resources and infrastructure, and knowledge and skills) that should be in place before an event to minimize consequences. The framework also specifies process components (coordination with external organizations, risk assessment and monitoring, psychological support, and communication and information sharing) to support evidence-informed interventions.
虽然关于灾害激增的医学方面的信息越来越多，但对于医疗机构来说，几乎没有如何应对可能涉及大量心理伤亡的大规模灾害的心理方面的指导。此外，没有任何模型可以指导培训课程的开发以满足这些需求。本文介绍了两个概念框架，以指导医院和诊所管理此类后果。一个框架是为了理解心理影响的前因，或“心理触发因素”（行动受限、资源有限、信息有限、创伤暴露和感知到的个人或家庭风险），这些因素导致大规模灾害后出现情绪、行为和认知反应。另一个框架是从 Donabedian 护理质量模型改编而来的，旨在指导医疗机构在应对心理触发因素反应的后果方面做出适当的灾难应对。该框架指定了在事件发生之前应具备的结构组成部分（内部组织结构和指挥链、资源和基础设施以及知识和技能），以将后果降至最低。该框架还指定了过程组成部分（与外部组织的协调、风险评估和监测、心理支持以及沟通和信息共享），以支持基于证据的干预措施。
