Cambridge College, Graduate School of Psychology and Counseling, Boston, Massachusetts.
Disaster Med Public Health Prep. 2022 Apr;16(2):734-740. doi: 10.1017/dmp.2020.356. Epub 2020 Sep 10.
When a complex emergency (CE) overwhelms infrastructure, the ability of health-care providers to work efficiently under duress saves lives. The author uses her experience of providing mental health supports to humanitarian aid workers and the pieces of training conducted for internal medicine practitioners to offer guidance on how to manage severe job-related stresses during the response to the coronavirus disease 2019 (COVID-19) pandemic. This work reminds responders about their professional mission and purpose, but its extreme physical and mental demands can take a toll on their well-being and health. In CEs, the sheer volume of work and the emotional over-engagement tend to produce toxic fantasies (eg, rescuer or helper fantasies), acting upon which threatens integrity of care and increases risks for both patients and providers. Accumulated fatigue and exposure to mass suffering and mortality can change the perceived value of life and increase reckless, risk-taking, and suicidal behaviors. Introducing a self-awareness framework prioritizes the awareness of the available choices and making situation-appropriate and informed decisions about balancing one's own and others' needs. The COVID-19 response has demonstrated that fostering peer supports, changing organizational culture, addressing self-awareness within a training and supervisory context, and strengthening supports for managers are important parts of disaster preparedness. It also revealed that more research is needed to better understand and meet the special psychological needs of health-care responders.
当复杂的紧急情况（CE）使基础设施不堪重负时，医疗保健提供者在压力下高效工作的能力可以拯救生命。作者结合自己为人道主义援助工作者提供心理健康支持的经验，以及为内科医生开展的培训内容，就如何在应对 2019 年冠状病毒病（COVID-19）大流行期间管理严重的与工作相关的压力提供指导。这项工作提醒急救人员注意自己的职业使命和目标，但它对身心健康造成的极端身心需求可能会产生影响。在紧急情况下，工作量大且情绪投入过度，往往会产生有毒的幻想（例如救援者或帮助者的幻想），而这种幻想的出现会威胁到护理的完整性，并增加患者和提供者的风险。积累的疲劳以及对大规模苦难和死亡率的接触，可能会改变对生命的价值认知，增加鲁莽、冒险和自杀行为。引入自我意识框架会优先考虑对可用选择的意识，并根据具体情况做出适当和明智的决策，以平衡自己和他人的需求。COVID-19 应对行动表明，培养同伴支持、改变组织文化、在培训和监督背景下解决自我意识问题以及加强对管理人员的支持，都是灾害准备工作的重要组成部分。它还揭示了需要进行更多研究，以更好地了解和满足医疗急救人员的特殊心理需求。
