1. IAEA International Atomic Energy Agency IX. EMERGENCY EXPOSURE SITUATION IX.8.1 Medical Management of Radiation Injuries Psychological Effects of Radiation Injury

2. IAEA Contents Introduction Medical consequences of radiation accidents Psychological consequences of radiation accidents What is psychological stress caused by the accident? What can we do about stress? Management of psychological effects

3. IAEA Introduction Importance of psychological impact of radiation accidents underestimated in past Psychosocial effects may far outnumber any direct health effects Reactions to nuclear and radiological accidents similar Role of scientific community, and physicians in particular, in influencing public perception of risk - and addressing psychological consequences of accidents

4. IAEA Medical Consequences of Radiation Accidents Health effects directly related to radiation exposure Deterministic Stochastic Health effects indirectly related to radiation exposure Caused by accident Caused by intervention

5. IAEA Reasons of Stress Reactions at Radiation Accidents Unknown threat Can not be felt Long term consequences of radiation Conflicting information in mass media Speculation of “radiation theme” by politicians Lack of education of general public, physicians and other professionals Inadequate actions of official authorities on mitigation of consequences of radiation accidents for general public

6. IAEA What is Psychological Stress Caused by Accident? Normal reaction to abnormal event Unusually strong psychological and emotional reactions which could interfere with ability to function during or after accident Can become post traumatic stress disorder

7. IAEA What is Psychological Stress Caused by Accident? New diagnostic entity “chronic environmental stress disorder” proposed Principal characteristics: apathy, asthenia, diminished interest and “learned helplessness”

8. IAEA Early stress reactions Physiological Cognitive Emotional

9. IAEA Early Physiological Stress Reaction Nausea Muscle tremors Sweating Dizziness Chills Increased heart rate Increased blood pressure Hyperventilation

10. IAEA Early Cognitive Stress Reaction Confusion Difficulty in making decisions Impaired thinking Difficulty problem solving Memory loss Calculation difficulties

11. IAEA Early Emotional Stress Reaction Anxiety Anger Fear Irritability Sense of guilt Feeling overwhelmed Grief Hopelessness

12. IAEA Late Stress Reactions Physiological Cognitive Emotional

13. IAEA Late Physiological Stress Reactions Fatigue Increased use of alcohol and drugs Exaggerated startle response Sleep disturbance Development of somatic disease

14. IAEA Late Cognitive Stress Reactions Decreased attention span Poor concentration Memory problems Flashbacks

15. IAEA Late Emotional Stress Reactions Feeling abandoned Resentment Feeling alienation Autism Numbness Depression

16. IAEA What Can We Do About Stress? Accidents can not be predicted BUT Psychological reaction to radiation accident could be mitigated using different programs: Preventive program Action program during an accident Action program after an accident

17. IAEA Preventive Program Increase of population literacy in the field of radiation influences Introduction of special course in formation for medical and paramedical staff, police, firemen

18. IAEA Action Program During an Accident provide timely, clear information to general public and specialists single trusted spokesperson organization of medical aid station determination of order and ways of evacuation provide psychological assistance

19. IAEA Management of Psychological Consequences After an Accident medical response psychological assistance social adaptation material support of the state long term rehabilitation programs of victims

20. IAEA Psychological Stress of Relocation Correct calculation of a dose of radiation influence It is required to weigh all pro and contra Negative impact on mental well being Elderly people especially likely to suffer

21. IAEA How to Reduce Psychological Effects Have ongoing information program Give clear, simple and timely advice Provide consistent advice and assessment Use international guidance Ensure protective action justified Correct false information Social support and education

22. IAEA Requirements for Warning Message Accurate, timely and complete Clear Simple Sufficient Concrete Consistent Frequently repeated Provided through multiply channels

23. IAEA Psychological Support in Different Types of Accident AccidentPsychological support is needed for: Affected victims General public Emergency responders Nuclear (reactor)Yes CriticalityYes Involving lost/stolen sourcesYes Not always TransportationYes Not always Nuclear power satellite re-entryYes, if anyYesNot always Laboratory accidentsYesNo Result of use/misuse of industrial sourcesYesNo Medical misadministration in diagnosis and therapyYesNo

24. IAEA Psychological Stress of Injured Individuals Patient needs Comfort, relief of symptoms Stability and authoritative support Information Concern Hope Control Stimulation Patient problems Overly scientific approach Repeated tests, examinations Photographs Reactions of others Too many “experts” Too much media attention

25. IAEA Psychological Support of Emergency Responders Provide instructions BEFORE an event Should have necessary knowledge about irradiation effects Should be psychologically prepared to work in stress conditions Periodic control of state of health of emergency responders, made by physicians, psychologists (psychotherapists); Medico psychological rehabilitation of emergency responders, if necessary

26. IAEA During an Event Provide an initial briefing on the following questions: Mission tasks Hazards Radiation protection Contamination control

27. IAEA During an Event (Continued) Provide adequate rest Care, attention (show concern) Provide guidance

28. IAEA Immediately After, and Continuing as Necessary Provide debriefing sessions Provide counseling as needed

29. IAEA Medical Staff Problems Fear / anxiety Isolation by others Lack of knowledge (medical treatment, long term effects, etc.) New experience: Interactions with “experts,” public officials, reporters, etc. Loss of autonomy (activities may be monitored/managed by authorities)

30. IAEA Supporting Mental Health Role of The Physician in Supporting Mental Health and Reducing The Patient’s Anxieties One physician in charge Keep patient and patient’s family informed. Be honest Encourage self-help and family support Assure patient privacy Discuss tactics of dialogue with a patient and his relatives with psychologist Provide psychological comfort when transferring the patient to other hospitals

31. IAEA What Must We Do After a Radiation Accident ? Truthful explanation of early and delayed effects of a radiation accident for all categories of involved people Provision of correct explanation of social and economic compensations for victims Provision of qualified supervision over delayed health effects of radiation accident of involved people and population with attraction of international experts Work with mass media

32. IAEA Mitigation of Psychological Consequences One of the functional requirements Applicable for all planning categories Should be performed by facility, local or national level of response Depending on planning category

33. IAEA Conclusion Psychological effects – more important in current situation What is stress caused by accident? What can we do about stress? Management of psychological effects Psychological support in different types of accidents Mitigation of psychological consequences