Upload
cody-stevens
View
221
Download
0
Tags:
Embed Size (px)
Citation preview
Intervention for Chronic and Emergency Exposure SituationsIntervention for Chronic and Emergency Exposure Situations
The Medical Management of Radiation InjuriesThe Medical Management of Radiation Injuries
Psychological EffectsPsychological EffectsLectureLecture
IAEA Post Graduate Educational Course in Radiation Protection and Safety of Radiation Sources
Module X.8 - The Medical Management of Radiation Injuries
2
IntroductionIntroduction
Importance of psychological impact of Importance of psychological impact of radiation accidents has been in the past radiation accidents has been in the past underestimatedunderestimated
This lecture willThis lecture will explain explain the the nature and nature and causescauses of of
psychological effects psychological effects in radiation emergencin radiation emergencyy describe the symptoms of psychological describe the symptoms of psychological
stress caused by the accidentstress caused by the accident present elements for management of present elements for management of
psychological consequences of the accidentpsychological consequences of the accident
Module X.8 - The Medical Management of Radiation Injuries
3
ContentContent
Medical consequences of the radiation Medical consequences of the radiation accidents accidents
Psychological consequences of radiation Psychological consequences of radiation accidents accidents
What is psychological stress caused by What is psychological stress caused by the accidentthe accident
What can we do about stressWhat can we do about stress Management of psychological effectsManagement of psychological effects SummarySummary
Module X.8 - The Medical Management of Radiation Injuries
4
Psycho-social Effects and Radiation Psycho-social Effects and Radiation AccidentsAccidents Psycho-social effects of an radiation Psycho-social effects of an radiation
accident can far outnumber any direct accident can far outnumber any direct effectseffects
The wide spread public anxiety and The wide spread public anxiety and pessimism in Chernobyl accident pessimism in Chernobyl accident appeared to be out of all proportions to th appeared to be out of all proportions to th eradiation induced health effectseradiation induced health effects
In accident management it is therefore In accident management it is therefore necessary to take these effects into necessary to take these effects into accountaccount
Module X.8 - The Medical Management of Radiation Injuries
5
Medical Consequences of Radiation Medical Consequences of Radiation AccidentsAccidents
Health effects directly related to radiation Health effects directly related to radiation exposureexposure Deterministic Deterministic StochasticStochastic
Health effects indirectly related to Health effects indirectly related to radiation exposureradiation exposure Caused by the accident per seCaused by the accident per se Caused by the interventionCaused by the intervention
Module X.8 - The Medical Management of Radiation Injuries
6
Health Effects Directly Related to Health Effects Directly Related to Radiation ExposureRadiation Exposure
Not related to awareness of exposure Not related to awareness of exposure or to subjective perception of riskor to subjective perception of risk
CCan be prevented or reduced by an be prevented or reduced by protective actionsprotective actions which minimise which minimise public exposurepublic exposure
Module X.8 - The Medical Management of Radiation Injuries
7
Health Effects Indirectly Related to Health Effects Indirectly Related to Radiation ExposureRadiation Exposure
CCan faran far o outnumber any direct effectsutnumber any direct effects CCan affect hundredsan affect hundreds o of thousandsf thousands Can last for many yearsCan last for many years Do not correlate well with Do not correlate well with actualactual exposure exposure
bbut with subjective perception of riskut with subjective perception of risk Protective actionsProtective actions to reduce exposure to reduce exposure
may be counterproductive with respect to may be counterproductive with respect to such effectssuch effects
Module X.8 - The Medical Management of Radiation Injuries
8
Why Do People Fear Ionising Why Do People Fear Ionising Radiation?Radiation?
Unknown threatUnknown threat Can not be seen or feltCan not be seen or felt Conflicting information in mass mediaConflicting information in mass media Contradictory data from different “scientists”Contradictory data from different “scientists” Use of “radiation theme” in economical and Use of “radiation theme” in economical and
political discussionspolitical discussions Long term consequences of radiation exposureLong term consequences of radiation exposure Lack of education among general public, Lack of education among general public,
physicians and other professionalsphysicians and other professionals Social understanding of any situation involving the Social understanding of any situation involving the
term “radiation” is negativeterm “radiation” is negative
Module X.8 - The Medical Management of Radiation Injuries
9
Psychological EffectsPsychological Effects
Psychological effects includePsychological effects include Psychic sufferingPsychic suffering Changes in risk perceptionChanges in risk perception Modification in individual and social Modification in individual and social
behaviorbehavior
Module X.8 - The Medical Management of Radiation Injuries
10
Psychological Effects (Cont’d)Psychological Effects (Cont’d)
Major accidents showed that affected Major accidents showed that affected peoplepeople Believe in the threat to their healthBelieve in the threat to their health Doubt what has been reported about Doubt what has been reported about
accident and resulted dosesaccident and resulted doses Got modification in the life styleGot modification in the life style Have somatic complainsHave somatic complains Got substance abuse (alcohol, Got substance abuse (alcohol,
tranquilizers, sleeping pills)tranquilizers, sleeping pills)
Module X.8 - The Medical Management of Radiation Injuries
11
The Severity of Psychological The Severity of Psychological ReactionsReactions
The severity depends on:The severity depends on: Factors related to the accident:Factors related to the accident:
suddenness, intensity, duration, available social support etc.
Factors related to individual:Factors related to individual: past experience, personal loss, perception
of threat, personal coping abilities etc.
Module X.8 - The Medical Management of Radiation Injuries
12
What Is Psychological Stress What Is Psychological Stress Caused by the Accident?Caused by the Accident?
A normal reaction to abnormal eventA normal reaction to abnormal event Unusually strong psychical and emotional Unusually strong psychical and emotional
reactions experienced in the face of an reactions experienced in the face of an accident could interfere with one’s ability accident could interfere with one’s ability to function during or after the eventto function during or after the event
In some cases these reactions can turn In some cases these reactions can turn into post traumatic stress disorderinto post traumatic stress disorder
New diagnostic entity “chronic New diagnostic entity “chronic environmental stress disorder” has been environmental stress disorder” has been proposedproposed
Module X.8 - The Medical Management of Radiation Injuries
13
Stress Reactions – Stress Reactions – PhysicalPhysical
Early Early NauseaNausea Muscle tremorsMuscle tremors SweatingSweating DizzinessDizziness ChillsChills Increased heart rateIncreased heart rate Increased blood Increased blood
pressurepressure HyperventilationHyperventilation
LateLate FatigueFatigue Increased use of Increased use of
alcohol and drugsalcohol and drugs Exaggerated startle Exaggerated startle
responseresponse Sleep - related Sleep - related
difficultiesdifficulties
Physical
Module X.8 - The Medical Management of Radiation Injuries
14
Stress Reactions – Stress Reactions – CognitiveCognitive
EarlyEarly ConfusionConfusion Difficulty making Difficulty making
decisionsdecisions Impaired thinkingImpaired thinking Difficulty problem Difficulty problem
solvingsolving Memory lossMemory loss Calculation difficultiesCalculation difficulties Difficulty to remember Difficulty to remember
namesnames
LateLate Decreased attention Decreased attention
spanspan Poor concentrationPoor concentration Memory problemsMemory problems FlashbacksFlashbacks
Cognitive
Module X.8 - The Medical Management of Radiation Injuries
15
Stress Reactions – Stress Reactions – EmotionalEmotional
EarlyEarly AnxietyAnxiety AngerAnger FearFear IrritabilityIrritability GuiltGuilt OverwhelmedOverwhelmed GriefGrief HopelessnessHopelessness
LateLate Feeling abandonedFeeling abandoned ResentmentResentment Feeling alienationFeeling alienation WithdrawalWithdrawal NumbnessNumbness DepressionDepression
Emotional
Module X.8 - The Medical Management of Radiation Injuries
16
Psychological ProblemsPsychological ProblemsLate Late
Continuation of some early problemsContinuation of some early problems Concerns about the consequences of the Concerns about the consequences of the
exposure exposure Discrimination from the other peopleDiscrimination from the other people Establishment of illness behaviorEstablishment of illness behavior
Module X.8 - The Medical Management of Radiation Injuries
17
Changes in Health Behavior of Changes in Health Behavior of Affected PeopleAffected People
Extensive medical examinations have Extensive medical examinations have further enhanced worries about current further enhanced worries about current aand future effectsnd future effects
Change in illness behaviour and Change in illness behaviour and diagnosticdiagnostic behaviour together with vast behaviour together with vast screeningscreening programprogrammemes have lead to s have lead to increase in number of diagnosed diseases increase in number of diagnosed diseases in most organ systemsin most organ systems
Module X.8 - The Medical Management of Radiation Injuries
18
Psychological Stress of Injured Psychological Stress of Injured IndividualsIndividuals
Patient needsPatient needs Comfort, relief of Comfort, relief of
symptomssymptoms Stability and Stability and
authoritative supportauthoritative support InformationInformation ConcernConcern HopeHope ControlControl StimulationStimulation
Patient problemsPatient problems Overly scientific Overly scientific
approachapproach Repeated tests, Repeated tests,
examinationsexaminations PhotographsPhotographs Reactions of othersReactions of others Too many ‘experts’Too many ‘experts’ Too much media Too much media
attentionattention
Module X.8 - The Medical Management of Radiation Injuries
19
Medical / Nursing Staff ProblemsMedical / Nursing Staff Problems
Fear / anxietyFear / anxiety Isolation by othersIsolation by others Lack of knowledge (medical treatment, Lack of knowledge (medical treatment,
long term effects, etc.)long term effects, etc.) New experiences:New experiences:
Interactions with “experts,” public Interactions with “experts,” public officials, reporters, etc.officials, reporters, etc.
Loss of autonomy (activities may be Loss of autonomy (activities may be monitored / managed by authorities)monitored / managed by authorities)
Module X.8 - The Medical Management of Radiation Injuries
20
What Can We Do About Stress?What Can We Do About Stress?
Accidents can not be predictedAccidents can not be predicted
BUTBUT Psychological reaction to the radiological Psychological reaction to the radiological
accident could be accident could be prevented / decreased / relaxedprevented / decreased / relaxed
using different methods applied using different methods applied
before / during / after the accidentbefore / during / after the accident
Module X.8 - The Medical Management of Radiation Injuries
21
Management of Psychological Management of Psychological ConsequencesConsequences
To reduce the psychological To reduce the psychological consequences several measures are consequences several measures are availableavailable Medical responseMedical response Public health follow-upPublic health follow-up Social assistanceSocial assistance Government actions guidelinesGovernment actions guidelines Community accountability Community accountability
Module X.8 - The Medical Management of Radiation Injuries
22
How to Reduce Psychological EffectsHow to Reduce Psychological Effects
Have an ongoing information programme Have an ongoing information programme Give clear, simple and timely adviceGive clear, simple and timely advice Give consistent advice (one official point)Give consistent advice (one official point) Use international guidance Use international guidance Ensure protective actions are justifiedEnsure protective actions are justified Correct false informationCorrect false information Consider education and counsellingConsider education and counselling
Module X.8 - The Medical Management of Radiation Injuries
23
Warning of the PopulationWarning of the Population
Timely warning is one of the most Timely warning is one of the most important psychological aspects of important psychological aspects of dealing with the accidentsdealing with the accidents
Provide to the person a sense of control Provide to the person a sense of control over the situationover the situation
Call for the active attitude to the situation:Call for the active attitude to the situation: Searching processSearching process Preparation for protective actionsPreparation for protective actions
Module X.8 - The Medical Management of Radiation Injuries
24
Requirements for Warning MessageRequirements for Warning Message
Consistency Consistency Accurate, timely and completeAccurate, timely and complete Clear Clear SimpleSimple Sufficient Sufficient ConcreteConcrete Provided through multiply channelsProvided through multiply channels Frequently repeatedFrequently repeated
Module X.8 - The Medical Management of Radiation Injuries
25
Implications for Health Care Implications for Health Care ManagementManagement
Education is needed Education is needed beforebefore, , duringduring and and afterafter an incident an incident
Debriefing sessions aid in relieving stress Debriefing sessions aid in relieving stress and anxiety of staffand anxiety of staff
EEducation about radiation healthducation about radiation health effects is urgently needed for effects is urgently needed for
health health professionals to limit the public professionals to limit the public health health problem of socio-psychological problem of socio-psychological
effectseffects
Module X.8 - The Medical Management of Radiation Injuries
26
Mitigation of Public Non-radiological Mitigation of Public Non-radiological ConsequencesConsequences
One of the functional elements in IAEA-One of the functional elements in IAEA-TECDOC-953TECDOC-953
Applicable for all planning categoriesApplicable for all planning categories Should be performed by facility, local or Should be performed by facility, local or
national level national level Depending on the particular planning Depending on the particular planning
categorycategory
Module X.8 - The Medical Management of Radiation Injuries
27
Non-radiological ImpactsNon-radiological ImpactsLong Term Protective ActionsLong Term Protective Actions
Effects onEffects on Mental healthMental health Economic conditionsEconomic conditions EmploymentEmployment Long term needs for social welfareLong term needs for social welfare
and other non-radiological impacts and other non-radiological impacts caused by taking caused by taking longer term protective longer term protective actionsactions should be considered should be considered
Module X.8 - The Medical Management of Radiation Injuries
28
Non-radiological ImpactsNon-radiological ImpactsCapabilitiesCapabilities
Establish capability for addressing the Establish capability for addressing the public’s concerns and reactions during an public’s concerns and reactions during an actual or perceived nuclear or radiological actual or perceived nuclear or radiological emergencyemergency
Assure that affected people will perceive, Assure that affected people will perceive, understand, believe, personalize, and understand, believe, personalize, and respond to the warning respond to the warning
Module X.8 - The Medical Management of Radiation Injuries
29
Non-radiological ImpactsNon-radiological ImpactsLong Term MonitoringLong Term Monitoring
Before long-term monitoring or other Before long-term monitoring or other activities are conducted in areas designed activities are conducted in areas designed for unrestricted use after an accident, for unrestricted use after an accident, ensure the public understands the ensure the public understands the reasons for these continuing activities reasons for these continuing activities (e.g., scientific investigations of behavior (e.g., scientific investigations of behavior of radioisotopes in the environment)of radioisotopes in the environment)
Module X.8 - The Medical Management of Radiation Injuries
30
Non-radiological ImpactsNon-radiological ImpactsCompensationsCompensations
The process used to develop the system The process used to develop the system of compensation for emergency workers of compensation for emergency workers and the public following an emergency and the public following an emergency (radiation, chemical or other) should be (radiation, chemical or other) should be established following careful established following careful consideration of the benefits and long-consideration of the benefits and long-term social, psychological and economic term social, psychological and economic effectseffects
Module X.8 - The Medical Management of Radiation Injuries
31
SummarySummary
The The nature and nature and causescauses of psychological of psychological effects effects in radiation in radiation emergencies were emergencies were explainedexplained
The symptoms of psychological stress The symptoms of psychological stress caused by the accident were describedcaused by the accident were described
Elements for management of Elements for management of psychological consequences were psychological consequences were presentedpresented
Module X.8 - The Medical Management of Radiation Injuries
32
Where to Get More InformationWhere to Get More Information
See referencesSee references
on cover page of this lectureon cover page of this lecture