The "Worried Well" Response to CBRN Events: Analysis and Solutions - Chemical, Biological, Radiation, Nuclear, Sarin, Anthrax, Goiania Radiation Incident, Aum Shinrikyo, WMD, Bioterrorism, Psychology

This excellent report has been professionally converted for accurate flowing-text e-book format reproduction. Chemical, biological, radiological or nuclear (CBRN) weapons in the hands of a terrorist or a rogue state is one of the greatest threats to the security of the United States. These weapons of mass destruction (WMDs) can cause catastrophic loss of life and innumerable injuries and challenge the US health system beyond its capacity to provide care. Most hospitals do not have the beds, equipment, staff, or facilities to adequately respond to a WMD event.

Compounding this problem is that many people who have minimal or no exposure to a CBRN agent will seek medical care and slow down medical treatment of genuinely affected patients. These "worried well" patients may comprise as many as 20 times the number of "legitimate" patients and may become one of the most difficult aspects in dealing with WMD events. This paper is an examination of the worried well phenomenon. It looks at three CBRN events that are often noted for unaffected masses seeking medical carethe Goiania Radiation Incident, the Aum Shinrikyo Attack, and the Anthrax Letters Incident.

The purpose of this paper is twofold. First, this paper provides a better understanding of the worried well response. The literature often contains bold proclamations of the problem without a substantial analysis, and researchers cite cases but fail to provide any in-depth study of them. This paper provides a closer examination of the cases and shows that the worried well response is neither irrational nor characterized by panic. Instead when examined from informational, medical, and psychological perspectives, the worried well response is largely a rational reaction.

The second purpose of this paper is to provide a strategy to mitigate the worried well response in CBRN events. Admittedly, it is beyond the scope of this paper to provide a detailed worried well response plan for every possible CBRN event. This paper, however, does provide the basic elements to reduce the response and still provide proper health care for everyone affected by a CBRN event.

CASE STUDIES * The Goiania Incident * The Aum Attack * Anthrax Letters Incident * UNDERSTANDING THE WORRIED WELL * Information Explanations for the Worried Well * Government Directions * Media Reports * Medical Explanations for the Worried Well * Group 1. People who were exposed and had minor symptoms requiring minimal or no medical care * Group 2. People who may have been exposed but had no clear physical symptoms related to the event or an organic etiology * Group 3. People who could not possibly have been exposed but came to the hospital seeking care for imagined illnesses or prevention * Group 4. Those hoping to profit either financially or emotionally * Group 5. Those experiencing stress disorders * Psychological Explanations for the Worried Well * Looking for Answers * RESPONDING TO THE LOW RISK PATIENT RESPONSE * Re-Thinking the Worried Well * Pre-CBRN Event Preparation * Community Involvement * Partner with the Media * Develop Trusted Agents * Prepare alternate communication channels * Post-CBRN Event: Preventing LRPs from Seeking Immediate Care * Tier 1: Prevent LRPs from Seeking Care * Tier 2: Stop LRPs at the Door * Tier 3: Comprehensive Medical Care * Other Considerations: Security and Liability coverage * LRP Response Plan Summary * CONCLUSIONS * APPENDIX: PROBLEMS ESTIMATING THE WORRIED WELL RESPONSE * APPENDIX: THE CRITICAL ROLE OF THE DEPARTMENT OF DEFENSE * BIBLIOGRAPHY

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