HPRT Recommendations : Caring for the patients and health workers traumatized by the Boston Marathon bombings

Many of our patients and staff have been deeply affected by this week’s tragic events.  The first thing to remember is that we have a common bond with our patients, because we are all affected in one way or another. These few recommendations for dealing with the emotional and physical aftermath of 4/15 in our clinical practice may be helpful to you.

1. In the few days ahead, ask your patients if they have been traumatized by the events.  Let them talk and tell you in what way and how they have been coping with the situation.  This will give you an opportunity to see if this tragedy is seriously affecting them, bringing back old memories and losses such as 9/11; making their medical problems worse; and/or exacerbating an existing mental health problem (e.g. anxiety, PTSD, depression).
2. Check to see if your patients are having sleep disturbances, especially nightmares.  You may want to provide reassurance – see item 4.
3. In all disasters, make sure people feel safe, secure, and know where all their family members are located and if they are OK.
4. Reassure the patients that it is completely normal to have some symptoms of PTSD, such as nightmares, poor sleep, ruminating on the events, worries about their safety, and depressive symptoms such as sadness, despair, and discouragement about the world situation.  For the great majority, these symptoms will resolve relatively soon.
5. Recommend to patients the 3 major social instruments of coping: altruism (i.e. helping others), work (or school studies); and spirituality.  Do not be afraid or worry you’ll offend the patients by speaking to them openly about their spiritual beliefs and practices.
6. Make sure their kids and teens are OK.  Encourage them to check in with their children. It is helpful to turn off the TV news, which is revisiting all the gruesome details of the tragedy over and over again.  Stimulating high emotional arousal in young children from TV images of violence is never a good situation.  Young children may think the events are recurring, leading to a lot of fear and anxiety.
7. Empathic and sensitive listening is your best therapy.  Only a small percentage of patients will need medication or a mental health referral.
8. Most importantly, show solidarity with your patients.  This is a situation when the health care practitioner and the patient have shared a tragic and disturbing event.  You can express your solidarity with the patient; the patient will really appreciate it.
9. Practice your own self-care since you’ll be experiencing a lot of distress and will need a way of dealing with this yourself.
10. Peer supervision is highly recommended.  At periodic meetings with your fellow healthcare professionals (which are not group therapy), discuss those cases related to the tragedy that are bothering you.  In this way you can receive and give support to your colleagues.  Peer supervision is one of the best things you can do to enhance staff morale and group self-care.