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Effects of Traumatic Stress

GORSKI-CENAPS Web Publications
www.tgorski.com
Published On: December 18, 2001          Updated On: December 18, 2001
© Terence T. Gorski, 2001

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Effects of Traumatic Stress

A Report By
The Center for the Study of Traumatic Stress
Henry M. Jackson Foundation for the Advancement of Military Medicine
1401 Rockville Pike, Suite 600
Rockville, Maryland 20842
Telephone: 301-319-6965

Executive Summary

The effects of traumatic stress on individuals, organizations, communities, and nations are of substantial and increasing concern in the present world climate.  Disasters such as the Kobe Earthquake, the TWA Flight 800 Explosion, Hurricane Andrew, Oklahoma City, and the Gulf War, as well as more common traumatic events such as motor vehicle accidents, floods, tornadoes, and physical assault are a health risk to a large number of our population.   In addition, these events carry national and international implications. The monetary cost of such events to productivity as well as to health and international affairs is enormous.

Overview

In the present world climate, traumatic stress is all too common.  Natural disasters take a large toll worldwide. The World Health Organization estimates that from 1900-1998, hurricanes left nearly 2 million people without homes and directly affected the lives of 4 million people. Floods alone afflicted 300 million people, and left more than 36 million homeless. Earthquakes, typhoons, and cyclones affected another 30 million people each and rendered 10 million homeless. The year 1995 was the most expensive year for disasters internationally - $150 billion was lost primarily in developed countries.   Scientists predict that the frequency of disasters affecting humanity is climbing.

Sadly, those least prepared to deal with disaster often suffer the most:  the less developed an area is economically, the greater the number of deaths, injuries and amount of damage its population sustains in a disaster - especially in more densely populated areas. Cities, states, and nations often lack the resources and insurance coverage they need to help people living in impoverished areas. Such traumatic events and their management have major political economic consequences. They influence the organization of communities and nations and frequently upset the economic balance leading to social disruption, disorganization and mass relocation. As the 1995 earthquake in Kobe, Japan (6,000 dead; 30,000 injured; 300,000 homeless) as well as Hurricane Andrew (49 dead; 200,000 homeless) in the United States illustrated, even industrialized countries with extensive disaster preparation are not immune.

In addition to natural disasters, human-made calamities increasingly cause devastation.  Industrial accidents such as Chernobyl and Bhopal demonstrated the terrible consequences of such catastrophes. Transportation accidents - particularly airline crashes - are increasingly of concern. Terrorism also represents a potential source of death and destruction through the use of weapons of mass destruction (nuclear, biological and chemical agents). Tragedies such as these, to name but a few, are major components of the stress of present day life.

Trauma and disasters are often defined as events that would be markedly distressing to almost everyone. These include a serious threat to one's life or physical integrity, serious threat or harm to one's children, spouse or other close relative or friend or seeing another person who has recently been or is being injured or killed as a result of an accident or physical violence. In general , such events are dangerous, overwhelming, and sudden and are marked by extreme or sudden force from an external agent typically causing fear, anxiety, withdrawal, and avoidance. These events include homicides, suicides, serious motor vehicle accidents, robberies, physical or sexual assault, personal injury, property loss or sudden relocation due to fire, tornadoes, hurricanes, or disasters (both natural and man-made), war including terrorism and hostage and prisoner of war events, exposure to mass casualities, chemical and biological warfare, and airplane crashes. All of these events have high intensity, are unexpected, infrequent, and vary in duration form acute to chronic.

Traumas and disasters have substantial acute and long-term effects on individual health, creating physical trauma and illness as well as psychiatric disease. The health effects of disaster and traumatic stress are seen in both psychological and physical health at the cellular, behavioral and community levels.

·        Studies following Three Mile Island have shown increased rates of hypertension among populations most directly exposed to the disaster.

·        Recently, studies have documented acute and long-term changes in immune function as well as changes in brain anatomy.

·        Similarly, recent studies of veterans of combat trauma have highlighted alterations in arousal and changes in physiologic tone following combat experiences.

·        A wide range of psychiatric disturbances have been related to traumatic events, in particular, Posttraumatic Stress Disorder, depression, and alcoholism.

·        The immediate problems of disaster victims include anxiety, depression, anger, guilt , and sleep disturbance.

·        Studies of the Coconut Grove nightclub fire in 1943, the Buffalo Creek Dam Collapse in West Virginia, and the Mount St. Helen's eruption have consistently indicated high rates of psychiatric disturbance following such events.

·        Communities struck by tornadoes show 20 percent of the population suffering from posttraumatic stress disorder following the tornado.

·        Similarly, victims of emergencies involving toxic waste, such as Love Canal, appear to experience high levels of stress with long-term consequences.

·        Studies of combat veterans - individuals exposed to the human made disaster of war - from the Vietnam War, and more recently the Gulf War, show increased rates of Post-traumatic Stress Disorder as well as changes in endocrine function.

Problem

A large proportion of our nation is affected by disasters which are extremely costly as well as traumatic. Weather disasters in the US alone between 1980 and 1997 cost approximately $140 billion. From August 1992 to May 1997, floods, hurricanes and other storms resulted in 911 deaths and over $90 billion in damages/costs. In 1996, the American Red Cross responded to 236 major disasters in 48 states, spending a total of $216 million in assistance. The Red Cross noted that virtually every community across the nation was affected by disaster. For example, during one weekend in April 1996, 70 tornadoes hit 10 Midwestern and southern states. Forest fires destroyed hundreds of home in California, New Mexico, Arizona, and Alaska.  And there was widespread flooding in the eastern U.S. due to a rapid spring meltdown of snow. There were also two major aviation disaster in 1996: the ValuJet and TWA Flight 800 crashes. It is estimated that in the year 2000 over 1700 deaths will occur in the United States due to major disasters and property and income loss will total more than $17 billion. These events impact hundreds and thousands of relatives, friends, and witnesses.

Particular areas of the country and particular populations - police, firemen, rescue operators, military personnel, as well as international travelers, high ranking members of private corporations, the federal government, and members of the State Department are at increased risk of disasters or traumatic events. Norris (1988) has highlighted the fact that even low prevalence traumatic events translate to large numbers of individuals when there is a large population at risk. It has been estimated that 6.8 percent of the population is exposed annually to traumatic events (Norris, 1988). Although this frequency indicates these are rare events, it must be noted that in the American population alone this amounts to nearly 17 million people exposed annually to trauma and disaster.

As one gets older, the probability that one would have experienced a trauma or disaster increases. In one community in Kentucky, 39 percent of the elderly have survived a natural disaster; 13 percent have been in a serious motor vehicle accident, 12 percent have been in a fire, and six percent have been physically assaulted.  In addition, 15 percent report some other terrifying experience during their lives (Norris, 1988).

The effects of traumatic stress on individuals, organizations, communities, and nations are of substantial and increasing concern in the present world climate. Terrorism, hostage events, disasters such as the Kobe Earthquake, the Oklahoma City Bombing, the poison gas attack on the Tokyo subway as well as more common traumatic events such as motor vehicle accidents, hurricanes, tornadoes, and physical assaults are a health risk to a large number of our population. In addition, these events carry national and international health and policy implications. The monetary cost of such events to health as well as productivity and international affairs is enormous. Because of the large number of individuals at risk for traumatic stress and the frequent national and international implications of these events, resources to better understand the health effects of traumatic stress on individuals, organizations, and communities and to provide consultation to private organizations and the Federal Government on policies related to traumatic stress are needed.

The health implications of traumatic stress are a focused interest following each trauma or disaster but tend to be lost from institutional memory because of the lack of an organized center for the maintenance and development this knowledge.

For further information about this website please email jstecklein@usuhs.mil.

Telephone: 301-295-2470

Center for the Study of Traumatic Stress
Henry M. Jackson Foundation for the Advancement of Military Medicine
1401 Rockville Pike, Suite 600
Rockville, Maryland 20842
Telephone: 301-319-6965

The Center is a new public-private partnership working to increase knowledge of the consequences of trauma and disaster and to apply this knowledge to helping people cope with traumatic events.  The Center provides education, consultation and training to our nation and its communities on the effects of trauma and disaster and individual and organizational recovery following these events while maintaining a wide-ranging, vigorous research program to extend our knowledge of the consequences of event-related stress.

The Uniformed Services University of the Health Sciences (USUHS) is one of, if not the, leading scholarly institution providing consultation nationally and internationally to private and government organizations in times of disasters and critical incidents. It is a national resource well situated to meet the needs of the nation in the area of traumatic stress. The Center has the resources to better understand the effects of trauma and disasters on individuals and communities and to provide consultation to private and federal agencies on health policies related to traumatic stress. A group of scientists, educators, and collaborators at the Uniformed Services University, F. Edward Hebert School of Medicine has established the Center for the Study of Traumatic Stress.  The Center provides an integrative and comprehensive approach to understanding the biomedical, psychosocial and public policy effects of trauma and disaster on individuals and communities.  Uniquely positioned for this endeavor, the Center scientists examine the full spectrum of trauma response ranging from the micro to the macro, from the impact of trauma on cells through the effects of policy on community recovery.

The Functions of the Center are as follows:

1.         Develops and carries out research programs to further extend our knowledge of the medical/psychiatric consequences of trauma and disaster.

2.         Educates and informs public and private agencies in order to prevent or mitigate negative consequences of disaster.

3.         Provides consultation to private and government agencies on:  the effects of trauma and disaster health policies related to the medical care of traumatic stress victims, their families and communities, and individual and organization recovery following traumatic events.

4.         Maintains an archive of medical literature on the health consequences of traumatic stress and traumatic events for individuals, families, organizations, communities, and nations.

5.         Provides opportunities for post-doctoral training of medical scientists to develop research skills in order to better understand the health consequences of the stress of trauma and disasters.

 

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