Lecture №6

Extreme situations and disaster area

Medical help to children in catastrophes.

The plan of lecture

1. Behavior of the people in ES and disaster area.

2. Peculiarities of organisation of the medical help to children.

1. Behavior of the people in es and disaster area.

The extreme situations caused by natural accidents, result not only in various infringements of vital functions of human organism, but also in mental frustration. Significant destruction, the amount of the dead and wounded, having been buried in the destroyed buildings, absence of the information about a general state of businesses and about their relatives, complete stopping of the electric power, water, disadaptive behavior of injured and other factors very strongly injure the man’s mentality.

Psychopathological frustrations in extreme situations have much in common with clinic of mental infringements developing in "usual" conditions. However there are also essential distinctions. Owing to multiple suddenly working psychotraumatic factors the mental infringements arise simultaneously at large number of the people. The clinical picture in these cases does not carry strictly individual character, and is reduced to small number of rather typical displays. Despite of occurrence of psychogenous frustrations, the man is compelled to continue struggle with consequences of acts of nature and accidents, struggle for the life and life of his relatives.

The mental infringements at many victims are combined with traumas and disorders of the functions of the inner organs.

It is possible to allocate, as a rule, three periods of development of a situation, in which are observed various psychogenous infringements.

The first is the acute period - (the phase of isolation) and it is characterized by suddenly arisen threat for own life and life of the relatives people. It proceeds from a beginning of affect till the organization of rescue works (for minutes, hours). The extreme situation in this period involves mainly the vital instincts (self-preservation) and results in development of unspecific extrapersonal psychogenous reactions, which basis makes the fear of various intensity. Here psychogenous reactions are mainly observed.

In all participants of an extreme situation the mechanisms of psychological protection are switched on. That is displayed in various types of reaction. The way of reaction is based on the previous experience of overcoming of difficult vital situations. At the first hour and the day after accident at the people, including the casualties, arise the following conditions:

The excitation manifested by increased alertness and sensitivity, anxiety developing into fear, horror and panic condition;

State of depression externally manifested by reduction of intellectual and motor activity, estrangement, at some people - stupor;

Transient states of confusion, surprise, bewilderment, hysterics.

Is established, that in conditions of fatal danger, even in last moments before destruction, the part of the people does not experience fear and horror. It is more characteristic of the people engaged in performance of the official duties. So, on the data of D. A. Johnson (1989), about 70 % of the persons with psychoemotional frustrations observed infringements of consciousness as the depersonalization syndrome (alienation from themselves, loss of individuality). Such condition arises at the moment of understanding of fatal danger and disappears, as soon as the threat to life ends(brightly is displayed during the first jump with a parachute, emergency on the automobile or other transport, etc). It is displayed in a strong flow of feelings, sensations, ideas. The feelings and sensations can be mutually incompatible, and thoughts "work" in two various levels of consciousness: at the one level of consciousness the injured tries to estimate and to take possession of a critical situation, and on the another one (he is as if split), observes himself and failure as though from aside - the accident has happened not to him, but to someone else. At this time one may notice the prolongation of time and a line of past events flies by in his mind. Feeling doomed, they are in a condition of complete rest and pacification. depersonalization, as well as fear, horror are very much widespread among severely injured people.

During earthquakes and at the first day after it at 90 % of injured the expressed reactive mental frustration is marked. The shortest on duration are sharply arisen reactions such as stupor and sub-stupor conditions proceeding from several seconds till several minutes. The peculiar state of "mental anesthesia" is displayed longer. It is characterized by sharp decrease of an acuteness of visual and acoustical sensations. Quite often, especially at the persons of young age, in this period are found short-term affective states of narrowing of consciousnesses shown by strong impellent excitation, loud shouts, sobbing, crying, wrining of hands, sometimes swearing. At some is observed the peculiar pseudostuporous condition accompanied with extreme reticence. In some cases the perception of time seems disturbed, it becomes prolonged.

One person or a group of people may be gripped by panic as the extreme state of tension. It is displayed by irrepressible, uncontrollable desire to avoid danger. Reason gives way to instinct. The condition of a panic can be transferred to other people, and may get "epidemic" features. The panic arises usually at a lack of the information about a situation and possible character of behaviour in it. A panic trigger (and one of its attributes) is the desire to leave a dangerous site faster. Some people owing to a panic have a condition close to emotional shock: feeling of doom and hopelessness.

In a number of cases the consequences of a panic can be much heavier, than consequences of the disaster. For example, at rendering assistance to a small size vessel the panic-stricken crew and the passengers, rushed on one board, can cause its overturning, though there is no obvious inevitability of its sinking.

For prevention of a panic the following should be done:

- preparation of all categories of the persons for action in an extreme situation, formation of psychological stability to emotional and physiological overloads at the people;

- duly and authentic information on conditions of failure;

- high level of professional training;

- Liquidation of a panic:

- personal example of the leader, his precise and competent commands, presence of mind

-to distract attention of the people from a source of fear

- support of the people who preserved the ability to control their actions

- division of the people covered by a panic into small groups

- to encourage and ensure casualties that they won’t be left in trouble and will be give n help.

In the second period proceeding at expansion of saving works, on figurative expression, the normal life in extreme conditions " begins ". At this time in formation of a condition of mental desadaptation and psychogenous frustration the large importance have the features of the injured person, his awareness of the situation dangerous to his life. New stress situations arise connected to loss or death of near relatives, separation of family, loss of a dwelling, property etc. The important element of prolonged stress in this period is the expectation of repeated influences, discrepancy of expectations with results of saving works, necessity of identification of the lost relatives. Psychoemotional tension, characteristic of the beginning of second period, is replaced with its end, as a rule, with increased tiredness and "demobilization" with astenico-depressive manifestations. They look weak-willed, inert and tired, mostly not mobile, not engaged in anything. When the speech comes about the disaster, the expression of the persons becomes sorrowful, there are tears on eyes. There is marked drowsiness in the afternoon and insomnia at night. Motor and voluntary activity is minimal. They may sit in a tent for a long time without changing body’s position, almost without responding to the surroundings (in their own words they have to do everything by overcoming themselves).

The special place is occupied by mental frustration of the persons who have received traumas and wounds. In such cases the qualified diagnostic analysis on revealing the cause and effect connections of mental infringements directly with psychogenies, and with the received damages (craniocerebral trauma, intoxication owing to burns etc.) is required.

The third period beginning after the evacuation of casualties to the safe areas is characterized by complex emotional and cognitive processing of a situation, estimation of one’s own experiences and sensations, original "calculation" of losses. Psychogenic traumatizing factors due to changes of life stereotype, residence in the destroyed area or in a place of evacuation become actual. Becoming chronic, the specified factors promote formation of rather stable psychogenous frustration. In the given cases there we observe the "somatization" of many neurotic conditions "neurotization" and "psychopatization", connected to awareness of severity and consequences of traumatic damages and somatic diseases. At the majority of victims received this or that mechanical damages there are marked psychogenous reactions of a different degree of severity reflecting a level and a condition of mental desadaptation. Its major parameter is the lack "of degrees of freedom" of adequate and purposeful reaction in conditions of psychotraumatic situation - from the psychologically understandable, in fact protective, physiological reactions up to the expressed pathological condition.

In view of possible development of this or that mental infringements in this period the importance has the presence or absence of visible, sensory felt displays of accident. So, during hurricanes, strong earthquakes and explosions the life-threatening situation is quite specific. It is determined by understanding of inevitability of catastrophic outcome, that derivates unspecific extrapersonal affective-shock reactions, which basis makes the fear of various intensity. Other situation is observed at the absence of external attributes of threat to life and health during failure. Thus psychogenous reactions develop only at comprehension by injured of yet not seen, but already occurred injury. In the first period of failure on Chernobyl NPP acute reactive conditions were marked mainly at those inhabitants of the area close to NPP, which were deprived of the particular information, but had the certain professional knowledge of possibilities of a radiating injury.

In the second period according to changing character of psychogenous states there were defined more various mental disorders, than at the moment of accident and directly after it. And a conducting place was occupied not by affective-shock but adaptive reactions, polymorphic neurotic frustrations (among which phobias prevailed), as well as personality decompensations (especially at presence of hysterical accentuation of character).

The third period is characterized by prevalence of different clinically formed stable marginal forms of mental disorders and psychosomatic disturbances. Thus various neurotic and neurosis-like conditions are developed. During inspection of 300 inhabitants of village areas of Byelorussia living within three years after failure on Chernobyl NPP, there was revealed, that only at 5 % from them psychogenous frustrations were absent.

About 40 % of cases were the atypical ones, so-called posttraumatic stress disturbances (PTSD). In the generalized form they are expressed in the reduction of the initiative acute reactions on the stimuli, connected with the basic injuring factor, change of the relations with an environment, formation of stable ideas of prosecution of those who are accused of what has happened.