Intersection of Mental Health and Hospital Management for CBRNE Incident Response

By Sally Huang, Biodefense PhD Student

In January 2021, I attended the Hospital Management—Chemical, Biological, Radiological, Nuclear, Explosives (HM-CBRNE) course organized by the United States Army Medical Research Institute of Chemical Defense (USAMRICD), the United States Army Medical Research Institute of Infectious Diseases (USAMRIID), and Armed Forces Radiobiology Research Institute (AFRRI). Seeing how the COVID-19 pandemic has overwhelmed hospitals nationwide, I was interested in learning how healthcare workers and first responders respond to CBRNE scenarios. With the Army offering the course virtually to substitute for what would normally be an in-person course, the HM-CBRNE course was a great opportunity for me to gain a first-hand look at hospital management operations and protocols as well as improve my understanding of CBRNE casualty symptoms. The course covered a variety of topics through informative lectures by subject matter experts, interactive seminar discussions, and a tabletop exercise and it provided a very useful complement to my education in the Biodefense Graduate Program at the Schar School of Policy and Government.

Though it was unfortunate that we could not be in the classroom to interact with the seasoned professionals who served as instructors, their vivid descriptions of various facilities and CBRNE equipment helped us learn how to navigate the frenzied scene at a hospital in the wake of a mass casualty incident. The virtual setting also did not inhibit our ability to communicate with the instructors or cooperate with other students. Setting aside reticent mannerisms that would have been apparent in the classroom, the virtual platform instead allowed us to more freely type or vocally express our opinions and questions. After the first day of acquainting ourselves with the platform and with each other, the following four days consisted of constant dialogue in the chat hub. It was particularly heartening to be part of a cohort who openly shared their personal and professional experiences with the rest of the class to create a more dynamic and memorable learning experience.

As hospital management is not regularly part of mainstream academic curriculum, the opportunity to familiarize myself with hospital protocols was a valuable experience. The course introduced me to essential federal disaster response frameworks, such as the National Incident Management System (NIMS), National Response Framework (NRF), and Occupational Safety and Health Administration (OSHA) best practices that help ensure that CBRNE response and recovery operations are carried out safely and effectively. Without knowing that these protocols exist, one may be forgiven for thinking that federal responses to such events are spur-of-the-moment occurrences. Through the HM-CBRNE course, I learned about the six critical areas vital to guiding interagency coordination for an all-hazards response effort: communication strategies, resources and assets, safety and security, staff responsibilities, utility management, and patient support activities. As important as it is to actively respond, learning the fundamentals in hospital logistics, planning, finances, and operations is equally important in order to optimize mass casualty CBRNE response.

I was especially glad to see the incorporation of mental health in the HM-CBRNE course. While healthcare providers may first scan for physical symptoms to indicate what kind of CBRNE agent is involved, it is equally important to recognize the telltale psychological signs that affect mental and behavioral health, increase mass panic, and cause the “worried-well” phenomenon. There is historical evidence of psychological effects from battlefield experience and, although mental health awareness has increased over recent years, we cannot dismiss the occurrence of psychological impacts during CBRNE events. Scorn and stigma remain highly correlated with mental health conditions, which can negatively impact the way that hospitals receive and treat patients. As a result, the HM-CBRNE course effectively highlighted how considerations of psychological symptoms can be integrated into casualty management to pave the way for more holistic, well-informed medical decisions.

This importance of mental health is particularly relevant as the COVID-19 lockdown and quarantine dominates our daily lives. From overworked and overstressed healthcare workers, individuals whose feelings of isolation compound preexisting mental health issues, and family members who have to simultaneously juggle professional and personal responsibilities, it is clear that the extent of a person’s limits is being tested like never before. Thus, it is important that we continue efforts to improve mental health awareness and actions beyond a case-by-case approach.

The HM-CBRNE course was an informative and distinct experience that any individual interested in mass casualty and CBRNE management would benefit from. The instructors and staff worked diligently to help make a challenging and complex area seem less scary. This week-long course, filled with high-quality lectures and interactive activities, demonstrated the Army’s deep commitment to providing civilian and military participants with functional hospital management knowledge about how to address CBRNE incidents. This was an amazing and instructive experience that provided me with an inside look at how the United States prepares for and responds to unconventional weapons and incidents.

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