Table 1.

How Primary Care Physicians Can Prepare for the Psychosocial Consequences of a CBRN Attack

Response planning (national level)

Leadership to meet with DHS, DHHS, SAMHSA

Leadership to address reimbursement issues

Support legislation

Partner with disaster agencies

Participation in disaster response exercises

Develop guidelines regarding management and referral of patients with DSR, MUPS

Response planning (state/local level)

Meet with local/state bioterrorism coordinators and public mental health

Partner with public health using Bioterrorism and Cooperative Agreement Program funds

Support legislation

Participation in disaster response exercises

Develop guidelines regarding management and referral of patients with DSR, MUPS

Response planning (institutional level)

Develop family, practice, and institution-level disaster plans

Develop psychosocial support plans for staff

Ensure representation in Incident Command Structure

Link information technologies and decision support programs to mental health

Two-way communication systems with behavioral health call centers

Adapt best practices models to local environment (e.g., Operation Solace, Engels, and Katon model)

Develop guidelines regarding management and referral of patients with DSR, MUPS

Research and education

Test triage algorithms, screening tools, brief psychologic interventions

Develop information technologies and decision support programs

Curriculum development (e.g., developing family and practice disaster plans; psychologic impacts of isolation and quarantine; formal skills in risk communication)

Develop guidelines regarding management and referral of patients with DSR, MUPS

CBRN, chemical, biologic, radiologic, or nuclear; DHHS, Department of Health and Human Services; SAMHSA, Substance Abuse and Mental Health Services Administration; DSR, Disaster Somatization Reaction; MUPS, multiple unexplained physical symptoms.