Terrorism is a relatively new stressor for Americans. Certainly we
were fearful of “the bomb” during the Cold War; fall-out shelters
were constructed or identified all over the country. But the prevailing
thinking at that time was that governments (that is, the former Soviet
Union) would not use an atomic bomb because it would unleash a destructive
cascade that was more horrific than any government would want or could
manage. The goal of nuclear threat in the 1950s and 1960s was that it
made everyone pay attention to those with the power; the mere threat of
nuclear warfare was a deterrent. That was also a time when our enemies
were generally other governments.
The enemies of the United States are now often not countries at all,
but groups with political, social, religious or ideological perspectives
that include destruction of the US government. These enemies are both
foreign and domestic.
For some time now terrorists have aimed at American targets. Americans
and American interests have been terrorist targets overseas: the 1988
bomb explosion on Pan Am Flight 103 over Lockerbie, Scotland by Libyan
terrorists; the bombing of the military barracks at Khobar Towers in 1996;
the bombings of two United States embassies in Kenya and Tanzania in 1998,
and the 2000 attack on the USS Cole, all alleged to be the work of Osama
bin Laden and Al-Qaeda.
We’ve also had terrorism on our own land. We’ve had domestic
terrorism, for example the Unabomber, Ted Kaczynski, who mailed letter
bombs across the US for over 20 years and Timothy McVeigh and Terry Nichols,
convicted, and in the case of Timothy McVeigh, executed, because of their
bombing of the Alfred P. Murrah Federal Building in Oklahoma City in 1995.
For decades we’ve experienced the domestic terrorism associated
with attacks on abortion clinics and those healthcare providers who provide
abortion-related services to women. We’ve experienced the World
Trade Center bombing in 1993 and the terrible terrorist attacks of September
11, 2001 in New York City, Washington, D.C. and rural Pennsylvania. We’ve
also experienced terrorism in which the source has never been identified:
the anthrax attacks in September-November, 2001. Clearly our current threats
come not so much from enemy governments, but rather from groups with ideological,
religious, economic and political missions.
Among the primary goals of terrorism is the emotional and psychological
distress that accompanies the dissemination of fear. Terrorists inflict
destruction and despair because they want others to see the devastation
and be fearful. The more gruesome the attack, the longer will we remember.
Terrorists want the possibility that they will strike to be as causing
of chaos as an actual attack. Experience with past events indicates that
there may be from 4 to 20 psychological victims for every
physical victim in a mass casualty situation (Myers, 2001).
Clearly, the threat of terrorism is destructive; however an actual attack
causes significantly greater distress in the population. Disturbances
of behavior, affect, and cognition can result directly from the destructive
actions of some radiological, chemical and biological weapons. But apart
from the specific action of these agents, any incident of terrorism, as
well as the threat of terrorism can contribute to disturbances of behavior,
affect and cognition. Some of these disturbances will occur acutely and
will be brief, others will develop into disorders. Some of these disorders
will be treated relatively easily and will resolve, others will have a
prolonged effect and will be chronic in nature. Some will have a delay
in onset (DiGiovanni, 1999). Effective therapeutic intervention in all
these psychological effects of terrorism, both real and threatened, involves
a broad range of clinical, social, and administrative actions (DiGiovanni,
1999).
This course will address the various psychological and behavioral human
responses to the threat of terrorism and the likely human reactions in
the event of another terrorist attack. Therapeutic interventions to mitigate
these responses and assist in returning survivors to baseline will also
be covered.
As frontline healthcare providers, nurses need to be aware of the various
responses that their patients, as well as their colleagues and what they
themselves are likely to experience. It is important to be aware of and
to prepare for this possibility as these human reactions can either hinder
or help the outcomes of such an attack (DiGiovanni, 2003).
This course was funded by the New York State Department of Health,
Emergency Preparedness Grant.
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