Demand for the development of up-to-date social psychological organizations as a part of Disastrous and Emergency Aid medicine

To 5th anniversary of the Regional Branch of Disastrous medicine

A general aim of this report is a substantiation of needs in social and psychological advise services organization and promotion for the people suffered from disasters by the Regional Center of Disastrous and Emergency Aid medicine, also, a description of methods and approaches available for problem solving.

Demand for the professional organization of medical and sociological assistance in a structure of rescue services is convinced with the following.

1. Appropriate contracting and further scheduled development of psychological diseases of persons suffered from disasters.
2. Stress character of work of emergency workers constantly distressed by extreme factors and overstraining their adaptive psycho-physiological conditions.
3. Rescuers’ efficiency depends on their psycho- physiological stability against loads and their ability to act efficiently in emergency situations.
4. Wide spreading among The Urals’ population the people with post- traumatic stress diseases (PTSD) and therefore, predisposed to an inadequate behaviour in crisis.

This thesis illustrates figures from Conclusion of the Yekaterinburg’s Regional Health Care Branch’s Board " State and prospects for development of the regional psycho- therapeutic service" (Protocol N 5 dated 01/07/98): "Morbidity of frontier mental pathology has grown up in 2.5 times for last two years at accounts of diseases in etiology and pathogenesis in which psychic and stress factors feature the key role…" In 1996 the number of suicides in the region accounted to 51 cases per population of 100’000. While, the level of 20 suicides per 100’000 is considered as a critical."

These facts do not only arise an importance of the social and psychological work among the people distressed by accidents but also, that is the most urgent thing, presents high requirements to a selection of staff in emergency and rescue services, their occupational psychological training before operations and an adequate surveillance after.

Apparently, a dynamics of psycho- physiological state of the people distressed by extreme factors passes in the natural consecutive order (M. M. Reshetnikov and co- authors, 1994):

• Phase1: vital reactions last for 5-15 minutes; at that moment a consciousness is narrowed; behaviour is bent up to self- preservation instincts;
• Phase 2. For the next 2-5 hours, the period of "extra- mobilization" lasts on a breaking point of physical efforts and mental faculties; speed of reaction on irritants increases;
• Phase 3. The period of "psycho- physiological demobilization" develops after the second phase and lasts for up to three days and expresses in sharp mental and physical efficiency decreasing;
• Phase 4. The "distant after- effects" emerges after the previous phases and could last for indefinitely long time.

The first three phases are characterized with affective and shock reactions, last under supervision of specialists, and normally the distressed get emergency aid. The fourth phase is a phase of "distant after- effects", often it passes beyond the surveillance by experts; lasts in forms of diverse neurotic diseases, phobias, disturbance of adaptive response ; and mostly, the patient finds himself alone faced to emerged problems, often non- understanding what happens to one and how to appeal for supporting. That is the fact, that during industrial disasters there is so-called "collective trauma" (S.N.Yenikonov) there, destroying settled ties uniting the people together. While, loss of the feeling of community or an emerging threat of the loss arouses the changes of " picture of the world" and it results in a sense of lost ego.

As the result, the people implicated and suffered from a collective trauma feel apathy, demoralization and cut themselves off the others even more than one year after. It is not uncommon, that the rescuers and liquidators oriented to being in a good body ignore the initial symptoms of a psycho- somatic fatigue and put on extra loads, that leads to reducing of their professionalism and arouses serious mental disturbances in future.

Considering the mentioned, it cannot be unsaid, that for last years, a great attention is attracted to organization of personal mental health monitoring systems for the people working with aggressive technologies and within dangerous occupational conditions. In details, this matter is dealt with in the "Regulations on the organization of medical examinations and psycho- physiological observations of employees at nuclear plants", it is agreed and stated in 1998 by the Administrative Department of medic- biological and emergency problems of the Ministry of Health Care of RF. This regulation is tailored in accordance with the Order of the Ministry of Health Care and medical industry of RF dated 14/03/96, N 90 "About an order of preliminary medical examinations for employees and medical regulations for the occupational access- control ", it stipulates several forms of relationships between psychologists and employees within dangerous sectors, incl.: psycho- physiological occupational selection, psychological testing, preliminary and periodical psycho- physiological observation, before-the-shift medical testing with psycho- physiological control, psychological personnel training before operation, staff supporting during operation in extreme conditions, psycho- physiological provision with necessary level of employees’ psycho- somatic health, psychological rehabilitation, i.e. recovery of important occupational individual properties of employees up to a normal level, and at last, psycho- physiological expertise of efficiency.

It is important, that this document provides an individual approach to an employee: via medical examination and psycho- physiological testing data. Normative group, risk group and reserve group are marked out, within these occupational loads and rehabilitation schemes differ depending on the testing results.

On our opinion, the presented approach to a selection and rehabilitation is important not only for employees within from nuclear industries but for many other sectors with risky and dangerous occupational terms and emergency services. Already now various social programmes linked with a staff selection for work in extreme conditions and a rehabilitation of people suffered from crisis, are to be promoted.

We consider this important to pay a particular attention for two matters. For successful undertaking these social programmes, are necessary:

• Flexible monitoring of occupationally important personal properties and
• Choice of adequate individual rehabilitation schemes.

Here are suggestions of using express- diagnostics computer technologies for testing a person’s psycho- physiological state for preliminary professional staff selection on risky occupational positions for further monitoring of their important professional personal features, also, for scheduled before- the- shift access- controlling.

For the comprehensive staff selection, it is very important to know the occupational requirements to potential employees in view of their physical and mental health. Such kind of the requirement is called " a professiogram".

Dealing with a professiogram, a personnel selection could be conducted in compliance with the requirements of employees’ psycho- physiological indications by quantity and by quality, reckoned up by psychological tests, anamnestic data selection and clinical researches.

Usually, the number of such researches is too large, and often it takes the long time for performance. Certainly, these researches are useful for drawing up an algorithm of professional staff recruitment and to verify the depth and breadth of information and analysis of every observation corresponding to its professiogram.

Including the express- diagnostic examination of employees’ psycho- physiological state into the chain of a preliminary professional personnel selection, it allows to get the complete picture of a patient’ s clinical health fast, and compare it with clinical and traditional psychological tests, estimate the level of tenseness of a potential employee’s adaptive abilities by quantity, also correspond the said parameters with psycho- physiological requirements of a professiogram.

Storage of acquired information in computer database ensures to create the individual database for an employee, including one’s mental and physical features that necessary for successful performance of occupational requirements. Further, it is possible flexibly to determine any inclination from available parameters by express- diagnostics methods with automated data analysis while performances of risky tasks, and to compare these with the previous individual monitoring data, as well as the analyzed "pattern" professiogram and group data in a general database for the professional staff selection.

Today, it is available to carry out the said features of computer technologies via "Integral system of automated work place (AWP) for a physician "ROFES". "ROFES" contains a person’s organism condition express- diagnostic methods on a base of galvanopuncture diagnostics, psychological tests variously oriented and database for storing, displaying and research data processing with automated expert evaluations.

Automated expert evaluations include the following integral characteristics based on the results of measuring bio- resonance and electrochemical properties of biologically active points of a human’s organism.

Vegeto- emotional tonus is a psychological parameter displaying the needs of a subject in energy supply and demand. High vegeto- emotional tonus means the needs in energy supply. Corresponds to choleric and sanguine subjects (extraverts) as a norm. It is characteristic for introverts – melancholic and phlegmatic – in case of disturbing their balance. Low vegeto- emotional tonus means the energy demand. Corresponds to melancholic and phlegmatic subjects – introverts – as a norm, to choleric and sanguine persons – extraverts- as an indication of overload and exhaustion.

A person’s functional condition is a sum of medical (clinical) organism condition components and its psycho- emotional background, i.e. the evaluation of the functional state, efficiency of homeostasis conservation and organism’s dynamic balance are characterized as an equilibrium between the biotic system and changing environmental terms.

There are five criterions of estimation: fine, good, satisfactory, unsatisfactory, rehabilitation is demanded.

Adaptive potential is an integral characteristics of a personal condition displaying its changes in response on actions of environmental stress factors and forming medical and psychological aspects of a personality. It is an indication of level of a person’s state harmoniousness as a balance one’s inner components – physiological and psychological statuses – and its reactions on environmental irritations. How lower an index of the adaptive potential then a person’s deepest personal structures are more dis-coordinated.

Psycho- emotional tonus is a psychological characteristics evaluating the level of emotional tension of an organism compensatory power.

In case of inclination of these values from ones available in database acquired in a preliminary professional selection, it is variable to access that person for undertaking one’s occupational duties. (See figures).

Available psycho- physiological condition express- diagnostic method as a tool for the professional selection has a precious advantage more that is particularly important in terms of the industrious waste pollution of the environment. In our previous researche it is shown, that "ROFES- diagnostics" can discover and differentiate psycho- physiological inclinations in human organism functioning caused by two reasons: a/ ecologically unfavourable place of residence, b/ subjectively perceived fear and anxiety.

Average rofograms of tested groups: Chernobyl’s –1 Afghans –2 High voltage power engineering specialists– 3

Rofograms dealt with below illustrate symptoms of stress- syndrome on a background of different unfavourable environmental factors in ecological and social aspects: participation in radiation accidents liquidation, in local war operations, living within a territory that is non- ferrous metallurgy waste polluted, etc.

Modules of this computer express- diagnostic system are used in the Russian Federal nuclear centre – The All- Russian scientific and research Institute of technical physics /Snezhinsk/ and at Beloyarsk’s Nuclear power plant /Yekaterinburg/ for psycho- physiological state diagnostics in professional staff selection, examination results monitoring and access controlling. There are galvanopuncture diagnostic "ROFES"’ tools used there / Certificate of conformity N POCC RU.ME27.B03460 Russian standard/.

Adduced data indicate that the algorithm of a human’s psycho- physiological condition changes mainly depends on a type and a character of an extreme factor distressing him. However, apparently, that distress by crisis situations is not depersonalized: as a light ray throughout a prism, its refract through personal responsibilities, motivations and basic human values of personalities, exciting different people being within the same conditions of different pathologic effects by its heaviness and appearance.

This is the core feature why the next issue of this report is dealt with an individual optimizing psycho- somatic rehabilitation for persons of risky professions.

Today, in European countries and USA, there are rich expertise on rehabilitation work with participants of local conflicts, rescuers, victims and others suffered from disasters. This experience is not limited only by medical service, but it harmoniously includes psychological and psycho- physiological surveillance. While, a schedule of the occupational selection and rehabilitation programmes is carried out considering an emergency worker’s personal mental state, namely: one’s aggressiveness (spontaneous and reactive), depression, sensitiveness, adequate self- awareness, perception of the surroundings, conformity, neurotic state, self- confidence and many other features.

There is the program based on defining the social adaptation types and schemes of further working with them developed. During personnel selection via psycho-physic testing, could be revealed strengths and weaknesses of a person’s psychic, and what is the most important, it is available to determine the periods when such features can emerge in maximum height promoting or preventing from performing the duties by rescuers.

Deeper research of personal psycho- physical states for initial selection using adequate tailored methods allows administrators of disastrous medicine organizations to range the personnel by their individual predisposition to undertaking some tasks or others. The psycho- physic research enables to define the following.

1/ stability of nervous system against loads (physic, mental, emotional). This knowledge is necessary for appraisal of a person’s successiveness under long- term loads of certain mode not losing one’s dynamic abilities in extreme situation.

2/ degree of rescuer’s diathesis to nervous disease, i.e. to estimate a level of sensitiveness, neurotic state and stability of mental condition, because the ratio namely of these features reflects a person’s unfitness for working in extreme and the possibility of panics and inadequate behaviour responses preventive from undertaking one’s occupational responsibilities and dangerous for the others.

3/ level of spontaneity in decision making, i.e. an ability to act unordinary. If the level of spontaneity is too high, there will be the risk that in a certain moment a rescuer could violate instructions what is fraught with consequences for victims. In case, if the level is too low, a rescuer will be not resolute enough to make unordinary and paradox decisions, when it is necessary, but strongly keep instructions that could result in a negative situation for victims, too.

4/ a level of initiative, i.e. independence in decision making. Often rescuers are forced to work without agreements with administrators and communication with the emergency aid headquarter, so, they have to be initiative enough for successful complication of the task.

On the base of defined social adaptive types, a situation can be forecasted when a certain person will lose one’s psycho- physiological balance and it is available to prognosticate how this disturbance would be expressed, also to predict how adequately a person of some social adaptive type or other will respond on one’s return to a peaceful life after disaster, and how successful one will be in adoption in a new reality. Therefore, the spade preventive work with the staff could be undertaken by means of emergency situational training modeling. This sphere provides large prospects for diagnostics and further psychological socialization / adaptation in a social life/ of people suffered from disasters. Conducting of psycho- rehabilitation work with counting the personal social adaptive types allows efficiently to correct psychic inclinations and restore steady mental state of a person. It is necessary for the safety of a person oneself as well as one’s associates.

The issues on active rehabilitation are of a considerable content not only by attitudes to victims of disasters and professional rescuers directly liquidating consequences of accidents. Problems of rehabilitation of the people making decisions are topical for the Disastrous and Emergency Aid medicine. Apparently, at present this category of employees independently on the environmental terms are being in the stress because of their occupational activity and in every- day life (1), not saying also about their work in emergency conditions. Namely such group might be referent, since the results of surveying them would be a basis during the work with other contingents acting in terms of intensive loads, lack of time and information for making right managerial decisions.

Here in certain value, various " scenario- and- group models of some teams and all the staff’ activities" help to low down the level of occupational stresses.

However, these methods demand for high- capacity computer facilities and informative support, and these are not always flexible and optimum enough, if it concerns a certain person’s psycho- physiological health rehabilitation. Considering a human as an open self- organizing system consisting of non-ideal elements, Mr. Tscheurin, one of the authors of this report, suggests to apply a specific algorithm of additional positive stress action starting up the personal sanogenetic mechanisms of the distressed oneself for increasing one’s rehabilitation efficiency for persons suffering from post- trauma stress diseases. This authorized methods is certified by educational bodies as a method of development of ecological thinking, it uses the successful experience of "Outworld bound"’ School /USA/ initiated to Vietnam war’ veterans rehabilitation, and is oriented on the principal of active humanity ecological recovery.

Since 1997 doctors and rescuers of the Centre of Disastrous and Emergency Aid Medicine /Yekaterinburg/ use the elements of this methods in the work. "Russian" methods of therapeutic tours comparing with American analogue is added with training courses on conflictology, new knowledge generating, self- improvement and creativeness; and, what is the most important thing, it is built up considering the features of adaptive processes and specific psycho- physiological reactivity of The Urals’ habitants.

A major feature of post- trauma stress diseases is its rigidity to a traditional therapy, low efficiency of an ambulatory physiotherapy, high number of meteo-reactions and disturbances in adaptation to climate changes during travelling to health-resort places; notable shortage (in 2-3 times comparing with a control) of remission duration after successful recovering in sanatoria. Obviously, widely spread in balneology the "passive" recovery course becomes inefficient: it doesn’t consider psychological conditions of patients, their personal reactivity, low compensatory- adaptive abilities, also their needs in repeated rehabilitation courses.

Evaluated by objective research methods, the efficiency of single recovery in the health- resort treated in a "passive" schedule by a patient’s side, accounts to approx. 65-75%.

Up-to-date rehabilitation methods radically change the structure of recovery process and enable to increase an efficiency of health- resorts cure up to 95-97%. These methods are notable with its active humanity ecological orientation. It is directed on a patient’s deliberate active participation in rehabilitation and health care processes, provides the normalization of one’s regulatory and, first of all, psycho- physiological adaptive mechanisms, improves a person’s ability to make free choice and take a responsibility for decision making.

The expertise already accumulated by The Urals’ balneologists on arrangement of individual stress- rehabilitation programmes is significant. These programmes flexibly include a variety of cure courses in different forms by duration, schedule and place, namely: 1/ adaptive, flexible by duration the recovery courses depending on needs of patients in local health- resorts and sanatoria (for 14, 7 or 3 days); 2/ special therapeutic tours within weak-stressed terms accompanied by an instructor in tourism and a psychologist, that in the best way enables to reduce a patient’s personal anxiety and aggression and to improve his compensatory- adaptive abilities; 3/ regular courses of home physio- balneo - therapy including up-to-date methods of aroma- balneo- therapy, actively affecting on a patient’s emotional state, their regulatory mechanisms ensuring normalization of skin and trans- membrane penetrability.

Modern conversion computer diagnostic and acupuncture physiotherapy methods acting on the principals of biotic feedback considerably increase the efficiency of psycho- physiological rehabilitation of people distressed by crisis.

Landscape scenes and geo- magnetic conditions of The Urals unique nature are magnificent for an arrangement of successful psycho- physiological training courses and further rehabilitation.

Today’s large- scale reforms in the health- resort treatment in Russia provide the adoption and development of new forms of psycho- physiological training, supporting and rehabilitation of rescuers. Apparently, to execution of the direction of President of RF dated 20/10/94 the decision stipulating the State Committee of physical culture and tourism (SCFCT) of RF as Federal executive body undertaking a governmental administration and realizing the state policy in health- resorting have been accepted

At present, this Committee jointly with the Ministry of Health Care and the Ministry of Education promotes the concept of health- resort business, the standards on health- resorting.

We consider it useful if the experience of Disastrous and Emergency Aid medicine on rehabilitation of the people distressed by emergencies will find due consideration in the standards.

Bibliography

1. G.V.Kipor "Psycho-physiologic problems of persons making decisions// Disastrous medicine.-1998 N 3-4 (23-24)- p.49-53
2. G.V.Thalalaeva, V.N.Zharikov, P.I.Jushkov "To the problem of bio-social typology of people suffered from psycho- ecological stress./ Materials from 2^nd International Conference " Distant medical consequences of Chernobyl’s disaster"- Kiev-1998-p.68-69
3. GVThalalaeva, A.I.Kornjukhin, I.G.Lavrik "Express- diagnostics of syndrome of dis-adaptation by "ROFES- diagnostics" method. Methodical recommendations – Yekaterinburg-1998-29 pages.
4. GV Thalalaeva, AI Kornjukhin, GS Thcheurin. Modern approaches to diagnostics and rehabilitation of the ecologically depended diseases. / Thesis of 1^st Russian scientific – practice conference "Topical problems of medical ecology"- Orel-1998-p.5-6.
5. GS Tscheurin "A human and the environment. Problems in forming the ecological thinking" – Bulletin of the Urals Ecological Found –1998- N3 (35).