Post Disaster Psychological Impact Among Health Care Workers Following Easter Sunday Bomb Blast Attack 2019 And The Adequacy Of The Psychological First Aid Support For Them At National Hospital Of Sri Lanka And District Hospital Negombo-Dr. Ayesha Dimali Samankula

ABSTRACT

Among the manmade disasters, terrorism and bomb blast attacks play a major role in destroying human beings and causing Post Traumatic Stress Disorder (PTSD). Certain socio-demographic factors, occupational factors, and certain disaster characteristics are strongly related to psychological distress among disaster victims and responders. Protective factors of reducing risk of developing Post-Disaster Psychological Impact (PDPI) following exposure to the disaster incidents include good pre-event mental fitness and health, disaster preparedness training and providing Psychological First Aid (PFA) support which is suggested in international treatment guidelines for PTSD and as an early intervention for disaster responders such as Health Care Workers (HCW).

This study was aimed to study at the devastating incident that happened in Sri Lanka on the Easter Sunday 2019 with the series of bombing attacks, ended up in 259 deaths including 45 foreigners and 500 casualties who drained to four major hospitals and there, HCW underwent psychological stress inevitably. The general objective of this study was to assess the Post-Disaster Psychological Impact and Psychological First Aid support among HCW in National Hospital of Sri Lanka (NHSL) and District General Hospital (DGH) Negombo following Easter attack 2019 and further described the associated risk factors among them. 

Methodology-The descriptive cross-sectional study design adopted and the study population were taken by a convenient sampling method. Sample size (n= 395) was included three major professional categories (doctors -n= 84, nurses -n =157, health care assistants -n=154) Data collected by validated General Health Questionnaire (GHQ)–12 direct questions included, self-administered questionnaire was given and the qualitative aspects of the responders were covered by focused group discussions, key informants and direct observations. PDPI was assessed by the GHQ score and analyzed by (21.0 version) IBM SPSS statistics.

Results- 44.8% of total HCW were psychologically affected. DGH Negombo (38.6%) was less affected than NHSL (51%) which was significant (p=0.013, χ2-6.171, df=1). Nurses (51.6%) were mostly affected and doctors (28.6%) were least affected. It was highly significant (p= 0.002, chi-square- 12.112, df- 2). The population was mostly below 40 years and there was a female predominance. Female HCW (72%) were affected than males which was highly significant. (p= 0.002, chi-square- 9.256, df- 1). All the working units were equally affected except Accident & Emergency (A&E) and those who were immediately exposed were most affected. PFA concept was not known, not provided and not trained to HCW adequately in Sri Lanka and HCW are in a need of PFA support and appropriate training. 

Discussion- The study population were represented and generalized to the incident. The GHQ score was a good tool to assess PDPI level. It scored accurately and estimated an individual’s current psychological state in relation to the criterion. The PDPI association following the incident among two institutes may be due to young population in NHSL. Doctors affected least among the professional category. It may be due to higher medical knowledge and coping skills than other categories which were found in this study.  Female gender was more affected which reproduced the same results as in other researches. It may be due to the care level, cultural aspects in Sri Lanka, seeing traumatized dimorphic body parts, dead bodies, mainly of children. And the incident was highly emotional and sensitive to them than men. First contact units were affected more. It may be due to the high demand and supply mismatch and without prior notice too. Patient receiving units were affected more. Hence, to minimize these psychological effects the PFA is needed. However it was not addressed in this incident for the HCW as careers.  The PFA knowledge was low among HCW and they are in a real need of PFA.

Conclusion and Recommendation- HCW had PDPI following the incident and there were lots of associated factors for developing PDPI. The GHQ score was a good tool and applicable to generate the real associations among risk factors and PDPI assessment. There is a need to revisit the A&E policy, guidelines, protocols and disaster plans and re-orient according to the system, institutes and resource allocation. PFA support assessment, development of newer protocols and guidelines in health sector are needed for A&E care level. This will be an opportunity to bring the Sri Lankan A&E health care level to adequate and appropriate level. In addition to that, not only the social, economic and property damage, but the psychological damage which occurs following a trauma or disaster is needed to be addressed.

Key words- PDPI, HCW, PTSD, PFA, GHQ