Utility of Fear Severity And Triage Management--论文代写范文精选

在2003年严重急性呼吸系统综合症(SARS)疫情,恐惧经常被认为是一种心理上的后果。恐惧本身被称为中央病原体，在早期的流行过程,传播速度比疾病本身更快。在香港,担心SARS爆发被认为是更强大和更广泛的的威胁生命的疾病，SARS流行不过是其中的一个例子。下面的essay代写范文讲述了这一问题。

Abstract 
Threats of bioterrorism and emerging infectious disease pandemics may result in fear-related consequences. If left undetected and untreated, fearbased signs and symptoms, may be extremely debilitating and lead to chronic problems with risk of permanent damage to the brain’s locus coeruleus and stress response circuits. The triage management of susceptible, exposed, and infectious victims seeking care must be sensitive and specific enough to identify individuals with excessive levels of fear in order to address the nuances of fear-based symptoms at the initial point of contact. 

These acute conditions, which include hyper-vigilant fear, are managed best by timely and effective information, rapid evaluation, and possibly medications that uniquely address the locus-coeruleus-driven noradrenalin over-activation. It is recommended that a Fear and Resilience (FR) Checklist be included as an essential triage tool to identify those most at risk. The use of this checklist facilitates an enhanced capacity to respond to limitations brought about by surge capacity requirements. Whereas the utility of such a checklist is evident, predictive validity studies will be required. In addition to identifying individuals who are emotionally, medically, and socially hypo-resilient the FR Checklist simultaneously identifies individuals who are hyper-resilient and can be asked to volunteer, and thus, rapidly expand the surge capacity.

Introduction 
During the 2003 severe acute respiratory syndrome (SARS) pandemic, fear frequently was cited as a psychological consequence.1–9 Fear itself was referred to as a “central pathogen” in the early epidemic process and was believed to be “spreading faster than the disease itself.”10 In Hong Kong, fear about the SARS outbreak was considered “stronger and more widespread” than the fear of any comparable, life-threatening illness.11 The SARS pandemic is but one example of modern day bio-events, which are defined as large-scale disasters secondary to biological agents that are either naturally occurring (e.g., Influenza A, potential H5N1 outbreak) or deliberate in nature (e.g., small pox, inhalational plague, anthrax).

12 Bio-events, like other “silent disasters” (chemical, radiation), provoke uncertainty through fear of exposure to an unseen bio-agent for an indeterminate time with the propensity to cause states of extreme fear/panic, helplessness, and horror within the population. Until recently, fear and its consequences (i.e., potential post-traumatic stress disorder [PTSD]), and their prevention and management options have received little attention or research. Advances in the neurochemistry of fear have provided mental health workers and disaster planners with new opportunities to identify and mitigate the suffering of individuals debilitated by consequences of fear. Whereas such opportunities often are overlooked in the greater scheme of disaster management protocols, the science of fear must be better understood and integrated into victim triage-management at the initial point of contact in any disaster, especially those of a “silent” nature, such as pandemics.

The Fear Response in Disasters: A 2006 Update 
Fear, in contrast to anxiety, is the emotion that occurs when there is a clear and obvious source of danger that would be regarded as real by most people.11,13 Individual fear and population panic involve the activation of the central and peripheral sympathetic nervous system, allowing one to respond quickly when faced with an imminent threat to survival. Previously, this was termed the “fight-or-flight” response. In a series of recent articles reviewing the biological literature on the hardwired human response to extreme fear, one of the authors has pointed out that the above 1929 catchphrase is incorrect and that the correct sequence of the initial responses to extreme fear is actually freezeflight-fight-fright.This especially is evident in silent disasters during which the “fight” segment of the fear response sequence is not applicable.14–16 Excessive fear, recognized as a hyper-vigilant fear response, may be seen in the susceptible, exposed, and infectious population seeking care.17 

It is caused by the over-activation of noradrenergic neurons and manifests as signs and symptoms of hyper-arousal; its persistent symptoms being recognized as the biological basis for acute and chronic PTSD.18,19 Disasters due to natural hazards commonly are accepted the world over as the “will of God or nature”. Although some level of emotional distress is common, the distress rarely reaches diagnosable levels and the duration of distress is self-limiting. The main exception is seen in persons who are less resilient because they have experienced prior psychological symptoms. They are at increased risk for developing elevated levels of anxiety, depression, and somatic symptoms. 

The same probably is true for persons who are less resilient because of financial or multiple medical problems. The incidence of post-disaster PTSD often is used as the standard by which psychological severity of a disaster’s impact on a population is measured.20 Current diagnostic criteria for PTSD require that a person experience, witness, or be confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of self or others, and that a person’s response involves intense fear, helplessness, or horror.21 Using measures specifically developed to assess PTSD, researchers have found low rates of PTSD following floods, volcanoes, mudslides, and tornadoes where property damage was substantial, but other dimensions of trauma thought to contribute to PTSD, such as direct threat to one’s survival or the presence of dead bodies, were not present.20 However, the relationship of PTSD with fear-based events, such as exposure to lethal, inter-group violence (combat, war zone exposure, or intentionally caused disasters that result from terrorism) produce PTSD rates that usually are several times higher, and, as such, require reinvestigation of the potential that they can be prevented and/or mitigated.19 Shalev et al conducted a landmark, prospective study of the onset, overlap, and course of PTSD and major depression in 211 subjects presenting to a general hospital’s emergency department following trau matic events. These authors found that major depression and PTSD occurred early after the event. The authors found that “63 survivors (29.9%) met criteria for PTSD at one month, and 37 (17.5%) had PTSD at four months. Forty subjects (19.0%) met criteria for major depression at one month, and 30 (14.2%) had major depression at four months. Comorbid depression occurred in 44.5% of PTSD patients at one month and in 43.2% at four months.” Shalev et al concluded that “major depression and PTSD are independent sequelae of traumatic events, have similar prognoses, and interact to increase distress and dysfunction. Both should be targeted by early treatment interventions and by neurobiological research.

Conclusion 
The scrutiny of the 2001 US anthrax incident, the SARS pandemic, and the realization of the global threat of emerging natural diseases have revealed that populationbased fear is a critical consequence worthy of intervention. Simultaneous advances in the understanding of the neurochemistry of fear-based brain circuitry has increased opportunities for early intervention and management to identify the victims and mitigate, if not prevent, their suffering. Fear and resilience recognition and fear severity scoring are the first steps in surge capacity triage management that must begin at the point of contact by healthcare providers and disaster managers alike. The FR checklist serves as a useful tool in assessing a state of fear in victims deserving of further evaluation, monitoring, and intervention. In large-scale bio-event disasters, the FR checklist has the potential of assisting in the targeting of limited surge capacity resources, identifying victims who would benefit most by the targeted resources, assisting in mitigating mass chaos, assess the effectiveness and applicability of risk communication and public announcements in limiting fear-based symptoms, and assist in identifying a potential volunteer force that exhibits levels of functional resiliency. Further research is needed to validate this process.（essay代写)

51Due网站原创范文除特殊说明外一切图文著作权归51Due所有；未经51Due官方授权谢绝任何用途转载或刊发于媒体。如发生侵犯著作权现象，51Due保留一切法律追诉权。（essay代写)
更多essay代写范文欢迎访问我们主页 www.51due.com 当然有essay代写需求可以和我们24小时在线客服 QQ:800020041 联系交流。-X（essay代写)