(4) Healthcare Provider Protection and Resources C: Practitioner Mental Health Concerns: (a) There is a basic assumption that health care providers operating outside of their areas of expertise will share many of the same concerns as the public and probably some of the same mental health effects. (b) The most likely psychological consequences for medical staff as a result of treating patients in a mass casualty incident are: (b-1) Fear, primarily because many people know a little about the effects of radiation and assume that radiation is more dangerous than it actually might be. There is also the lingering concern about unknown long-term side effects, such as the increased risk of cancer. (b-2) Suspicion of being contaminated by radiation and carrying that radiation home to one's family. This preoccupation may distract health care providers from their work. (b-3) The decisions made regarding who to save and who not to save. Providers are likely to have a real sense of guilt when they cannot treat everyone and are not able to do as much as possible for each patient. This concern could result in anger, feelings of helplessness, depression (potentially longterm), and sleep disturbances. All of these will be aggravated by fatigue and exhaustion from response demands. (b-4) Apprehensions, when the state or federal government personnel arrive, that their decisions will be second-guessed. This could lead to guilt and anxiety. (c) Possible physical signs that staff may be experiencing psychological effects include vomiting, diarrhea, nausea, and headaches (10). Coincidentally, these physical signs are also associated with acute radiation exposure. (d) Psychological effects are most likely to occur among staff who have the greatest amount of contact with the deceased and/or dying, and those dealing with children or pregnant women. These effects are more likely to occur with staff who are severely fatigued by being on duty for a long period of time. (e) Prevention is the best treatment and, because prevention and treatment for provider mental heath concerns are so intertwined, it is important to educate health care providers now to provide the best care for all when it is needed. (e-1) The first lesson in treatment is to have a critical incident stress management team that includes credentialed mental health providers in place at each facility before a critical incident. (e-2) Hospitals should have mental health providers who can dedicate time to staff support. (e-3) Hospitals should screen for those who are at higher risk of psychological complications. (e-4) Provider education and training are key components. Do not assume that practitioners know more about radiation than the general public. (e-5) Staff will be concerned about their own families, so hospitals should establish a communication liaison for them. (e-6) Provide for rotation of staff to reduce fatigue. (f) Hospitals should conduct tiered levels of debriefing after a mass casualty event to gather data and to address mental health concerns. The debriefing groups should not be cross-discipline (physicians with nurses, etc.). This allows participants to express concerns more freely