Senaida Muric Class, This week we will evaluate the effectiveness of the process of primary care management for behavioral reactions during a weapons of mass destruction (WMD) incident in the United States. The course of behavioral reactions to an attack involving WMD is predictable (Lacy & Benedek, 2003, p. 394). When in groups, people may experience “mass panic, acute outbreaks of medically unexplained symptoms, and chronic cases of medically unexplained physical symptoms”, while individuals may experience “psychiatric disorders such as posttraumatic stress disorder” (Lacy & Benedek, 2003, p. 394). However, each behavioral reaction to WMD attacks, whether in groups or individual responses, have been studied for the appropriate primary care management. The U.S. continues to improve upon primary care management preparedness in the case of a WMD attack. I believe the U.S. is somewhat prepared for primary care management during a WMD incident; however, some improvements could be made. In situations of mass panic, it is difficult to train individuals to react rationally, such as not becoming paralyzed or socially unorganized; however, primary care providers (PCPs) anticipate mass panic as “a common problem after a devastating attack” (Lacy & Benedek, 2003, p. 395). As suggested, providing accurate knowledge to the public regarding the attack is the best way to reduce mass panic (Lacy & Benedek, 2003, p. 395). Unfortunately, the other option is to provide advanced training and disaster simulation to the public, which, in my opinion, is nearly impossible to do. The U.S. government and PCPs cannot provide the public advanced training and disaster simulation exercises for every possible situation that may occur. Instead, mass media communication is used to educate the public and “promoting responsible behaviors” (Lacy & Benedek, 2003, p. 395). In the case of WMD related attacks, PCPs are prepared to “mitigate barriers” and respond to “psychosocial consequences” (Eisenman et al., 2005, p. 772). “Since the September 11, 2001, and subsequent anthrax attacks, substantial federal funds have been devoted to improving the health care system's capacity to detect and respond to a chemical, biologic, radiologic, or nuclear (CBRN) weapon attack” (Eisenman et al., 2005, p. 772). PCPs are prepared to triage patients to provide the best primary care management possible. Unfortunately, people become noncompliant with public health recommendations. In the 2001 anthrax attack, 30,000 people were offered the prophylactic antibiotics, because it is known that unexposed patients “may present with somatic symptoms mimicking exposure symptoms” (Eisenman et al., 2005, p. 773). Some of the improvements that need to be made would help PCPs overcome barriers in delivering mental health care in a CBRN event. “Leaders in primary care should improve linkages with local, state, and federal mental health and public health agencies” (Eisenman et al., 2005, p. 773).

1. Senaida Muric
Class,
This week we will evaluate the effectiveness of the process
of primary care management for behavioral reactions during a
weapons of mass destruction (WMD) incident in the United
States. The course of behavioral reactions to an attack involving
WMD is predictable (Lacy & Benedek, 2003, p. 394). When in
groups, people may experience “mass panic, acute outbreaks of
medically unexplained symptoms, and chronic cases of
medically unexplained physical symptoms”, while individuals
may experience “psychiatric disorders such as posttraumatic
stress disorder” (Lacy & Benedek, 2003, p. 394). However, each
behavioral reaction to WMD attacks, whether in groups or
individual responses, have been studied for the appropriate
primary care management. The U.S. continues to improve upon
primary care management preparedness in the case of a WMD
attack. I believe the U.S. is somewhat prepared for primary care
management during a WMD incident; however, some
improvements could be made.
In situations of mass panic, it is difficult to train individuals
to react rationally, such as not becoming paralyzed or socially
unorganized; however, primary care providers (PCPs) anticipate
mass panic as “a common problem after a devastating attack”
(Lacy & Benedek, 2003, p. 395). As suggested, providing
accurate knowledge to the public regarding the attack is the best
way to reduce mass panic (Lacy & Benedek, 2003, p. 395).
Unfortunately, the other option is to provide advanced training
and disaster simulation to the public, which, in my opinion, is
nearly impossible to do. The U.S. government and PCPs cannot
provide the public advanced training and disaster simulation

2. exercises for every possible situation that may occur. Instead,
mass media communication is used to educate the public and
“promoting responsible behaviors” (Lacy & Benedek, 2003, p.
395). In the case of WMD related attacks, PCPs are prepared to
“mitigate barriers” and respond to “psychosocial consequences”
(Eisenman et al., 2005, p. 772). “Since the September 11, 2001,
and subsequent anthrax attacks, substantial federal funds have
been devoted to improving the health care system's capacity to
detect and respond to a chemical, biologic, radiologic, or
nuclear (CBRN) weapon attack” (Eisenman et al., 2005, p. 772).
PCPs are prepared to triage patients to provide the best primary
care management possible. Unfortunately, people become
noncompliant with public health recommendations. In the 2001
anthrax attack, 30,000 people were offered the prophylactic
antibiotics, because it is known that unexposed patients “may
present with somatic symptoms mimicking exposure symptoms”
(Eisenman et al., 2005, p. 773).
Some of the improvements that need to be made would help
PCPs overcome barriers in delivering mental health care in a
CBRN event. “Leaders in primary care should improve linkages
with local, state, and federal mental health and public health
agencies” (Eisenman et al., 2005, p. 773). Coordination between
teams to maximize use of existing resources would improve
primary care management. Similarly, as previously mentioned,
disaster planning cannot be given to the public; however,
disaster planning and training should be given to PCPs about
ways to respond to emotional and behavioral responses during a
WMD attack (Eisenman et al., 2005, p. 774). Finally, there are
“critical knowledge gaps” that should be identified and
remedied by PCPs and “different service sectors that will
operate in a CBRN event” (Eisenman et al., 2005, p. 774).
Communication continues to be one of the biggest issues in
responding to emergency situations; therefore, breaking
communication barriers between all response units would
improve the skills and speed at which primary care management

3. is provided.
Senaida
Resources
Eisenman, D.P., Stein, B.D., Tenielian, T.L., & Pincus, H.A.
(2005). Terrorism’s psychological effects and their implications
for primary care policy, research, and education. J Get Intern
Med, 20(8): 772-776.
Lacy, T.J., & Benedek, D.M. (2003). Terrorism and Weapons of
Mass Destruction: Managing the behavioral reaction in primary
care. Southern Medical Journal, 94(4): 394-399.
Justin Miller
Class,
This week we are learning about the process of primary care
management for behavioral reactions during a weapons of mass
destruction in the United States. With the question being posed
to us of whether or not we feel the United States is prepared for
primary care management during such an attack. Now with that
being said here goes my take on the subject. I believe that the
United States is doing a solid job of training and putting
programs and procedures into place to handle a mass casualty
situation or in this case a Weapon of Mass Destruction (WMD)
attack. For example, back in week three we read about the
Stafford Act which talked about all the dangers and hazards as
well as who takes control of a major incident scenario (Blix,
2006). As well as local law enforcement using Incident

4. Command Systems (ICS) where the most senior responder takes
control of the scene, if they can contain then the State Law
Enforcement is notified who has the Office of Emergency
Services which includes the National Guard in their arsenal,
then if the incident is beyond their capabilities then the federal
agencies receive a notification which would most likely be the
Federal Bureau of Investigations (FBI) who has multiple
programs and departs to handles incidents of this magnitude as
well as the Federal Emergency Management Agency (FEMA)
and they ultimately take point and rule the show (Blix, 2006).
The government also has the Center for Disease Control (CDC)
on standby incase the attack is biological in nature From the
lesson this week it touched on how one of the best ways to
avoid mass panic and inappropriate action from the general
public is to make it publicly known and ways to help and stay
safe (Blix, 2006). I feel this is a major factor due to the general
public majority not having the training and expertise of the
responders or military affiliates that are involved in the initial
attack. These few facts show that our responders and affiliates
are well trained. Now since the attacks on September 11, 2001
and the increase in anthrax shortly thereafter the government
devoted a lot of money and resources into giving the proper
training and supplies necessary to handle more chemical,
biological, radiological attacks as well as the mental
displacements that come along with a mass casualty scenario
(Lacy, Benedek, 2003). So with the increased training,
education and resources on CBRN attacks the better the chances
of reducing the workload in such an event as well the
prevention of burn out of the staff working to help the people
(Lacy, Benedeck, 2003). The big problem I see with all this is
the actual facilities and the amount of resources, I feel like the
primary care systems will be over loaded with clientele and
people needing medical treatment in a scenario of WMD or
mass casualty attack, that I would be afraid they would not be
able to meet the demand. The only way I can see getting around
that is to make the training more known, so that people may

5. respond quicker.
V/R,
Justin
Blix, H. (2006). Weapons of terror: Freeing the world of
nuclear, biological and chemical arms.
Stockholm: WMDC.
Lacy, T.J. & Benedek, D.M. (2003). Terrorism and Weapons of
mass destruction:
Managing the behavioral reaction in primary care.
Southern Medical