Terrorism and weapons of mass destruction: managing the behavioral reaction in primary care

Any terrorist attack using weapons of mass destruction will result in substantial psychological trauma and stress. Primary care and emergency clinics will likely see patients who have stress-related emotional or physical symptoms, or exacerbations of preexisting health concerns. Significant psychological and behavioral reactions to an attack with weapons of mass destruction are certain, include both group and individual reactions, and will follow a predictable course. Possible group reactions include mass panic, acute outbreaks of medically unexplained symptoms, and chronic cases of medically unexplained physical symptoms. Possible individual reactions include psychiatric disorders such as posttraumatic stress disorder, which occurs in approximately 30% of people exposed to extreme trauma. Most people have symptoms of arousal that are normal reactions to abnormal events and that resolve with rest, reassurance, support, and education. Mandatory debriefings are not recommended, and medications may be used when more conservative measures are not sufficient.