| INTRODUCTION
The bombing of the Alfred P. Murrah
Federal Building in Oklahoma City on April 19, 1995,
killed 168 people including 19 small children. Hundreds
more were injured in the building and in the surrounding
neighborhood. The bombing was both a terrorist act
and a major crime. Media coverage produced powerful
images of trauma, loss, and suffering. For days,
nothing except bomb-related programming aired on
the major broadcasting stations in the area.
ORGANIZATION
Establishing Institutional
Roles
The aftermath of a disaster is
commonly characterized by chaos and confusion. The
Oklahoma City bombing was no different. The community
response was dramatic involving over 12,000 individuals.
Many wanted to contribute and many felt a need to
be involved in the process. Coordination was essential,
especially with a response of this magnitude. Local,
state, and national professional organizations,
public agencies, volunteer groups, and individuals
emerged as leaders in the response.
One of the first important individual
or institutional tasks in responding to disasters
of such magnitude is to determine an appropriate
role which should be based on an examination of
the individual's or the institution's relative strengths.
Failure to identify an appropriate role may result
in duplication of services, exhausted personnel,
and depleted resources.
In the Oklahoma City bombing, the
Governor aided in the assignment of roles among
state agencies by designating the state Department
of Mental Health and Substance Abuse Services (DMHSAS)
as the agency responsible for coordinating publicly-funded
mental health services. The bomb-site Compassion
Center, established to provide crisis care, was
eventually relocated and renamed Project Heartland.
Project Heartland remains in operation today, well
over one year later. Staff at Project Heartland
provide crisis intervention, brief treatment, group
work, referral, and outreach. The University of
Oklahoma Health Sciences Center (OUHSC) was charged
with responsibility for overseeing research activities.
The two organizations continue to work closely together,
and with the Oklahoma Department of Health, another
major public agency responsible for many aspects
of the disaster response.
Funding
The Federal Emergency Management
Agency (FEMA) provided an immediate services grant
to the DMHSAS, which was available within weeks
of the bombing. That was followed by a nine-month
regular services grant beginning November 1995.
The DMHSAS utilized many community providers and
institutions by awarding subcontracts for service
to special populations such as children, the aged,
and minority groups. An extension grant provided
new monies and allowed monies already received to
be expended over a longer period of time. The extension
is crucial in the Oklahoma City disaster because
of anticipated problems associated with the criminal
trial.
Referral Mechanism
There is often little time to develop
and organize services following a disaster. When
many individuals are seen for brief periods by providers
with different levels of training and experience,
pathology may go unrecognized. This is especially
important in disasters like the Oklahoma City bombing
because: the need was so great, most volunteer providers
had little or no experience with disasters of this
magnitude, and the federally-funded program relied
heavily on non-doctoral clinicians and did not provide
for comprehensive evaluation and intensive treatment.
When individuals experience more serious psychological
responses, they may require referral, making it
essential that a mechanism be established early.
The professional response in Oklahoma City was impressive;
many professionals volunteered their time to treat
bomb-related problems for free or at reduced rates.
Long Term Care
Long term care must be considered
immediately because federal monies do not cover
those services. In Oklahoma City, funding requests
to address long term need began within weeks after
the disaster. There remains concern, however, that
the funds secured will be inadequate to meet that
need.
CONSULTATION AND TRAINING
Few mental health professionals
have had experiences that would prepare them for
disasters of the magnitude of the Oklahoma City
bombing. Recognizing this, FEMA provided funding
for consultation and for training of professionals.
Consultation by a number of individuals and organizations
has been useful in anticipating and identifying
concerns related to community needs and in organizing
the immediate, short term, and longer term efforts.
In the immediate aftermath of the bombing, minimal
attention was paid to individual training and experience,
but within weeks, a mechanism for the screening
of professionals was established.
RESEARCH
When the impact of disaster is
as great as in the Oklahoma City bombing, it is
important to assess individuals at risk for problems
due to their emotional and/or physical proximity
to the disaster or to preexisting conditions. Screening
should identify symptomatic individuals who have
not come to professional attention. Screening should
also provide information useful for planning service
delivery, developing funding requests, and research.
Disaster research is fraught with
concern. Victims may be exploited, even traumatized
or retraumatized, in the research process and results
may not accurately reflect events that occurred,
particularly if people are subjected to repeated
and leading questioning. Most, if not all, mental
health research related to the bombing has been
motivated by clinical or service delivery needs,
with care taken in the design and timing of our
studies. The collection of data following the bombing
was particularly important because there had not
been a disaster of this magnitude in our country
in recent memory.
CONCLUSION
Disaster is rarely anticipated.
It burdens individuals and institutions, forces
people and agencies into new roles and relationships,
alters priorities, and exerts an emotional impact
on rescuers and responders as well as victims and
survivors. An abundance of support poured into Oklahoma
City on April 19, 1995, and the days that followed.
That support came from within the community, state,
and nation. Both the bombing and the response changed
the complexion of our community, proud of the compassion
that emerged to support the newly vulnerable.
©1996 by The
American Academy of Experts in Traumatic Stress,
Inc.
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