The terror attacks in Paris (France) on November 13, 2015 were devastating to those who lost loved ones and to those who suffered physical damage and injuries. Approximately 130 people died during the murderous, senseless and barbaric acts of terror. Some of those murdered died instantly and others subsequently died after lingering, horrific suffering. The cowardly terrorists physically injured more than 400 others, many of whom are still struggling to recover. About 100 victims remain in the hospital and some are yet perilously fighting for their lives (they death toll may continue to rise in the coming months). Many of those in Paris have already undergone multiple operations and face months or years of additional surgery, physical rehabilitation and life-long disability. These consequences are in addition to the acute psychological trauma of seeing friends, family and strangers killed before their eyes.

Liz Alderman writing in the New York Times reports that on “the night of Nov. 13, doctors performed nearly 300 operations to remove bullets from victims’ torsos, organs, arms, legs, necks and brains, as well as shrapnel from explosive belts that the attackers had detonated. Within the first 24 hours, more than 35 surgical teams treated 76 people with life-threatening injuries, according to a chilling account published by French doctors in The Lancet, the London-based medical journal. Seven people died after being admitted to the Paris hospitals network, which typically sees only five gunshot patients a year.”

However, what is less known is that the post-disaster psychological damage(s) are persistent and problematic for those who are trying to recover in the aftermath of the horrific act(s) of terrorism.

Liz Alderman in the New York Times continues:

“The majority of the {Paris} attack victims and their families, and a large number of medical personnel, are receiving psychological support for emotional trauma. Many will require treatment for years, said Fadi Zebouni, the chief psychologist at Pitié Salpêtrière Hospital, who oversees a staff of 100 professionals. “These people are completely astonished,” he said. “Their relatives are dead or seriously injured, or even in a coma. Even the people that were present at the Bataclan who were able to escape are saying that while they are not dead, they feel psychologically dead,” he said. Many express feelings of “survivor guilt,” questioning whether they did enough to help others as they fled. Over time, said Mr. Zebouni, post-traumatic stress disorders may wind up being less widespread in Paris than in the United States following the Sept. 11 attacks in New York City, where nearly 2,800 people died. Researchers found strong evidence that people who directly experienced or witnessed the Sept. 11 attacks had high levels of post-traumatic stress disorder, according to an article summarizing numerous studies, published in The Lancet in 2011. Those included people who suffered injuries, people who lived near the World Trade Center, rescue and recovery workers, and people whose spouses died in the attack.”

The September 11^th 2001 terror attacks have changed our understanding of these emotional and psychological consequences. See the following resources: Psychological and Emotional Effects of the September 11 Attacks on the World Trade Center; The Psychological Impact of Terrorist Attacks; and What have we learned since 9/11?

In fact, others have previously written about the post-disaster effects documented in the aftermath of the 9/11 terror attacks. Amanda Gardner reporting for ABC news (9/11's Psychological Scars Slowly Healing) describes some of the on-going issues that haunt those impacted by the September 11^th terror attacks in the U.S.:

“’And every year, as the anniversary of the {9/11} disaster approaches, health-care workers often see a spike in anxiety disorders and other mental health issues among survivors. Some 12 percent to 15 percent of people report persistent mental health problems,’ said Dr. Philip J. Landrigan, who oversees The World Trade Center Medical Monitoring and Treatment Program at the Mount Sinai School of Medicine in New York City. That, he added, is ‘amazingly similar to being in combat.’ ‘People who didn't normally drink were drinking alcohol, people who didn't usually take drugs were taking drugs,’ Landrigan said. ‘A lot of that was a short-term phenomenon that has faded now after seven years, but there are still persistent mental health problems in a substantial proportion.’ A new report from the World Trade Center (WTC) Health Registry, just published in the Journal of Public Health this week, finds that in the two to three years following the catastrophe, 16 percent of adults enrolled in the registry reported that they probably had PTSD, while 8 percent had severe psychological distress. ‘The most common things we saw were anxiety disorders, PTSD and depression,’ Muller said. According to the report, the PTSD rate was highest among people who were injured during the attacks (35 percent), low-income people (31 percent) and Hispanics (30 percent). Overall, minorities, low-income individuals and women experienced higher rates of both mental and physical problems. ‘There are a couple of factors that seem to predispose people to having persistent symptoms,’ Landrigan said. ‘One is having directly witnessed the trauma like people jumping out of buildings, which seems to have been worst of all. Second is having preexisting mental health problems, people who are already anxious.’  Children who had experienced previous trauma were also at heightened risk as were people who did not have specific training, the so-called "naive volunteers.’ ‘These would be people like construction workers, thousands of constructions workers who jumped into bulldozers and rushed to the site on the afternoon of 9/11 to help with rescue and recovery,’ Landrigan said. ‘It made a huge difference, but they're not used to dealing with death and destruction, and most have been devastated.’ Preschool children exposed to ‘high-intensity WTC attack-related events’ are at increased risk for sleep problems and anxious/depressed behavioral symptoms, reported a study in the Feb. 2008 issue of the Archives of Pediatric & Adolescent Medicine. The 9/11 attacks also altered, literally, the dreams of Americans, with dreams after the disaster showing more intense images.”

Researchers indicate that the psychological scars suffered by New Yorkers during the 9/11 attacks are still not completely healed.

This same process is also currently unfolding in San Bernardino County, California where the December 2015 terrorist attack involved a mass shooting and an attempted bombing that killed 14 people and injured 22 others. Such post-disaster psychological consequences are serious and challenging for those who are trying to recover in the aftermath of the horrific act(s) of terrorism. The psychological impacts of these traumatic terror events may touch those who are not in immediate or close contact with the events (see Sydney Engelberg Ph. D., San Bernadino and the Hidden Cost of Terrorism, Psychological Today)

Those of us working in the disaster recovery, crisis management, business continuity and consequence management disciplines need to increase our focus on aspects of human performance before, during and after major traumatic events. There are five key starting points for improving our handling of these people processes:

• Plan, Prepare and Practice Psychological First Aid. Katherine Harmon wrote an insightful article on the changing state of psychological first aid in her Scientific American essay The Changing Mental Health Aftermath of 9/11--Psychological "First Aid" Gains Favor over Debriefings. She has some useful advice for approaches for treating terrorisms’ psychological wounds.
• Prepare to treat the whole person (and their families and close friends) and not just their bodies. Read this article by Dr. Jeffrey Fetter Psychosocial Response to Mass Casualty Terrorism: Guidelines for Physicians to learn more about this holistic approach.
• Communicate and educate your people prior to the next traumatic event. Building resilience is an investment that will protect your people and aid their recovery. There are steps you can take to “inoculate” people and their psyche in advance of the next crisis, emergency or disaster. Such advance resilience can help mitigate the consequences and aid in managing a full recovery.
• Access and utilize planning resources now. Seek professional assistance. Develop plans to predict and successfully manage the affective and cognitive consequences of these events. There are lots of available tools, tips, technology and subject matter expertise. Find it, use it and benefit.
• Train leaders and key people to assist themselves and others so as to manage, cope and survive such events. Set goals and objectives – and hold people accountable to meet these targets. Select, train, assess and evaluate these knowledge, skills and abilities in your team leaders, managers and other key personnel. Make these skill sets meaningful through the appraisal and evaluation process.

Image: http://www.telegraph.co.uk