与灾害相关的身心健康中家庭医生的角色

Disaster-Related Physical and Mental Health:A Role for the Family Physician

每年,自然灾害、技术灾害和大型暴力冲击了美国数百万人。灾害后,提供初级保健服务的时间要增至12个月或更长。帮助受害者的概念框架包括,理解灾害后影响身心健康的个体和环境风险因素。灾害的受害者呈现给家庭医生的典型问题包括急性躯体健康问题,如胃肠炎或病毒综合征。慢性问题常需要药物治疗和提供初级保健服务。有些受害者可存在急性或者慢性身心问题的风险性,如创伤后应激障碍、抑郁症或者酒精依赖。灾害后出现身心健康问题的风险因素包括,灾害前的心理健康问题和高水平暴露于灾害相关的应激源(如对死亡或者严重创伤的担心、暴露于严重创伤或者死亡、与家庭分离,长时间迁居)。对灾害有效的行动计划需要做好充分的准备工作。针对灾害对身心健康的威胁性,家庭医生应该做好自我教育,并且与地方和国家相关组织机构进行配合;保证诊所或办公场所有充足的药品、缝合和打石膏用品等医疗资源。医生也应该对其家庭安全做出应有的计划。

Objective Natural disasters, technologic disasters, and mass violence impact millions of persons each year. The use of primary health care services typically increases for 12 or more months following major disasters. A conceptual framework for assisting disaster victims involves understanding the individual and environmental risk factors that influence post - disaster physical and mental health. Victims of disaster will typically present to family physicians with acute physical health problems such as gastroenteritis or viral syndromes. Chronic problems often require medications and ongoing primary care. Some victims may be at risk of acute or chronic mental health problems such as post - traumatic stress disorder, depression, or alcohol abuse. Risk factors for post - disaster mental health problems include previous mental health problems and high levels of exposure to disaster - related stresses （e. g. , fear of death or serious injury, exposure to serious injury or death, separation from family, prolonged displacement）. An action plan should involve adequate preparation for a disaster. Family physicians should educate themselves about disaster - related physical and mental health threats; cooperate with local and national organizations; and make sure clinics and offices are adequately supplied with medications and suture and casting material as appropriate. Physicians also should plan for the care and safety of their own families.