| 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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