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U.S. Department of Health and Human Services


Promoting Behavioral Health for Responders on the Front Lines of Health during the COVID-19 Pandemic

Author: Rachel Kaul, LCSW, CTS, Senior Advisor for Behavioral Health, HHS/ASPR Emergency Management and Medical Operations
Published Date: 8/14/2020 9:14:00 AM
Category: Response & Recovery;

ASPR Implements Check-in Calls for NDMS Responders Returning from the Field

When disaster strikes, state, tribal, or territorial authorities can call on responders from the National Disaster Medical System (NDMS) to help handle some of the nation’s toughest emergency-related health challenges.  NDMS responders are elite medical professionals who work as doctors, nurses, pharmacists, and other civilian health professionals in communities across the country. Following a disaster or emergency event, NDMS responders deploy at the request of states to provide medical support and increase capacity. Since the beginning of the pandemic, NDMS responders have been serving across the country, assisting states and territories as well as tribes and local communities.

In the initial days of the Novel Coronavirus 2019 (COVID-19) outbreak, NDMS responders provided medical support during the first quarantine operations in more than 50 years.  Since then, NDMS responders helped save lives at alternate care sites, including the Javits Center in Manhattan, provided mortuary assistance, helped decompress ICUs, worked to help prevent the spread of COVID-19 in hard hit areas like the Northern Navajo Nation, and more. The response to COVID-19 is continuing at a relentless, unprecedented pace, and our NDMS responders are answering the call to service by providing the best of care during one of the greatest public health crises in a century.

The work that NDMS responders do is vital to public health – and it is hard.  NDMS responders are working with determination, dedication, and perseverance to protect health and save lives; and ASPR is committed to ensuring our responders remain healthy, both mentally and physically.   

Although some responders experience challenging stress reactions while they are deployed, some of them have distressing symptoms that only start to manifest after they return home.  After NDMS responders return home, they are contacted by behavioral health professionals who have experience working in disasters and are themselves on NDMS teams.  Building on similar programs that have been implemented by the U.S. Public Health Service and the Centers for Disease Control and Prevention, responders are contacted after they have been home 10 to 14 days.  The goal is to follow up at the 30-day mark with those responders who could benefit from additional contact.

Talking to a behavioral health specialist is completely voluntary, but many of our responders have told us that it helps.  For some responders, this is one of the few times that they pause to really reflect on their deployment and how it has impacted them personally. Many comment on just appreciating the gesture on the part of the U.S. Department of Health and Human Services and NDMS.

The signs and symptoms of stress can be identified by a behavioral health specialist over the phone, and they encourage returning responders to take such signs seriously so their symptoms do not evolve into disorders. For some responders, these symptoms can manifest as a memory that they keep reliving over and over again.  Others may have trouble sleeping or suffer from guilt or worry over potentially exposing others to COVID-19. Some people just find that they are irritable and less tolerant around family and friends. Many responders think about the patients they were not able to help and the ones who passed away despite their best efforts. Others suffer from compassion fatigue, the emotional exhaustion that comes from facing so much death and so many hard cases.

First, behavioral health professionals help responders recognize when they have a problem and need to take care of themselves.  From there, the behavioral health specialists talk to the responders about strategies they can use to cope with the stress of their deployment.  Just as the response to COVID-19 is very different from many previous responses, so are the strategies for coping in the aftermath of this challenging disaster response.  In the past, behavioral health professionals encouraged responders to  get together with people in  their communities, their friends, and their families when they returned from deployment. Now, responders have to balance the need for connection with the need to keep the people around them safe by practicing social distancing, so many of the practices we once encouraged are not viable or must be approached with extreme caution. Today, our behavioral health responders help the NDMS medical responders identify the source of their concerns; learn about simple, practical strategies like practicing mindfulness and gratitude or meditation; and connect to resources that can help responders cope.  The NDMS behavioral health professionals also help responders recognize when they need more than just a phone call.  Although a few calls can help a lot of our responders, some people need more assistance.  In those cases, we help connect them with the professionals who can provide longer term medical or psychological care.

Although responding to a disaster is hard, most responders we have talked to say that they are glad that they deployed.  Even though they face a complex set of stressors, many NDMS responders also find satisfaction in the service and a sense of connection with their NDMS teammates.  For many responders, being a part of the team that helped respond to COVID-19 at healthcare facilities in hotspots across the country makes them proud.

The challenges that NDMS responders face are, of course, not unique.  Medical professionals across the country are also suffering from stress disorders and other behavioral health issues, including compassion fatigue, moral injury, and more.  If you are in a leadership role and manage part of the healthcare workforce, check out these practical tips to help promote behavioral health. If you are a healthcare worker, try to take some time for self care.


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