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Managing the “Worried Well” during a large-scale incident

William Bullock, DHSc, CIH, CSP, FAIHA, E. Reed Smith, MD, FACEP, Craig Heligman, MD, MPH


A number of recent incidents in the United States resulted in a large number of citizens reporting to the Emergency Room seeking reassurance that they were okay. These citizens are being referred to in the medical community as the “Worried Well.” We conducted a review of a transportation incident involving a chemical release and fire, which resulted in over 100 people reporting to the local emergency room for evaluation. Few, if any of the patients seen in the hospital had a potential exposure to the chemical or combustion byproducts. It is probable that stress hormones released by the sympathetic nervous system caused the symptoms experienced by the majority of the patients. This review suggest the need for better coordination between incident command and the hospital, including more timely situation reports including parameters such as the wind direction and potential downwind pollutant levels, to assist the physicians and nurses more appropriately manage these “Worried Well.”


worried well, emergency response, chemical release, fire, incident command, evacuation

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