Whilst many distressed survivors are evacuated to ERs, smaller but yet unknown numbers require clinical interventions and even fewer might require or be willing to attend formal therapy. Few Israeli hospitals provide systematic reaching out for traumatized survivors. Patient-initiated help-seeking is, therefore the key for receiving professional help in the aftermath of terrorist attacks (though help centers are regularly advertised). The NII offers a network of free consultations for identified direct survivors.
A recent outreach program, conducted at Hadassah University Hospital in Jerusalem, indicates that 311 (36%) of 862 trauma survivors have clinically significant distress within 5 days of ER admission. Of those, 183 (59%) have accepted an offer to see a psychologist for clinical consultation; 91 of the latter (50%) were found, by clinicians, to require early treatment and 62 (68%) started early treatment. This brings the number of potential patients for early clinical interventions to about 10% of those exposed.
On the basis of these data, and of clinical experience across the country, one can safely assume that a significant proportion of psychological casualties go undetected and might never come for formal therapy. Two community surveys (see below) indicate that much help is sought from other community resources (e.g., general practitioners, religious authorities) and most help is received within families. An estimate based on 7 years of ER admissions in Jerusalem shows that the rate of PTSD following terrorist attacks is twice as high as that observed in other traumatic events. However, recovery from early PTSD symptoms during an era of terror (2000-2003) is similar to that observed before the current wave of hostilities . Thus, as might be the case in other areas of the world, the interface between the acute response and prolonged disorders is not entirely covered, and there might be a gap in the management of victims during that transition.
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