Todd Holzman, M.D., first learned that EgyptAir flight 990 crashed off the coast of Nantucket, Mass., early on the morning of Sunday, October 31, when he received a call from his local Red Cross chapter putting him on alert.

As the head of the disaster mental health services for the Massachusetts Bay Chapter, Holzman met with Red Cross operations staff to discuss the latest decisions by national and local agencies responding to disasters. He also told local mental health professionals who volunteer with the Red Cross to be on alert.

When the operations team learned that the U.S. Coast Guard Air Station (formerly Otis Air Force Base) on Cape Cod would be used for a search-and-rescue operation, Holzman dispatched two mental health professionals to help there.

"Our goal is to provide emotional support in a crisis to members of the Coast Guard and other rescue workers by being available for informal conversations. We may suggest having a cup of coffee or going for a walk," he explained.

Because the Coast Guard’s mission is to save people and conform to certain safety rules, rescue workers experience a rush of adrenaline and a lot of stress, said Holzman. "When they found no survivors, there was an emotional letdown," to be explained.

He noted that the Coast Guard was also active in the search-and-rescue mission for survivors of John F. Kennedy Jr.’s plane crash near Martha’s Vineyard in July. "People don’t often think about the impact of disasters on rescue workers, but in searching for survivors, they see the human carnage and wreckage, which takes its toll."

When the EgyptAir rescue mission changed to recovery, the National Transportation Safety Board set up a central command post for its investigation at the Newport Naval Station in Rhode Island. Families of the victims staying in hotels at the John F. Kennedy Airport in New York were moved to hotels in Newport to be closer to the investigation, according to Holzman.

He said a team of about 10 mental health volunteers from his chapter traveled to Rhode Island to assist the local Red Cross Chapter. They worked in a variety of support roles including setting up family assistance centers, communicating with families and medical examiners to identify the victims, accompanying families to collect their relative’s remains, helping spiritual directors plan memorial services, and supporting rescue workers, said Holzman.

Earlier in the week, when families were still at the JFK Airport Ramada Inn in New York City, four psychiatrists who are members of the New York County District Branch helped evaluate distressed family members. The Red Cross used the hotel for debriefings, according to Anand Pandya, M.D., who assisted the families.

He told Psychiatric News, "We worked in shifts around the clock so one of us was always available to talk to family members or Red Cross personnel seeking our advice."

He continued, "We encountered family members who were agitated, acutely anxious, and experiencing severe insomnia. Some of them also were taking medications for preexisting psychiatric conditions, but in their haste to travel to JFK, they forgot to bring them."

Pandya is a fellow in the department of psychiatry at New York University (NYU) School of Medicine in New York City. His colleague Craig Katz, M.D., commented to Psychiatric News, "We prescribed hypnotic medications such as lorazepam for individuals with sleeping and anxiety problems and replacement medications for others. Although we had some initial difficulty obtaining medications from local hospitals, we succeeded in getting a supply on site."

Katz, also a fellow in psychiatry at NYU, said that Red Cross workers and emergency medical technicians working with distressed families asked for the psychiatrists’ pager numbers in case someone appeared suicidal. "They told us that it was reassuring and useful for us to be there 24 hours a day."

To communicate with family members from Egypt who spoke only Arabic, Pandya and Katz relied on translators. "The interpreters provided by the New Jersey Islamic Society were great. Among them were their spiritual leaders [imams], who also performed valuable pastoral counseling," said Pandya.

Katz and Pandya got their first dose of aviation disaster services last September. They assisted the Red Cross after Swissair Flight 111 crashed into the Atlantic Ocean near Halifax, Nova Scotia, killing all 229 people aboard. Like EgyptAir Flight 990, the plane left from JFK Airport, so victims’ families stayed at a hotel there, and then some families flew to Halifax, said Pandya.

"When the New York Chapter of the Red Cross and the state Department of Mental Health put out a call for psychiatrists to volunteer, we responded. But we were struck by the lack of an organized response for psychiatrists," said Pandya.

He noted that the Red Cross uses mainly social workers and psychologists to provide mental health services to disaster victims and their relatives and doesn’t allow volunteers, including psychiatrists, to prescribe medications.

"When we talked to our local Red Cross mental health committee about why so few psychiatrists were involved in their disaster assistance, they encouraged us to form our own organization to provide a range of psychiatric services and work with them," said Pandya.

Thus, Disaster Psychiatry Outreach Inc. was born. Pandya, Katz, and Edward Kenny, M.D., and Michelle Presser, M.D., two psychiatrists affiliated with Columbia University College of Physicians and Surgeons in New York City, formed the organization last year, which recently was incorporated.

"We plan to recruit new members from area residency programs and the New York County District Branch," said Pandya.

He and the other founders have taken the Red Cross training course in disaster mental health services, but participation in it is not required to volunteer with the psychiatry outreach group, said Pandya.

Information on Disaster Psychiatry Outreach is available by writing the organization at P.O. Box 91, New York, N.Y. 10159-0091 or calling (212) 860-8665. Pandya’s e-mail address is anandpandya@hotmail.com.