Psychological factors affecting those who handle human remains after mass disasters and their potential importance in the setting of modern terrorist attacks

Recent geo-political events such as the global war on terrorism and the unprecedented attacks upon the Pentagon in Washington, DC and the World Trade Center in New York City have stimulated a renewed interest in the concept of terrorism, as well as its psychological effects en masse. Due to a number of factors that seem to indicate a more war-like shift in terrorist tactics, there may be heightened risk of attacks resulting in mass death. Disaster relief workers involved specifically in body handling duties may be especially vulnerable to the psychological impact of their work in these contexts. Psychological factors operative among body handlers in the setting of terrorist attack scenarios has not received systematic study; however, there exists a literature describing experiences, vulnerability factors and health outcomes among individuals exposed to human remains in the aftermath of wartime and other disasters that may have a broad applicability even to crises associated with terrorist attacks. We begin the present review by describing modern terrorism and its propensity to cause mass disaster and summarizing the existing literature concerning the stress of handling human remains during disaster relief exercises. We close by attempting to tie relevant points from the literature summary to potential modern terrorist attack scenarios.