Disaster mental health is a well-defined role in emergency preparedness and disaster response. Psychiatric mental health (PMH) nurses are critical members of the disaster response workforce. Using principles of psychological first aid, critical incident stress debriefing, and crisis management, together with rapid response and early intervention, PMH nurses help mitigate long-term effects of potentially traumatic events. Christine Tebaldi, MS, McLean Hospital, Belmont, Massachusetts, USA, discussed the role of PMH nurses in the response to the 2013 Boston Marathon bombings.

The National Disaster Recovery Framework comprises a continuum of activities that take place during the phases of a disaster (Table 1) [National Disaster Recovery Framework. Federal Emergency Management Agency. 2011].

Massachusetts' emergency preparedness program has multiple partners, including the federal government, which work together to conduct emergency exercises and drills and create and implement emergency response plans. Emergency planning for the 2013 Boston Marathon included activation of multiple organizations as liaisons on the course, medical tents along the course, activation of emergency medical service (EMS) and hospital plans, and volunteer activation.

On the day of the 2013 Boston Marathon, 2 explosions killed 3 people and seriously injured > 260. Within moments, law enforcement and EMS personnel arrived on the scene, and ambulances began transporting the most critically injured to hospitals. All preactivated organizations shifted into response mode, engaging in acute medical intervention and stabilization, mass care, disaster mental health, communication and education, and service triage and coordination.

The disaster mental health response continued through the short and long term with outreach and triage, education, advice to leaders, staffing of call centers, and attendance at meetings and community events. Victims and families were supported through various transitions, including returning to the bombing sites, moving the temporary memorial, and the Family Assistance Center, which transitioned to the Resilience Center.

The disaster mental health responders helped victims and families cope with the situation and take necessary actions as they moved through the phases of emotional response to disaster.

The principles of Psychological First Aid (PFA) [Psychological First Aid: Field Operations Guide, 2nd ed. National Center for Posttraumatic Stress Disorder. 2006] and the Red Cross Three-Element Intervention Strategy (Table 2) [Disaster Mental Health Handbook. American Red Cross. 2012] provided validated strategies for assisting individuals affected by the disaster. The PFA includes helping in the immediate aftermath to reduce the initial distress and fostering short- and long-term adaptive functioning and coping.

The partner agencies remained engaged through the long-term recovery and planning for the 2014 Boston Marathon. Education sessions were held prior to the event. The 1-year tribute and the marathon were staffed with mental health volunteers, who worked with the medical team, supported Team Red Cross, and staffed reception centers in the event of course disruption.