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In the past decade, there have been significant increases in disaster mental health (DMH) planning and preparedness for natural, technologic, and transportation accidents. 1 This preparedness continues to be challenged, and in the process modified, by the recent spate of terrorist attacks in or against the United States. Some examples of these incidents include the bombings of Pan Am Flight 103, the World Trade Center, Olympic Park, and the Murrah Federal Building in Oklahoma City. Terrorism is an entirely different class of disasters. These disasters are intentional and have the purpose of intimidation and coercion, as well as a goal of inducing a sense of helplessness and chaos among those targeted. Terrorism has a potential for consequences that could overwhelm existing disaster response plans. This is particularly true for nuclear, biological, and chemical events.

This article addresses general principles for …