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Terror & triage


This paper highlights the results of an international qualitative study examining the impact of terrorism on social service agencies and their labor force. This international study was conducted with focus groups of health care personnel. The major research question concerned the impact of September 11th and other disasters on agencies and social service personnel.

Materials and methods

This qualitative inquiry included a total of 14 focus groups. Recruitment letters were sent to executive directors of a convenience sample of 14 agencies of varying sizes, and locations. Six to eight health care workers were selected to participate in the focus groups.


Findings of this study indicate that when disaster strikes, respondents are often placed in situations where they are expected to assign priority to one action, while negating another, all within an environment of scarcity. Respondents indicated that they experienced feelings of doubt, discomfort, and other forms of ethical dissonance before, during and after a process of prioritization of resources and services, knowing that their actions although beneficial on one level, may perhaps be devastating on another.


Respondents expressed that although experiencing a certain degree of ethical dissonance, decisions were made, and at times, despite feeling that the decision was correct, respondents expressed concern about what was done. A fail-safe model for making ethical decisions does not exist. As a result ethical ambiguity ought to be expected as a natural component of the decision making process, especially during disaster relief, and need not affect the rightness or goodness of a decision.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Linzer, N., Sweifach, J. & LaPorte, H.H. Terror & triage. Ann Gen Psychiatry 7 (Suppl 1), S98 (2008).

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