Psychological First Aid: Assistance in the Aftermath of Disaster

“Preparation through education is less costly than learning through tragedy.”— Max Mayfield

Have you ever been at the scene of a disaster?  For most, the answer is probably no which makes it impossible for us to comprehend the level of chaos, confusion, and fear.  If you’re not among those who have witnessed devastation first-hand, consider yourself fortunate.

Death tolls and injury counts are measurable outcomes of a disaster.  What we don’t hear about in media, however, are the immeasurable psychological effects on those who were present at the disaster site.  The psychological effects of a disaster can last for days, weeks or even years after the event.  Psychological First Aid (PFA) gives us an opportunity to lessen the psychological burden in the aftermath.

What is Psychological First Aid?

Psychological First Aid (PFA) is a modular approach used by mental health and disaster response workers to help individuals in the immediate aftermath of disaster.  PFA is designed to reduce the initial distress caused by traumatic events and to foster adaptive functioning and coping for both the short and long term.

During a disaster, survivors can be hurt, confused, overwhelmed, fearful, and anxious.  The basic objectives of PFA are to provide survivors with tools and assistance they need to manage their immediate situation.  PFA is not something only professionals can do.  It’s not professional counseling.  This means anyone can be trained to respond to an event with PFA.  No matter your profession or walk of life, you can help.  While experts recommend formal training before you respond to your first PFA event, the following steps provide an overview of the elements of PFA and what they mean.

Who Needs Assistance? 

PFA can be administered to adults, children, or entire families who are survivors or witnesses.  Even first responders can benefit from PFA.  If it’s a large disaster, that’s a lot of people that may need help.  However, PFA does not assume that all those affected will develop mental health problems or long-term difficulties.  Instead, it is based on an understanding that those affected will experience a broad range of early reactions, some of those reactions causing enough distress to interfere with adaptive coping.  In these instances, recovery may be aided by support from a PFA responder.

As you get orientated at the disaster site, shelter, or wherever else you may be responding to, the first step is to determine who may need immediate assistance.  Observe your surroundings.  Look for individuals who look agitated, confused, frightening or overwhelmed.  Also keep an eye out for those who are isolating themselves or children who are alone.  Active outreach is important since most individuals will not approach you directly. However, be mindful of the importance of your timing.  Do not interrupt conversations or people who are supporting one another.  If someone declines your assistance, ask if you can check in with them later.

Once you’ve identified someone in need, techniques known as “PFA Core Actions” will assist you in addressing their needs and concerns.

Core Actions

The core actions of PFA are part of the basic objectives of providing early assistance following an event.  They can be adapted to be effective in a number of settings – disaster assistance service centers, shelters, field hospitals, medical triage areas, acute care facilities, and staging centers for first responders, for example. Regardless of your location and applicability, the eight PFA Core Actions are:

Contact and Engagement   This step includes responding to contacts initiated by the affected, or initiating contacts in a non-intrusive, compassionate, and helpful manner.  Introduce yourself, your role, and tailor your offer to the individual or group in order to communicate most effectively.  Engage those who accepted your assistance.  Your non-verbal approach is just as important as your verbal approach. Speak calmly and softly, show compassion, and use language that is easy to understand. Find out if they have any pressing problems that need immediate attention, including basic needs.  Make medical concerns a priority and don’t make or imply promises you might not be able to keep.  This is your first chance to build trust.

Safety and Comfort   The goal of this action is to enhance immediate and ongoing safety and provide physical and emotional comfort.  Sometimes just knowing that help is close by can be comforting.  In other cases, a more hands-on approach is necessary.  You can enhance physical safety and emotional comfort in a number of ways.  For example, ensuring immediate physical safety, providing accurate situation information, attending to physical and emotional comfort, and promoting social engagement.  It’s also important to recognize individuals with special needs and to protect survivors from additional trauma and trauma reminders.  You can also help by supporting those who have been notified of a loved one’s death and being knowledgeable of spiritual and cultural needs and differences.  No two people are the same; what works for one individual may be ineffective for another.

Stabilization (when needed)   The purpose of stabilization is to calm and orient emotionally overwhelmed and disoriented individuals.  Signs of distress that might indicate being disoriented or overwhelmed include glassy eyes, vacant expressions, unresponsiveness, uncontrollable crying, and uncontrollable physical reactions.  When stabilizing, it’s important to respect the person’s privacy.  Give them a few minutes before you intervene.  Remain calm, quiet, and present – just be present while you give them an opportunity to calm down.  Offer support, help them focus, and give information that orients them to their surroundings.  Exposure to disaster may worsen pre-existing conditions, so reestablishment of a medication supply is important. Lastly, consider each individual you’re assisting.  How you approach stabilization with a child may differ from how you approach it with an adult.

Information Gathering on Current Needs and Concerns   The goal of information gathering is to identify immediate needs and concerns and to ascertain what additional information will help you to tailor PFA interventions.  In most PFA settings, your ability to gather information will be limited by a number of factors.  A formal assessment isn’t appropriate, but you might ask if they have a need for immediate referral or a need for additional services.  Gather information about their experience or loved ones.  Ask about health conditions or anything else that might allow you to tailor and prioritize your interventions to meet the needs of each specific individual.  Gathering and clarifying information begins immediately after contact and continues throughout PFA.

Practical Assistance   This step means offering practical help to affected individuals in addressing immediate needs and concerns.  Offering practical assistance is composed of four steps.

• • Identify the most immediate needs  If the individual has identified several needs and concerns, helping them focus on one at a time will be important.
  • Clarify the need  Talk with the individual to specify the problem.  If the problem is understood and clarified, addressing it will be easier.
  • Discuss an action plan  Discuss what can be done to address the individual’s need or concern. You can help obtain food, clothing, shelter, or medical care; mental health or spiritual care services; financial assistance; help in locating missing family members or friends; and volunteer opportunities for those who want to contribute to relief efforts.
  • Act to address the need  Help the individual take action.  For example, help set up appointments, or assist with paperwork.  Be an active participant in addressing their needs.

Connection with Social Supports   The goal of this action is to help establish brief or ongoing contacts with primary support persons and other sources of support, including family members, friends, and community helping resources.  Social support is directly related to emotional well-being and recovery.  Fostering connections as soon as possible and assisting the affected in developing and maintaining social connections is critical.  Social support comes in many forms.  Some examples include emotional support, feeling needed, reliable support, physical assistance, and material assistance.  An immediate concern for most after a disaster is to contact those with whom they have a primary relationship (spouse/partner, children, parents, etc.).  Take practical steps to assist in reaching these individuals.

Information on Coping   Once you’ve addressed immediate concerns, the next action is to provide information about stress reactions and coping to reduce distress and promote adaptive functioning.  Information that can help survivors manage their stress reactions and deal more effective with problems includes what is currently known about the unfolding event, what is being done to assist them, what services are available, stress reactions and how to manage them, self-care, family-care, and coping.  Whatever their reaction to the disaster, never make them feel as though their behavior is abnormal.  Simply offer support, information, and reassurances.  Providing information on basic coping and relaxation techniques can change someone’s entire post-disaster experience.

Linkage with Collaborative Services   The final core action of PFA is to link survivors with available services needed at the time or in the future.  Discuss which of the individual’s needs require additional information or services and then do what is necessary to ensure effective linkage with those services.  The service might be for a new concern (like an acute medical or mental health problem) or for concerns that were being addressed by agencies (like child welfare services, or drug and alcohol support groups) before the disaster.              

While these core actions provide a basis for response, it’s important to remember that different people have different needs after a disaster.  Carefully evaluate each situation and act accordingly.  The goal is to reduce distress, not be a source of it.

PFA Do’s and Don’t

Administering PFA can be tricky and requires a great deal of thought and understanding.  It’s easy to get lost in the chaos of a disaster scene but the moments of chaos are the moments when it’s so important for PFA responders remember their training and remain calm and collected.  Here are some suggestions for things to say and do, and what not to say and do to offer effective assistance.

What to do:

• • Be yourself. Be genuine and sincere.
  • Respect privacy and confidentiality.
  • Be free of judgements and expectation.
  • Be patient and calm.
  • Let them know you are listening.
  • Allow for silence.
  • Acknowledge feelings.
  • Show respect for each individual’s reactions and ways of coping.
  • Acknowledge the person’s strength.

What not to do:

• • Don’t pressure anyone.
  • Don’t interrupt or rush someone’s story.
  • Don’t rush to tell someone they will be okay.
  • Don’t think or act as though you must solve all of the person’s problems.
  • Don’t judge what they’ve done, haven’t done or how they’re feeling.
  • Don’t talk about your own troubles.
  • Don’t give false promises or reassurances.
  • Don’t tell them it could have been worse.
  • Don’t take away someone’s ability to care for themselves.

If someone needs more advanced support that you can provide, that’s okay.  Recognize that and do your best to alert someone who might be more equipped.  Each person is capable of recovery, but PFA responders aren’t always what someone needs.

Don’t Forget to Take Care of Yourself!

PFA isn’t just for the people you help while you’re on a disaster scene.  Take care of yourself as well by modeling the behaviors you teach to others.  Adopt PFA principles for yourself, especially during a PFA response event.

You can manage stress by maintaining a healthy routine and knowing your limits.  Eat well, drink water, and if you feel particularly troubled by a case or client, consult with someone who is more experienced or consider handing it off.  Always maintain hope.  Believe in something that has strong meaning to you and reflect inwardly on how you’ve managed stress before. Take regular breaks during your shift and then leave when your shift is over to get sufficient rest before your next one.  Most importantly, stay connected to your support system.  Remember, we can’t effectively help others until we’ve first cared for ourselves.

Prepare the Umbrella Before It Rains

Thankfully, disasters don’t happen every day.  But that doesn’t mean that we don’t need to be prepared for when they do.  PFA is a tool that can be utilized in every disaster scenario and having trained PFA responders is so important.  PFA is not something that only licensed professionals can do.  It’s not professional counseling, so this means anyone can train to be a PFA responder – the only requirement is compassion.

If you find yourself wanting to help, seek out training.  It’s available from many different sources.  Educate yourself and become a resource.  The world needs people who are equipped to help when disaster does strike.  We must prepare the umbrella.