Psychological

First Aid
for
Disaster
Relief Workers

Olivier, Rodman & Associates, LLC

© 2009
www.PlanPracticePrepare.com
 Overview

1 Impact of Disaster on
Communities

2 Psychological Intervention
 Disasters are traumatic events-
1 dangerous, overwhelming….
...and usually sudden
No one who sees a
disaster is
untouched by it…
Phases of Disaster Reactions

• Warning of Threat
• Impact
• Rescue or Heroic
• Remedy or Honeymoon
• Inventory
• Disillusionment
• Reconstruction and Recovery
 Typical Phases of a Disaster

(Community Cohesion) Reconstruction

Honeymoon

f
rie
Pre-disaster

hG
ug
ro
Th
Heroic

g
kin
Inventory Integration

or
-W
ms
Threat

r
Te
to
Impact
ng
mi
Co

Trigger Events
Disillusionment
Zunin/Meyers
Adapted from

One to Three Days One to Three Years

During these phases, the demand for
community service increases or “surges”
 “In disasters, the number
of people affected
psychologically is greater
than the number sustaining
personal harm, Psychological
damage to home, “Footprint”
or loss of valued 80%
possessions… Medical
Footprint
20%

…the size of the psychological footprint is larger

than the size of the medical footprint.” (Shultz
et al,2003)
Critical Disaster Stressors
 Critical Disaster Stressors

• Threat to one’s life

• Threat of harm to family
• Destruction of home or community
• Significant media attention
• Witnessing another’s trauma
• Being trapped or unable to evacuate
Chronic Disaster Stressors

• Family disruption
• Financial strain
• Work overload
• Bureaucratic
difficulties
A Variety of Reactions

• Physical
• Emotional
• Cognitive
• Behavioral
Physical Reactions to a Disaster

• Headaches
• Generalized discomfort, hot or cold
• Hypertension, heart pounding
• Gastrointestinal distress
• Exacerbation of psychiatric illness
• Accelerated physical decline
• Fatigue or exhaustion
• Increase/decrease in appetite
 Emotional Reactions to a Disaster

• Feeling depressed or sad

• Feeling irritable, angry, resentful
• Experiencing anxiety or fear
• Feeling despair or hopelessness
• Being apathetic
• Feeling overwhelmed
Cognitive Reactions to a Disaster

• Trouble concentrating or remembering

things
• Difficulty making decisions
• Preoccupation with the event
• Recurring dreams or nightmares
• Questioning spiritual beliefs
Behavioral Reactions to a Disaster

• Isolation from others

• Increased conflicts with family
• Hyper-vigilance, startle reactions
• Avoiding reminders
• Crying easily
• Not eating
 Key Concepts
‰People pull together during and after
disaster

‰Stress and grief are normal reactions to an

abnormal situation (transitory reactions)

‰Emotional reactions relate to problems of

living (abnormal and excessive disruptions
to daily routines)
2 Psychological Intervention

9Psychological First Aid

9Communicating with Those in

Crisis

9Taking Care of Yourself

 Response Intervention:
Working with Individuals

• Rapid assessment and triage

• Crisis intervention
Response Intervention:
Working with Groups

• Debriefings
• Community meetings
• Information and referral
 Response Intervention:
Psychological First Aid

• Supportive listening
• Problem-solving immediate issues
• Education about disaster stress
What is
Psychological First Aid?

“An evidence-informed modular

approach to assist children,
adolescents, adults and family in the
immediate aftermath of disaster or
terrorism”
-Medical Reserve Corp website
Psychological First Aid (cont’d)

“A supportive and compassionate presence

designed to reduce acute psychological
distress and/or facilitate continued support,
if necessary.”

Everly, GS, Jr & Flynn, BW(2005)

Principles and Practice of Psychological First Aid
Johns Hopkins Center for Public Health Preparedness
 Psychological First Aid….
• Is evidence informed
• Represents the current intervention standard
endorsed by experts
• Helps almost anyone exposed to trauma
• Can be provided by any caring person
• Promotes application of the receiver’s natural
psychological resilience

www.nctsn.org/nctsn_assets/pdfs/pfa/2/psyfirstaid.pdf
Who delivers
Psychological First Aid?

-Disaster relief workers who provide

acute assistance as part of the
organized disaster response.

-Mental health professionals who

are part of the disaster relief effort
Where to use Psychological First Aid
• Shelters
• Hospital ED or Family Assistance
Center
• Emergency Operations Centers
• First Aid Stations
• PODs
• Staging Areas
• Schools
 So how does it work?

The most usual and expected

NOTE personal reaction to traumatic
incidents is…
…Psychological Resilience
 Psychological Resilience
during a disaster

• Most people manage disaster by usual

means of coping

• Some benefit from assistance in

accessing/applying their natural resilience

• A minority are not successful and may

require traditional professional assistance
 Three Dimensions of
Psychological First Aid
…….. ABC’s of Medical 1st aid…..

At the conclusion of psychological first aid

intervention, you should be able to answer the
following:

1. Is the individual safe, secure, and

comfortable? (Physical Health)

2. Is the individual functioning adequately?

(Psychological Health)

3. Does the individual have a plan of action?

(Behavioral Health)
 Three Dimensions of
Psychological First Aid

# 1. Physical Health
Restoring physical safety and
diminishing the physiological
stress response
# 1: Safe, secure, & comfortable?

• Are they out of harm’s way?

• Are they physically comfortable?
• Are there immediate health/medication
needs?
• Do they need to be referred?
• What is their stress level, how can you
help lower it?
 Three Dimensions of
Psychological First Aid

# 2. Psychological Health
Facilitating psychological
function and perceived sense of
safety and control
 #2: Functioning adequately?
(Or emotionally overwhelmed)

• Be a compassionate, non-intrusive presence

• Establish rapport (Eye contact, Calm presence)
• Use active listening
• Use attentive observation and appraisal
• Stabilize emotionally-overwhelmed survivors
• Provide “psycho-education” regarding survivor
reactions
 Three Dimensions of
Psychological First Aid

# 3. Behavioral Health

Initiating action toward disaster

recovery and return to normal
activity
 #3: Plan of Action?
If amenable, provide problem-solving assistance:
• Help provide focus
• Ask what is needed
• Help prioritize a specific issue
• Evaluate options, help find information, select a
course of action
• Establish follow-through

REMEMBER, FIRST STEPS OF ACTION

CAN BE VERY LIMITED
 Recap: Three Dimensions of
Psychological First Aid (PFA)

At the conclusion of psychological first aid, you

should be able to answer the following
questions:

1. (P) Is the individual physically safe, secure,

and comfortable?

2. (F) Is the individual functioning adequately?

3. (A) Does the individual have a plan of action

 Remember, PFA is
brief supportive intervention
NOTE Those most directly exposed:

• Saw/heard death or serious injury of

others
• Death of family member, friend, pet
• Survivor of physical injury or threat of
death

…Research shows these indicators are

more important than symptoms/distress
indicators
 Get help immediately…
If a person:
• Hints or threatens harm to him/herself or others
• Cannot be calmed after attempts to comfort &
reassure
• Behaves erratically, exhibits questionable
judgment, because he/she is under influence of
alcohol or drugs
• Acts confused/disoriented, saying or doing things
that do not make sense in the context of the
situation
• If someone has lost someone due to the disaster
• Whenever problem is beyond your capabilities.
Communicating with Those
Who Are in Crisis

¾Speak in short sentences, use short

simple words
¾Use simple directives
¾Be clear
¾Use the person’s name
¾Repetition may be necessary
¾Remember, your thinking processes
may be affected as well
 Things to remember

Do say to survivors:
• “It’s understandable that you feel this way.”
• “Your reactions are normal.”

Do:
• Get help when you’re unsure about what to do.
• Function only within your scope of
responsibility.
 Things to remember

Don’t:
• Expect things to be organized
• Assume all problems are disaster related
• Say: “I know how you feel” or “everything
will be alright”
• Speculate or offer undocumented
information
Recipe for Responder Burnout

Dr. George Everly of Johns Hopkins

School of Public Health gives us the
following recipe for disaster responder
burnout…
 Dr. George Everly’s
Disaster Worker Burnout Club
9Be a perfectionist, never accept
excellence.
9Never exercise
9Empathize with ALL disaster victims, you
MUST “feel their pain”.
9Eat as much fast food as possible
 Dr. George Everly’s
Disaster Worker Burnout Club
9Accept responsibility for everything and
everyone, all the time!
9Engage in an endless process of
controlling everything and everyone,
especially those people/things over which
you have not actual control. It is YOUR
responsibility to make all disaster victims
“happy.”
 Dr. George Everly’s
Disaster Worker Burnout Club

9Strive to sleep as little as possible!

9NEVER desire to return home, if forced to
do so, feel guilty.
9Use alcohol to relax, stimulants to get
going.
9Remember, the glass is always half
empty.
 Take Care of Yourself

• Eat well
• Drink water
• Take breaks
• Find opportunities for exercise
• Get sufficient sleep
• Limit caffeine and alcohol
• Monitor yourself, recognize when you
are in need, and seek personal support
NOTE Disaster stress for responders

• Disaster work is extremely satisfying

• Disaster responders face challenges of

working in situations of extreme destruction
and human anguish

• Disaster response may generate compelling

emotional reactions
 …be prepared

• Create a family disaster plan

• Have survival supplies in home/cars
…don’t forget pets!
• Make a disaster responder “go kit”
• Train for disaster role
• Clarify who would deploy you (& how)
• Individual stress management strategies
 Psychological First Aid Resources
Medical Reserve Corp: Online training:
www.medicalreservecorp.gov
National Center for PTSD: Psychological First Aid
manual , 2nd Ed
www.nctsn.org/nctsn_assets/pdfs/pfa/2/psy
firstaid.pdf
Substance Abuse and Mental Health Services
Administration (SAMHSA) www.samhsa.gov
American Red Cross Psychological First Aid: © 2006
http://redcross.tallytown.com/dsp/formDSCLS206AP
W.pdf