Psychological First Aid (PFA)-1

Psychological
First Aid
An Australian guide to
supporting people
affected by disaster
 Second edition published by:
Australian Red Cross 2013
155 Pelham St, Carlton, Victoria 3053
and
Australian Psychological Society
Level 11, 257 Collins St, Melbourne,
Victoria 3000
 What is psychological first aid?

• Psychological first aid is a ‘humane, supportive

response to a fellow human being who is
suffering and who may need support’.
• Psychological first aid is an approach to
helping people affected by an emergency,
disaster or traumatic event.
• It includes basic principles of support to
promote natural recovery.
 What is psychological first aid?

• This involves helping people to feel safe,

connected to others, calm and hopeful, access
physical, emotional and social support, and
feel able to help themselves.
• Psychological first aid aims to reduce initial
distress, meet current needs, promote flexible
coping and encourage adjustment.
 What is psychological first aid?

• Psychological first aid is useful as the first thing

that you might do with individuals or families
following a disaster.
• It is most widely used in the first hours, days
and weeks following an event.
• Psychological first aid is based on an
understanding that people affected by disasters
will experience a range of early reactions
(physical, psychological, emotional,
behavioural). These reactions may interfere
with their ability to cope.
 What is psychological first aid?

• These reactions are normal and

understandable given people’s experiences.
• Recovery may be helped by psychological first
aid.
• A small part of an affected population will
require further mental health support to assist
recovery.
• But most people recover well on their own or
with the support of compassionate and caring
disaster workers, family and friends.
 What is psychological first aid?

• Psychological first aid is most commonly used immediately

after a disaster.
• But its use is not limited to this time period. Sometimes
the first contact people have with psychological first aid
comes months or even years after the emergency.
• Outreach visits conducted by Red Cross nine months after
the 2009 Victorian bushfires, for example, were the first
time many people received psychological first aid.
• Psychological first aid skills can also be applied to public
inquiries and anniversaries of emergencies or traumatic
events, all of which may take place years after the event.
 Psychological first aid is:
• NOT debriefing
• NOT obtaining details of traumatic experiences
and losses
• NOT treating
• NOT labeling or diagnosing
• NOT counseling
• NOT something that only professionals can do
• NOT something that everybody who has been
affected by an emergency will need.
 Who need PFA?
people may be at more risk of negative
consequences. These may include those people
who:
• have had previous traumatic experiences
• have underlying mental illnesses
• were exposed to events where the horror element
was high
• thought they were going to die
• experienced traumatic bereavement
• have had serious losses of property, livelihoods, or
disruption to communities and networks.
This includes people who are:
• seriously injured and needing emergency
medical care
• so distressed that they are unable to perform
the basic activities of daily life
• threatening harm to themselves or others.
• It is important to remember that not everyone
who experiences an emergency will have
emotional distress or problems during or after
the crisis.
• Not every one who experiences a crisis will
need psychological first aid. Some protecting
factors include:
• good level of functioning
• social support
• ability to cope
• strong moral belief systems
• Returning to normal life
 The aim of psychological first aid

• Psychological first aid is humane, caring and

compassionate.
• It addresses emotional and practical needs
and concerns above all else.
• An important aim of psychological first aid is
to build people’s capacity to recover.
• Psychological first aid supports recovery by
helping people to identify their immediate
needs and their strengths and abilities to meet
these needs.
 The goals of psychological first aid
include efforts to:

• calm people
• reduce distress
• make people feel safe and secure
• identify and assist with current needs
• establish human connection
• facilitate people’s social support
• help people understand the disaster and its
context
• help people identify their own
 The goals of psychological first aid:

• strengths and abilities to cope

• foster belief in people’s ability to cope
• give hope
• assist with early screening for people needing further
or specialized help promote adaptive functioning
• get people through the first period of high intensity
and uncertainty
• set people up to be able to recover naturally from an
event
• reduce the risk factors of mental illness as a result of
the event, such as post traumatic stress disorder.
 Five elements of psychological first aid

There are five basic elements to psychological first aid

that have been drawn from research on risk and
resilience, field experience and expert agreement.
The elements of psychological first aid are to promote:
• safety
• calm
• connectedness
• self-efficacy and group efficacy
• hope.
 1. Promote safety

• Remove from, or reduce exposure to, threat of

harm.
• Help people meet basic needs for food, water,
shelter, financial and material assistance.
• Help people obtain emergency medical attention.
• Provide physical and emotional comfort.
• Provide repeated, simple and accurate
information, in a range of methods, on how to
get these basic needs met.
 2. Promote calm

• Stabilizepeople who are overwhelmed or

disoriented.
• Provide an environment, as far as practical,
removed from stressful situations or exposure
to sights, sounds and smells of the emergency.
• Listen to people who wish to share their
stories and emotions, without forcing them to
talk.
• Remember that there is no right or wrong way
to feel.
• Be friendly and compassionate even if people
are being difficult.
• Offer accurate information about the disaster
or trauma and the relief efforts underway to
help survivors understand the situation.
• Provide information on stress and coping.
• When they express fear or worry, remind
people (if you know) that more help and
services are on the way.
 3. Promote connectedness

• Help people contact friends and loved ones.

• Keep families together.
• Keep children with parents or other close
relatives whenever possible.
• Help establish contacts with support people
(friends, family or community helping
resources).
• Respect cultural norms regarding gender, age
and family structures.
•
 3. Promote connectedness
• Offer practical help to people to address
immediate needs and concerns.
• Provide information and direct people to those
services that are available.
• Link people with available services.
• Respect cultural norms regarding gender, age,
family structures and religion.
 4. Promote self efficacy

• Engage people in meeting their own needs.

• • Assist with decision making, help them to
prioritise problems and solve them.
5. Promote hope
• Convey expectancy that people will recover.
• Be there/be willing to help.
• Reassure people that their feelings are normal.
 Where is psychological first aid delivered?

Psychological first aid can be delivered in diverse settings. Psychological

first aid could be delivered at the scene of the emergency or at places
where affected people gather, such as:
• evacuation centres
• recovery centres
• hospitals
• humanitarian assistance centres
• homes
• schools
• businesses
• shopping centres
• airports
• train stations
• memorial services
• community centres.
 Preparing to provide psychological first aid in
the field

• Many emergency situations can be stressful

and often require urgent action.
• The more that is known about the situation,
and the better prepared a person is
psychologically, the more effective the support
will be.
 Prior to using psychological first aid in the field people should:

• Learn about the crisis event.

• Learn about available services and supports.
• Learn about safety, access and security
concerns.
• Consider their physical and mental
preparedness.
Important questions to ask before
entering an emergency site
 The emergency event

• What happened?
• When and where did it take place?
• How many people are likely to be affected and
who are they?
• How long did it go on for/will go on for?
 Available services and supports

• Who are the relevant authorities managing the

crisis?
• Who is providing for basic needs like emergency
first aid, food, water, material assistance, shelter
• Where and how can people access these
services?
• Who else is helping? Are community members
involved in responding?
• Is the Register, Find, Reunite, Service active to
help families reunite?
 Safety and security concerns

• Is the crisis event over or continuing, such as

aftershocks from an earthquake, or an
unfolding flood event or high bushfire danger
period?
• What dangers may be in the environment, such
as debris or damaged infrastructure?
• Are there areas to avoid entering because they
are not secure (for example, obvious physical
dangers) or because you are not allowed to be
there?
 Physical and mental preparedness

• Do you have everything you might need to be

away from home/office (phone, charger, drink
bottle, etc)?
• Have you let family members/friends know
what you are doing and how long for?
• Have you made arrangements for children,
people you are caring for and pets?
• Do you feel emotionally ready to provide
psychological first aid?
 Psychological first aid action principles
• The World Health Organization (WHO) has
developed a framework consisting of three
action principles to assist in the delivery of
psychological first aid.
• These principles provide guidance for how to
view and safely enter an emergency situation
(LOOK) in order to understand the needs of
affected people (LISTEN) and link them with
the information and practical support they
need (LINK). (Principle of 3L)
 Psychological first aid action principles
(3L)
Principles Actions
Look
• Check for safety.
• Check for people with obvious urgent basic needs.
• Check for people with serious distress reactions.
Listen
• Approach people who may need support.
• Ask about people’s needs and concerns.
• Listen to people and help them to feel calm.
Link
• Help people address basic needs and access services.
• Help people cope with problems.
• Give information.
• Connect people with loved ones and social support
 Psychological first aid action principles
(3L)
Important questions and messages to consider when
using psychological first aid Principles Actions
Look
Check for safety
• What dangers can you observe, e.g. damaged road,
unstable buildings, fire, flooding etc?
• Ask if you can be there safely without harming
yourself or others
• If you are not certain that the area is safe, then DO
NOT GO!
 Check for people with obvious urgent basic needs

• Does anyone need emergency first aid?

• Do people need urgent protection (e.g.
clothing)?
• Are there any people who might need special
attention?
• Know your role and try to obtain help for
people who need special assistance or who
have obvious urgent basic needs
 Check for people with serious distress reactions

• Are there people who are extremely

upset, immobile, not responding to
others, disturbing others, or in shock?
• Where and who are the most distressed
people?
• Consider who may benefit from
psychological first aid and how you can
best help.
 Listen

Approach people who may need support

• Approach people respectfully and according to
cultural norms
• Introduce yourself by name and organisation
• Ask if you can provide help
• If possible, find a quiet and safe place to talk
• Help the person feel comfortable
 Ask about the people’s needs and concerns

• Address any obvious needs. For example, if a

person’s clothing is torn or they need a
blanket.
• Always ask for people’s needs and concerns.
• Do not assume you know.
• Find out what is most important to them at
this moment.
• Help them work out what their priorities are.
 Listen to people and help them to feel calm

• Stay close to the person

• Do not pressure the person to talk
• Listen in case they want to talk about what
happened
• If they are very distressed help them to feel
calm and try to make sure they are not alone
 Link

Help people address basic needs and access

services
• For example, food, water, shelter, material
needs.
• Learn what specific needs people have and try
to link them to available assistance.
• Do not make promises you cannot keep.
 Help people cope with problems

• Help identify their most urgent practical needs

and assist with prioritising.
• Help the person identify support people.
• Give practical suggestions for people to meet
their own needs (e.g. how to register with
Centrelink etc).
 Give information

• Find out where to get information and updates.

• Try to get as much information as you can before
approaching people with support.
• Keep updated.
• Only say what you know.

Connect people with loved ones and social support

• Keep families together and children with their parents

• Help people to contact friends or relatives.
• If prayer or religious practice is important people may
benefit from being linked with their spiritual base
 Connect people with loved ones and social support

• Keep families together and children with their

parents
• Help people to contact friends or relatives.
• If prayer or religious practice is important
people may benefit from being linked with
their spiritual base
 For culture

• Culture can refer to the behaviours and beliefs

of a person’s social, ethnic and/or age group.
• Culture determine how we relate to people,
and what is right and not right to say and do.
• It is important to adapt our communications
with people as a way of being respectful to
their choice of culture.
• Consider the following questions:
 Dress

• Do helpers need to dress a certain way to be

respectful?
• Body covering? Colors?
• Will people affected be in need of certain clothing
items to keep their dignity and customs?
Language
• What is the customary way of greeting people in
this culture?
• What language do they speak?
• Are there formal and informal forms of address?
 Gender, age and power

• Should affected women only be approached by women

helpers?
• Who may be approached (in other words, the head of the
family or community)?

Touching and behavior

• What are the usual customs around touching people?

• Is it all right to hold someone’s hand or touch their shoulder?
• Are there special things to consider in terms of behaviour
around the elderly, children, women or others?
• Is eye contact appropriate?
 Beliefs and religion

• Who are the different ethnic and religious

groups among the affected people?
• What beliefs or practices are important to the
people affected?
• How might they understand or explain what
has happened?
 For children and young people

The following points are important when using

psychological first aid with children and young people.
Keep together with loved ones
• When unaccompanied, link them with a trustworthy
child protection network or agency.
• Do not leave the child unattended.
• Be wary of offers of help with looking after children
from unauthorised strangers.
• If no child protection agency is available, take steps to
find their caregivers or to contact other family who can
care for them.
 Keep safe

• Protect them from being exposed to any

gruesome scenes, like injured people or
terrible destruction.
• Protect them from hearing upsetting stories
about the event.
• Protect them from the media or from people
who want to interview them who are not part
of the emergency response.
 Listen, talk and play

• Be calm, talk softly and be kind.

• Introduce yourself by name and let them know you are there to
help.
• Find out their name, where they are from, and any information
you can in order to help find their caregivers and other family
members.
• Listen to children’s views on their situation.
• Try to talk with them on their eye level, and use words and
explanations they can understand.
• Support the caregivers in taking care of their own children.
• If passing time with children, try to involve them in play activities
or simple conversation about their interests, according to their
age.
• ( World Health Organization, War Trauma Foundation )
 For people with health conditions or
physical or mental disabilities
The following points are important when
assisting people who may have health
conditions or physical or mental disabilities:
• Help people get to a safe space.
• Ask people if they have any health conditions,
or if they regularly take medication for a
health problem.
 For people with health conditions or
physical or mental disabilities
Try to help people get their medication or access
medical services, when available:
• Stay with the person or try to make sure they have
someone to help them if you need to leave.
Consider linking the person with relevant support to
assist them in the longer term.
• People with a disability, particularly a cognitive
disability, may rely upon rigid routines in their lives.
• Disruption to these routines may make them highly
anxious.
• Face and speak directly to the person rather than
through the companion, attendant or sign-
language interpreter who may also be present.
For example do not say “tell her...” or “can he...”
• Never speak about the person as if they are
invisible, cannot understand what is being said or
cannot speak for themselves. If a person requires
an interpreter or care giver to assist them in
conversation, make sure there is enough time for
the person to absorb information and respond on
their own.
• Allow for short breaks if a person needs extra
time to process information.
• Offer several different options for further
contact.
• Some people may feel more comfortable with
face to face interaction while others may
prefer the telephone or email.
 Self care

• The delivery of psychological first aid following

an emergency can be very rewarding for
people involved in the emergency response.
• However, it can also be very challenging and
stressful.
• It is not uncommon for people to feel
stressed, distressed, tired, overwhelmed,
troubled, or frustrated in the course of their
work.
 Self Care
• Stress is the body’s way of getting energy to operate
outside our normal comfort zone.
• Stress is caused by stressors, these can be internal,
such as thoughts or feelings or external, such as poor
health, conflict, noise etc.

• If it is not possible to relax between demands, or there

is not enough time to unwind between the problems,
the stress builds up.
• It is not the actual difficulty of the task that causes
chronic stress; it may be the sheer quantity or
continuity of work.
 Reducing stress

• Stress will not resolve spontaneously.

• People need to take steps to break the cycle of
stress.
• It is important to identify what causes stress
for you and put in place some steps to reduce
stress.
• This sort of self care is especially important if
we wish to support others during times of
crisis.
 Reducing stress

• Think about what has helped you cope in the

past and what you can do to stay strong.
• Try to take time to eat, rest and relax, even for
short periods.
• Try to keep reasonable working hours so you
do not become too exhausted.
• Consider, for example, dividing the workload
among helpers, working in shifts during the
acute phase of the crisis and taking regular
rest periods.
 Reducing stress

• People may have many problems after a crisis

event.
• You may feel inadequate or frustrated when
you cannot help people with all of their
problems.
• Remember that you are not responsible for
solving all of people’s problems.
• Do what you can to help people help
themselves.
 Reducing stress

• Minimize your intake of alcohol, caffeine or

nicotine and avoid nonprescription drugs.
• Check in with fellow helpers to see how they
are doing, and have them check in with you.
• Find ways to support each other.
• Talk with friends, loved ones or other people
you trust for support.
THANK YOU

THE END