psycological first aid

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PsychologicalFirst Aid

for

DisasterRelief Workers

Olivier, Rodman & Associates, LLC

2009www.PlanPracticePrepare.com


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Overview

Impact of Disaster onCommunities

Psychological Intervention

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Disasters are traumatic events-dangerous, overwhelming....and usually sudden

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No one who sees adisaster is

untouched by it


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Phases of Disaster Reactions

Warning of Threat Impact

Rescue or Heroic

Remedy or Honeymoon

Inventory

Disillusionment Reconstruction and Recovery


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Pre-disaster

Heroic

Typical Phases of a Disaster

Honeymoon

(Community Cohesion)

Disillusionment

Coming

toTerm

s-Work

ingThroughGrie

f

Reconstruction

Integration

Trigger Events

Inventory

One to Three Days One to Three YearsAdapted

from

Zunin/M

eyers

Threat

Impact


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During these phases, the demand forcommunity service increases or surges


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In disasters, the number

of people affectedpsychologically is greaterthan the number sustaining

personal harm,damage to home,or loss of valued

possessions

the size of the psychological footprint is largerthan the size of the medical footprint. (Shultz

et al,2003)

PsychologicalFootprint

80%

MedicalFootprint

20%


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Critical Disaster Stressors


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Critical Disaster Stressors

Threat to ones life

Threat of harm to family Destruction of home or community

Significant media attention

Witnessing anothers trauma

Being trapped or unable to evacuate


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Chronic Disaster Stressors

Family disruption

Financial strain

Work overload Bureaucratic

difficulties


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A Variety of Reactions

Physical

Emotional

Cognitive Behavioral


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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


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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


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Cognitive Reactions to a Disaster

Trouble concentrating or rememberingthings

Difficulty making decisions

Preoccupation with the event

Recurring dreams or nightmares

Questioning spiritual beliefs


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Behavioral Reactions to a Disaster

Isolation from others Increased conflicts with family

Hyper-vigilance, startle reactions Avoiding reminders

Crying easily

Not eating


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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 disruptionsto daily routines)


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Psychological Intervention

Psychological First Aid

Communicating with Those inCrisis

Taking Care of Yourself

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Response Intervention:Working with Individuals

Rapid assessment and triage

Crisis intervention


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Response Intervention:Working with Groups

Debriefings Community meetings

Information and referral


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Response Intervention:

Psychological First Aid

Supportive listening

Problem-solving immediate issues

Education about disaster stress


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What isPsychological First Aid?

An evidence-informed modularapproach to assist children,

adolescents, adults and family in theimmediate aftermath of disaster or

terrorism-Medical Reserve Corp website


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Psychological First Aid (contd)

A supportive and compassionate presencedesigned to reduce acute psychologicaldistress 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


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Psychological First Aid. Is evidence informed

Represents the current intervention standardendorsed by experts

Helps almost anyone exposed to trauma

Can be provided by any caring person

Promotes application of the receivers natural

psychological resilience

www.nctsn.org/nctsn_assets/pdfs/pfa/2/psyfirstaid.pdf


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Who deliversPsychological First Aid?

-Disaster relief workers who provideacute assistance as part of theorganized disaster response.

-Mental health professionals whoare part of the disaster relief effort


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Where to use Psychological First Aid

Shelters

Hospital ED or Family AssistanceCenter

Emergency Operations Centers

First Aid Stations

PODs

Staging Areas

Schools


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So how does it work?

The most usual and expectedpersonal reaction to traumaticincidents is

Psychological Resilience

NOTE


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Psychological Resilience

during a disaster

Most people manage disaster by usualmeans of coping

Some benefit from assistance inaccessing/applying their natural resilience

A minority are not successful and mayrequire traditional professional assistance


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Three Dimensions of

Psychological First Aid.. ABCs ofMedical 1staid..

At the conclusion of psychological first aid

intervention, you should be able to answer thefollowing:

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)


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Three Dimensions ofPsychological First Aid

# 1. Physical Health

Restoring physical safety anddiminishing the physiological

stress response


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# 1: Safe, secure, & comfortable?

Are they out of harms way?

Are they physically comfortable?

Are there immediate health/medicationneeds?

Do they need to be referred?

What is their stress level, how can youhelp lower it?


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# 2. Psychological Health

Facilitating psychologicalfunction and perceived sense of

safety and control


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#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


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# 3. Behavioral Health

Initiating action toward disaster

recovery and return to normalactivity


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#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 acourse of action

Establish follow-through

REMEMBER, FIRST STEPS OF ACTION

CAN BE VERY LIMITED


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Recap: Three Dimensions of

Psychological First Aid (PFA)

At the conclusion of psychological first aid, youshould be able to answer the followingquestions:

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


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Remember, PFA is

brief supportive intervention


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Those most directly exposed:

Saw/heard death or serious injury ofothers

Death of family member, friend, pet

Survivor of physical injury or threat ofdeath

Research shows these indicators aremore important than symptoms/distressindicators

NOTE


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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 questionablejudgment, because he/she is under influence ofalcohol or drugs

Acts confused/disoriented, saying or doing thingsthat 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.


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Communicating with ThoseWho Are in Crisis

Speak in short sentences, use shortsimple words

Use simple directives

Be clear

Use the persons name

Repetition may be necessaryRemember, your thinking processes

may be affected as well


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Things to remember

Do say to survivors:

Its understandable that you feel this way. Your reactions are normal.

Do: Get help when youre unsure about what to do.

Function only within your scope of

responsibility.


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Things to remember

Dont:

Expect things to be organized

Assume all problems are disaster related

Say: I know how you feel or everythingwill be alright

Speculate or offer undocumentedinformation


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Recipe for Responder Burnout

Dr. George Everly of Johns HopkinsSchool of Public Health gives us thefollowing recipe for disaster responderburnout


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Dr. George EverlysDisaster Worker Burnout Club

Be a perfectionist, never acceptexcellence.

Never exerciseEmpathize with ALL disaster victims, you

MUST feel their pain.

Eat as much fast food as possible


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Dr. George EverlysDisaster Worker Burnout Club

Accept responsibility for everything andeveryone, all the time!

Engage in an endless process of

controlling everything and everyone,especially those people/things over whichyou have not actual control. It is YOURresponsibility to make all disaster victimshappy.

D G E l


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Dr. George Everlys

Disaster Worker Burnout Club

Strive to sleep as little as possible!NEVER desire to return home, if forced to

do so, feel guilty.

Use alcohol to relax, stimulants to getgoing.

Remember, the glass is always halfempty.


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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 youare in need, and seek personal support


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Disaster stress for responders

Disaster work is extremely satisfying

Disaster responders face challenges ofworking in situations of extreme destructionand human anguish

Disaster response may generate compelling

emotional reactions

NOTE


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be prepared

Create a family disaster plan

Have survival supplies in home/cars

dont 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


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Psychological First Aid Resources

Medical Reserve Corp: Online training:

www.medicalreservecorp.gov

National Center for PTSD: Psychological First Aidmanual , 2nd Ed

www.nctsn.org/nctsn_assets/pdfs/pfa/2/psy

firstaid.pdfSubstance Abuse and Mental Health Services

Administration (SAMHSA) www.samhsa.gov

American Red Cross Psychological First Aid: 2006

http://redcross.tallytown.com/dsp/formDSCLS206APW.pdf

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