The Psychological First Aid (PAPs) are designed to assist people who have been victims of major disasters in the immediate aftermath of the disaster. The objective is to reduce the initial discomfort caused by a traumatic event, favoring adaptive behavior in the short, medium and long term, providing victims with timely coping skills.
They consist of providing non-invasive help and support to these people, attending to their basic needs (food, water, orientation and information), listening to them without pressure and comforting them to a state of calm.
The PAPs should be applied by people who have specific training for it, not having to be necessarily health personnel. In fact, in the case of children and adolescents, the best people to apply PAP are their reference adults, ie their parents or the nearest adults.
Psychological first aid involves immediate intervention. This means that to be effective they must be applied within the first 72 hours after the incident, since, according to experts, from that moment their effectiveness is reduced. This does not mean that once these 72 hours have passed, the victims of the catastrophe will not need psychological support.
The PAPs help the impact of the critical incident be less, avoiding deep psychological sequelae in the victims from the first moment. WHO recommends that, following the implementation of the PAPs, psychological care should continue for at least several weeks (about 4 weeks).
What should you do before applying psychological first aid?
In order to be a real help to people affected by the disaster, as a person who performs PAP, you must be well informed about the nature of the event, the current circumstances and the type and availability of relief and support services.
Before you go to the place where the disaster happened, you should be clear about the following issues:
- How is the environment where the disaster happened?
- What is the extent of the location of the critical incident? How many victims are there? What is the severity of those affected?
- What is the protocol of action? (The steps that will follow the groups of emergencies and community aid).
- Who is assisting those affected?
- Where are you withdrawing those affected to help them?
- Who are the people authorized to help? You can inform about your training, and your willingness to help.
If you are not sufficiently informed of the resources available and the organization of the collaborating agents, instead of helping you, you may get in the way.
What you should never do
- You should not force anyone to share their feelings or talk to you.
- Do not tell her that"everything is going to be okay"or"at least you have survived."
- Do not tell her what to do, feel or think.
- Do not tell her that they should have acted sooner.
- Do not make any promises you can not keep.
- Do not criticize community services or relief activities, which are one of the sources that will provide security and hope to those affected.
How do you act in Psychological First Aid?
Below, we show you the protocol of action in the PAPs in 8 phases.
Contact and approach
It is the first contact with those affected and the main objective is to test who needs psychological assistance. The first contact with the people affected is essential, since it will be decisive in the capacity of help of the person who attends them.
In order for this first contact to be effective, your approach must be respectful and helpful, which will help the victim be more receptive to help. You should keep in mind that not all people want to be helped.
In that case, they are made aware that they have available help if they wish to obtain it. A small display of sincere interest and security may be enough to help people who are feeling overwhelmed and confused at the moment.
Safety and Comfort
The restoration of the feeling of security and calm of the affected people is the primary objective in an intervention of PAP. You should seek to promote safety and comfort, as these are keys to reducing the anguish and concern of a situation of such high emotional stress.
To ensure the safety and comfort of those affected, you can:
- Propose that the people involved carry out dynamic activities (instead of passively waiting), practices (using available resources) and family (based on past experiences).
- Obtain up-to-date and accurate information, preventing survivors from being exposed to confusing or excessively disturbing information.
- Establish connections with sources of practical resources available.
- Get information on how relevant people are improving safety conditions.
Containment and stabilization
This phase of PAP intervention is not always necessary since not all people living in such a traumatic situation have such high levels of activation that they need stabilization.
People who need stabilization may have the following symptoms:
- Crystal eyes, missing or lost gaze.
- Absence of answers to questions or verbal orders.
- Unintentional unorganized behavior.
- Intense emotional responses such as disconsolate crying, aggressive behavior, hyperventilation, or rocking motion.
- Uncontrollable physical reactions.
- Desperate search behavior.
- Feeling of incapacity because of concern.
- Participation in high risk activities.
In the event that you go to attend to someone who needs to be restrained, you should talk in a calm and calm, letting the person express himself at his pace. You should always respect the privacy of the person, although showing support and availability to help you when you need it.
On some occasions it may be necessary that you orientate the person in time and space, because you present clear symptoms of disorientation. To relax, you can advise him to walk or drink water. This will help stabilize your emotions.
Information. Identify current needs and concerns
You have to collect all the information that may be useful when intervening: What concerns the person, their immediate needs, whether they have had any other important life event, whether they are afraid, where they were at the time of the disaster, If there are acquaintances affected, etc.
This process starts from the moment of first contact and continues throughout the PAP process.
The assistance itself
This is where you have to plan how you are going to intervene in the person based on the needs detected, establishing an order of priorities and following specific steps for it.
It is common for people who have experienced a critical incident to experience a process of acute despair. In this sense, you must work to increase feelings of empowerment, hope and dignity through the facilitation of coping strategies and problem solving.
Connection to the support network
Social support relates to Emotional well-being And recovery after a critical incident. Social support can come in many forms: Feeling heard, hugging, understanding, acceptance, feeling part of a collective...
But in particular, people who have experienced these traumatic situations have a great need to reunite the family nucleus. That is why you must prioritize the search for connection with your main support network, the family, which will be very useful in favor of your security and recovery.
Coping Guidelines
This is the moment in which you inform the affected of the normal behaviors that appear in your situation, so you do not worry excessively and know what may be happening or how your symptoms will happen. In this way, you will know what happens to you and how you can manage your emotional reactions.
It is vital that you provide tools to help address these emotional reactions, as you will see that they work and help empower the affected person.
The most typical reactions of posttraumatic stress
- Intrusive Reactions : Which are recurrent thoughts that recall the traumatic event.
- Avoidance and withdrawal reactions : How to avoid talking, thinking and having feelings about the event, as a way of self-protection.
- Physical Excitation : Such as sweating, excessive nervousness, tremors, as if the traumatic event had not yet ended.
Connection with external services
Finally, you should facilitate contact with external collaborating services, such as police, medical services or primary care.
What is the state of crisis?
A person is in a state of active crisis when he / she presents an imbalance due to a great emotional tension. This condition lasts from 2 to 6 weeks, during which the reactions mentioned above may occur, including high arousal, immobilization, thinking disorders or an inadequate intellectual functioning.
This state of malaise is usually accompanied by an excessive preoccupation with the traumatic experience until a state of"natural"readjustment, which consists in the habituation to the new situation.
The reactions that appear to a crisis are:
- Confusion and disorientation
- Difficulty in decision making
- Sleeping problems
- Questioning of beliefs
- Concern for disaster
- Disordered thoughts and Intrusive
- Difficulty concentrating
- Concern for insignificant details
- Passivity
- Isolation
- Guilt
- Avoidance or negation
- Impulsiveness
- Dependence
- General tiredness
- Anxiety and Hyperventilation
- Change in appetite
- Worsening of general physical health
- Sadness hopelessness
- Fear
- Hypersensitivity
- Emotional distancing
- Low self-esteem
- Depression
The phases of a crisis
Phase 1: The traumatic situation occurs
It gives the event perceived as threatening, which causes acute stress in the person. Denial responses or states of shock can be given.
Phase 2: First disorganized answers are given
The first behaviors of response to the traumatic situation appear. Affliction, anguish, disorientation... These answers are just an attempt to understand what happened.
Phase 3: Explosion
Loss of control of thoughts, emotions and behavior. Inappropriate or destructive behavior may occur.
Phase 4: Stabilization
The internal disorder of the individual begins to stabilize from the understanding of what has happened. It is a very sensitive phase, because you can still go back to phase 3 when you remember what happened.
Phase 5: Adaptation
A reconciliation between the traumatic event and the actual reality of the person is achieved. You can take control of the situation.
How can the reactions and symptoms evolve over time?
When an acute stressful situation occurs such as experiencing a natural disaster or an accident, crisis reactions are the normal and expected response. It is a reaction of the organism to protect itself and to face what happened, that looks for the adaptive behavior.
In both children, adolescents and adults, the ultimate response should be adaptation. Little by little, people will get used to it, learn to live with what happened and even learn from it.
Usually, this acceptance process will take about 4 weeks from the occurrence of the traumatic event.
In some cases, people can not fully recover. If the symptoms persist for a longer time, increase in intensity or begin to interfere in the daily life of the person, you will need to seek psychological treatment.
References
- Australian Red Cross (2013). Psychological First Aid. An Australian Guide to supporting people affected by disaster. National Library of Australia: Victoria.
- National Center for PTSD (2015). Psychological first aid (2d).
- New York City Department of Health and Mental Hygiene (2016). Providing psychological first aid (PFA).