Trauma and disaster recovery: Psychological first aid

Trauma and disaster are highly distressing and potentially traumatic experiences for all involved. Although human beings are remarkably resilient and the majority will recover without developing long term mental health problems, the way in which health services and others respond may have a lasting impact on affected individuals’ ability to cope. In the initial days and weeks after a traumatic event (e.g. a natural disaster, terrorist attack, or multiple fatalities), psychological first aid is now internationally recognised as the recommended intervention.

Psychological first aid (PFA) is an evidence informed approach to assisting individuals and families in the immediate aftermath of a disaster.¹ It is based on five principles to guide post-disaster interventions: promoting a sense of safety, promoting calming, promoting a sense of self- and community-efficacy, promoting connectedness, and instilling hope.²

Given that most people will regain a sense of wellbeing on their own, PFA focuses on enhancing resilience and naturally occurring resources rather than assuming that all survivors will develop mental health problems or long-term difficulties.^1,3,4 PFA is appropriate for use with disaster survivors of all ages, and is designed to reduce initial distress and foster short and long-term adaptive functioning.⁵ It is typically delivered by generalist health and disaster response workers, with back up and supervision from mental health professionals.

The first stage of PFA is establishing a human connection with affected individuals in a non-intrusive, compassionate manner.

The second stage requires PFA providers to enhance immediate and ongoing safety, and to provide physical and emotional comfort. During this stage, it may also necessary to help survivors who are missing loved ones.

The third stage is to calm, reassure and emotionally orient overwhelmed and distraught survivors. In rare circumstances where extreme distress does not begin to settle, consideration may be given to short term use of sedating medication.

An important goal of PFA is to provide the most efficient and helpful assistance for the survivor; gathering information on immediate needs and concerns is therefore essential.

Having established problems the survivor is facing that require immediate attention, the PFA provider should offer practical help to address these concerns. As soon as practicable, survivors should be connected to naturally occurring social support networks, such as family, friends, and community resources.

Educating survivors about stress reactions and coping strategies promotes a sense of self-efficacy and hope. However, judgement is needed on if and when to present this information.

In most cases, relocation of either the PFA provider or disaster survivor (or both) means continuity of care after is often not possible. Therefore, the last stage of PFA is to link survivors with appropriate services, and to inform them about services that may be needed in the future. If initial distress does not subside within two weeks of the traumatic experience, more formal clinical interventions may need to be considered.

For more information, see Trauma and Disaster Recovery: Psychological First Aid.

References:

Brymer MJ, Jacobs AK, Layne CM, Pynoos RS, Ruzek JI, Steinberg AM, et al. Psychological first aid: Field operations guide, 2nd edition [online]. National Child Traumatic Stress Network, National Center for PTSD. 2006 [cited 19 February 2009]. Available from URL: http://www.ncptsd.va.gov./ncmain/ncdocs/manuals/nc_manual_psyfirstaid.html
Hobfall SE, Watson P, Bell CC, Bryant RA, Brymer MJ, Friedman MJ, et al. Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry. 2007; 70(4): 283-315.
Australian Centre for Posttraumatic Mental Health. Australian guidelines for the treatment of adults with acute stress disorder and posttraumatic stress disorder. Melbourne, Victoria: ACPMH; 2007.
Ruzek JI, Brymer MJ, Jacobs AK, Layne CM, Vernberg EM, Watson PJ. Psychological first aid. J Ment Health Couns. 2007; 29: 17-49.
Vernberg EM, Steinberg AM, Jacobs AK, Brymer MJ, Watson PJ, Osofsky JD, et al. Innovations in disaster mental health: Psychological first aid. Prof Psychol Res Pr. 2008; 39: 381-8.