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1. Psychological First Aid
Kathy Berlin, RN
MRC Coordinator
Elizabeth McClure, MD, MPH
Medical Director
Academic Health Center
Office of Emergency Response

2. Training Objectives
 Understand key points of
Psychological First Aid (PFA)
 Increase awareness of the signs
and symptoms of stress
 Identify strategies to limit distress
and negative health behaviors
 Identify strategies to support
resilience among responders

3. Psychological First Aid
Key Points
 Parallel to medical first aid
 Uses skills you probably already have
 Designed for use in the immediate
aftermath of a disaster
 Offers practical assistance &
information

4. Psychological First Aid
Key Points
 Appropriate for all ages
 Culturally informed
 Consistent with research
evidence on risk and resilience
following trauma

5. Psychological First Aid:
Who, Where, When?
 Who delivers PFA?
– First responder teams, Medical Reserve
Corps (MRC), Community Emergency
Response Teams (CERT) and others
 Where is PFA used?
– Family assistance centers, mass triage
facilities , mass dispensing sites, special
needs shelters
 When is PFA used?
– As an integral part of the immediate
disaster response

6. Endorsed by……
 American Psychological
Association
 WHO, CDC, MDH
 National Institute for Mental
Health
 National Center for PTSD
 Metro Disaster Behavioral Health
Work Group
 SAMHSA

9. Psychosocial Consequences of Disasters
Fear and Distress
Response
Impact of
Disaster
Event Behavior
Change
Psychiatric
Illness
Source: Butler AS, Panzer AM, Goldfrank LR, Institute of Medicine Committee on
Responding to the Psychological Consequences of Terrorism Board of on Neuroscience
and Behavioral Health. Preparing for the psychological consequences of terrorism:
A public health approach. Washington, D.C.: National Academies Press, 2003.

10. Reactions to Stress
Adults
 Physical
 Behavioral
 Emotional
 Cognitive
 Spiritual

11. Reactions to Stress
Children
 Physical
 Behavioral
 Emotional
 Cognitive
 Spiritual

13. Events are More Stressful or
Traumatic When……
 Event is unexpected
 Many people die, especially
children
 Event lasts a long time
 The cause is unknown
 The event is poignant or
meaningful
 Event impacts a large area

14. Minimize negative emotional
impact of a disaster through…..
 Rapid intervention
 Identification, labeling,
and expression of
emotions
 Regaining a sense of
mastery and control
over life

15. PFA Big Picture:
Target Outcomes
 Restore Safety
– Safeguard
– Sustain through basic needs
 Facilitate Function
– Comfort
– Connect
 Empower Action
– Education
– Resilience

16. Psychological First Aid
Help Card
 Goal:
– Promote Safety
– Calm and Comfort
– Connectedness
– Self-empowerment

17. Psychological First Aid
Help Card
 Responder Resilience
– Prevention Strategies
– Self care
 When in Doubt- CONSULT!

18. PROMOTE SAFETY
 Meet basic survival needs
 Offer practical assistance
and information
 Shield survivors from
onlookers/ media
 Repeat information as often
as needed
 Assist in finding resources
Safeguarding
survivors and
sustaining
their basic
needs

19. CALM AND COMFORT
 Compassionate presence
 Active listening
 Don’t push for information
 Use stress management
techniques
 Be flexible and supportive
 Comfort, console, soothe
Facilitate
psychological
function
through
calming and
connection

20. What People Need
 To talk to about their
experience
 Someone to care
 Someone to really
listen
 Someone to lean on
or cry with

21. Active Listening
 Body language
 eye contact
 facial expression
 tone of voice
 Gentle prompts
 Label, summarize, and mirror
 Compassionate presence

22. Active Understanding
 Try not to interrupt until story
ended
 Do ask questions to clarify
 Occasionally restate part of the
story in your own words to make
sure you understand

23. Active Understanding
 Avoid Why/Why not?
 Don’t judge
 Avoid “I know how you feel.”
 Avoid evaluation of their
experience and their reactions
 Silence is O.K.

24. It is NOT OK to say….
 Let’s talk about something else
 You should work toward getting
over this
 You are strong enough to deal with
this
 You’ll feel better soon
 You did everything you could
 You need to relax
 It’s good that you are alive

25. Stress reactions are normal
 Basic information
on ways of coping
 Psychological
reactions are
common and
expected
 Simple relaxation
techniques

26. Agitation
 Refusal to follow directions
 Loss of control, becoming
verbally agitated
 Becoming threatening
 It is not personal
 This is their reaction to an
UNCOMMON situation, it has
nothing to do with you

27. When to Refer
 Harm to self or others
 Inability to make simple decisions
 Significant withdrawal
 Ritualistic behavior
 Hallucinations/paranoia
 Disorientation to time and place
 Unable to care for self

28. How to Refer
 Ask about reaction to referral
 Make referral with individual
present
 Don’t push referral unless person
appears to be at imminent risk to
self or others
 Cold referrals are generally not
successful

29. CONNECTEDNESS
 Help connect with friends and
loved ones
 Keep survivor families intact
 Reunite children with family
 Connect survivors to available
support services
Facilitate
psychological
function
through
calming and
connection

30. SELF EMPOWERMENT
 Clarify Disaster information
 Engage towards meeting own
needs
 Work toward “normal” life
activities
 Guide towards what to expect,
teach resilience
Reestablish
hope and
action through
education and
empowerment

31. Resiliency
Ability to accommodate
and bounce back after a
setback disappointment
crisis or major distress.

32. Promote Resiliency
 Everyone who experiences a
disaster is touched by it
 We have the ability to bounce
back after a disaster to a new
normal
 Resilience can be fostered
 One goal of PFA: support
resilience in ourselves and others

33. Personal Resiliency Plan
 Know your unique stressors
and red flags
 Know unique stressors of the
event: extent of damage, death,
and current suffering
 Monitor on-going internal
stress
 Emotional pain and anxiety are
contagious

34. Responder Resiliency
Tools
 Help Card
– Prevention Strategies
– Self Care
 Resiliency
– Pre-event
– During event
– Post-event

35. Building Responder Resilience
Pre-event
 Educate and train
 Build social support systems
 Instill sense of mission &
purpose
 Create family communications
plan
 Learn coping strategies

36. Building Responder Resilience
During event
 If possible, use the buddy system
 Focus on immediate tasks at hand
 Monitor health, safety, and
psychological well-being
 Know your limits
 Activate family communications
plan

37. 37
There is a cost to caring. We professionals
who are paid to listen to the stories of fear,
pain, and suffering of others may feel,
ourselves, similar fear, pain and suffering
because we care.
Compassion fatigue is the emotional
residue of exposure to working with the
suffering, particularly those suffering from
the consequences of traumatic events.
Charles R. Figley, Ph.D.
Compassion Fatigue

38. Building Responder Resilience
Post-event
 Delayed reactions seen among
general public and emergency
responders
 Monitor health and well-being
 Take time to recover
 Seek support when needed

39.  Expect a reintegration period
upon returning to your usual
routine.
 Pay attention to cues from your
family that you are becoming
too involved.
Self Care
Post-event

40. GROUP PARTICIPATION

41. Q: Effective communication during
times of trauma may include
repeating information often.
Q: Which of the following describes
possible symptoms of stress in
children?
a. Fear of being alone
b. Difficulty sleeping
c. Sense of guilt or responsibility for event
d. Regression
e. All of the above

42. Q: Physical symptoms of stress, such as
elevated heart rate & breathing can
sometimes improve with calm,
soothing verbal intervention.
Q: Children may feel more secure in a
structured environment (such as
school) after a traumatic event.

43. Q: During a traumatic event, it is helpful to
provide immediate psychotherapy.
Q: During the crisis response, it is important
to do which of the following?
a. Work in partners or teams
b. Take brief stress breaks
c. Check in with others
d. Talk about your feelings at the end of the day
e. All of the above

44. Q: There is an adjustment period after
returning from a crisis.
True or False

45. Learn More
• On-line Courses:
– “Psychological Issues Following a Disaster”, U of M Center for
Public Health Preparedness
• http://cpheo.sph.edu (I ½ hours)
– Mental Health Consequences of Disasters”,
Johns Hopkins Center for Public Health Preparedness
• http://nccphp.sph.unc.edu/training (I hour)
• Other Resources
– DEEP PREP “All Hazards Disaster Behavioral Health Training”
– SAMHSA Website
• http://mentalhealth.samhsa.gov/publications/Publications_browse.a
sp?ID=181&Topic=Disaster%2fTrauma
– American Academy of Child and Adolescent Psychiatry Website
• http://mentalhealth.samhsa.gov/_scripts/redirect.asp?ID=775