The 'Psychological First Aid' Professionals Deliver In A Crisis — And How You Can Learn It, Too
Do you know how to respond to emotional trauma?
michaeljung / Shutterstock.com In emergency response terms, a critical incident it is a stressful event powerful enough to overwhelm the coping skills of an individual or a group. The stress related to such an event can give rise to a range of cognitive, emotional, physical and behavioral signs and symptoms that affect the body, mind and spirit.
In the wake of a crisis, first responders often are called upon to provide emotional and mental stabilization, as well as to treat physical injuries. Psychological first aid is an initial response to this type of stress.
Time is of the essence for psychological first aid
The urgent window of time after a catastrophic event is a turning point during which the survivor might feel either supported or abandoned. When a crisis presents itself, whoever is affected has lost a sense of control over their life.
Safety and security have been undermined. Nothing will ever be the same again. Emotional triage can help a patient remain calm and condition their mind to process the aftermath of the crisis.
The methods first responders use to deliver psychological first aid can provide valuable lessons for everyone who seeks to offer ongoing emotional support to someone who needs it. Even though the sense of urgency isn't the same as in a crisis, the stakes can be just as high for someone working through a chronic mental health condition.
The core actions of psychological first aid
How can first responders assist someone in stabilizing and reestablishing a sense of safety and control? They can't. Not really.
The secret is, that although we cannot do this for someone, we can assist in helping someone do this for themselves. This is the object of the core actions of psychological first aid.
Psychological first aid (PFA) is an initial, short-term, supportive disaster response intervention whose goal is to promote safety, stabilize survivors of disasters, reduce their trauma
symptoms, help them return to adaptive functioning and connect individuals to resources for continuing supportive care.
Here are the core actions (and some good-to-know takeaways for anyone providing emotional support):
Contact and engagement
If this is a major event and someone is in charge, check in with them and offer your support as there may be processes or support options in place that would benefit you to have in your toolbox. You will be a contributor to a larger unit.
If this is a singular event such as a motor vehicle accident, make sure that someone is calling 911. There can be chaos and often people think someone else has taken care of this basic step when they have not
When you meet your survivor: Introduce yourself with your name, and your agency (if any). If you have a badge with your name, wear it. Tell the survivor that you are there to help.
Good to know: Keep it simple. The person is focused on their calamity and their need for help, not on you.
Safety and comfort
If there are physical concerns, don’t wait to get basic information such as the person's name, address, birthdate, phone number, and their emergency contact.
Make sure the person feels comfortable and, if at all possible, physically relaxed. If the survivor can be moved, create distance from the situation. If possible, take the person to a safe place — take a walk, get something to drink.
This helps to focus on the present moment. Ask: “Are you in pain? Where does it hurt? Are you too cold? Too warm? Is there anything physical happening that needs immediate attention?"
Good to know: Ask, “What are you feeling?” not, “How?" Keep your question concrete.
Physical & mental stabilization
Information gathering: If there were no physical issues, this is a good time to collect personal data and to begin to assess the person's emotional state. How would the person like to be reached? Give the person time to answer.
Good to know: In a stressful type of situation, asking a question that requires a bit of thought slows things down. This type of question helps your person begin to make choices for themselves.
Rendering practical assistance
Ask about immediate needs and what they might be. Were they in the midst of going to meet someone or pick a child up from school or were they on their way home and someone is expecting them?
Don’t prejudge based on age, race or other identifying characteristics. A grandparent may be picking up a child from school or meeting someone for lunch.
Ask questions and wait for the answers. Do they need a phone or is there someone you can call for them? Is there someone who might see the incident on the news and who needs to know they are safe, or that they will not be arriving somewhere when expected?
Does a loved one need time to come and be with them? Ask about clergy. They can be incredibly helpful in times of stress.
Good to know: Engage your person’s support system as soon as possible.
Acknowledgment of the crisis
Ask if the person wants to talk about what happened. Allow the person to talk. Give the person space to think.
Listen, listen, listen. It does not make a difference if you have other facts. It is important the way the person remembers something from their own perspective.
Good to know: If there is silence, don’t fill it in. Encourage the person to tell you what they are seeing in their mind.
Allow emotional release
Don’t give people tissues right away. Allow the tears to come out. Often people are embarrassed about crying. Assure them it is OK and even healthy to cry or be angry or whatever they are.
Never use platitudes or trivialize. Do not try and make sense of an irrational act.
Good to know: Stay honest. If you don’t know something, say you don’t know. If you think you can find out, let them know you will try to find out and make sure you get back to them with the response even if the response is that you didn’t find out.
Believe in resilience
It is most important to believe that people have the ability to get through a situation. Situations happen in life. It is how we handle them that makes a difference. Do we use them as stumbling blocks or stepping stones?
As a responder, being respectful, ethical and having clear boundaries is essential. Psychological first aid is a short-term opportunity to help. People are vulnerable. Keep what
you are hearing and seeing confidential. If you are a professional, do not self-refer.
When people have a crisis, all the bells and whistles of life become meaningless. What is truly important, like caring, consideration and simplicity, are what matter.
A crisis can be a turning point. It is a time when people often re-evaluate the meaning of their lives.
In a way, it's a type of rebirth. As with any birth, one can be a helper. However, a person must use their own personal strength to get through the incident.
The helper can cheer them on. The helper can breathe with them. The helper can make sure their dignity is protected and they are in a safe space. But you cannot have their experience — which is true for a crisis as well as an ongoing mental health treatment.
Ultimately, the work to process emotional trauma is for them alone and you can only speak to the power that they must find in themselves that will make this situation a stepping stone and not a stumbling block.
Rev. Ellyn Kravette is a psychospiritual counselor who believes that the essence of spirituality means that each one of us is a part of something greater.