When emergency psychologists carry out an intervention , whether in mass emergencies or in everyday emergencies, we must take into account the wide variety of reactions and feelings that we may find in each patient.
This will depend on the nature and seriousness of the events, on the one hand, and on the other hand, on the personal characteristics of the affected person, such as previous experiences, perceived social support, history of physical and mental health, culture and age. In psychological first aid, all these elements are taken into account .
Psychological intervention in emergencies
In these first moments of tension that we find when we arrive at the scene, we are not, of course, going to carry out a multi-method assessment as we would in consultation. Our source of evaluation will therefore be the observation we make of the overall situation and the verbalizations both of the patient himself and of witnesses or other members of the security forces.
The same thing happens to the intervention as to the evaluation. In most cases we will be with them for hours, but we will not see them again, and normally the protocol of choice in emergencies will be Psychological First Aid (PFA).
Psychological First Aid
Let’s focus on Psychological First Aid (PFA). These are evidence-based techniques designed to help all types of population affected by a critical incident , applied in the first hours after impact. After the first 72 hours they are no longer the technique of choice.
With its application we seek to reduce the level of stress and encourage adaptation and coping in the short, medium and long term.
Before applying the Psychological First Aid, a knowledge of the environment in which we are going to work is made, to know what has happened and what is going to happen. We will also establish communication with the rest of the emergency staff to coordinate in a better way.
Upon arrival at the site, those in need of assistance are identified. Whenever possible, we try to regroup the families to work with them; it is very common for spontaneous groups to emerge among those affected; we also work with them in a group way.
Finally, once again we must emphasize that we will have to adapt to the diversity of the population with which we are going to work. Normally they will be from very different cultures and therefore we will have to adapt our intervention to this.
The phases of Psychological First Aid
The application of the PAPs is divided into eight phases. Below we will see what to do and what not to do in each of them.
1. Contact and presentation
The presentation to the affected person should be made in a non-intrusive way, explaining who we are and what we do. We must not overwhelm the affected person, we must stay close but not be intrusive. At this moment the other person is in a state of alert, so we must not leave room for uncertainty, as this can be a source of fear.
A good approach is the key to the correct and effective application of the PAPs, as it sets the tone for the whole relationship that will follow this phase.
2. Relief and protection
Those affected must know that we are there to cover their basic needs, that we are there for them so that they don’t have to worry about anything else ; from promoting water and food to a mobile phone charger or a phone with which to help family reunification. In this way they can gradually relax and stop being afraid of the uncertainty of the present.
3. Emotional Containment
On many occasions those affected by an emergency are in a state of shock, disoriented and dislocated . Our task as emergency psychologists will be to guide them in space and time in a non-aggressive manner, adapting to the reality of the patient.
4. Collection of information
The way in which we interact with the affected person is very important, we must do it in a way in which they do not feel uncomfortable, so that we can access as much information as possible to provide the most effective help.
In order to do so, we must speak slowly, exploring all the needs and clarifying the information, and we must also order the priorities of attention and attend to them according to the available resources . We must not give trivial advice just as we will not trivialize needs based on our opinions.
5. Practical assistance
First of all, we must anticipate useful practical information that the victims may not yet be aware of, such as where the toilets are, the meeting points, the food supplies, etc.
In response to the questions of those affected, with this information we will be able to reduce their anxiety and fulfil the objective of satisfying their basic needs . Thus, anxiety stops accumulating, since we offer attention to the most fundamental things.
6. Connection to the social support network
It is of utmost importance to help those affected to reconnect with their support network . Either by providing them with a phone number to contact or, in case they do not have one, by contacting the security forces to request their help in this task.
Until there is no one accompanying that person, preferably from their support network, we will not leave.
7. Coping guidelines
The most important task will be to normalize symptoms, many affected people believe that in addition to what has happened to them they are becoming “crazy”, we must move away from that idea by reporting the basic stress reactions that can be expected in the next hours and days.
They are trained in basic relaxation techniques, being diaphragmatic breathing the technique of choice, so we will manage to reduce their level of physiological activity and give them a tool to cope with possible future symptoms.
On the contrary, we should not say that now he has to be strong or brave; the only thing we do with that statement is not to let the affected person experience his own coping resources.
8. Connection with external services
At the closing time of the intervention, as we have done at the beginning, we will have to explain that we are leaving and what will be the procedure from that moment on.
We will not leave those affected alone, we will leave when the victim’s social support network arrives or, failing that, our relief. In addition, we must give the affected person guidelines on when and from whom to ask for help, connecting them to the public health network.
As a conclusion I would like to emphasize the usefulness in the day to day of the PAPs and the necessity of their training in all the population, after all, don’t we all know first aid techniques like CPR or the Heimlich maneuver?
Let us take care not only of the physical, but also of the mental .