Psychological First Aid

So the earthquake has ended in your town, the dust has settled, you and your family are still alive and uninjured. But your area is out of contact with the rest of the state for at least 48 hours. You, and others, go round, giving medical first aid, mark structures in accordance with good CERT practice, you shelter in place. But some people in your area are in seemingly severe mental crisis; some are hyperactive and get in your way constantly, a few others just sit there in spite of the bitter cold, still others are disruptive and complaining constantly. What can you do?

Learning some psychological first aid is as important as learning CPR and [medical] first aid. It is simple and is mostly common sense. It can be important as victims of psychological distress can endanger you and your group; extremely rarely by assaulting, mostly by getting in the way (often from the best of motives) or being a "drain" on scarce resources.

The way I learned it way back when was as the Four Rs; a model used for dealing with combat stress:
R emove (from stressful environment); can be as simple as blocking their view of the scene
R est
R eplenish; food, water, etc. , unless contraindicated by injuries, etc.
R estore (their confidence/"to duty"); treat them as if you expect them to recover, no "labels".

This is about as simple as it gets; give immediate care to help keep the person's condition from worsening, reduce the risk of their condition worsening, provide reassurance, punt ASAP to qualified personnel if the person does not improve. I have successfully used this model post-earthquake, at accident scenes, and once with victim of a sexual assault.

Remember that people react to emergencies in their own way; some "rise to the challenge" and do what has to be done, then, maybe "it hits them" and they experience some anxiety or "shut down". Others react with hysterics, still others shut down with the "thousand yard stare". Take them as you find them, deal with what you see, just use common sense. And remember, people in crisis, especially children, take their cues from you: model competence and calm, be systematic, smile.

Here are a few suggested readings for you to learn how to deal with this important aspect of post-disaster and survival situation care:

(Book) Where there is No Psychiatrist; Very well written, easy to understand and apply. Covers all aspects of psychological well being, excellent chapter on disaster/war trauma. Good shelf companion for your copies of Where there is no Doctor and Where there is No Dentist.

(online document) Psychological First Aid...; Medical Reserve Corp: Step by step guide to providing basic psychological first aid. Gives very good examples to illustrate the concepts being described.

(online document) Psychological First Aid Heath Care Professionals; NY Office of Mental Health: Brief outline of principles of care in the context of a flu pandemic.

(online document) Psychological First Aid ; American Mental health Counselors Association: Technical article on various early intervention strategies. Good,short, discussion of critical incident stress debriefing (CISD), one of the "touchstones" of the field of early intervention which does not seem to work.