Psychological First Aid in a Crisis
By Erin Bryant
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| Photo by Erin J. Pond |
In the wake of a trauma of any kind—school violence,
a crisis, or a natural disaster—attending
to the emotional and psychological needs of survivors
can be critically important.
The SAMHSA-funded National Child Traumatic Stress Network (NCTSN) and the National Center for
Post-Traumatic Stress Disorder at the U.S. Department of Veterans Affairs recently posted online the second edition
of Psychological First Aid: Field Operations Guide.
The 189-page guide provides information for first responders, disaster relief workers, crisis
counselors, and volunteers to help survivors immediately in the aftermath of a traumatic event.
(See SAMHSA News online, July/August 2006.)
Available online, the guide describes key steps for providing psychological first aid (PFA) including
how to approach someone in need, how to talk to them, how to help stabilize someone, and how to
gather information.
Appendices include resources about service delivery sites and settings, provider care, and worksheets
and handouts.
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What is Psychological First Aid?
Psychological first aid is an evidence-based approach and intervention, built on the concept
of human resilience, to help survivors in the immediate aftermath of a traumatic event, crisis,
or natural disaster. PFA can help everyone—children, adolescents, adults, elders, and families.
Designed to reduce the initial distress caused by these events, PFA acknowledges the seriousness
of the experience of danger and the increased feelings of vulnerability that often follow. PFA
fosters long- and short-term adaptability, basic functioning, and coping skills.
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School-Based Violence
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Photo by Erin J. Pond |
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In the case of school-based violence, for example, students often fear that there will be a recurrence
of the danger.
An important aspect of PFA is to re-establish the “protective shield” of
adults.
Crisis intervention team members can help students to understand and recognize common reactions
to danger, help students verbalize their feelings, and help identify traumatic reminders that
trigger renewed fears.
PFA, administered by a skilled school mental health professional, allows for the expression of
difficult feelings and assists students in developing coping strategies and constructive actions
to deal with fear and anxiety.
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Objectives
Basic objectives of PFA include the following:
Enhance immediate and ongoing safety and provide physical and emotional comfort for survivors. Establish a non-intrusive, human connection and compassionate manner. Help survivors tell you specifically what their immediate needs and concerns are and gather additional
information as appropriate. Offer practical help—food, water, blankets—to help survivors cope effectively with
the situation at hand. Connect survivors as soon as possible to social support networks, including family members, friends,
neighbors, and community resources.
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What To Do
Politely observe first before approaching a survivor—don’t intrude. Some signs that someone might be experiencing emotional distress and may need assistance include being disoriented, agitated, angry, or extremely withdrawn. Speak calmly and slowly in simple concrete terms. Don’t use acronyms or jargon. Be patient,
responsive, and sensitive. If communicating through a translator or interpreter, look at and talk
to the survivor. When you are unsure of how to help, ask “How can I help?” And trust what the person
tells you.
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Working With Youth
Talk to the adolescent as you would to an adult. Do not “talk down” or patronize. Help school-age children verbalize their feelings, concerns, and questions. Avoid extreme words
like “terrified” or “horrified,” because these may increase their distress. For young children, sit or crouch at the child’s eye level, and match your language to
the child’s developmental level.
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| Photo by Erin J. Pond |
The full-text text of Psychological First Aid: Field Operations Guide, 2nd
Edition, is available
at www.nctsn.org or www.ncptsd.va.gov. For more information about SAMHSA’s Disaster Readiness & Response
program, visit www.samhsa.gov/Matrix/
matrix_disaster.aspx. 
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