2. Preparedness

2.2. Implementation of Psychological First Aid

Kimberly Burkhart, Ph.D.

Objectives

  1. Explain how Psychological First Aid can be used in the immediate aftermath of a catastrophic event.
  2. Identify training resources.

Psychological First Aid (PFA), created by the National Child Traumatic Stress Network in partnership with the National Center for PTSD, is intended for use with children, adolescents, caregivers, families, and adults. It can be implemented in a variety of settings, including field hospitals, shelters, emergency departments, family assistance centers, and schools.

PFA is based on the assumption that most people will not develop posttraumatic stress symptoms in response to a traumatic event. By meeting people’s immediate needs through human connection, providers can help create a buffer against ongoing distress.

Posttraumatic stress symptoms include trauma-related symptoms such as anxiety, negative thoughts, and flashbacks that meet the criteria for a specific trauma- or stressor-related disorder. PFA is a supportive intervention that can be delivered by first responders, mental health professionals, and other disaster response workers in the immediate aftermath of a disaster, defined as up to four weeks after exposure.

Guidelines for Delivering PFA

Providers should observe the situation before approaching an individual. Respectful questions should be used to determine what the individual or family needs and what approach should be taken. Providers should remain calm, patient, and responsive and communicate in developmentally and culturally appropriate ways.

When working with children, it is particularly important to:

  • Help children verbalize their emotions.
  • Listen carefully and conduct frequent check-ins so children know they are heard.
  • Identify and build on the child’s strengths.
  • Recognize that the child may show developmental regression.
  • Provide parenting guidance when needed.

Survivors may present as disoriented, panicked, withdrawn, irritable, angry, or extremely worried. The provider should focus on problem-solving and offering coping strategies in response to the immediate situation.

Eight Core Actions of PFA

PFA consists of eight core actions: Contact and Engagement, Safety and Comfort, Stabilization, Information Gathering, Practical Assistance, Connection with Social Supports, Information on Coping, and Linkage with Collaborative Services.

Not every action will be needed in every situation. The provider uses active listening to determine which core actions are appropriate. Each core action and an example of an associated intervention are described below.

  1. Contact and Engagement: Respond to and initiate contact with survivors. Introduce yourself, discuss the limits of confidentiality, and ask about immediate needs.
  2. Safety and Comfort: Enhance safety by providing physical and emotional comfort. Attend to survivors’ immediate physical comfort; contact relatives to obtain pertinent medical information; ask whether survivors need help with activities of daily living; and determine whether a survivor presents a risk of harm to themselves or others. Create a child-friendly space.
  3. Stabilization: Calm and orient survivors when needed. Use grounding techniques such as diaphragmatic breathing combined with naming objects or experiences in the current environment associated with the five senses. Obtain information about medications that may be needed and medical professionals who may be able to assist.
  4. Information Gathering: Identify immediate needs and concerns. Obtain information about the nature and severity of the disaster exposure, immediate post-disaster circumstances, and any ongoing threat.
  5. Practical Assistance: Offer practical help in response to immediate needs and concerns. Look for opportunities to build on protective factors such as survivors’ positive beliefs about themselves and others, their faith, and their access to resources. Identify concerns and develop an action plan.
  6. Connection with Social Supports: Facilitate contact with established supports. Enhance access to primary support persons and connect survivors with immediately available support. Group activities, such as drawing or playing tic-tac-toe, can also provide distraction.
  7. Information on Coping: Provide information about stress reactions and basic coping skills that can decrease distress. Explain the three types of posttraumatic stress reactions—intrusive reactions, avoidance and withdrawal, and physical arousal—as well as the possible role of trauma reminders.

    Reinforce basic coping skills such as obtaining adequate nutrition and sleep, taking breaks, scheduling pleasant activities, using calming self-talk, and focusing on something practical that can be done in the moment. Providers can also share strategies for returning to a routine and using simple relaxation techniques.

  8. Linkage with Collaborative Services: Link survivors with community-based services. Provide a direct connection to services and recommend follow-up care that includes a brief evaluation of child and adolescent adjustment.

PFA in Practice

Psychological First Aid practice scenario

Case Scenario

A 6-year-old boy, “Mikey,” presents to the emergency department following a wildfire. Mikey and his mother were separated at the hospital. His mother is receiving medical treatment for burns, while Mikey has minor cuts on his arms. Mikey is crying and repeatedly asking about his mother. You have been asked to respond to him.

What Should You Do?

Consult your PFA Field Operations Guide, available through the National Child Traumatic Stress Network and linked in the resources below. Assess Mikey’s current needs in four areas:

  • Behavioral
  • Emotional
  • Physical
  • Cognitive

Mikey has received medical treatment for his cuts. He is experiencing anxiety related to separation from his mother and being in an unfamiliar medical setting. He is tearful and has difficulty remembering and describing what happened.

Applying the Core Actions

Contact and Engagement: Ask about immediate needs and consider what could make Mikey more comfortable. You determine where his mother is and assure him that hospital staff are taking good care of her. You also bring Mikey a cup of water.

Information Gathering: Find out what Mikey knows about the wildfire. Mikey does not know his phone number or address and is not a patient within your hospital system. Once calm, he remembers that contact information is written on the tongue of his shoe. Mikey reports that his father was not home and has been away for some time.

Connection with Social Supports: Call the two phone numbers listed in Mikey’s shoe. His father answers and explains that he is away on a business trip. He provides the necessary contact information and arranges for Mikey’s grandmother to come to the hospital. You call his grandmother and develop a plan for her to connect with Mikey.

Information on Coping: Explain the action plan to Mikey using developmentally appropriate language. Check that he understands that doctors are caring for his mother, his father is on his way home, and his grandmother is coming to pick him up. Explain that you will continue to check on him until she arrives.

You notice that Mikey is wearing a superhero T-shirt. You begin a conversation about the superhero and tell Mikey that he has been very brave. You coach him through deep breathing by asking him to breathe in through his nose as though he were smelling a flower and breathe out through his mouth as though he were blowing out a birthday candle.

Mikey is now calm, and you are able to attend to other patients presenting to the emergency department.

Additional Information

Training

Field Guide

Journal Articles

Handouts