Psychological first aid: principles and applications

Psychological First Aid (PFA) is a system that has been created to fill the newly perceived need of first responders and the way in which they meet the needs in turn experienced by victims in a disaster situation. Recently, officials recognized the need for a set of clear guidelines to help disaster personnel handle the stress and rigors of meeting the psychological and emotional needs of victims while also creating a platform for logistical support. To facilitate this, the PFA system consists of eight core actions, including contact and engagement, safety and comfort, stabilization, information gathering, practical assistance, connection with social supports, information on coping support, and linkage with collaborative service. Of these, the first two will be considered in more depth.

The first component, contact and engagement, is a response to the immediate challenge that disaster responders face when arriving at the site in question. This challenge focuses on the need to rapidly establish contact with survivors and developing positive relationships with them (Ruzek et al., 2007). The specific challenge here is that survivors will be suffering from shock and trauma, which will cause many to reject attempts at psychological support and assistance. Disaster personnel therefore need to be able to handle overt hostility while still defusing the emotionally charged situation to such a degree that the rescue operations can proceed without difficulty. Within this component then, a good way to establish initial contact is for the responder to introduce him- or herself with a first or full name and describe the response role. Secondly, permission should be requested to speak with the survivor. It has been found that survivors respond better when they are provided with concrete information while their immediate needs are met.

After initial contact, safety and comfort is the second core component of PFA. This is the stage at which practical help can begin. (National Center for PTSD, n.d., p. 23). Once contact has been established and permission obtained to speak with and help the survivor, the responder should start by ensuring the immediate physical safety of the victim. In addition, the PFA provider should also provide both physical and emotional comfort while creating a psychological sense of safety for the victim. At the same time, it should also be recognized that victims may pose a danger to themselves or others as a result of either physical contamination or psychological instability. In such a case, it is important to ensure the safety not only of the individual, but also of others who may be affected (Ruzek et al., 2007).

In all the core actions of Psychological First Aid, it is important to recognize that responders should use their judgment in the type and amount of assistance required. Some victims will refuse permission for first contact, for example. In such a case, it is in both the victim's and the responder's best interest to move on to other sites where needs should be met. Also, the type of safety and comfort that is immediately required should be accurately assessed in order to provide the best level of assistance.