Providing Psychological First Aid Following a Disaster

PFA doesn't rely on skills of a professional mental health provider, but rather, engages the skills that most of us already have.

• By Raquelle Solon
• May 01, 2016

Companies with emergency response plans know the importance of having that plan in the event of an emergency. Considerable time and effort went into thoughtfully assessing the types of disasters that could possibly occur and putting different response scenarios on paper. Your safety team conducted a review of your plan, and with a few tweaks, it worked. You think you're ready, but are you? How resilient will your employees be in the aftermath of a disaster? Does your plan include offering psychological first aid (PFA) to support your employees? If so, have you designated a provider to offer that?

What is Psychological First Aid?
In a nutshell, PFA is a supportive intervention for immediate use in the aftermath of a disaster. It was developed by the National Center for PTSD in 2006 and has since spread to many agencies, governments, and localities throughout the United States and internationally.

PFA is an evidence-informed approach built on the concept of human resilience to help people—from children to adults—in the aftermath of a disaster, act of terrorism, or even a personal crisis. It's designed to reduce stress symptoms caused by those traumatic events and to foster short- and long-term functioning and coping. It also connects survivors to additional services. It's understood that survivors affected by those events will experience a broad range of early reactions that can cause enough distress to interfere with coping and recovery.

Your emergency response plan likely includes a compulsory hot wash or critical incident stress debriefing period. While PFA addresses many issues involved in debriefing, it is not debriefing. Nor is PFA counseling. PFA doesn't rely on skills of a professional mental health provider, but rather, engages the skills that most of us already have. It is used in settings where trauma is found because it is an approach that recognizes reactions and behaviors associated with the stress caused by the traumatic event rather than diagnosis and treatment of it.

PFA lies in the understanding that it will likely be a multiple touch point process with the individuals affected, versus a single interaction, and is inclusive of obtaining outside services to help those who need additional assistance. It is giving people what they need to rebuild their lives. It’s giving employees the tools to get back to work.

Companies can offer PFA services under their Employee Assistance Program umbrella. According to the Employee Assistance Trade Association, an EAP helps employees and employers by providing:

• Employee support—counseling for employees and family members
• A healthy workplace—using the EAP for mental health and wellness issues keeps the organization healthy and provides help in traumatic situations
• Business value—an overall healthy workforce reduces business costs
• Better mental health—EAPs restore hope to workers, and a healthy workforce tends to have better mental health

PFA is:

• Consistent with research evidence on risk factor and resilience following trauma
• Applicable and practical for out in the field or workplace settings
• Flexible to be appropriate with all different demographic groups

What Does PFA Aim to Achieve?
The goal of psychological first aid is to create and sustain an environment of:

• Safety. Restoring a sense of safety is critical. Establish a sense of safety to provide physical, psychological, and emotional comfort.
• Calm and comfort. Survivors are overwhelmed or distraught and take their cue from others. Establish a human connection in a non-intrusive, compassionate manner. It's important to maintain a calm, non-judgmental demeanor.
• Connectedness. Provide resources and practical assistance to employees to meet their immediate needs and concerns. Connect survivors to social support networks or other sources of support, including family members, friends, and community resources. Also, direct them to the resources available through their EAP, including referrals to professionals as needed.
• Self-empowerment. Support positive coping. Acknowledge coping efforts and strengths and empower survivors. Encourage them to take an active role in their recovery. A printed handout of positive supports is helpful to cope effectively with the psychological impact of a disaster.
• Hope. Tomorrow will be another day.

In the aftermath of a traumatic workplace event, these five qualities are important for recovery and healing. If your organization prefers to have certified counselors respond and provide on-site triage and PFA after a traumatic event that affects your employees, there are companies able to assist in this manner.

During 9/11, our company's "boots on the ground" provided for immediate traumatic response, though it was before PFA came about. Look for an EAP provider that is skilled at triaging with a company's employees after trauma occurs, even for events not as large scale as 9/11. For example, if your company experiences a data breach and personal information is out on the Internet, your customers and/or employees can feel traumatized, especially if they are victims of identity theft.

From large-scale terrorist events and natural disasters to random acts of violence that affect your workforce, you'll want a provider who is able to provide support, directly in person and via a crisis call center and EAP service group. Additionally, when you have a trained professional on site, you have peace of mind knowing they have at their fingertips the additional resource referrals that may need to be made for those who’ve been traumatized.

Does PFA Extend to Family Members?
Family members of employees involved in a disaster at work can be traumatized as well. People can be traumatized not only by experiencing trauma first hand, but also by listening to stories that their loved ones tell them and by witnessing the events they've experienced. This is called secondary trauma. It can be just as traumatic as the first-hand trauma experience because every person is different in his or her resilience coping mechanisms.

It's important to note that although most survivors of a disaster will not experience any long-term negative mental health effects, some will. First responders tend to have first contact with the survivors and, therefore, are in a position to provide needed mental health assistance to survivors. But at the same time, first responders can be traumatized when providing support to the first-hand victims by listening to their stories and seeing the effect of the disaster.

Common Stress Reactions to Look For After a Disaster
Trauma varies by individual, and anyone can incur traumatic stress if they believe they are in danger. The greater the belief, the higher the traumatic stress may be.  Common reactions and adult behaviors include:

• Disorientation and unresponsiveness when approached
• Strong emotional and physical responses to the event
• Incapacitated by worry
• Family difficulties
• Substance abuse
• Being overprotective of family
• Keeping excessively busy
• Isolating oneself from others
• Being very alert at times, startling easily
• Avoiding places, activities, or people that bring back memories

In addition, an employer also may observe individuals frantically searching. Frantic searching behavior is communicating the need to find and re-establish the person's psychological, emotional, mental and physical safety. This is observed in an individual who is constantly looking for something that he or she can't quite name or put a finger on. What the person is really looking for is to feel and be safe again. You may also observe individuals engaging in activities that to someone outside the circumstances seem risky, but to the individual, the abnormal high-risk behavior is a normal response to the trauma he or she is experiencing.

There's no set timeframe for the PFA process. Each person experiences and deals with trauma in unique ways. PFA is individual to the person who has experienced the trauma and it proceeds at his or her pace.

The next time your team pulls out the emergency response plan to update or drill, be mindful of the PFA aspect. Offering your workforce an Employee Assistance Program that includes PFA services is a thoughtful way to show your concern for your employees and helps to keep your workforce more resilient.

This article originally appeared in the May 2016 issue of Occupational Health & Safety.