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Psycological First Aid

- A guide for health care professionals

 

A brief guide to the treatment of persons exposed to violence, threats, accidents, catastrophes or other traumatic incidents.

 

The guide will be useful for health care professionals in assisting patients and their relatives as well as colleagues and others exposed to stressful incidents.

 

The following pages will offer advice on how to help a traumatized person in the first hours and days following the critical incident.

 

The main goal of psychological first aid is to re-establish normal stability and balance of thoughts, feelings, behaviour and bodily functions as soon as possible.

 

Important:

In any case ofbodily harm or signs of somatic illness, and in cases where the injured person does not respond to normal contact, the person always has to be referred to medical examination and treatment immediately.

It is recommended to read the guidelines in the stated order.

 

Common symptoms

One or more of the following symptoms will often be found:

 

  • Anxiety symptoms such as a rapid pulse, a dry mouth, increased sweating.
  • Withdrawal.
  • Numbness.
  • A feeling of difficulties in thinking.
  • Disorientation and confusion.
  • Anger or verbal aggression.
  • Irritability.
  • Despair and hopelessness.
  • Exaggerated or purposeless hyperactivity.
  • Uncontrolled or exaggerated grief reactions (in relation to cultural background).
  • Difficulties in relaxing and sleeping

 

Facts

Acute stress reactions are comparable to what is normally referred to as serious crisis reactions.

The reactions may vary from person to person.

 

This guide focuses on the immediate reaction that will normally wear off within a few days. The reaction may be triggered by an extremely stressful incident, physical or psychological, as for instance violence, threats, death, war,bodily harm or an unexpected loss of close relations. In most cases the reaction can be described as a normal reaction and will normally wear off within a few hours or days. The reaction is characterized by anxiety symptoms and emotional outbursts.

 

The reaction can be expressed in a number of very different ways. It is here important to be aware of the variants where the victim becomes quiet, withdrawn or even numb. These victims may easily be ignored in chaotic situations.

 

If the symptoms have not decreased within 48 hours, professional medical or psychological treatment is required.

 

The first hours

 

Even though most stress reactions wear off with no or moderate help from others, a more structured assistance from health care professionals can be recommended.

 

1. Forming a general view of the situation, establishing a primary contact and clarifying the conditions

 

  • Take the time necessary to establish an overview of the situation.
  • Select a primary helper to talk to the victim.
  • Select other helpers to assist with practical matters.
  • Make sure that a possible threat or danger has disappeared.
  • Find an undisturbed room.
  • Collect information about the victim’s name, address, date of birth and so forth.
  • Ask the victim how you can be of help.
  • Avoid detailed questioning about the incident.
  • Always end the primary contact by an agreement on what is to be done next, both by the victim and the helper.

 

2. Care for somatic symptoms

Medical treatment of bodily harm and illnesses must always be prior to the treatment of the psychological condition.

 

  • Examine the person for physical injuries.
  • Listen to somatic complaints and worries.
  • Be aware of symptoms such as headaches, nausea, bodily feebleness, difficulties in speaking, bodily asymmetry, abnormal eye movements. 
  • Find out if the victim is a regular user of prescribed medicine.
  • Make sure that necessary medicine is available.
  • In case of doubt, refer the victim to medical examination and treatment, if necessary accompanied by a helper.

 

Important:

A medical description of physical and somatic consequences of violence and accidents is normally a prerequisite for reporting to insurance companies. Be aware that  an independent medical examination may be required.

 

3. Care for personal hygiene

After accidents, violence and other critical incidents the victim will often be dirty with torn clothes and a smeared and tearful face.

 

  • Assist the person getting washed and shaped up.
  • Necessary, get the person clean clothing.

 

Important:

In cases of violence or rape it is important to contact medical care and police before cleaning and changing of clothes. This is to make sure that important evidence for possible legal procedures is collected.

 

4. Psychological care within the first hours

 

The main goal of psychological care is to re-establish harmony and balance of thoughts, feelings, behaviour and bodily functions.

As the victim is sometimes unknown to the helper, it may be necessary to try to establish what is considered a common “normal” and balanced condition.

 

  • Sit down together with the victim at eye level, preferably at either side of a table, with a glass of water.
  • Select a chair on which the victim can sit in an upright position.
  • Make clear that the conversation is to take no more than 30 – 45 minutes.
  • If necessary, make an appointment for another conversation to take place after a break containing practical activities and a possible walk.
  • Let the victim talk about the critical incident. Listen without asking about details and the victim’s feelings.
  • Tell the victim that it is common to have extreme reactions to extreme situations and assure him that his behaviour in the situation was understandable and maybe even appropriate.
  • Tell the victim that the extreme reactions will normally decrease within a few hours.
  • Inform the victim about the facts of the incident to avoid possible scary fantasies.
  • Be aware of even the slightest signs of suicidal thoughts and ideas of hurting himself or others.
  • In any case of doubt, contact a doctor or psychologist immediately.
  • Make a list of the victim’s big and small worries and urgent needs.
  • Discuss with the victim what has to be done first, how and by whom. It is helpful for the victim to take an active part.

 

5. Helpful Advice

 

The following advice may be given to the victim:

 

  • Avoid excessive consumption of coffee, tea, alcohol and tobacco, especially before bedtime.
  • Eat and drink regularly.
  • Do not talk too much about the critical incident.
  • Kindly ask relatives and friends not to ask too many questions about the critical incident.
  • Take long walks alone or together with a friend.
  • Join social activities together with friends or relatives.

 

The next days

Most reactions to critical incidents wear off markedly without professional help from psychologists or psychiatrists.

 

6. Be aware of changes

However, be aware of possible changes of behaviour, mood and habits as for instance:

 

  • Difficulties in returning to former patterns of job, spare time activities and family life.
  • Changes of eating and drinking habits
  • Increased consumption of coffee, tea, alcohol and tobacco.
  • Irregular sleep patterns and nightmares.
  • Signs of unpleasant thoughts.
  • Reports of intrusive unpleasant memories of the critical incident (flashbacks).
  • Strong or unexpected emotional outbursts.
  • Irritability and aggressiveness.
  • Forgetfulness or confusion.
  • Reports of anxiety symptoms such as a rapid pulse, increased sweating and dizziness.
  • Avoidance of particular places, situations, persons or subjects of conversation.

 

If the above mentioned changes of behaviour, mood and habits do not wear off and return to normal within a few days, it is strongly recommended that the victim is referred to a psychologist or a doctor specialized in psychotraumatology.

 

7. Check-up within a couple of weeks

 

If there is contact to the victim, and if it is appropriate, it is recommended to evaluate after a couple of weeks:

 

  • Check if the victim still has symptoms.
  • Ask if the victim has remaining worries.
  • Discuss how the possible symptoms and worries can be dealt with.
  • Make clear who is to do what.
  • If necessary, recommend referral to a doctor or psychologist.

 

8. Preventing a new critical incident

 

  • Discuss how the critical incident can possibly be prevented in the future.
  • Discuss what can be learnt from the situation around the critical incident and from the recovery process.