If you work in an environment where people are likely to get physically injured, then it stands to reason you would want people available with the skills to help.
Most workplaces are comfortable with the notion of a first aider. They understand their purpose and the need for someone who can administer immediate support when there has been a physical injury. They recognise that often this early intervention is all that is needed and that it may even prevent more serious problems from developing.
Generally we consider the functioning of our physical apparatus but completely ignore our mental functioning. As though it’s not really important or will somehow take care of itself!
Following a traumatic event, psychological first aid or crisis intervention can be just as valuable as physical first aid and follows the same guiding principles.
Any good physical first aider will tell you that the first rule when attending a casualty is to survey the scene and determine the cause of the injury so as to avoid becoming another casualty. Assessment is equally important with psychological first aid (PFA).
What has happened? Who needs help?
This may sound obvious but many psychological injuries are less visible. We need to assess and monitor based on the less subtle signs of distress. It’s not always about someone expressing loud emotions – especially in the close protection working environment! We tend to make assumptions about what will or won’t affect people and many organisations have tick-boxes. Unless you fall into one of their categories – perhaps “shots fired, death or serious injury occurred” – then nobody will even consider anything needs doing. A trained psychological first aider will have a good understanding of the factors that make an event potentially traumatic, and the range of trauma reactions, enabling them to base their intervention on individual need rather than misconceptions.
Crisis intervention is very practical.
Psychologist Abraham Maslow created a hierarchy of human needs (shown in the pyramid diagram). The foundations of the pyramid must be in place before higher levels can be attended to. A traumatic incident may result in the very foundations of the hierarchy being undermined.
• Physiological or survival needs: this includes access to air, food, water, warmth and sleep
• Safety needs: such as shelter from the elements, security, freedom from fear, law and order
• Love, affection and belonging: this means being connected to others – family, friends, work colleagues.
A criticism of untrained but well-meaning helpers is that they focus on asking “how are you feeling” before ensuring these basic needs have been met. The individual in crisis can’t even safely consider this question at that stage. A metaphor I often use is to imagine you stumble across a man drowning in the river. Would you sit on the river bank and ask how he is feeling, what is it like in the water? OR would you throw him a rope, haul him out, and make him safe, warm and dry?
Higher needs are less important when the foundations are not being met but these may also be disturbed by a traumatic event.
• Esteem: for example having a sense of achievement, independence, respect and status
• Self-actualisation: means seeking personal growth and self-fulfilment
Maslow’s hierarchy of needs
With PFA, we can’t really consider emotional first aid whilst any danger continues. However, it is not necessarily about being safe but about feeling safe – not always the same thing! The psychological first aider must have a calm reassuring presence to actively promote this sense of safety and recognise how the individual’s survival response will be tuned to ongoing threat. Often, connecting with secure and trusted others helps to induce that much-needed sense of safety.
Psychological first aiders will next aim to reduce distress. They may facilitate the individual in safely releasing emotions and beginning the process of verbalising what happened to them. This is the start of “downloading” the masses of sensory data from the incident and making sense of it – vital tasks for the brain.
Physical first aiders will offer advice on the injury – ice-pack, keep it clean, don’t overly put weight on it etc. Psychological first aiders will similarly offer guidance on the simple steps the person can take to reduce Post Traumatic Stress symptoms as well as discouraging actions that may inadvertently hinder recovery. Informational handouts (for the individual and for their loved ones) are commonly given and will remind the person of the ways they can reduce their symptoms.
Triage is a crucial aspect of both types of first aid.
Psychological first aid is exactly that – first aid. You wouldn’t expect the physical first aider to fully resolve a heart attack or loss of limb. The physical first aider will always be assessing what ongoing level of care is required. This may simply be advising the individual to keep a cut clean and dry or to rest a sprain. This may be sufficient for a full recovery. However, they may advise them to seek further assistance – ranging from seeing their doctor in a day or so (if symptoms deteriorate or don’t clear) right up to immediately calling an ambulance and handing the care over to a paramedic.
Triage is similarly always considered in a crisis intervention and again may vary from offering more education on self-care to seeking further assistance from a mental health professional. The psychological first aider will always arrange a follow up over the next few days. This is important as initially shock may prevent a proper assessment of needs. Trained psychological first aiders will be aware of the range of helpful interventions and when they are most appropriate to use.
Whenever we support someone in need we should
Keep it simple: following a traumatic event, the brain needs to process what was often overwhelming sensory data. Until the survival response is switched off, there is little room for complex information.
Keep it short: For the same reason, whatever we do needs to be brief. The closer to the event that we are intervening, the simpler and shorter that intervention needs to be.
What has helped you in a crisis?
Think of a critical time in your life when you needed emotional support and someone helped you.
• What was it they said, did or expressed that helped?
• What, if any, special qualities did the person have?
• What did they do that didn’t help, for example judge or advise you?
• How did you feel about telling them about your problems?
• How did you feel afterwards?
• Was this a formal relationship – e.g. a health professional or therapist, or informal – family member, close friend?
You may notice that often it’s the small things that made a big difference – in either a positive or negative way. Sometimes, though we try so hard to say and do what we think is the right thing that we forget the basics – being human and genuinely caring. There are lots of psychological first aid skills that can help support those affected by crisis and trauma but without these attributes we will always be less than helpful.
To learn more about training as a psychological first aider, please contact us at firstname.lastname@example.org or speak to SafeHaven Trauma Centre – our licensed provider of training courses – on 0161 635 3522 or email email@example.com
First aid for a psychological injury
By Dr. Liz Royle
Dr. Liz Royle is an international speaker and author who specialises in providing psychological trauma consultancy and training for high risk organisations. She was a founder Board member for the UK Psychological Trauma Society and leads the Uniformed Services Task Force on behalf of the European Society for Traumatic Stress Studies.