FIELD GUIDE TO PSYCHOLOGICAL FIRST AID · Vulnerable agent: Any system composed of men and his physical environment (communities, settlements, productive areas…). Risk: Probability

FIELD GUIDE TO PSYCHOLOGICAL

FIRST AID

www.gob.mx/cenapred

CENAPRED

Field guide to psychological �rst aid 2017It is a publication edited by

Centro Nacional de Prevención de Desastres

© AUTHORSPh.D. Carlos Rodrigo Garibay RubioLic. Graciela Yvette Fonseca García

Lic. Yolanda Alejandra González Servin

Collaborators:Lic. Jesús Mandujano Rojas

Lic. María Paola García GómezC. Ana Belem Reyes García

C. Yolanda Alejandra González SerrínC. Ana Paola Avila Zepeda

Edition:Abigail Araceli Cervantes Cantero

Editorial design:Maricela Rojas Vázquez

Secretaría De Gobernación

Miguel Ángel Osorio ChongSecretario de Gobernación

Luis Felipe Puente EspinosaCoordinador Nacional

de Protección Civil

Carlos Miguel Valdés GonzálezDirector General del

Centro NacionadePrevención de Desastres

Enrique Adelaido Bravo MedinaDirector de la Escuela Nacional

de Protección Civil

© SECRETARÍA DE GOBERNACIÓNAbraham González Núm. 48,

Col. Juárez, Del. Cuauhtémoc,C.P. 06600, México, CDMX.

© CENTRO NACIONAL DE PREVENCIÓN DE DESASTRESAv. Delfín Madrigal Núm. 665,

Col. Pedregal de Santo Domingo,Del. Coyoacán, C.P. 04360,

México, CDMX.Teléfonos:

(55) 54 24 61 00Fax: 56 06 16 08

mail: [email protected]

www.gob.mx/cenapred

Derechos reservados conforme a la ley

Content owned by the World Health Organization (WHO), was used under the authorization permit ID: 219618 for WHO copyrighted material dated February 21, 2017

3Field guide to psychological �rst aid

PRESENTATION

Natural and social disturbing phenomena can be a threat to the health and wellbeing of the people involved, creating a temporary state of disorganization, altering daily life in a signi�cant way.

The goal of this guide is to be a tool for those interested in psycholo-gical �rst contact voluntary work to the affected people of a critical event.

GLOSSARY

Vulnerable agent: Any system composed of men and his physical environment (communities, settlements, productive areas…).

Risk: Probability of occurring damage or product losses by a distur-bing phenomenon. Quantitatively, the risk is de�ned as the function of danger, vulnerability, and exposure.


Risk = f (Danger, Vulnerability, Exposure)

R = f (P, V, E)

GLOSSARY

Danger: Probability of disturbing phenomenon occurring with a potentially harmful in a given site.

Vulnerability: The amount of expected losses of exposed systems to be affected.

Exposure degree: Amount of people, properties, and systems that are on the site of the event, feasible to be damage.


DISASTERS

Sudden events provoke material, human and social harm, altering the balance of a community leaving the population in need of receiving help.

The system can by divided in:

Disturbing agents Vulnerable agents Regulation agents


The length of each phase will depend on:

Intensity of the event. Socio-economics development Preparation level Reconstruction resources available Stress tolerance of the affected

DISASTER PHASES

Pre-impact

Pre-impact

Alert

Impact Post-impact

HeroicHoney moon

DisappointmentReconstruction


PRE-IMPACT PHASE REACTIONS

Pre-Impact

People make an effort to by prepared for the disaster.Indifference and denial of any risk.Anxiety and disorganization.Calm and concentration.

Alert

Agitation and overacting.Calm and initiative



IMPACT PHASE REACTIONS

FearTendency to giving up, running away or rescuing othersBlocking of external and internal stimuliStereotypical reactionsDistortion of time perceptionSelective attentionTunnel visionIncrease of pain toleranceIndividualismPersonal and offspring survival

POST-IMPACT PHASE REACTIONS

Honey moon

- Tendency to share experiences - Prevalence of joy and hope


Heroic

- Efforts to survive and regain assets- Altruism- Irritability and exhaustion

Reconstruction

- People need to know they have to take care of themselves.- Failure in achieving this can bring bitterness and animosity.

Disappointment

- Disappointment when help is not being received as anticipated - Injustice feelings- Sadness

POST-IMPACT PHASE REACTIONS


DISTURBING AGENTS


Disturbing agents are phenomena that alter the balance of the system and can trigger a disaster. Identify if the agent began sudden-ly or slowly, the threat level and if it is a product of:

Natural occurrence Human actions The interaction between natural occurrence and human actions

DISTURBING AGENTS: NATURAL PHENOMENA


ASTRONOMICS

The interaction between an external space object

and the Earth

Example: magnetics storms or meteorites

impact

GEOLOGICAL

Actions and violent movement in the Earth’s surface.

Example: earthquakes and tsunamis.

HYDROMETEOROLOGICAL

Violent actions of atmospheric agents

Example: hurricanes or droughts

DISTURBING AGENTS: ANTROPOGENIC PHENOMENA


CHEMICAL-TECHNOLOGICAL

Substances action in which its molecular interaction includes

destructive phenomena.

Example: �res, radiation or toxic leaks

SANITARY ECOLOGIC

The action of biologic agents that attack a population,

generating death or altering health.

Example: epidemics or pollution

SOCIO-ORGANIZATIONAL

Human mistakes or premeditated actions that

affect a large concentration of population.

Example: terrorism or civil disturbance

REGULATION AGENTS


Institutes and organizations responsible for protecting affected agents. They establish actions and programs; they prevent and con-trol the effects of the disaster.

CENAPRED

SENDAI FRAMEWORK FOR DISASTER RISK REDUCTION 2015-2030


Speci�c measures:

1 Understand the risk of disasters.

2 Strengthening risk governance to manage it.

3 Invest in risk reduction for resilience.

4 Increase preparation for disaster in order to give an effective

response and "rebuild better" in areas of recovery, rehabilitation,

and reconstruction.

SENDAI FRAMEWORK FOR DISASTER RISK REDUCTION 2015-2030

COMPREHENSIVE RISK MANAGEMENT

COMPREHENSIVE RISK MANAGEMENT


Administrative decisions of an organization and operational knowledge whose purpose are to implement policies, strategies, and strengthen capacities to reduce the impact of threats and disasters. It is classi�ed in:

Prospective: avoids the generation of new risks, diminishing vulnerability.Corrective: it carries out comprehensive actions to diminish the existent risksReactive: makes plans and executes actions to attend emergencies and disasters, with contingency plans, rehabilitation, and reconstruction.

COMPREHENSIVE RISK MANAGEMENT PHASES

COMPREHENSIVE RISK MANAGEMENT PHASES


Identify risks

Forecast

Prevention Mitigation

Preparation

Help Recovery

Reconstruction

DO NOT CONFUSE: DISASTER AND EMERGENCY

A disaster is declared by the in�uence of a disturbing phenomenon that negatively impacts on society, its assets and its ecologic environ-ment where it also overcomes the capacity of community responses.

An emergency is an abnormal situation that can provoke harm to society and lead to excessive risks to the security and integrity of the population.

Therefore, the key to differentiate is the capacity to response.


WHAT IS A STRESSFUL SITUATION?

Any event that overpasses normal human experiences and generates disruption in daily life. Take into account that not everyone reacts in the same way: 1/6 do not show any reaction 1/6 shows a normal response 1/3 shows psychological and behavior syndromes 1/3 develop psychological disorders

Remember: as well as the answers vary, also will the ways of intervention.


INDIVIDUAL DIFFERENCES

People will be affected in different ways, given that the ways to address the event and its impact will depend on a variety of factors.

Age and physical health Personal background Personal characteristics Previews experiences Culture and traditions Individual and community resources Community cohesion Proximity to the event Type and duration of the phenomena


PHASES OF THE RESPONSE PROCESS

Remember that emotions can modify overtime.It is important to consider the moment of the event to identify the phases of the individual response.

1 Event2 Shock (�rst moments)3 Psychological acute emergency (up to 6 hours later)4 Emergency (up to 3-4 weeks)5 Crisis (up to 6 months later)6 Disorder (inde�nite time)


POST-TRAUMATIC STRESS DISORDER

CONSIDERATIONS

Exposure to the traumatic event (that occurred at least 6 months after) generates intense fear, horror or hopelessness sensation

Includes re-experience of the event symptoms, hyperactivation and avoidance behaviors

Inde�nite time

Prevalence of 1-3% of the general population

PTSD can only be diagnosed by a professional


COMPLEX POST-TRAUMATIC STRESS DISORDER

CONSIDERATIONS

Chronic trauma

It includes normal symptoms of PTSD plus self-destructive behavior such as substance abuse, self-�agellation, or harm to others

It is the result of continuous exposure to traumatic events during long periods

Complex PTSD can only be diagnosed by a professional


PSYCHOLOGICAL CRISISCONSIDERATIONS

The effects prevail even 6 months after the eventThe emotional imbalance surpasses all emotional and response capacityThe coping mechanisms are insuf�cient, producing psychological maladaptationProfessional help may not be needed.It is divided in:

-Positive: drive motor for the future -Negative: dangerous, self-aggression, suicide, delusions, and hallucinations


PSYCHOLOGICAL EMERGENCY

CONSIDERATIONS

It is presented in the next 6 hours after the event It is a situation produced by an event that destabilizes the individual to react in a habitual way

At this point, the intervention goals will be: Help the a�ected recover their psycho-emotional balance Allows the response to the present situation and overcome it Use containment and intervention techniques to improve the lives of the victims


BASIC MODEL

86% of the involved in a crisis event will present some type of reaction in any sphere of the system during the �rst 24 hours after the event.

Remember that this is normal because of the abnormality of the living situation.


Behavior Affective Somatic Interpersonal Cognitive

COMMON RESPONSES: BEHAVIOR


Social isolation

Hyperactivity

Changes in eating habits

Loss of interest in previously enjoyed activities

Drugs use

Being absent and accident prone

Run away

Denial

Aggressiveness

Passivity

Hypersexuality

Dependency

Incredulity

Alienation

Restlessness

Obsessive traits

Exaggerated startle responses

COMMON RESPONSES: AFFECTIVE


Feelings of being overtaken by the situation

Feel isolated

Affective �attening

Anger attacks

Irritability

Fear

Inability to convey feelings

Anxiety

Frustration Tiredness

Questioning of religious values

Fear of darkness

Separation anxiety

COMMON RESPONSES: SOMATIC


Increase of heart rate

High blood pressure

Increase of sweating

Dif�culties breathing

Weakness and fatigue

Muscle tightness

Heart problems

Digestive problems

Headaches

Trembling

Insomnia

Hypervigilance

Muscle tension

General fatigue

Constipation

Lack of appetite

NORMAL RESPONSES: INTERPERSONAL


Avoid conversations

Avoid activities

Avoid places

Avoid people

Detachment

Restricting affective life

Fear of isolation

Distrust of strangers

Family and social con�icts

NORMAL RESPONSES: COGNITIVE


Confusion

Dif�culties making decisions

Lack of spiritual values

History of unsolved losses

Sensation of a limited future

Dif�culties to concentrate

Recurring memories

Recurring dreams

Intrusive memories

Flashbacks

Inability to remember

PSYCHOLOGICAL FIRST AID


It is at in the �rst moment of the event

Focused on empathic contact and safety of those affected

Assumes the existence of natural resilience in people and communities

Describes a human response of support to another human being who is suffering

Normalizes responses

Provides the generation of alternatives to face the event

Minimizes pathologic incidence

PSYCHOLOGICAL FIRST CONTACT: WHAT IS IT?


Provide practical support.Evaluate the needs and the immediate worries.Help people get their basic needs.Use active listening.Help people identify their own strengths and coping abilities.Provide comfort and help calm people.Help people to understand the disaster and the living context.Foster the belief in people of their own ability to face the event.Help people reach information, services, and social support.Protect from the possible threats.Reduce the risk factors involved in the development of mental disorders.

PSYCHOLOGICAL FIRST CONTACT:REMEMBER WHAT IT IS NOT

35

It is not something that can only be held by professionals. It is not something that every affected by the event needs. It is not psychological therapy. It is not tagging or making a diagnose. It is not an invasive interrogation.It is not asking the affected to analyze or organize what has happened. It is not about pressuring the affected to tell their current feelings and reactions during the situation.

Field guide to psychological �rst aid

FOR WHOM IS IT?


Psychological �rst aid is directed to any person who needs it and desi-res it after being affected by a serious critical event.

Remember to identify and canalize those who need immediate professional support:

1 People that are not capable of taking care of themselves or their families because of the impact of the event.

2 People that may hurt themselves

3 People that may hurt others.

WHERE CAN IT BE GIVEN?


There is not an established place.

It is commonly given in communities where there are more affected people places like accident scenes, health centers, temporary shel-ters, camps, or schools.

It seeks to maintain some privacy for con�dentiality issues.

38 Field guide to psychological �rst aid

The rights to life and health frame the human spirit and act in psychological �rst aid. For those affected, take care of

RESPONSABLE SUPPORT

SAFETY

Avoid actions that may cause more damage.

Make sure that the person is protected from physical and psychological danger.

DIGNITY

Provide respect based on cultural and social norms.

RIGHTS

Ensure that people receive care without injustice or

discrimination.Help people to assert their

rights and get help.

ETHICS


BASIC PRINCIPLES:

Show humility and be trust worthy.

Respect that the other person is free to make their own decisions.

Keep prejudice and personal preferences aside.

If the person rejects the help, inform him/her that he/she can receive the help in the future.

Have in mind that the con�dentiality and privacy of the person is the priority.

Act in an assertive way based on culture, age, and gender of the person.

ETHICS


AVOID:

Taking advantage of the given authority.

Asking for favors or economic resources in exchange of the help.

Making promises that cannot be kept.

Being arrogant or obtrusive.

Pushing people to tell their story.

Judging actions or feelings.

ADAPTATION TO CULTURE


Before giving support, familiarize yourself with the context, social, cultural and religious standards of the community.

Being conscious of the different cultures will allow giving suitable and comfortable help.

Takes into account that there are contexts in which:

it is not customary to talk about feelings, physical contact is prohibited, women can only speak with other women, it is necessary to talk with certain members of the community.

BASIC RECOMMENDATIONS FROM WORLD HEALTH ORGANIZATION


WHAT TO DO:

Try to �nd a quiet place to talk, minimizing external distractions.

Respect privacy and keep the con�dentiality of the case, unless needed otherwise.

Place yourself near the person keeping appropriate distance depending on age gender, and culture.

Make him or her understand that you are listening

Be patient and keep calm.

In case you have it, offer concrete information. Be honest about what you know and what you do not.

Recognize their strengths.

Leave spaces for silence.


WHAT NOT TO DO:

Do not pressure and do not interrupt.Do not touch the person if you are not sure that it is appropiated.Do not judge feelings or actions.Do not make up things you do not know.Do not use too technical expressions. Do not tell the story of other person. Do not make false promises.Do not take away their strengths.Do not talk about others in a negative way.

BASIC RECOMMENDATIONS FROM WORLDHEALTH ORGANIZATION

PRE-ACTION INFORMATION


You must collect as much general information as possible to create a dynamic, �exible, and adaptable work plan.Previously inform yourself about the occurred situation:Crisis situation What, where, and when did it happened? How many affected are there?

Available support services Who provides them, and where are they located?

Safety matters Has the crisis situation ended? What dangers are there, and are there unavailable areas?Remember to always consult of�cial sites for information

!"#$ %$&'!

FIRST ACTION PRINCIPLE: OBSERVE


BASIC INTERVENTION GUIDELINES

Safety

Do not go to the place of crisis if you are not convinced that it is safe. Try to get help for the affected from a safe distance.

Identify if someone needs immediate help or presents nervous alteration or some serious response of distress

Be conscious of your role, consider who may need PFC. Get support for those who require an special aid. Derive serious injuries to medical personnel or physical �rst aid.

SECOND ACTION PRINCIPLE: PROTECT



Get the person away from any sort of danger.

Protect the person from social media.

If the person is in severe distress, try not to leave him/her alone.

Care for abuses, violence, and discrimination for those who suffer

health problems or physical or mental disabilities.

Care for abuses and exploitation of kids and teenagers.

THIRD ACTION PRINCIPLE: LISTENING



Listen with eyes, ears, and heart.

Find out what is more important to the affected.

Help them to calm down and establish priorities.

Avoid scattered attention and the instinct to express your own opinion.

FOURTH ACTION PRINCIPLE: CONNECT


BASIC INERVENTION GUIDELINES

Help as much as to attend basic need as to have access to services.

Help people solve their problems.

Inform rightly.

Connect with loved ones and support networks.

INTERVENTION PROGRAM


There is no single methodology to approach events with a high emotional load.They are dynamic, �exible, and adaptable to the circumstances.

The development of a successful intervention program must provide: Sense of security Calm Sense of individual and collective identity Bonding Hope

PROMOTING A SENSE OF SECURITY

50

INTERVENTION GUIDELINES

Provide objective information about the dangers

Help them know the state of their loved ones

Avoid to over-expose the affected to perturbating news and

traumatic stories

Take care of children's exposure to the media

Field guide to psychological �rst aid

PROMOTING A SENSE OF CALM



Use breathing and relaxing techniques

Normalize the affected's responses: Help to identify their affections as understandable and expected

Try to develop actions that guide the resolution of problems

PROMOTING A SENSE OF INDIVIDUAL AND COLLECTIVE IDENTITY



Help the affected to believe in his own recovery and �nd the networ-ks and resources for it

Empower them, but link resources to intervention

Invite the affected to participate in community activities such as getting involved in simple reconstruction, get togethers, playful activities, economic activities or othersTeach children emotional regulation abilities

PROMOTING A SENSE OF BONDING



Help them to quickly recover contact between the victim and their family

Guide the affected to seek help

Help them get involved in social connection: It will help acquire knowledge to face the event in a safe and comprehensive environment.

PROMOTING A SENSE OF HOPE



Do not judge the religious beliefs of the affected

Help them regain their daily life

Maintain con�dence in the victim

Help them generate realistic perspectives

Disminish catastrophic perspectives

EMOTIONAL CONTAINMENT TECHNIQUES


Remember to mitigate the discomfort feeling and help stabilize their psychological situation, reinsuring the victim with elements that not only return her or him to the here and now, but also, emotionally link with their relatives, friends or acquaintances.

Do not forget to canalize those with suicidal thoughts

EMOTIONAL CONTAINMENT TECHNIQUES:DIAPHRAGMATIC BREATHING


CONSIDERATIONS

Concentrate the individual thoughts in the ascending and decreasing movements of the abdomen

Softly inhale through the nose, �ll the abdomen with air, hold the air for a few seconds and softly exhale through the mouth

Repeat this process 5 to 10 minutes

EMOTIONAL CONTAINMENT TECHNIQUES:FROWN LIPS BREATHING


CONSIDERATIONS

Useful when the individual has hyperventilation or a sensation of shortness of breath

Inhale softly through the nose and exhale long and softly through frown lips

Air must come out naturally, without containing it or forcing it.

Repeat until the affected can regulate his/her breathing

EMOTIONAL CONTAINMENT TECHNIQUES:VERBALIZATION AND REINSURANCE


CONSIDERATIONS

Use a calm tone of voice, attitude, and gestures

Promote, without pressuring, emotional verbalization

Through the speech, take the affected person to remember their motivations (children, partners, parents, ...)

Return the individual to the here and now by identifying priorities

RESPONDANT: INTERVENTION TRANSVERSAL ELEMENTS


1 Individual security: Avoid danger, do not become a victim.

2 Perspective: Emotions are contagious: give the example keeping calm.

3 Sense of bonding: It is helping one another, people who want to support others.

4 Empathy: Empathy generates a sense of safety in the affected. Understand what he/she feels and focus on what unites to you.

RESPONDANT: SPECIFIC CHARACTERISTICS


Internal motivation

Orientation to challenges

Work dedication

Initiative to take risks in order to rescue and help people

Priority in wanting quick results

Failure to accept challenges

RESPONDANT: PRINCIPLE FANTASIES


Omnipotence fantasyWanting to solve everything assuming a heroic role.

Passivity fantasy Feel pressure to do something when they only need to listen.

Power of thoughts fantasyBelieve that by assuming or saying what may not happen, things can happen.

RESPONDANT: NORMAL RESPONSES


Remember that also the intervenors are subjected to stress and suffering. You must establish measures to prevent that demands do not exceed your resources.

PHYSICAL REACTION PSYCHOLOGICAL REACTIONS SOCIAL REACTIONS

Dif�culties falling asleep

Muscle pain

Digestive problems

Hyperactivity

Frustration

Sadness

Anxiety

Desintegration and/or alienationfrom family

Dif�culties returning to daily life

Resistance to groupseparation

RESPONDANT: MITIGATION STRESS MEASURES


Think about what has helped in the past to stay strong

Rest properly, even if it is for short periods of time

Avoid overloading hours of intervention

Look for support inside the group to release pressure

RESPONDANT: SELF-HELPING TECHNIQUES


Talk about what happened with a person of trust respecting the con�dentiality

Look for healthy hobbies

Take care of yourself

Express feelings

Eat properly

Limit the ingestion of alcoholic beverages and tobacco.

Avoid self-medication

Measure your sexual activity

SELF-APPLICABLE EMOTIONAL MANAGEMENT TECHNIQUES:HELP YOURSELF TO HELP OTHERS


Self-hygiene of psychic health.

They have extreme utility in PFA interveners.

Auto-re�exive writing Diaphragmatic breathing Visualization, tension, and distension Autogenous relaxation Expression of anger

TECHNIQUE: AUTO-REFLEXIVE WRITING


CONSIDERATIONS:

You can write about any event that affects you in some way

The event can be recent or old

The description must be in the �rst person singular

You must write everything that comes to mind about the event, thoughts or feeling in the moment

TECHNIQUE: DIAPHRAGMATIC BREATHING


CONSIDERATIONS:

Inhale softly through the nose and exhale through the mouth

Hold the air for a few moments

Concentrate on the ascendant and decreasing movements of the abdomen

Continue the activity for 5 to 10 minutes

Useful in any tension moment

TECHNIQUE: VISUALIZATION, TENSION AND DISTENSION


CONSIDERATIONS:

Lean on another person or recording that guides you about the mental images you should focus on

Stay in a quiet environment and stay comfortable

Do not perform this activity if the critical event is recent

TECHNIQUE: AUTO RELAXATION


CONSIDERATIONS:

Lie back in a quiet environment and stay comfortable

Visualize your body, starting at the head and ending at the feet

Name each part of your body with a phrase like:“My head feels calm; as I relax, my head feels increasingly loose, warm and calm”

TECHNIQUE: EXPRESION OF ANGER


CONSIDERATIONS: Stand in front of your bed, raise your �sts and hit it

In the time that the hits last, you must bring to mind the memory causing the discomfort and verbally express something related to this fact, until the activity ends

Useful when there is a feeling of anger or impotence

EMOTIONAL MANAGEMENT TECHNIQUES, REMEMBER:


You can apply them to daily basis

They favor psychic and emotional aid

They avoid affective over�ow

They decrease the likelihood of developing pathologies

They increase resilience

Secretaría de Gobernación Coordinación Nacional de Protección CivilCentro Nacional de Prevención de Desastres

Av. Delfín Madrigal núm. 665,Col. Pedregal de Santo Domingo,

Del. Coyoacán, Ciudad de México, C.P. 04360

www.gob.mx/cenapred

Documents

FIELD GUIDE TO PSYCHOLOGICAL FIRST AID · Vulnerable agent: Any system composed of men and his physical environment (communities, settlements, productive areas…). Risk: Probability