Biomedical Engineering Reference
In-Depth Information
to reduce the burden on medical and nursing
providers and staff). PFA provides a guide for
mental health-informed and trauma-informed
assistance to affected victims, families, and first
responders in the immediate wake of critical
incidents. In the form of “second aid” and “third
aid” PFA involves the delivery of brief mental
health interventions in the first weeks and months
after critical incidents and into the longer term
recovery phase (see below).
PFA involves four essential functions which
flow in a sequence (Table 11.2) but in actual
fact often occur simultaneously: In abbreviated
form, the functions are to “direct” the person to
resources that can assist with basic immediate
needs, “protect” the person from further harm
or unnecessary additional stress, “select” coping
Table 11.1
Risk factors for persistent psychosocial
and vocational impairment among first responders
Pre-traumatic vulnerability
Lower levels of prior education
Younger age
Single/unmarried
Traumatic exposure
Witnessing severe physical harm and suffering (e.g., burns
and dismemberment)
Peri-traumatic reactions
Acute stress disorder
Post-traumatic life experiences
Stressful life events following a traumatic rescue or
recovery deployment
Post-traumatic coping and social support
Use of alcohol or drugs to cope with stress
Avoidant coping and emotional numbness
Problems with anger and irritability
Social isolation and reduced involvement in social support
networks
Table 11.2
Psychological first aid functions
responders, albeit typically not right at the disaster
epicenter. Even highly experienced and seasoned
providers and staff (e.g., Emergency Department
clinicians and staff) can experience post-traumatic
reactions when their unit is flooded for hours and
dayswith horrifically injured and extremely psycho-
logically distressed patients and family members.
These reactions often are described as “vicarious
trauma” or “secondary trauma,” but in fact they are
no different than the “direct” trauma experienced by
witnesses and responders.
(I) Direct: Engagement
Goal
: To provide helpful direction to affected persons based on
observing the context and persons (including responders) with
whom contact may be made, respond to contacts initiated by
affected persons, initiate contact in a non-intrusive and helpful
manner, listen and respond effectively to immediate needs and
concerns expressed or demonstrated by affected persons, and
enhance motivation for adaptive coping by affected persons.
(II) Protect: Safety and Orientation
Goal
: To ensure immediate safety, comfort, orientation, and
access to resources by affected persons, and to protect them
from unnecessary exposure to traumatic or other stressors.
11.2.1 Psychological First Aid: Protect,
Direct, Connect, and Select
The first step in addressing the psychological
needs of people seeking healthcare in the wake
of terrorist incidents is to provide “psychological
first aid” (PFA). The PFA is not in the purview
primarily of psychiatry or social service providers,
but they can provide essential training and
consultation to medical, nursing, and other health
professionals and hospital staff in providing PFA.
The goal of PFA is to help distressed persons to
regain the capacity to modulate their emotions
and think clearly so that they can benefit from
needed medical care and not use medical services
as a means of getting psychological help (i.e.,
(III) Select: Stabilization and Self-Regulation
Goal
: To help affected persons to recognize (in tolerable
amounts and ways), understand (in practical terms that do are
easily remembered and utilized at times of stress in which
cognitive capacity may be reduced), and modulate expectable
changes in emotional reactivity (i.e., to keep reactions within a
manageable range of intensity or to recover and resume manage-
able levels if extremely intense or dissociated reactions occur).
(IV) Connect: Connectedness
Goal
: To promote a feeling of connectedness (i.e., that other
people care about and can help you, and that you can care about
and help others), by providing respectful, non-intrusive, and
supportive ongoing relationship to people directly or by being
involved in systems that can provide ongoing support and help
affected people get back on their feet and regain their lives.
