Post Trauma Support – Providing Psychological First Aid (PFA)

Psychological First Aid

PFA- Care for immediate needs

Start with the basics. Do people need medical care? Are they in a place of safety? Do they need food, drink, clothing? Have they go somewhere to stay? Find out what else people need. Perhaps they're due to collect their kids from school. Is their mobile phone out of charge? Once we've found out what they need, we can ask if they want our help. We want to support, collaborate and empower. Doing with, not to. Help them develop a plan that is both practical and realistic and then support them to action the plan

PFA - Protect from further threat and distress

Ensure their immediate safety and consider how to increase their sense of safety. Do they need to all someone? If they're panicky or very distressed, we want to help them feel in control of their emotions. Not suppressing these feelings, but perhaps talking calmly, helping the regulate their breathing, bringing their attention to their pre4sent safety.
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If possible, we want to protect them from further danger or distress. One example of this might be media coverage. Are there photographers at the scene, or a TV showing images of the traumatic event on a loop? How many times are they being asked to describe what happened to them?
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Where the incident has occurred in a work or volunteering context, try to minimise exposure beyond what is required to fulfil their role (physically and online). However, don’t assume they need to leave their role. This can feel like the best thing to do but can give an unintended message that we think they can't cope or are incompetent. Our urge to protect must always be trumped by importance of giving people choice and control. Do they want to stay or would they rather leave? Remember if social support is key to recovery after trauma exposure, then being with colleagues and at work/volunteering may be best thing we can do to help them. If they do leave, arrange to check in with them.

Ensure operational debriefs are psychologically safe. Focus on understanding and learning, rather than blame or criticism.

PFA - Comfort and console

If you’re there beside someone trying to help, then you’re already comforting and consoling. Emotional reactions are natural and it is important to communicate this to the person you're supporting and to remember it yourself. If someone is distressed in the aftermath of a traumatic event, it means they need comfort and support, not a referral for professional help. Spend time with them and allow the expression of emotion while you see if there's anything else they require.

Communicate care / support
Acknowledge (and believe) that emotional reactions are natural
Give choices - do they want you to stay or help them get some space?
Tell them you’d like to keep in touch to see how they’re doing

PFA - Provide Practical Support

Having worked out what help people need, work with them to achieve this. Trauma can remove a sense of control and agency from us. PFA wants to restore this. Remember the key points:

Do with, not to
Empower
Collaborate
Restore choice and control

PFA - Support for practical tasks

PFA - Educate about normal responses

‍Share what you know about our hard-wired, instinctive responses. Understanding our reactions

Empowers us
Gives us choices
Reduces shame and self-blame

Explain that in the days and weeks after we’ve experienced something frightening or shocking, we go through a natural recovery process. Our body’s alarm system re-sets, we file the experience away in our memory and gradually start to come to terms with what has happened. While this is happening, we’re likely to feel more emotional than usual, find ourselves frequently thinking and dreaming about it and may have some unpleasant physical sensations. To understand more about these normal reactions to trauma exposure have a look at Understanding my response to trauma and stress.

One of the most important things we can do is help people make sense of their reactions. Our Quick Guide on Post Trauma Support gives an overview of what helps us recover after a traumatic experience.

PFA - Provide information on coping

As well as educating people about normal reactions following trauma exposure, we want to provide information on coping. This helps them start to feel a bit better in the short-term and will support a healthy recovery.
If we don't discuss this, then people may rely on less helpful strategies, like pushing their thoughts or emotions away, or using substances to numb themselves.
PFA asks us to share and explain some helpful coping tips, e.g., how moving around following trauma exposure can use up excess adrenalin. This may happen naturally for people who have physical tasks to complete after trauma exposure, but can be more of a challenge for colleagues in desk / PC based roles. A walk around the building can help.

Here are some tips on coping following trauma exposure that you can share:

Give yourself time and space to recover ‍
Try to keep to routines where possible
Be gentle with your body – it’s likely to be in alarm mode for a while
Trust your brain – allow yourself to think about what has happened so you can process the memory
Avoid avoidance – with time you will be able to cope with reminders
Stay connected – spend time with people who care and talk to them if you’re able
Accept that this experience will shape you and become part of your life story

You can also have a look at the section on Recovering from Post Traumatic Stress Injuries in What can I do if I'm not ok and also Coping and self-care

PFA - Connect with social supports

Good social support is key to recovery following trauma exposure but traumatic events can fracture social support. PFA wants to build social support on an individual and community basis. Talk to people about their network and help them connect to it. This might be providing people with a phone or charger cable.
Consider:

Who’s around for them?
Can they talk to family or friends?
Can we help family & friends to understand what’s going on, for example by highlighting to people the Info for friends, family and supporters on the website?
If no-one is available at home, then make a plan on how they can be supported

Trauma Informed Care

Trauma Informed means being able to recognise when someone may be affected by trauma, collaboratively adjusting how we work to take this into account and responding in a way that supports recovery, does no harm and recognises and supports people's resilience.When supporting people affected by traumatic events, remember the key principles for trauma-informed care which aim to redress the harm trauma causes:

Safety
Trust
Collaboration
Choice
Empowerment

You may find the information on the National Trauma Transformation Programme page of help.

Why might we all react differently?

Although everyone is affected in some way by traumatic events, there are a wide range of reactions and feelings each person can have. Many people may feel overwhelmed, confused or very uncertain about what is happening. They can feel very fearful or anxious, or numb and detached. Some people may have mild reactions, whereas others may have more severe reactions. How someone reacts depends on many factors, including:

the nature and severity of the event(s) they experience
their experience with previous distressing events
their physical health
their personal and family history of mental health problems
the support they have in their life from others
their cultural background and traditions
their age (for example, children of different age groups react differently)

Every person has strengths and abilities to help them cope with life challenges. We discuss this in our sections on Why I’m OK most of the time. However, some people are particularly vulnerable in a crisis situation and may need extra help. Have a look at Understanding my response to trauma and stress and also Recovering from Post Traumatic Stress Injuries where we explain what happens to us when we are exposed to potentially traumatic events and some tips on recovery.

Self-care for you

Caring for ourselves is essential – it will help us to be there for others. The emotional labour involved in successfully managing our own feelings whilst attending to the needs and distress of others can be very demanding (both at work and at home) in times of crisis. It is important that we are all able to talk openly and honestly about our mental health and wellbeing. Looking after our mental health is just as important as our physical health.

Using the ABC of self-care in a crisis situation can really help us to maintain our own personal resilience and strength in the face of increasing stress and emotional labour.

Awareness
Awareness of your own responses
Acknowledge and accept feelings and thoughts
Activate self-compassion and calm coping strategies

Balance
Breaks: regularly recharge
Basics: routine, eat well, hydrate, exercise, sleep
Boundaries: establish boundaries and protect these

Connections
Colleagues: kindness to and from peers
Cherish values: the importance of things that have meaning for you
Community: virtual and physical connection with family and friends

You can also have a look at this section on Coping and self-care