NCTSN/NCPTSD

Psychological First Aid

(PFA)
Overview presented by
Eric Vernberg, Ph.D.
University of Kansas and the
NCTSN Terrorism and Disaster Center

PSYCHOLOGICAL FIRST AID

Field Operations Guide
Sponsors:
National Child Traumatic Stress Network
National Center for PTSD

Principal Authors (alphabetical order)

Melissa Brymer, Anne Jacobs, Chris Layne, Robert Pynoos,
Joseph Ruzek, Alan Steinberg, Eric Vernberg, and Patricia Watson

Special consultants (alphabetical order)

Steve Berkowitz, Dora Black, Carrie Epstein, Julian Ford, Laura
Gibson, Robin Gurwitch, Jack Herrmann, Jessica Hamblen,
Russell Jones, Robert Macy, William Saltzman, Janine Shelby,
Merritt Schreiber, Betty Pfefferbaum, Rose Pfefferbaum,
Margaret Samuels, Cynthia Whitham, Bonita Wirth, and Bruce
Young.

Basics of Psychological First

Aid
What: establish safety and security, connect to
restorative resources, reduce stress-related
reactions, and foster adaptive short- and long-term
coping
For: individuals experiencing acute stress reactions
or who appear to be at risk for significant impairment
in functioning
By: mental health professionals and others who
provide crisis assistance after catastrophic events
When: Immediate and early phase post-event, in as
little as 30 minutes and extended as needed
Where: in a broad range of emergency settings, in
either single or multiple sessions, adapted for use in
group settings
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PFA
Principles and techniques of PFA meet
four basic standards:
(1) consistent with research
evidence on risk and resilience
following trauma
(2) applicable and practical in field
settings
(3) appropriate to developmental
level across the lifespan
(4) culturally informed

Strengths of PFA

Evidence-Informed
Modular format
Information-gathering
Concrete examples

Developmental Framework
Attention to Cultural Factors
Handouts

Basic Requirements for

Early Intervention Providers
Capacity to connect with wide range of individuals
Tolerance for symptomatic behavior and strong
expression of affect
Capacity for rapid assessment of survivors
Ability to provide care tailored to timing of
intervention, context, culture
Recognition and response to emotional numbing
processes
Knowledge of self capacities
Ability to provide clear, concrete information
Ability to shift from conventional clinical practice
Capacity for self-care

Some Basics

Expect normal recovery

Assume survivors are competent
Recognize survivor strengths
Promote resilience

PFA Core Actions

Contact and engagement

Safety and comfort
Stabilization (if needed)
Information gathering: current needs and
concerns
Practical assistance
Connection with social supports
Information on distress reactions and
coping
Linkage with collaborative services

Contact and Engagement

1: Establish a connection with affected persons in a
non-intrusive, compassionate manner.
Introduce self and describe role
Ask for permission to talk
Explain objective
Ask about immediate needs
Be informed about cultural norms related to
personal contact

Safety and Comfort (1)

2:

Enhance immediate and ongoing safety, and

provide physical and emotional comfort.

Ensure immediate physical safety

Provide information about disaster response
activities/services
Offer physical comforts
Offer social comforts
Attend to children who are separated from their
parents/caregivers
Protect from additional trauma and potential trauma
reminders

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Safety and Comfort (2)

Help survivors who have a missing family member
Help survivors when a family member or close
friend has died
Attend to grief and spiritual issues
Provide information about casket and funeral
issues
Attend to issues related to traumatic grief
Support survivors who receive death notification
Support survivors involved In body identification
Help caregivers confirm body identification to a
child or adolescent

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Stabilization (1)

3: Calm and orient emotionallyoverwhelmed/distraught survivors.

Stabilize emotionally overwhelmed survivors
Talking points for emotionally overwhelmed
survivors
Role of medications in stabilization

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Stabilization (2):

Signs a Survivor is Disoriented or

Overwhelmed

Looking glassy eyed and vacant

Unresponsive to verbal questions or commands
Disoriented
Exhibiting strong emotional and physical responses
(uncontrollable crying, hyperventilating, rocking or
regressive behavior, shaking, trembling)
Exhibiting frantic searching behavior
Feeling incapacitated by worry
Engaging in risky activities

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Stabilization (3)
If extremely agitated or losing touch with the
surroundings:

Ask them to listen to and look at you

Speak softly and calmly
Orient to surroundings
Talk about aspect of the situation that is
under their control, hopeful, or positive

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Information Gathering: Current

Needs and Concerns (1)

4: Identify immediate needs and concerns, and gather

additional information as appropriate to the situation.

Form and maintain an alliance with the survivor

Remain sensitive to survivor needs and perceptions
Identify individuals in need of immediate referral
Identify components of PFA that may be especially
helpful

Integrate survivor education with informal assessment

Identify need for additional services or referral

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Information Gathering: Content Areas

(2)
Nature and severity of experiences
Death of a loved one
Concerns about the immediate post-disaster
circumstances and ongoing threat
Separation from or concerns about the safety of loved
ones
Physical illness and need for medications
Losses incurred as a result of the disaster
Feelings of guilt or shame
Thoughts about causing harm to self or others
Developmental Impact
Lack of adequate supportive social network
Prior alcohol or drug use or psychiatric problems
Prior exposure to trauma and loss
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Practical Assistance
5: Offer practical assistance and information to
address survivors immediate needs and
concerns.
Identify the most immediate need(s)
Clarify the need
Discuss an action response
Act to address the need

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Connection with Social Supports

6: Connect survivors as soon as possible to social
support providers, including family members,
friends, and community helping resources.
Enhance access to primary support persons
(family and significant others)
Encourage use of immediately-available support
persons
Discuss support-seeking
Special considerations for children and
adolescents
Model supportive behavior
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Information on Coping (1)

7: Provide the individual with information that may
help them cope with the event and its aftermath,
including information about:
Provide basic information about common
psychological reactions to traumatic experiences
and losses
Talk with children and body and emotional
reactions
Provide basic information on ways of coping
Teach simple relaxation techniques

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Information on Coping (2)

Assist with developmental issues
Assist with anger management Address highly
negative emotions
Address highly negative emotions (e.g., guilt,
shame)
Help with sleep problems
Address alcohol and substance use

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Linkage with Collaborative Services

8: Links survivors with needed services, and

inform them about services that may be
needed in the future.
Provide direct links to additional needed
services
Promote continuity in helping relationships

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Next Steps: Training

Develop strategic plan for dissemination and training
NCTSN Terrorism and Disaster Network Committee
Partnerships and adaptations

Medical Reserve Corps (MRC)

Spiritual care providers
Health care settings
Schools
Community Emergency Response Teams (CERT)

Standardized training packages

Videos
Skills training
Integration with drills
Online training version

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Next Steps: Evaluation

Assessing effectiveness of PFA
Does PFA facilitate decision-making
Does PFA reduce immediate distress
Does PFA help survivors avoid additional risk or risktaking behavior?
Does PFA help survivors connect to important
services more quickly

Assessing impact of PFA training on providers

Confidence, attitudes, knowledge
Behavior in post-disaster settings
Analog studies (e.g., behavior in training exercises)

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