Is there such a thing as a first aid kit for common psychiatic stuff: shock, depression, grief, denial, or whatever is considered a "common" psychiatic condition one can expect to encounter in emergency situations?

Is there a compact first aid oriented booklet for such things?

Thoughts?

Thanks.

not that I've heard of. Which makes sense - most psychiatric care is long term. The normal CISD stuff should help for short term. or just talk with your neighbors and do the amateur talk-therapy.

?CISD?

I am thinking of doing the right thing to get folks past an immediate obstacle, like moving when they are frozen scared or emotionally overwhelmed. Or abandoning a victim to get themselves to safety. Or out of a rage or unreasonable position to allow themselves and others to get on with what must be done.

First responders must run into such difficult stuff where an right-now solution is in order.

Not looking to start long-term talk therapy or treatment.

Common sense and intuition will probably serve you better than any field guide. I find a lot people just need someone to hear what they have to say.

You see it in the movies all the time. "Snap out of it!" followed by a slap in the face. "Thanks, I needed that" . This is just a bit unrealistic.

There is something known as "taking charge of the situation," which is often unremitting chaos when a first responder arrives on the scene. This is generally accomplished by prioritizing actions, giving calm, confident instructions, setting people to work, and getting on with the business at hand. It is a definite plus if you actually know what to do.

From experiance: Most people think that leaving is fleeing, so they baulk. Give then a task, even if it's "securing" the lifeboat. Something that allows them to leave honorably.

Nice reference, NightHiker!

The American Red Cross has a course in Psychological First Aid for its volunteers, focusing on serving clients undergoing stress in disasters. I found it to be a very worthwhile course, and the Red Cross recently made it a required / recommended course for higher level (supervisor) volunteers. Red Cross has a significant disaster health services commitment, and part of that is mental health services.

Folks will lose their homes and possessions, some may lose family and loved ones. There can be depression, sadness, tuning out, anger - you want watch for signs and deal with them as best you can. Any disaster causes disruption, we all deal with that kind of stress differently. And people bring their pre-existing physical and mental health issues to your shelter or service.

Critical Incident Stress Debriefing.

Basically everyone that was in the incident sits in a circle and talks about what happened, what they did, how they're feeling. It typically meets soon after an incident but can meet more than once. It's more in teh Fire/EMS realm after an incident but it's a good point to start with sorting out emotions.

I took a 2-hour disaster psychology course that DHS offered to CERTs, RACES and others in my area. I thought it was a good course.

In my limited experience people who withdraw benefit from being warm, dry, in a quiet location. Hot food and drink seem to help. If they go the other way to hysteria being assigned a simple repetitive job seems to be very calming. Everyone, withdrawn, hysterical, or no apparent symptoms, benefit from simply talking about their experiences and feelings, as unnatural and difficult as that may be for men to do.

I'm afraid I have a different opinion regarding CISD (and probably regarding many other forms of "Psychiatric First Aid")

Critical Incident Stress Debriefing (CISD) is often used in in an attempt to prevent or minimize adverse outcomes of traumatic exposure. There are relatively few controlled studies on CISD, and among trauma researchers (not necessarily those who train and "sell" CISD to agencies) there is IMHO no consensus that CISD is actually helpful. Some studies have shown it can be harmful, others have not.

"The intervention has generated controversy, perhaps in part due to its widespread use in the absence of solid empirical evidence from randomized clinical trials to demonstrate its effectiveness. Now a new study by VA and DoD investigators provides the first such evidence—and the results are disappointing. "

Participants in carefully done CISD probably DO feel that the intervention was helpful. This perception (among participants) that it was helpful and not harmful suggests that it will continue to be used... if only for the social and emotional comfort it initially provides. It probably reduces immediate distress and improves group cohesion among first-responders and military units.

However, aside from this there is little evidence of meaningful effect in preventing or reducing any of the serious psychological consequences seen among trauma survivors (such as ASD or PTSD). Neither the presence or absence of CISD has an effect on these problems.

According to The National Center for PTSD
"recent research indicates that psychological debriefing is not always an appropriate mental-health intervention. Available evidence shows that, in some instances, it may increase traumatic stress or complicate recovery. Psychological debriefing is also inappropriate for acutely bereaved individuals. While operational debriefing [this is NOT really CISD..sic] is nearly always helpful (it involves clarifying events and providing education about normal responses and coping mechanisms), care must be taken before delivering more emotionally focused interventions.

A recent review of eight debriefing studies, all of which met rigorous criteria for being well-controlled, revealed no evidence that debriefing reduces the risk of PTSD, depression, or anxiety; nor were there any reductions in psychiatric symptoms across studies. Additionally, in two studies, one of which included long-term follow-up, some negative effects of CISD-type debriefings were reported relating to PTSD and other trauma-related symptoms (1).

Therefore, debriefings as currently employed may be useful for low magnitude stress exposure and symptoms or for emergency care providers. However, the best studies suggest that for individuals with more severe exposure to trauma, and for those who are experiencing more severe reactions such as PTSD, debriefing is ineffective and possibly harmful. "

Damned if you do and also if you don't?

Well, perhaps. To be honest with you, I have a great deal of professional experience with this and I personally recommend the DON'T.

Well, if as I have confirmed, the Red Cross thinks psychological first aid makes sense enough to teach, then I am going to try to get into a class - or at least get a set of their teaching material.

Dweste, if you do Psychological First Aid (PFA) the way the Red Cross teaches/recommends it, I think you're good to go. I just don't like the "debriefing" components some people seem to use.

The World Health Organization (I think in recent years... at least after 2007) looked at PFA across the world. They DO seem to endorse: "basic, non‐intrusive pragmatic care with a focus on: listening but not forcing talk; assessing needs and ensuring that basic needs are met; encouraging but not forcing company from significant others; and protecting from further harm." PFA is very different from psychological debriefing in that it does not necessarily involve a discussion of the event that caused the distress..."

Psychological First Aid is designed to reduce the initial distress caused by traumatic events, and to foster short- and long-term adaptive functioning. I really can't find compelling evidence that it does the later (promotes long-term adaptive functioning). But that's a hard case to make in any event because of "base rate" problems: 70% of survivors do not suffer any such consequences. Of the 30% that may, we still aren't very adept at identifying the factors that explain who will or won't have consequences.

Here's a guide to PFA:

http://www.vdh.state.va.us/EPR/pdf/PFA9-6-05Final.pdf

The dinosaur rises to speak (I was most active before the time of CISD). I dealt with some fairly nasty outcomes in SAR, and definitely was stressed by them. What seemed to help the most was another operation with a positive outcome. IME, the high from a successful operation far exceeded the lows from a bad one. I also would not discount the support from fellow team members.

Seems this thread has a split personality about "psychological first aid." Some comments seem most relevant to first responder types, some to the victims of emergencies. I am learning from both.

C.I.S.D, Dealing with Bereavment etc, you are dealing with some very complex, difficult and often conflicting emotions that most people have no real understanding of.

Take this as an absolute:

If it has not happened to you then you will never understand what and why, or even with the best will in the world, be able to really help. Yes, you can blunt the physical harm but the mental is beyond your powers.

If it has, then you can be of great help and in my view,and speaking from experience, C.I.S.D. should only be done by people who have been there.

[quote=Leigh_RatcliffeTake this as an absolute:
If it has not happened to you then you will never understand what and why, or even with the best will in the world, be able to really help. Yes, you can blunt the physical harm but the mental is beyond your powers.

If it has, then you can be of great help and in my view,and speaking from experience, C.I.S.D. should only be done by people who have been there.
[/quote]

Leigh, I can't agree that this is an absolute. I've never been shot - yet I've helped scores of cops and operators who have been. I've never had body parts blown off, but have helped many who have. I've never lost everything in a disaster, but I treated many Katrina victims with reasonable success. I could go on, but my point is that treatment can be very helpfully delivered by someone who didn't actually experience that same or similar trauma.

I've had the training and I've done C.I.S.D., and I noted some of my objections in the above thread. I respect your opinion regarding "been there-done that", but there isn't any empirical evidence to support calling this an "absolute." For instance, there are law enforcement agencies and fire departments who use trained "peers" to do CISD. Other agencies use outside professionals. Some have.. and some have not experienced similar traumas. I can't find any evidence of a difference in efficacy.

I do know that even if one has experienced the exact same type of event it is (contrary to what one may expect) very perilous to "self-disclose" - to assume, or to communicate, that you know how the other person feels because of your own experience. The risks of such significantly outweigh any assumed benefit of self-disclosure about one's own experience or "knowing how the other person feels." This is true in treating psychological trauma (e.g. PTSD) and in PFA.

Glad DW is a Social Worker. I can handle the survival stuff and she can handle the hysterical antics of those around us.

This does raise an important point though. Mental preparedness is as important as the physical preparedness and having the right gear on hand. What good are all your other preps if you are one of the ones who break down in the aftermath.

Don't discount it. Put yourself in a situation where your significant other, children, parents and/or a lot of other family members have died. Add to that your home has been destroyed. Add to that you are badly injured yourself. Add to that ...

It is easy for us to assume in the aftermath of a disaster we will be the ones who rise from the rubble with our caches of gear and our wealth of knowledge. Put the other shoe on and it changes things drastically.

Back to Dweste's original thought for a moment - When thinking of in-the-moment psychology, we should also give consideration to on-lookers. As a Scout leader, I teach the kids "Safety First." You can't help anyone by becoming a victim yourself. Unfortunately, theory and reality do not always mirror each other.

DH and I once stopped at the scene of an MVA on the side of a major highway. 3 vehicles were involved and 2 of the vehicles had rolled over. There were 10 victims, 6 adults and 4 kids, all injured, a couple of them severely. It was winter and we were in the middle of a snow storm. We weren't the first ones on the scene but we were the first active responders. About a dozen cars had pulled over, most people were out of their cars with several kids left buckled into their car seats.

DH and I immediately set to work triaging and treating the victims. As we worked, we advised everyone who wasn't helping to get back in their vehicles and leave if they weren't witnesses. Nobody moved, except 3 guys who ran over to one of the cars and started yanking on the door trying to open it, rocking the car pretty significantly as they did. I finally got through by yelling at them, and convinced them that they were hurting more than they were helping, and they stopped. I got two of them to hold pressure bandages on, and the other threw-up and went back to his car.

An off-duty nurse soon arrived, but nobody listened to her either. An off-duty, out of uniform cop had little success getting the gawkers to move either. Only when cruiser arrived and that officer told everyone to get back into their cars and leave if they weren't witnesses, did they finally leave the side of the road.

There must have been 20 people standing on the side of the icy, low-visability bend in the highway, WHERE A SERIOUS ACCIDENT HAD JUST HAPPENED BECAUSE OF ON-GOING CONDITIONS, giving no consideration to their own safety, or the safety of the kids that were left buckled in the targets, I mean, cars on the side of the ACCIDENT SCENE. It took a uniformed officer with lights flashing to get them to snap out of it.

Just read this article about the pyschological impact of the Salve Lake fire and thought it was timely for the post-event portion of this discussion:

http://www.cbc.ca/news/canada/story/2011/05/19/f-psychology-trauma.html

There is a reason that public safety people are in uniform. It really makes a significant difference in getting n appropriate response from the onlooking public. Lookie-loos often constitute a significant hazards in themselves. Here in SoCal, just the slowing of passing freeway traffic as gawkers gaze can mess traffic flow up significantly and add to the hazard.

Mental preparedness and mental toughness are good in the abstract but I have profound doubts as to how anyone, short of long term psychoanalysis and gaining a very deep understanding of their own mental landscape so they can avoid getting blind-sided, can improve their preparedness in this area.

Many of those I've met who are most concerned about it often have, IMHO, a deep and abiding need to be worried. I'm not referencing anyone here on this forum.

I do think there are ways to mentally buffer shocks. Feeling well supported and secure helps. Things that help include: having someone you can talk to without fear of scaring them off, friends and family who accept you for who you are (warts and all), a history of loving and being loved, an established roll in life that gives you a feeling of being needed, and, last but not least, a highly developed sense of humor. All of them seem to act as psychological seat belts. They won't stop all damage but they bolster resilience and seem to allow people to recover more quickly when/if they do lose it.

When I was younger, my best friend's dad was a cop. I went to work with him on one of those Bring a Kid to Work days. When we were in his cruiser, he showed me a black and white photo of a decapitated head laying on the side of the road. He told me it was a guy who witnessed an accident and wouldn't get back in his car. Said he kept it in his cruiser to show the lookie-lous who didn't want to listen. I don't think I'll ever erase that image from my head. In this day and age, he'd probably need full colour high-def video with surround sound to have the same effect.

The only technique I know of deals with anxiety. Have the person experiencing anxiety sit down and sit down next to that person directly facing him or her. Look at that person and have that person look at you. Tell that person to breathe with you Take deep, slow breaths.

I have never practiced this technique. This was taught at the Citizen's Fire Academy.

Jeanette Isabelle

I am not fully convinced that this is an absolute. From my observation a person who went through one type of trauma can be a help to a person who has went through another type of trauma.

Jeanette Isabelle

Might help, might not. People have different respiratory profiles in panic/anxiety attacks. Probably the majority will feel a bit calmer after a little (a little!) slow, deep breathing. Others, however, will feel worse. In a crisis situation you don't really have time to carefully explore this, so I'd recommend that you might try it briefly - but if it doesn't help in a minute or two (or if it seems to make the person more uncomfortable) don't persist.

My experience is that what helps the most universally is to just let them talk about what their physical sensations actually are. This "processing" seems to lighten the discomfort pretty reliably. I've never seen it have an adverse response, and I certainly have seen adverse responses to any of the typical breathing techniques (Benson Breathing, Diaphragmatic breathing, etc.).

I suggested trying the above slow-deep breathing briefly because even if the person feels worse you haven't done any harm: they'll usually just stop complying with your instructions.

The "face to face" helps some... makes others feel worse. Again: try it, but pay attention. If the person feels worse, perhaps have them shut their eyes.

The bottom line is to not wed yourself to a particular tool: watch, and change what you're doing if it isn't working.

You bring up valid points. I have a general anxiety disorder and while I EDC as needed medication, for minor attacks all I need to do is hold the bottle of medication as this has a calming effect. I don't even need to take a pill. For more severe attacks, I need a pill.

Jeanette Isabelle