Psychological First Aid: national and international guidelines

Psychological First Aid: national and international guidelines

The importance of providing adequate psychological assistance in emergency situations and a Psychological First Aid is increasingly recognized both nationally and internationally. In 2011, the WHO prepared some guidelines to direct countries towards an effective approach in the protection of survivors or those in shock.


Advertising message This article takes into consideration three intervention models adopted by Psychological First Aid operators. It constitutes the first step to be taken in the continuum of treatment and must be taken by specifically trained personnel, with the main purpose of mitigating distress in the acute phase.

The First Psychological Aid (PSP), in English Psychological First Aid (PFA), arises from the need to give an immediate, structured and coordinated response in defined emergency situations and to the related socio-psychological distress. The World Health Organization defines it as a tool applicable both on a large scale and on individual cases, during and in the phases immediately following a stressful and potentially traumatic event.

More precisely, the PFA refers to a modality of compassionate and supportive approach put in place to mitigate symptoms of acute stress that have just arisen: of course it is only the first step to be taken in the continuum of treatments that will follow. With the implementation of these aid modalities, we do not aim to cure complex pathologies such as PTSD or acute stress disorder, or to replace a structured psychological or psychotherapeutic treatment path, but to stabilize and mitigate distress in order to encourage better future processing of what happened. It is not a question of doing therapy, but of supporting a person who asks for help in one of the most difficult moments of his life: the operator offering assistance must therefore have adequate training that allows him to recognize,

The first research on psychological first aid was developed after the Second World War, to meet the psychological needs of veterans. Some subsequent studies, such as those following the terrorist attack on the Twin Towers, show that the psychological first aid interventions immediately following the traumatic event were predictive of minor post-traumatic consequences, compared to many psychotherapy sessions carried out later in absence of an adequate first intervention (Everly et al. 2014; 2017). This data underlines the importance of an ad hoc and consequential first intervention on exposure to the potentially traumatic event, to give the victim the basis for being able to elaborate what happened in the future.

In 2011 the World Health Organization (WHO) developed the manual “Psychological First Aid: Guide for field workers” which constitutes both a field work tool and a training tool aimed at health, social, civil protection and volunteers.

In Italy, alongside a legislative, institutional and cultural recognition and a strong commitment by the National Order of Psychologists and Regional Orders, psychological interventions in major emergencies are mainly carried out by voluntary psychologists and psychotherapists. Various social volunteer actors contributed during various emergencies, such as the non-profit association SIPEM SoS (Italian Society of Emergency Psychology Social Support Federation).

The CISM (Critical Incident Stress Management) program is an intervention protocol developed specifically to mitigate stress related to critical events, which is divided into seven key elements:

A technique widely used in emergency psychology is precisely Defusing, a short intervention, not necessarily managed by a mental health professional, which involves a conversation between 20 and 40 minutes to be carried out immediately after the critical intervention, in a sort psychological first aid in which hot emotions are collected and an attempt is made to give an initial construction of meaning to events that are often inexplicable and out of control. The rescuer must in any case have received adequate training to intervene in this phase.

The Debriefing is instead conducted by an emergency services team composed of qualified mental health professionals (Psychologists or Psychotherapists) assisted by colleagues from the group members. The Debriefing should take place 24-76 hours after the critical event and never on the scene of the traumatizing event, but in a structure that offers a safe atmosphere.

Advertising message In the United States, the most widespread protocols are Roberts’ Seven-Stage Intervention Crisis Model and the RAPID Model of Johns Hopkins University in Everly. In conceptualizing the processes relating to the intervention on the crisis, Roberts in 1991 identified seven decisive steps or phases that therapists and clients usually face along the path of stabilization, resolution and control of the crisis itself. These steps, listed below, are essential, sequential and, at times, superimposable in the crisis intervention process.

The model of Johns Hopskins University is divided into five steps, the initials of which make up the acronym RAPID: Reflective listening, Assessment of need, Prioritization, Intervention, Disposition. The RAPID model provides important indications that operators who intervene in crisis situations can use. It has proven effective in promoting personal and community resilience following catastrophic events, and is based on a type of empathic and non-judgmental listening together with the use of different intervention strategies. The approach also focuses on aspects such as triage, i.e. establishing a hierarchy of the most needy in order to ensure that they have priority in using the service,

Although different in name and procedure, all the models examined are intended to protect psychological experiences in the first interventions aimed at people who survived natural disasters, terrorist attacks or other defined emergency situations, such as a sudden mourning and a road accident. The international guidelines are clear in determining the need for adequate training by operators who intervene in emergency situations, in order to guarantee a service capable of effectively supporting those involved in an acute stress situation. Empathy, recognition of the level of risk, examination of needs and connection of social networks are some of the key points that are found in each approach, together with the awareness that a psychological first aid does not replace the course of treatment that will eventually be undertaken. Mitigating the shock caused by exposure to a potentially traumatic event that has just been experienced, and establishing a first contact with the assistance services, are decisive factors in favoring an adaptive emotional recovery and the restoration of a good personological functioning.

For further information on the RAPID model, it is possible to take a free online course on www.coursera.com, where in addition to the theoretical explanation and practical examples, strategies are provided for operators on how to protect themselves from compassion fatigue and burnout, which can arise due to the emotional and cognitive load given by assisting people in acute suffering.