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SAMHSA News - May/June 2007, Volume 15, Number 3

Psychological First Aid in a Crisis

photo of emergency vehicle
Photo by Erin J. Pond
In the wake of a trauma of any kind—school violence, a crisis, or a natural disaster—attending to the emotional and psychological needs of survivors can be critically important.

The SAMHSA-funded National Child Traumatic Stress Network (NCTSN) and the National Center for Post-Traumatic Stress Disorder at the U.S. Department of Veterans Affairs recently posted online the second edition of Psychological First Aid: Field Operations Guide.

The 189-page guide provides information for first responders, disaster relief workers, crisis counselors, and volunteers to help survivors immediately in the aftermath of a traumatic event. (See SAMHSA News online, July/August 2006.)

Available online, the guide describes key steps for providing psychological first aid (PFA) including how to approach someone in need, how to talk to them, how to help stabilize someone, and how to gather information.

Appendices include resources about service delivery sites and settings, provider care, and worksheets and handouts.

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What is Psychological First Aid?

Psychological first aid is an evidence-based approach and intervention, built on the concept of human resilience, to help survivors in the immediate aftermath of a traumatic event, crisis, or natural disaster. PFA can help everyone—children, adolescents, adults, elders, and families.

Designed to reduce the initial distress caused by these events, PFA acknowledges the seriousness of the experience of danger and the increased feelings of vulnerability that often follow. PFA fosters long- and short-term adaptability, basic functioning, and coping skills.

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School-Based Violence

photo of people walking on street outside hospital emergency area

Photo by Erin J. Pond

In the case of school-based violence, for example, students often fear that there will be a recurrence of the danger.

An important aspect of PFA is to re-establish the “protective shield” of adults.

Crisis intervention team members can help students to understand and recognize common reactions to danger, help students verbalize their feelings, and help identify traumatic reminders that trigger renewed fears.

PFA, administered by a skilled school mental health professional, allows for the expression of difficult feelings and assists students in developing coping strategies and constructive actions to deal with fear and anxiety.

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Basic objectives of PFA include the following:

  • Enhance immediate and ongoing safety and provide physical and emotional comfort for survivors.

  • Establish a non-intrusive, human connection and compassionate manner.

  • Help survivors tell you specifically what their immediate needs and concerns are and gather additional information as appropriate.

  • Offer practical help—food, water, blankets—to help survivors cope effectively with the situation at hand.

  • Connect survivors as soon as possible to social support networks, including family members, friends, neighbors, and community resources.

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What To Do

  • Politely observe first before approaching a survivor—don’t intrude. Some signs that someone might be experiencing emotional distress and may need assistance include being disoriented, agitated, angry, or extremely withdrawn.

  • Speak calmly and slowly in simple concrete terms. Don’t use acronyms or jargon. Be patient, responsive, and sensitive. If communicating through a translator or interpreter, look at and talk to the survivor.

  • When you are unsure of how to help, ask “How can I help?” And trust what the person tells you.

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Working With Youth

  • Talk to the adolescent as you would to an adult. Do not “talk down” or patronize.

  • Help school-age children verbalize their feelings, concerns, and questions. Avoid extreme words like “terrified” or “horrified,” because these may increase their distress.

  • For young children, sit or crouch at the child’s eye level, and match your language to the child’s developmental level.

photo of the outside of an emergency room
Photo by Erin J. Pond
The full-text text of Psychological First Aid: Field Operations Guide, 2nd Edition, is available at or For more information about SAMHSA’s Disaster Readiness & Response program, visit
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Inside This Issue
Expanding HIV Assistance:
Outreach, Testing for
At-Risk Individuals
Part 1
Part 2
Resources on HIV/AIDS
HIV/AIDS Consumer Guide

From the Administrator: On Capitol Hill

Grants: Manual Clarifies Application Process

Children's Mental Health

Virginia Tech Tragedy: Coping with Trauma

Psychological First Aid

Veterans, Families: New Resources

Around the World Treatnet: Improving Treatment Around the Globe

Expanding Treatment in Central America

Treating Alcohol Dependence: Advisory

Recovery Month: Toolkit, PSAs Help Planning Efforts

PRISM Awards in Spotlight

Depression: Reports Offer Statistics

Mental Health Report Available

TAP 21A: Competencies for Clinical Supervisors

HBCU Conference Highlights Workforce

Homelessness Web Site Launched

STD Rates: Alcohol, Drug Use Linked

Staff in the News:
Dr. Kenneth S. Thompson


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SAMHSA News - May/June 2007, Volume 15, Number 3