psychological first aid for cisco dirt responders

© 2008 Cisco Systems, Inc. All rights reserved. Cisco PublicDIRT-Intro-rbharani 1

Psychological First-Aid (PFA) for Cisco DIRT Responders

Rakesh BharaniaCisco Tactical Operations

The content of this presentation has been approved by TACOPS Medical Direction and is based on the PFA Course by the American Red Cross.

© 2008 Cisco Systems, Inc. All rights reserved. Cisco PublicDIRT-intro-rbharani 2

Goals of the class Defining Psychological First-Aid (PFA) Disaster-related Stress Behaviors PFA Actions Putting it all together

Agenda


Before we go any further …

Thank you for volunteering.


To empower Cisco Disaster Incident Response Team (DIRT) members with mechanisms to identify disaster- related stress in themselves and others

To identify actions you can take to provide comfort and support to yourself, colleagues or others who are experiencing disaster-related stress.

To know what resources are available for additional help.

Even though we are technology responders, rememberthat disasters are fundamentally human events, not technological ones!

Goals


Introducing Psychological First-AidIntroducing Psychological First-Aid


PFA is the practice of recognizing and responding to people (yourself and others) who need help because they are feeling stress, resulting from the disaster situation in which they find themselves.

Knowing PFA will allow you to:

Create a compassionate environment for yourself, fellow responders, and disaster survivors.

Assess what a person might need & give immediate support.

Help develop good coping mechanisms.

What is Psychological First-Aid?


Disasters are stressful for both survivors, and the workers who help them:

Small disasters (house fire): affects a family and a neighborhood.

Large disasters (9/11, Hurricane Katrina, Haiti Earthquake) have a global “stress footprint” affecting populations near and far.

Stress is a common reaction among disaster workers – 1/3 report depression/negative emotions after the emergency even if their personal experience was positive.

You’re at risk: deployed, or working support on the back-end.

Categories of stress: Feelings, Thoughts, Physical Effects, Behavioral, Spiritual.

Disasters and Stress


Rage/Anger/Irritability

Resentment

Anxiety, Fear

Despair, Hopelessness

Numb

Terrified

Guilty

Sad

Helpless

Loss of control

Uninterested

Overwhelmed

Feelings


Difficulty concentrating

Difficulty making decisions

Forgetful

Confused

Distortion of time

Lowered self-esteem

Self-blame

Intrusive thoughts / flashbacks

Worry

A sense of being cut off from reality

Self-harm

Thoughts


Fatigue, difficulty sleeping

Agitation

Physical ailments (headaches, stomach problems, etc.)

Decreased/increased appetite

Decreased/increased sex drive.

Easily startled

Increased cravings: caffeine, nicotine, sweets, alcohol, illicit substances

Lightheadedness

Weakness

Physical Effects


Crying spells

Angry outbursts

Avoiding people / places / situations

Argumentative

Not wanting to leave scene until work is finished

Work problems

Denying the need to “turn off” and rest

Risky behaviors (erratic driving, unsafe sex or multiple partners, etc.)

Inattention to appearance and self-care

Behaviors


Change in belief/relationship with God/Higher Power

Abandonment of prayer, ritual

Questioning beliefs of their faith

Rejection of spiritual care providers

Struggle with questions about meaning of life, justice, fairness, afterlife

Loss of familiar spiritual supports

Loss of faith

Spiritual


Contributing Factors to Stress Response

Cause of disaster (human/natural) When it occurs (time of day/year) Who was affected What is affected (schools,

healthcare, famous structures) Where it happens (geographic

boundaries)


Leaving family and loved ones to go on deployment

Working in unfamiliar and challenging environment

Little privacy

Encountering unfamiliar cultural or ethnic populations

Listening to survivors’ stories

Seeing disturbing sights

Working with difficult supervisors and co-workers

Returning home and re-integrating

Supporting the deployment remotely also has its own challenges… like being at home yet feeling you’re at a disaster.

Factors that affect you as a responder


PFA ActionsPFA Actions


We will now introduce the principles of Psychological First-Aid (PFA)

Consider these principles as the awareness you can develop, attitudes you can adopt, and actions you can take to provide comfort and support to yourselves and your teammates.

Most disaster stress is temporary and will abate over time with good support mechanisms in place.

Adopting PFA actions


Make a connection

Helping people be safe

Being kind, calm, compassionate

Meeting people’s basic needs

Listening

Helping people connect

Giving timely and accurate information

Encouraging good coping

Taking care of yourself

PFA Actions


Make a connection> Don’t have to wait for someone to approach you.> Focus your attention on the other person

Help people be safe> Be aware of your surroundings> Enter a scene only when you’re sure it’s safe

Be kind, calm, compassionate> Could be as easy as handing someone a bottle of water.> Express patience and compassion, even when people are being

difficult> Speak in a calm voice> Remain courteous and respectful of people> Disaster work can be chaotic and intense – it’s easy to be impolite

without meaning to. Apologize.

PFA Actions in detail


Meet people’s basic needs> Disaster workers often ignore their own needs of eating and drinking, getting rest, and staying engaged with a supportive community.

> Offer or direct people to food and water> Encourage your teammates to sleep and get rest (rotate duties,

“take a walk”, etc.)

Listen> When some people are stressed, they want to talk about it.> Be attentive, listen carefully, be available> You can’t make someone talk who doesn’t want to.

Give realistic reassurance> Remember that what people are feeling and thinking is

understandable

> Don’t minimize their reactions.

PFA Actions in detail (cont’d.)


Encourage good coping

Help people connect> It is important to connect people to their usual support systems.> Family, friends, etc.> Use a phone / email / IM / WebEx etc. to stay in touch.

Give accurate & timely information> Avoid amplification of rumors and misinformation.> Expect “fog of war”

Take care of yourself – adopt the PFA actions personally.

PFA Actions in detail (cont’d.)


Putting it togetherPutting it together


Be tolerant> treat all with respect and dignity.

Keep boundaries: > don’t tell people what to do/what not to do> don’t push people to talk when they don’t want to> don’t insist people share personal details when they are not ready.

Respect people’s privacy: > Even if a person is a danger to herself, there are ways of

engaging help that maintain trust.

Rules of the Road


Limit on-duty work time to no more than 12 hours per day.

Rotate work assignments between high stress and lower stress functions.

Drink plenty of water and eat healthy snacks and energy foods.

Take frequent, brief breaks from the scene when you are able.

Keep an object of comfort with you such as a family photo, favorite music, or religious material.

Stay in touch with family and friends.

Pair up with another responder so that you can monitor one another’s stress.

Your reactions are normal – give yourself permission.

Taking care of yourself – here or there.


If a person appears to be in immediate danger to themselves or others. (seek immediate help! Call 9-1-1)

If a person appears to be inconsolable and is no longer able to function in a normal capacity even after you have used PFA and attempted to take care of immediate needs.

If the person behaves erratically, or exhibits questionable judgment in a way that does not make sense in the context of the situation.

Resources for escalation…> 9-1-1 or other emergent care> Your TacOps coordinator> Referrals to Cisco Employee Assistance Program (EAP).

When should you escalate?

psychological first aid for cisco dirt responders

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