Psychological First Aid: Supporting people affected by disaster in Australia - Australian Red Cross

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Psychological First Aid: Supporting people affected by disaster in Australia - Australian Red Cross
Psychological First Aid:
Supporting people affected
by disaster in Australia
Psychological First Aid: Supporting people affected by disaster in Australia - Australian Red Cross
Psychological First Aid:
                                                          Supporting people affected
                                                          by disaster in Australia
© Australian Red Cross
Third edition published by:
Australian Red Cross 2020
155 Pelham St, Carlton, Victoria 3053
and
Australian Psychological Society
Level 11, 257 Collins St, Melbourne, Victoria 3000
Photography copyright: All images are referenced
within and remain the property of the Australian
Red Cross, stated photographer, or other parties as
noted.
Within this resource, the term ‘emergency’ is used
and can apply to any form of emergency incident
or disaster. Where the term ‘disaster’ is used, this is
interchangeable to ‘emergency’ and connotations of
one term over the other should not be made.
All rights reserved. No part of this publication may
be reproduced, stored in a retrieval system, or
transmitted in any form, or by any means, electronic,
mechanical, photocopying, recording or otherwise
without the prior written consent of the publisher.
Cover image: ©Australian Red Cross
Psychological First Aid: Supporting people affected by disaster in Australia - Australian Red Cross
Contents
Foreword                                                    4    Psychological first aid for children                    30
                                                                 Additional guidance for supporting children             32
Psychosocial reactions to crisis situations                 8
Common reactions                                            10   Psychological first aid for people with physical or
Complex reactions                                           12   mental health conditions or intellectual disabilities   34

Understanding psychological first aid                       14   Self care for people working in the field               38

What is psychological first aid?                            15   Reducing stress                                         39

What psychological first aid isn’t                          16   Look, Listen, Link for self care                        40

The aim of psychological first aid                          17   Supporting your colleagues                              41

Five elements of psychosocial support                       18
                                                                 Useful organisations                                    42

Providing psychological first aid                           22
                                                                 References and resources                                44
Who benefits from psychological first aid?                  23
Who delivers psychological first aid?                       24   Acknowledgments                                         48
Where is psychological first aid given?                     25
                                                                 End Notes                                               50
When do you provide psychological first aid?                25
Psychological first aid action principles                   26   Fundamental Principles                                  52
Preparing to provide psychological first aid in the field   28

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Psychological First Aid: Supporting people affected by disaster in Australia - Australian Red Cross
Foreword

This psychological first aid guide is     This guide sets out to simply outline         After an emergency, people can lose           It has been recognised both in Australia
for people working in disaster            how psychological first aid can be            confidence in the norms, networks, and        and internationally that psychosocial
preparedness, response and recovery.      operationalised in Australia. The guide is    trust in the society that is supposed to      support in emergencies is best delivered
It provides an overview of best           also used in conjunction with psychological   protect them.1 Until the late 1970s, the      as a community-based activity.1 Providing
                                          first aid training delivered by Australian    psychosocial aspect of emergencies was        coordinated psychosocial support in
practice approaches to psychological
                                          Red Cross.                                    often ignored. Emergency management           emergencies has now become a critical
first aid following disasters and                                                       activities focused more on the rebuilding     part of preparing for, responding to and
traumatic events.                         Emergency is the generic term used in
                                                                                        of towns damaged by floods, fire or           recovering from an emergency.
                                          Australia to describe disruptive and/
                                                                                        storms and healing the physical wounds of
In Australia, each state and territory    or destructive events that cause loss of                                                    This guide is in line with the
                                                                                        those injured.
has plans to deal with the health         life, property and livelihoods, injury and                                                  following resources:
impacts of disasters. Included in these   damage to communities. For the individual     Disaster mental health and the                A Guide to Psychological First Aid
plans are arrangements that cover the     this may mean the loss of:                    identification of post-traumatic stress       (International Federation of Red Cross
mental health impacts of emergencies.                                                   disorder led to a shift in approaches to      Red Crescent Societies, 2018) and
                                          •   Loved ones or significant others
                                                                                        emergency management. Responses during        Psychological first aid: Guide for field
                                          •   Control over one’s own life and future    this period focused on applying clinical      workers (World Health Organization, War
                                          •   Hope and initiative                       mental health skills in emergency settings,   Trauma Foundation and World Vision
                                          •   Dignity                                   for which they were never intended.           International, 2011).
                                          •   Social infrastructure and institutions    It was then recognised that most people
                                          •   Access to services                        did not develop serious mental health
                                          •   Property and belongings                   issues after emergencies. Most people
                                                                                        recover well with some basic support. This
                                          •   Livelihoods                               led to the development of psychological
                                          •   The natural environment, important        first aid as a primary tool for supporting
                                              cultural sites and other places of        people after an emergency.
                                              significance.

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Psychological First Aid: Supporting people affected by disaster in Australia - Australian Red Cross
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    7

Australian Red Cross
Psychological First Aid: Supporting people affected by disaster in Australia - Australian Red Cross
Psychosocial
reactions to
crisis situations
                    People may experience strong              These may include situations such as:
                    emotional and physical distress           •   Personal crises
                    reactions when faced with situations      •   Social challenges
                    that result in death, or serious injury
                                                              •   Health challenges
                    to themselves or others. Feelings of
                    intense fear and thinking one may         •   Disasters caused by natural hazards
                    die or be seriously injured can also      •   Human caused disasters
                    cause intense feelings of distress.       •   Violence
                    These situations can be either directly   •   Armed conflict
                    experienced or witnessed. The loss        •   Forced migration.2
                    of treasured belongings, community
                                                              Community-level crisis situations, such
                    icons and connections to place also can   as disasters, armed conflict and forced
                    cause psychosocial distress.              migration have far-reaching and varied
                                                              impacts on people and the communities
                    There are many different situations
                                                              they belong to, geographic or otherwise.
                    that may cause people to experience       The impacts of disasters affect all aspects
                    suffering and distress.                   of wellbeing, degrade quality of life
                                                              and undermine the social connectivity
                                                              of communities.3

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Psychological First Aid: Supporting people affected by disaster in Australia - Australian Red Cross
Common reactions
                                                Remember:5
How people react to difficult experiences
                                                • People do not all react at the same time
depends on the nature of the experience,
                                                  or in the same way to a crisis
their resilience, their age and personality,
their support system and usual coping           • Not everyone needs or wants support
methods, how much time has passed               • Witnesses to a frightening event may
since the time of the event, and previous         also be strongly affected and need
experiences.                                      support
However, there are some common                  • Some people are calm and do not react
emotional and physical distress reactions         strongly at the time of an event, but

                                                                                                                                                   Australian Red Cross
that can be expected immediately during           have strong reactions later
and in the days, weeks, months or years         • Some people have strong reactions, and
after a crisis event.4 These include, but are     can manage their situation on their own,
not limited to:                                   or have support from other sources.
• Feelings of guilt, sadness, relief, anger,
  fear, anxiety, confusion, uncertainty,        Stress
  hopelessness                                  Stress is a state of pressure or strain that
• Feeling numb, increased heartbeat,            takes place in many different situations.
  sweating, shaking, trembling or               It can be caused by any change – positive      Distress
  shortness of breath                           or negative. Stress is an ordinary part of
                                                                                               This is when someone is unable to cope
                                                everyday life. It is positive when it makes
• Difficulty making decisions and                                                              with or adapt to the challenges or situation
                                                a person perform well, for example, in a
  comprehending complex information                                                            they are facing. Distress leads to physical
                                                test or exam. However, stress can also be
• Difficulty communicating clearly with                                                        and emotional discomfort and suffering. It
                                                negative and lead to distress and crisis.6
  others                                                                                       can be caused by a one-off crisis event or
                                                                                               from stress building up over time.7
• Feelings of helplessness or
  powerlessness
• Feeling overwhelmed.

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Psychological First Aid: Supporting people affected by disaster in Australia - Australian Red Cross
Complex reactions8                              Prolonged grief is when someone finds           Certain factors can increase the risk of
                                                it hard to accept and adapt to the loss of      developing complex reactions. For example
Complex reactions are more serious than         someone they loved. The grief then affects      if the person:
common reactions to distress. A person          how the person lives from day to day and
with complex reactions often needs referral                                                     • Was separated from their family
                                                how they relate to other people. It is not
for specialised help or other assistance.       an immediate reaction. It develops over a       • Thought they were going to die
Examples of complex reactions are:              period of time. It can also lead to extreme     • Was involved in a situation where the
                                                feelings of distress when the person              horror element was high
Panic attacks and feelings of
                                                experiences new challenges or is somehow        • Has had previous traumatic experiences
overwhelming anxiety can produce a faster
                                                reminded of their grief.                        • Lost loved ones
heartbeat, shortness of breath, and pain in
the chest. A person may sweat more than         Sleeping problems are very common after         • Has an underlying psychological
normal, feel dizzy or light-headed and feel     crises. Many people find it difficult to fall     disorder.
like they want to be sick.                      asleep or experience nightmares. Some
                                                people sleep more than usual and find it
Anger and aggressive behaviour are
                                                hard to wake up. If sleeping problems go
familiar reactions to crisis in situations of                                                   Feelings of anxiety and anger are common
                                                on for many days and nights, it can lead
violence, or when people have experienced                                                       reactions to crisis. However, some people
                                                to physical and psychological problems.
immense losses.                                                                                 may experience intense or prolonged
                                                Severe sleeping problems interfere with
Self-harm and suicide. Self-harm is when a      daily living, moods and relationships with      feelings that do not resolve as expected.
person hurts himself or herself on purpose,     other people, and seeking support can           These people may benefit from more
for example, by cutting or burning their        be helpful.                                     specialised support.
skin and flesh. Suicide is when someone
                                                Flashbacks are when a person feels as if
intentionally takes his or her own life.
                                                they are back in the moment of the original
It is important to always take someone
                                                stressful event. Flashbacks often feel real
who threatens to harm or kill themselves
                                                and can be confusing and frightening. They
seriously and not leave the person alone
                                                can be a normal reaction to abnormal
until more help arrives.
                                                experiences. However, the person may still
Harmful coping methods include self-            need help to manage them.
medicating with drugs or alcohol, becoming
violent or aggressive, withdrawing or
keeping oneself completely apart from
other people.

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Understanding
psychological
first aid
                What is psychological first aid?                 stressful experience.11 Psychological first
                                                                 aid can be a useful support activity at these
                Psychological first aid is a psychosocial        times as well, many of which may take
                support activity that helps people               place years after the event.
                affected by an emergency, disaster
                                                                 Psychological first aid is based on an
                or traumatic event. It is a ‘humane,
                                                                 understanding that people affected by
                supportive response to a fellow human
                                                                 disasters will experience a range of early
                being who is suffering and who may               reactions (physical, psychological, emotional
                need support’.9                                  and behavioural). These reactions may
                                                                 interfere with their ability to cope.12 These
                It includes basic principles of psychosocial
                                                                 reactions are normal and understandable
                support to promote natural recovery.
                                                                 given people’s experiences. Recovery may
                This involves helping people feel safe,
                                                                 be helped by psychological first aid.
                connected to others, calm and hopeful,
                and ensuring access to physical, emotional       A small part of an affected population
                and social support.10 Psychological first        will have more complex reactions and will
                aid aims to reduce initial distress, meet        require further mental health support to
                current needs, promote flexible coping and       assist recovery. But most people recover
                encourage adjustment.                            well on their own or with the support of
                                                                 compassionate and caring disaster workers,
                Psychological first aid is useful as the first
                                                                 family and friends.
                thing that you might do with individuals
                or families following a disaster. It is most     Psychological first aid has a long history.13
                widely used in the first hours, days and         It has become more popular since
                weeks following an event. However, there         the emergence of research showing
                can be situations months or years after an       the dangers of critical incident stress
                event that trigger strong stress reactions,      debriefing.14 Since 2002, psychological first
                such as anniversaries of the event or            aid has been recommended as a key part
                experiencing or witnessing something             of the provision of psychosocial support
                similar which reminds someone of the             following disasters.

14                                                                                                           15
The aim of psychological                       • Facilitate people’s social support
                                                                                                                        first aid                                      • Help people understand the disaster and
                                                                                                                                                                         its context
                                                                                                                        Psychological first aid is fundamentally
                                                                                                                        about providing humane and                     • Help people identify their own strengths

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                                                                                                                        compassionate care. It addresses emotional       and abilities to cope
                                                                                                                        and practical needs and concerns above all     • Foster belief in people’s ability to cope
                                                                                                                        else.                                          • Give hope
                                                                                                                        An important aim of psychological first aid    • Assist with early screening for people
                                                                                                                        is to build people’s capacity to recover.        needing further or specialised help
                                                                                                                        Psychological first aid supports recovery by   • Promote adaptive functioning
                                                                                                                        helping people to identify their immediate     • Get people through the first period of
What psychological first aid isn’t              It is important to limit contact at this point                          needs and their strengths and abilities to       high intensity and uncertainty
                                                to simple support, like psychological first                             meet these needs.
It is important to clarify what psychological                                                                                                                          • Set people up to be able to recover
                                                aid. People who display marked signs                                    One of the most important research               naturally from an event
first aid is not to differentiate it from       of risk (e.g. suicidal ideation) should be
earlier forms of post-disaster support, most                                                                            findings is that a person’s belief in their    • Reduce the risk factors of mental illness
                                                referred to formal mental health services.                              ability to cope can predict their outcome.
notably critical-incident stress debriefing.                                                                                                                             such as posttraumatic stress disorder as
                                                Psychological first aid is:                                             Typically people who do better after             a result of the event.
It is not useful – and may be harmful – to                                                                              trauma are those who are optimistic,
directly encourage disaster survivors to talk   • NOT debriefing                                                        positive and feel confident that life and
about what happened to them if they do          • NOT obtaining details of traumatic                                    self are predictable, or who display other
not want to. If a person wants to discuss         experiences and losses                                                hopeful beliefs.16
their experiences, it is useful to provide      • NOT treating
them with support. But this should only be                                                                              The goals of psychological first aid include
                                                • NOT labelling or diagnosing                                           efforts to:
in a way that does not push them to discuss
more than they want.15                          • NOT counselling                                                       •   Calm people
                                                • NOT something that only professionals                                 •   Reduce distress
Post-emergency settings are not clinical
                                                  can do
environments and it is inappropriate                                                                                    •   Make people feel safe and secure
to conduct a clinical or psychological          • NOT something that everybody who
                                                                                                                        •   Identify and assist with current needs
assessment within the setting.                    has been affected by an emergency
                                                  will need.                                                            •   Establish human connection

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Five elements of                              1. Ensuring safety
psychosocial support                          People’s experience of negative
                                              psychological reactions following disasters
There are five basic elements to
                                              or mass violence will continue while they
psychosocial support that have been drawn
                                              are under threat, in danger or perceive a
from research on risk and resilience, field
                                              threat to themselves or loved ones. Studies
experience and expert agreement.17 These
                                              have shown this to be the case across
elements underpin the psychological
                                              cultures. When safety is reintroduced
first aid approach. When providing
                                              negative reactions have been shown to
psychological first aid people should keep
                                              gradually reduce over time. Ensuring safety
these principles in mind.
                                              may include:
The elements of psychosocial support are:
                                              • Removing people from, or reducing their
• Ensuring safety                               exposure to, the threat of harm
• Promoting calm                              • Helping people meet basic needs for
• Promoting connectedness                       food, water, shelter, financial and material
                                                assistance
• Promoting self-efficacy and group
  efficacy                                    • Helping people obtain emergency
                                                medical attention
• Instilling hope.
                                              • Providing physical and emotional
                                                comfort
                                              • Providing repeated, simple and
                                                accurate information, through a range
                                                of methods, on how to get these basic
                                                needs met.

                                              2. Promoting calm
                                              Some anxiety, distress and negative
                                              psychological reactions are normal
                                              and are healthy responses following a
                                              traumatic event. Most people will return
                                                                                               Australian Red Cross

                                              to manageable levels of emotions within

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days or weeks. However, ongoing negative      3. Promoting connectedness                     4. Promoting self-efficacy
symptoms may lead to the development          Following crises, having access to social      Having a sense of control over positive        Self-efficacy is the belief that one’s actions
of longer term mental health disorders. It    support activities and networks increases      outcomes in one’s life is generally            are likely to lead to positive outcomes,
is important to normalise stress reactions.   opportunities for emotional understanding,     psychologically beneficial. Following crises   and feeling able to help oneself.
Other ways of promoting calm may include:     knowledge to be shared, to normalise           people may feel as though they lack the
• Stabilising people who are overwhelmed      reactions, and solve problems. Research        competency to handle tasks ahead. Most
  or disoriented                              across cultures has found that social          survivors of disasters and mass violence
                                              support is related to better emotional         had the capacity to cope with and manage
• Providing an environment, as far as
                                              wellbeing and recovery following mass          day-to-day problems prior to the crisis.
  practical, removed from stressful
                                              trauma. Re-establishing connections with       In the aftermath, it is not so much about
  situations or exposure to sights, sounds
                                              loved ones and fostering social connections    building self-efficacy but reminding people
  and smells of the emergency
                                              as quickly as possible in the aftermath        of their efficacy. Promoting self-efficacy
• Listening to people who wish to share       of crisis is critical to recovery. Promoting   may include:
  their stories and emotions, without         connectedness may include:
  forcing them to talk                                                                       • Engaging people in meeting their own
                                              • Helping people contact friends and             needs
• Remembering that there is no right or
                                                loved ones                                   • Assisting with decision making, and
  wrong way to feel
                                              • Keeping families together                      helping them to prioritise problems and
• Being friendly and compassionate even
                                              • Keeping children with parents or carers        solve them.
  during difficult interactions with people
• Offering accurate information about the     • Helping establish contacts with support
                                                                                             5. Instilling hope
  disaster or trauma and the relief efforts     people (friends, family or community)
                                                                                             Those who remain optimistic in times
  underway to help survivors understand       • Offering practical help to people to
                                                                                             of crisis are more likely to experience
  the situation                                 address immediate needs and concerns
                                                                                             favourable outcomes following trauma.
• Providing information on stress and         • Providing information and directing          This is because people can retain a
  coping                                        people to those services that are            reasonable degree of hope for their future.
• Reminding people when they express            available                                    Instilling hope may include:
  fear or worry, that more help and           • Linking people with available services
                                                                                             • Conveying an expectancy that people
  services are on the way (if you know).      • Respecting cultural norms regarding            will recover
                                                gender, age, family structures and
                                                                                             • Being there/being willing to help
                                                religion.
                                                                                             • Reassuring people that their feelings
                                                                                               are normal.

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Providing
psychological
first aid
                Who benefits from psychological              • Were exposed to events where the
                first aid?                                     horror element was high
                                                             • Thought they were going to die
                The sudden, disruptive nature of             • Have experienced traumatic
                emergencies means that people will             bereavement
                be exposed to uncertainty and stress.        • Have had serious losses of property,
                People will experience different               livelihoods, or disruption to
                degrees of distress. Any person                communities and networks.
                in distress should have access to
                                                             There will also be some complex situations
                psychological first aid, where possible.     where people have an immediate need
                This includes adults, adolescents and        for more care than can be provided by
                children, as well as disaster relief and     psychological first aid. These people need
                recovery workers and first responders.       to be promptly referred to specialised
                                                             support. This includes people who are:
                How people respond and cope depends
                on a variety of factors, including their     • Seriously injured and needing
                experience of the emergency, their health,     emergency medical care
                their personal history and their available   • People who have suffered sexual and
                supports.                                      gender-based violence
                Some people may have more complex            • So distressed that they are unable to
                reactions and may be more at risk of           perform the basic activities of daily life
                negative consequences than others. These     • Threatening harm to themselves
                may include those people who:                  or others.
                • Have had previous traumatic                • Children experiencing child abuse/
                  experiences                                  neglect.
                • Have underlying mental illnesses

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It is important to remember that not            In Australia, this coordinated response         It is useful to differentiate between general   When do you provide psychological
everyone who experiences an emergency           could include: health and allied health         psychological support and the way all           first aid?
will have emotional distress or problems        professionals, teachers and other               emergency responders provide help in
during or after the crisis. Not everyone who    education professionals, members of the         responsible ways. Responsible helping           Psychological first aid can help at different
experiences a crisis will need psychological    clergy and other faith-based organisations,     respects the dignity and capacity of            times after a crisis event. Most people need
first aid. Some protective factors include:18   Red Cross psychosocial support volunteers,      survivors. The primary role of psychological    psychological first aid during or shortly
                                                other trained responders from community         first aid is to protect and promote the         after a crisis. Others may feel distress much
•    Good level of functioning                                                                                                                  later: weeks, months or even years after
                                                organisations, and local government staff.      mental health and psychosocial wellbeing
•    Social support                                                                             of survivors.                                   an event. New challenges or reminders
                                                The principles of psychological first aid                                                       of the crisis, such as anniversaries of the
•    Ability to cope
                                                mean that support can be offered by a                                                           date, may set off memories and lead to
•    Strong moral belief systems                wide variety of people in the community –       Where is psychological first
                                                                                                                                                distress.21
•    Returning to normal life                   from emergency personnel to neighbours          aid given?
•    Reducing disruption.                       and volunteers – in addition to trained         Psychological first aid can be delivered in
                                                responders.                                     diverse settings. Psychological first aid can
Some people will need much more support
than psychological first aid. It is important   Psychological first aid is a humane,            be delivered at the scene of the emergency
that helpers know their limits and ask for      supportive and practical response to a          or at places where affected people gather,
help from others who can provide medical        person who has been exposed to serious          such as:
or other assistance when required.              stresses and may need support.19 Most           •   Evacuation / relief centres
                                                people responding to an emergency are
                                                                                                •   Recovery centres
Who delivers psychological                      able to provide this type of assistance,
                                                comfort and support to people in distress.20    •   Hospitals
first aid?
                                                                                                •   Humanitarian assistance centres
                                                The principles of psychological first aid are
Anyone can provide support to people in                                                         •   Homes
                                                an important grounding for all emergency
distress. However, in large scale disasters
                                                personnel responding to an emergency.           •   Schools
psychological first aid should be delivered
                                                Their primary focus will be on responding       •   Businesses
by appropriate agencies as part of
                                                to the emergency. But these people are
coordinated response mechanisms.                                                                •   Shopping centres
                                                usually the first contact survivors have with
This means that responses can be                the ‘system’. So they have an important role    •   Airports
undertaken in a coordinated manner and          to play in assisting in helping to promote      •   Train stations
that psychosocial support is provided as        recovery in safe and effective ways.            •   Memorial services
a key part of the emergency response.
                                                                                                •   Community centres.

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Psychological first aid
action principles22                           LOOK                                       LISTEN                                       LINK
                                              LOOK refers to the safety of helpers and   LISTEN refers to the way that helpers        LINK has practical outcomes in terms of
When providing psychological first aid, the
                                              identifying and prioritising who may be    communicate with people in distress from     the helper giving information and helping
actions helpers take will depend on the
                                              most in need of support.25                 the moment they approach and start to        people attend to basic needs and access
situation and needs of the people being
                                                                                         interact with them.27                        the resources they need to cope with their
assisted. There are three basic sets of       To do this, PFA helpers need to gather
                                                                                                                                      situation.
actions – LOOK, LISTEN, and LINK – that       information on what has happened and       To do this, PFA helpers must consider
guide the psychological first aid approach.   what is happening, and assess.26           how they:28                                  To do this, helpers support people to:29
These action principles provide guidance      •   Who needs help                         •   Approach someone                         • Access information
for how to view and safely enter an           •   Safety and security risks              •   Introduce oneself                        • Connect with loved ones and social
emergency situation and determine             •   Physical injuries                      •   Pay attention and listen actively          support
who requires assistance (LOOK) in order                                                                                               • Tackle practical problems
to understand the needs of affected           •   Immediate basic and practical needs    •   Accept others’ feelings
people (LISTEN) and link them with the        •   Emotional reactions.                   •   Calm the person in distress              • Access services and other help.
information and practical support they                                                   •   Ask about needs and concerns
need (LINK).23                                                                           •   Help the person(s) in distress find
It is important to note that in reality                                                      solutions to their immediate needs and
helpers may have to go through these                                                         problems.
actions in different ways and sequences.24
For example, helpers may have to repeat
actions from ‘Look’ or ‘Listen’ several
times. It depends on the situation and
needs of the affected persons.

26                                                                                                                                                                               27
Important questions to ask before entering an emergency site:
                                                                                                                    About the emergency event                     About safety and security concerns
                                                                                                                    • What happened?                              • Is the crisis event over or continuing,
                                                                                                                    • When and where did it take place?             such as aftershocks from an earthquake,
                                                                                                                                                                    or an unfolding flood event or high
                                                                                                                    • How many people are likely to be
                                                                                                                                                                    bushfire danger period?
                                                                                                                      affected and who are they?
                                                                                                                                                                  • What dangers may be in the

                                                                                             Australian Red Cross
                                                                                                                    • How long did it go on for/will go on for?
                                                                                                                                                                    environment, such as debris or damaged
                                                                                                                    About available services and supports           infrastructure?
                                                                                                                    • Who are the relevant authorities            • Are there areas to avoid entering
                                                                                                                      managing the crisis?                          because they are not secure (for
                                                                                                                                                                    example, obvious physical dangers)
                                                                                                                    • Who is providing for basic needs
                                                                                                                                                                    or because you are not allowed to
                                                                                                                      like emergency first aid, food, water,
                                                                                                                                                                    be there?
                                                                                                                      material assistance, shelter?
Preparing to provide psychological           Prior to providing psychological first aid in
                                             the field helpers should:                                              • Where and how can people access             About your own physical and mental
first aid in the field30
                                                                                                                      these services?                             preparedness
Many emergency situations can be stressful   • Learn about the crisis event
                                                                                                                    • Who else is helping? Are community          • Do you have everything you might need
and often require urgent action. The more    • Learn about available services and                                     members involved in responding?                to be away from home/office (phone,
that people responding to the disaster         supports
                                                                                                                    • Is the Register.Find.Reunite. service          charger, drink bottle, etc)?
know about the situation, and the better     • Learn about safety, access and security                                active to help families reunite?            • Have you let family members/friends
prepared each person is psychologically,       concerns
the more effective the support will be.                                                                                                                              know what you are doing and how
                                             • Consider their physical and mental                                                                                    long for?
                                               preparedness.
                                                                                                                                                                  • Have you made arrangements for
                                                                                                                                                                     children, people you are caring for
                                                                                                                                                                     and pets?
                                                                                                                                                                  • Do you feel emotionally ready to provide
                                                                                                                                                                     psychological first aid?

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Psychological first
aid for children

                      Psychological first aid for children          ‘LISTEN’ with additional considerations
                      follows the same action principles as         and steps for supporting children:
                      for adults. However, there are some           • Approach the child and introduce
                      key differences between helping adults          yourself
                      and children, and some additional             • Do not instigate touch
                      actions may be required.31                    • Calm the child
                      It is hard to focus on taking care of one’s   • Pay attention and listen actively
                      children during a crisis, if parents and      • Accept and validate the child’s reactions
                      other caregivers are also in distress and       and feelings
                      feel overwhelmed. Psychological first aid     • Ask about needs and concerns with
                      for children includes helping parents and       age-appropriate questions
                      caregivers, so that they can cope better
                      and be able to support their children.        • Help the child find solutions to their
                                                                      immediate needs and problems.
                      Look, Listen, Link for                        ‘LINK’ with additional considerations and
                      supporting children                           steps for supporting children:

                      ‘LOOK’ with additional considerations         • Assess the child’s needs, with the child,
                      and steps for supporting children:              if possible
                                                                    • Help the child access protection and
                      • Information on what has happened
                                                                      services for basic needs
                      • Safety and security risks
                                                                    • Give age-appropriate information
                      • Who the child is with or whether
                                                                    • If alone, connect the child with loved
                        the child is alone
                                                                      ones and, if needed, child protection
                      • Physical injuries                             services.
                      • Immediate basic, practical and
                        protection needs
                      • Emotional reactions.
30                                                                                                              31
Additional guidance for                          Keep safe
supporting children                              • Protect children from being exposed to
                                                   any potentially distressing scenes, like
• Keep together with loved ones
                                                   injured people or terrible destruction
• When unaccompanied, link children
                                                 • Protect children from hearing upsetting
  with a trustworthy child protection
                                                   stories about the event
  network or agency. Do not leave the
  child unattended                               • Protect children from the media or from
                                                   people who want to interview them who
• Do not allow offers of help with looking
                                                   are not part of the emergency response.
  after children from unauthorised
  strangers                                      Listen, talk and play
• Report child protection concerns to child      • Listen to children’s views on their
  protection authorities or, if not available,      situation
  the police
                                                 • Try to talk with them on their eye level,
• Report child protection concerns                  and use words and explanations they
  through government organisations chid             can understand
  safeguarding protocols.                        • Support the caregivers in taking care of
                                                    their own children
                                                 • If passing time with children, try to
                                                    involve them in play activities or simple
                                                    conversation about their interests,
                                                    according to their age.
                                                                                                Australian Red Cross

32                                                                                                                     33
Psychological first
aid for people with
physical or mental
health conditions or
intellectual disabilities
                            The following points are important              attendant or sign-language interpreter
                            when assisting people who may                   who may also be present. For example
                            have physical and/or mental health              do not say “tell her...” or “can he...”
                            conditions or intellectual disabilities.      • Use ‘Person-First’ language in regards
                                                                            to disability. This means to put the
                            • Help people get to a safe space               person first rather than the disability
                            • Ask people if they have any health            they may have. For example, “John has
                              conditions, or if they regularly take         an intellectual disability”, not “John is
                              medication for a health problem               disabled.”
                            • Try to help people get their medication     • Never speak about the person as if
                              or access medical services, when              they are invisible, cannot understand
                              available                                     what is being said or cannot speak
                            • Stay with the person or try to make           for themselves. If a person requires
                              sure they have someone to help them if        an interpreter or carer to assist them
                              you need to leave. Consider linking the       in conversation, make sure there is
                              person with relevant support to assist        enough time for the person to absorb
                              them in the longer term32                     information and respond on their own
                            • People with a disability, particularly      • Disability can be obvious (e.g. walker/
                              a cognitive disability, may rely upon         wheelchair) or invisible (e.g. sight
                              rigid routines in their lives. Disruption     impairment/ intellectual disability).
                              to these routines may make them               Don’t make assumptions about the
                              highly anxious                                person’s capacity, instead let the
                                                                            person with the disability direct you
                            • Face and speak directly to the person
                                                                            with regard to volume and speed of
                              rather than through the companion,
                                                                            communication

34                                                                                                                      35
• Allow for short breaks if a person needs
  extra time to process information
• Offer several different options for
  further contact. Some people may feel
  more comfortable with face to face
  interaction while others may prefer the
  telephone or email.33

Remember that people are resilient.
With appropriate levels of support when
needed all people have the ability to cope.
Help people use familiar coping strategies
and supports.

                                              Australian Red Cross

36                                                                   37
Self care for
people working
in the field
                 Supporting people following an               Reducing stress
                 emergency can be very rewarding              Stress will not resolve spontaneously.
                 for those involved in the emergency          People need to take steps to break the
                 response. However, it can also be            cycle of stress. It is important to identify
                 very challenging and stressful. It is        what causes stress for you and put in place
                 not uncommon for disaster workers            some steps to reduce stress. This sort of
                 to feel stressed, distressed, tired,         self care is especially important if we wish
                 overwhelmed, troubled, or frustrated         to support others during times of crisis.35
                 in the course of their work.                 • Think about what has helped you cope
                                                                in the past and what you can do to stay
                 Stress is the body’s way of getting energy
                                                                strong
                 to operate outside our normal comfort
                 zone. Stress is caused by stressors, these   • Try to take time to eat, rest and relax,
                 can be internal, such as thoughts or           even for short periods
                 feelings or external, such as poor health,   • Try to keep reasonable working hours
                 conflict, noise etc. If it is not possible     so you do not become too exhausted
                 to relax between demands, or there is        • Consider, for example, dividing the
                 not enough time to unwind between              workload among helpers, working in
                 the problems, the stress builds up. It is      shifts during the acute phase of the
                 not the actual difficulty of the task that     crisis and taking regular rest periods
                 causes chronic stress; it may be the sheer
                                                              • People may have many problems after a
                 quantity or continuity of work.34
                                                                crisis event. You may feel inadequate or
                                                                frustrated when you cannot help people
                                                                with all of their problems. Remember
                                                                that you are not responsible for solving

38                                                                                                      39
all of people’s problems. Do what you      and volunteers’ working conditions and          reach out for support from others, for
     can to help people help themselves         organisational issues, as well as to personal   example, through peer support or by
                                                distress in seeing the impact of a crisis on    contacting your team leader or manager.
• Minimise your intake of alcohol, caffeine
                                                affected populations.                           You might need to begin activities that will
  or nicotine and avoid non-prescription
                                                                                                help you feel better as part of a self care
  drugs                                         Questions to consider:
                                                                                                plan such as taking walks, spending more
• Check in with fellow helpers to see how       • Are there physical, emotional, mental,        time with your friends, or taking a regular
  they are doing, and have them check             spiritual or behavioural signs that may       break from work, etc.
  in with you. Find ways to support each          be a cause for concern?
  other                                                                                         Supporting your colleagues
                                                • Have you noticed changes or new signs
• Talk with friends, loved ones or other          within yourself which could indicate a        Just as you can use ‘Look, Listen, Link’
  people you trust for support.                   concern?                                      to help you with your own self care you
                                                • Are certain symptoms not going away?          can use psychological first aid to support
Look, Listen, Link for self care36                                                              your colleagues.
                                                The next step is in LISTENing to how these
When providing psychological first aid to       reactions are impacting how you feel about      This could include:
others, the principles ‘Look, Listen, Link’     your work. It is like listening to an inner     • Using the PFA Action Principles (Look,
can help you recognise risk factors in          voice.                                            Listen, Link) to support a colleague who
relation to your own wellbeing, what your
                                                Are you having thoughts similar to:               is distressed
personal limitations are, and what kinds
of situations may be overwhelming or                                                            • Keeping an eye on a colleague for signs
                                                • “I am too busy to take a break”                 of stress
particularly stressful for you. This can help
                                                • “This was too difficult for me. I don’t      • Listening to a colleague if they need to
you to build awareness of your strengths
                                                    really know what I’m meant to be              talk
and weaknesses as a helper, and know
                                                    doing”
when to call for help from others.                                                              • Helping a colleague to feel calm after a
                                                • “I don’t think I’m the right person to         distressing experience
The first step you can take in self care            be here”
is in observing, or LOOKing at, your                                                            • Helping restore someone’s confidence if
                                                • “I’m not coping as well as everyone else”       they are feeling useless
own reactions to the circumstances
you are facing in responding to crisis          LINKing with others or engaging in              • Referring a colleague for further support
situations. From experience we know that        activities is the vital third step in helping     or assistance.
reactions are commonly related to staff         you care for yourself. You may want to

40                                                                                                                                             41
Useful
organisations
Australian Child & Adolescent Trauma, Loss &   International Federation of Red Cross and
Grief Network (ACATLGN)                        Red Crescent Societies Reference Centre for
www.earlytraumagrief.anu.edu.au                Psychosocial Support
                                               www.pscentre.org
Australian Institute for Disaster Resilience
www.aidr.org.au                                National Center for PTSD
                                               www.ptsd.va.gov
Australian Psychological Society (APS)
www.psychology.org.au                          National Child Traumatic Stress Network
                                               (NCTSN)
Australian Red Cross                           www.nctsn.org
www.redcross.org.au
                                               National Institute of Mental Health (NIMH)
beyondblue                                     www.nimh.nih.gov
www.beyondblue.org.au
                                               Phoenix Australia – Centre for Posttraumatic
Department of Human Services (DHS), State      Mental Health
Government of Victoria                         www.phoenixaustralia.org/
www.dhs.vic.gov.au/emergency
                                               Sphere Standards Humanitarian Charter
Emerging Minds                                 and Minimum Standards in Humanitarian
www.emergingminds.com.au                       Response
Inter-Agency Standing Committee (IASC)         www.spherestandards.org
www.interagencystandingcommittee.org           Substance Abuse and Mental Health Services
International Committee of the Red Cross       Administration (SAMHSA)
(ICRC)                                         www.samhsa.gov
www.icrc.org                                   World Health Organization (WHO)
International Federation of Red Cross and      www.who.int
Red Crescent Societies
www.ifrc.org
                                                                                              Australian Red Cross

42                                                                                                                   43
References
and resources

ACPMH 2009, Community Recovery Following          Hobfoll, SE, Watson, P, Bell, CC, Bryant, RA,   immune function after Hurricane Andrew’,          Raphael, B 1977b, ‘The Granville train
Disaster: Training for Community Support          Brymer, MJ, Friedman, MJ et al. 2007, ‘Five     Psychosomatic Medicine, vol. 59, pp. 128–41.      disaster: Psychological needs and their
People – Workshop Guide and Resource,             essential elements of immediate and mid-                                                          management’, Medical Journal of Australia,
                                                                                                  Jacobs, G 2010, Roundtable discussion
Australian Centre for Posttraumatic Mental        term mass trauma intervention: Empirical                                                          vol. 1, pp. 303–5.
                                                                                                  between Professor Jerry Jacobs and various
Health & beyondblue, Melbourne, Australia.        evidence’, Psychiatry, vol. 70, pp. 283–315.
                                                                                                  Australian emergency management experts,          Raphael, B 1986, When Disaster Strikes –
Australian Institute for Disaster Resilience,     Inter-Agency Standing Committee (IASC)          19 July 2010, Australian Psychological Society,   How Individuals and Communities Cope with
2018. Community Recovery Handbook 2.              2007, IASC Guidelines on Mental Health and      Melbourne, Australia.                             Catastrophe, Basic Books, New York, USA.
Bisson, JI, Brayne, M, Ochberg, FM & Everly,      Psychosocial Support in Emergency Settings,
                                                                                                  Johns Hopkins Bloomberg School of Public          Raphael, B, Stevens, G & Taylor, M 2009,
GS 2007, ‘Early psychological intervention        IASC, Geneva, Switzerland.
                                                                                                  Health & International Federation of Red          Disaster Response and Resilience Research
following traumatic events’, American Journal     International Federation of Red Cross and Red   Cross and Red Crescent Societies 2008,            Group, University of Western Sydney,
of Psychiatry, vol. 164, pp. 1016–19.             Crescent Societies 2019, A Short Introduction   Public Health Guide in Emergencies, 2nd edn,      Australia.
Bisson, JI & Lewis, C 2009, Systematic Review     to Psychological First Aid for Red Cross and    Geneva, Switzerland.
                                                                                                                                                    Rose, S, Bisson, J & Wessley, S 2003, ‘A
of Psychological First Aid, commissioned by       Red Crescent Societies, IFRC Reference Centre
                                                                                                  ‘Does early psychological intervention            systematic review of single psychological
the World Health Organization.                    for Psychosocial Support, Copenhagen.
                                                                                                  promote recovery from posttraumatic stress?’,     interventions (‘debriefing’) following
Brymer, M, Jacobs, A, Layne, C, Pynoos, R,        International Federation of Red Cross and       Psychological Science in the Public Interest,     trauma – Updating the Cochrane review and
Ruzek, J, Steinberg, A, Vernberg, E & Watson,     Red Crescent Societies 2018, A Guide to         vol. 4, pp. 45–79.                                implications for good practice’, in RJ Orner
P 2006, Psychological First Aid – Field           Psychological First Aid for Red Cross and Red                                                     & U Schnyder (eds) Reconstructing Early
                                                                                                  National Institute of Mental Health 2002,
Operations Guide, 2nd edn, National Child         Crescent Societies, IFRC Reference Centre for                                                     Intervention after Trauma Innovations in the
                                                                                                  Mental Health and Mass Violence – Evidence-
Traumatic Stress Network & National Center        Psychosocial Support, Copenhagen.                                                                 Care of Survivors, pp. 24–9, Oxford University
                                                                                                  based early Psychological Intervention for
for PTSD, USA.                                                                                                                                      Press, Oxford, UK.
                                                  International Federation of Red Cross and       Victims/Survivors of Mass Violence, NIMH
Carver, C 1999, ‘Resilience and thriving:         Red Crescent Societies 2009, Psychosocial       publication No. 02-5138, US Government            Ruzek, JI, Brymer, MJ, Jacobs, AK, Layne,
Issues, models and linkages’, Journal of Social   Handbook, IFRC Reference Centre for             Printing Office, Washington DC, USA.              CM, Vernberg, EM & Watson, PJ 2007,
Issues, vol. 54, pp. 245–66.                      Psychosocial Support, Copenhagen, Denmark.                                                        ‘Psychological first aid’, Journal of Mental
                                                                                                  Queensland Health (2008) Psychological First
                                                                                                                                                    Health Counseling, vol. 29, pp. 17–49.
Drayer, CS, Cameron, DC, Woodward, WD             Ironson, G, Wynings, C, Schneiderman,           Aid Core Actions Emergency Management
& Glass, AJ 1954, ‘Psychological first aid in     N, Baum, A, Rodriguez, M, Greenwood,            Unit Fact Sheet.                                  Solomon, Z 2003, Coping with War-Induced
community disaster’. Journal of American          D et al. 1997, ‘Post-traumatic stress                                                             Stress – The Gulf War and the Israeli
                                                                                                  Raphael, B 1977a, ‘Preventive intervention
Medical Association, vol. 156, 1, pp. 36–41.      symptoms, intrusive, thoughts, loss, and                                                          Response, Plenum, New York, USA.
                                                                                                  with the recently bereaved’ Archives of
                                                                                                  General Psychiatry, vol. 34, pp. 1450–4.

44                                                                                                                                                                                                 45
Stevens, G & Raphael, B 2008a, CBRN SAFE:      World Health Organization, War Trauma
Psychosocial Guidance for Emergency            Foundation and World Vision International
Workers – Chemical, Biological, Radiological   (2011). Psychological first aid: Guide for field
& Nuclear Incidents, University of Western     workers. WHO: Geneva.
Sydney, Australia.
                                               World Health Organization (WHO) 2010,
Stevens, G & Raphael, B 2008b, CBRN SAFE –     Helping in Crisis Situations in Low and Middle
Incident Pocket Guide, University of Western   Income Countries Guide to Psychological First
Sydney, Australia.                             Aid – currently in draft.
Substance Abuse and Mental Health Services     Wooding, S & Raphael, B 2010. Psychological
Administration (SAMHSA) 2007, Psychological    First Aid – Level 1 Intervention Following
First Aid – A Guide for Emergency and          Mass Disaster, University of Western Sydney,
Disaster Response Workers, US Department       Australia.
of Health and Human Services, Washington,
                                               Young, B 2006, ‘The immediate response to
DC, USA.
                                               disaster – Guidelines for adult psychological
Substance Abuse and Mental Health Services     first aid’, in EC Richie, PJ Watson & MJ
Administration (SAMHSA) 2010, Psychological    Friedman (eds) Interventions Following Mass
First Aid for First Responders – Tips for      Violence and Disasters – Strategies for Mental
Emergency and Disaster Response Workers        Health Practices, pp. 134–54, Gilford Press,
(http://store.samhsa.gov).                     New York, USA.
van Ommeran, M, Saxena, S & Saraceno,
B 2005, ‘Mental and social health during
and after acute emergencies – Emerging
consensus?’, Bulletin of the World Health
Organization, vol. 83,
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Watson, PJ, Friedman, MJ, Ruzek JI & Norris,
FH 2002, ‘Managing acute stress response to
major trauma’, Current Psychiatry Reports,
vol. 4, pp. 247–53.
                                                                                                  Australian Red Cross

46                                                                                                                       47
Acknowledgments

This guide was first produced by the             The second edition, released in 2013,              The first edition of the guide was informed   Dr Bob Montgomery
Australian Psychological Society and             included updated information on using              by participants at the 2009 roundtable        Consultant Psychologist, Past President
Australian Red Cross in 2011. The first          psychological first aid in the field. This         and those that have provided subsequent       Australian Psychological Society
edition was developed following roundtable       information was reproduced courtesy of             comments, including:                          Professor Beverley Raphael
discussions on 15 December 2009, co-hosted       the World Health Organization, War Trauma          Professor Richard Bryant                      University of Western Sydney and the
by Australian Red Cross and the Australian       Foundation and World Vision International          University of New South Wales                 Australian National University
Psychological Society. The roundtable            from the document Psychological First Aid:
                                                                                                    Brigid Clarke                                 Associate Professor Joseph Reser
was attended by representatives of both          Guide for field Workers. The second edition
                                                                                                    Victorian Department of Health                Griffith University
organisations, the National Mental Health        supported Psychological First Aid training
Disaster Response Taskforce, Australian          developed by Australian Red Cross in 2013.         Andrew Coghlan                                Professor Kevin Ronan
Centre for Post traumatic Mental Health and      The principal authors of the second edition        Charmaine O’Brien                             University of Central Queensland
the Victorian Department of Human Services.      were Dr Susie Burke (Australian Psychological      Sally Paynter                                 Dr Sally Wooding
                                                 Society), John Richardson and Shona Whitton        Australian Red Cross                          University of Western Sydney
The first edition of the guide was based on
discussions at the roundtable and material       (Australian Red Cross).                            Professor Mark Creamer
                                                                                                    Australian Centre for Post Traumatic          The second edition was informed by the
developed in the United States by the National   This third edition, updated in 2019, includes
                                                                                                    Mental Health                                 work of:
Child Traumatic Stress Network (NCTSN)           further guidance on using psychological
and National Center for Posttraumatic Stress                                                        Greg Eustace                                  Alison Schafer
                                                 first aid in the field. This edition is informed
Disorder, the Substance Abuse and Mental                                                            Queensland Health                             World Vision Australia/International
                                                 by new material from the International
Health Services Administration (SAMHSA)          Federation of Red Cross and Red Crescent           Dr Rob Gordon                                 Mark van Ommeran
and the paper ‘Five essential elements of        Societies (IFRC) Reference Centre for              Consultant Psychologist to Department of      World Health Organisation
immediate and mid-term mass trauma               Psychosocial Support and six years of              Human Services Victoria, and Australian       Leslie Snider
intervention: Empirical evidence’ by Stevan      experience providing psychological first aid       Red Cross                                     War Trauma Foundation
Hobfoll and colleagues in 2007. The principal    after crises in Australia.                         Heather Gridley
authors of the first edition were, Dr Susie                                                                                                       The third edition was informed by the work
                                                 The principle authors of the third edition         Craig Wallace
Burke (Australian Psychological Society) and                                                                                                      of IFRC Psychosocial Reference Centre.
                                                 were Shona Whitton (Independent Consultant         Australian Psychological Society
John Richardson (Australian Red Cross).
                                                 for Australian Red Cross) and Dr Lyn O’Grady
                                                 (Australian Psychological Society).

48                                                                                                                                                                                          49
End Notes

1	For more information see Inter-Agency           11 	International Federation of Red Cross and     21 	International Federation of Red Cross       29 	International Federation of Red Cross and
    Standing Committee 2007; International            Red Crescent National Societies, 2018,             Red Crescent Societies 2019, A Short             Red Crescent National Societies, 2018,
    Federation of Red Cross and Red Crescent          A Guide to Psychological First Aid For Red         Introduction to Psychological First Aid for      A Guide to Psychological First Aid For Red
    Societies 2009; van Ommeran, Saxena &             Cross Red Crescent Societies                       Red Cross and Red Crescent Societies             Cross Red Crescent Societies
    Saraceno 2005                                  12 	For more information see Brymer et al.        22 	World Health Organization, War Trauma       30 	World Health Organization, War Trauma
2 	International Federation of Red Cross and         2006                                               Foundation and World Vision International        Foundation and World Vision International
    Red Crescent National Societies, 2018,         13 	For more information see Drayer, Cameron,        (2011). Psychological first aid: Guide for       (2011). Psychological first aid: Guide for
    A Guide to Psychological First Aid For Red        Woodward & Glass 1954, Raphael                     field workers. WHO: Geneva.                      field workers. WHO: Geneva
    Cross Red Crescent Societies                      1977a&b and 1986.                               23 	ibid                                        31 	International Federation of Red Cross and
3	Australian Red Cross, 2015, Emergency           14 	For more information see National Institute   24 	International Federation of Red Cross and      Red Crescent National Societies, 2018,
    Services training toolkit: Recovery               of Mental Health 2002; Rose, Bisson &              Red Crescent National Societies, 2018,           A Guide to Psychological First Aid For Red
4 	International Federation of Red Cross and         Wessley 2003; Bisson, Brayne, Ochberg &            A Guide to Psychological First Aid For Red       Cross Red Crescent Societies
    Red Crescent National Societies, 2018,            Everly 2007; Bisson & Lewis 2009.                  Cross Red Crescent Societies                  32 	World Health Organization, War Trauma
    A Guide to Psychological First Aid For Red     15 	For more information see Watson et al.        25 	World Health Organization, War Trauma          Foundation and World Vision International
    Cross Red Crescent Societies                      2002; Ruzek et al. 2007; McNally, Bryant, &        Foundation and World Vision International        (2011). Psychological first aid: Guide for
5	International Federation of Red Cross and          Ehlers 2003.                                       (2011). Psychological first aid: Guide for       field workers. WHO: Geneva.
    Red Crescent National Societies, 2018,         16 	For more information see Carver 1999,            field workers. WHO: Geneva.                   33 	Australian Institute for Disaster Resilience
    A Guide to Psychological First Aid For Red        Ironson et al. 1997, Solomon 2003.              26 	International Federation of Red Cross and      2018, Community Recovery Handbook 2
    Cross Red Crescent Societies                                                                         Red Crescent National Societies, 2018,        34 	Gordon, R (2005). Information and advice
                                                   17 	For more information see Hobfoll et
6 	International Federation of Red Cross             al. 2007, IFRC 2009, SAMHSA 2010,                  A Guide to Psychological First Aid For Red       about stress, trauma and psychological first
    Red Crescent Societies, 2019, A Short             Queensland Health (2008).                          Cross Red Crescent Societies                     aid.
    Introduction to Psychological First Aid for                                                       27 	World Health Organization, War Trauma       35 	Gordon, R (2005). Information and advice
                                                   18 	For more information see Johns Hopkins
    Red Cross and Red Crescent Societies                                                                 Foundation and World Vision International        about stress, trauma and psychological first
                                                      School of Public Health & International
7 	ibid                                              Federation of Red Cross and Red Crescent           (2011). Psychological first aid: Guide for       aid
8 	ibid                                              Societies 2008.                                    field workers. WHO: Geneva.                   36 	International Federation of Red Cross and
9 	The Sphere Project and the Inter Agency        19 	For more information see Inter-Agency         28 	International Federation of Red Cross and      Red Crescent National Societies, 2018,
    Standing Committee                                Standing Committee 2007.                           Red Crescent National Societies, 2018,           A Guide to Psychological First Aid For Red
                                                                                                         A Guide to Psychological First Aid For Red       Cross Red Crescent Societies
10 	For more information see Hobfoll et al 2007   20 	For more information see World Health
                                                                                                         Cross Red Crescent Societies
                                                      Organisation 2010.

50                                                                                                                                                                                                   51
Fundamental
Principles

In all activities, our volunteers,            Impartiality                                      Voluntary service
members and staff are guided by the           It makes no discrimination as to nationality,     It is a voluntary relief movement not
Fundamental Principles of the Red             race, religious beliefs, class or political       prompted in any manner by desire for gain.
                                              opinions. It endeavours to relieve the
Cross and Red Crescent Movement.                                                                Unity
                                              suffering of individuals, being guided solely
                                              by their needs, and to give priority to the       There can be only one Red Cross or Red
Humanity                                      most urgent cases of distress.                    Crescent Society in any one country. It
The International Red Cross and Red                                                             must be open to all. It must carry on its
Crescent Movement, born of a desire to        Neutrality                                        humanitarian work throughout its territory.
bring assistance without discrimination       In order to continue to enjoy the confidence
to the wounded on the battlefield,            of all, the Movement may not take sides           Universality
endeavours, in its international and          in hostilities or engage at any me in             The International Red Cross and Red
national capacity, to prevent and alleviate   controversies of a political, racial, religious   Crescent Movement, in which all Societies
human suffering wherever it may be            or ideological nature.                            have equal status and share equal
found. Its purpose is to protect life and
                                                                                                responsibilities and duties in helping each
health and ensure respect for the human       Independence                                      other, is worldwide.
being. It promotes mutual understanding,
                                              The Movement is independent. The
friendship, co-operation and lasting peace
                                              National Societies, while auxiliaries in the
amongst all people.
                                              humanitarian services of their governments
                                              and subject to the laws of their respective
                                              countries, must always maintain their
                                              autonomy so that they may be able at
                                              all times to act in accordance with the
                                              principles of the Movement.

52                                                                                                                                            53
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