Response strategies refer primarily to the actions taken to deal with a disaster at the time of the emergency, particularly the actions of emergency services such as fire, ambulance, police and first responders in the disaster area. Response also involves people’s own reactions and actions together with strategies to assist people at this time. The most effective interventions in the immediate phase are practical assistance and Psychological First Aid (PFA).
Those affected by a disaster need to be approached in a non-clinical way (unless or until clinical needs are identified and accepted by the affected person, which will only be the case for a minority of people). This means that health and mental health professionals must be prepared to take on a different role from their normal practise. It is important not to automatically carry clinical assumptions and behaviours into the disaster. Even as health professionals, our first objective in the aftermath of disaster is usually to ensure that immediate practical needs are met.
In Australia, disaster response and recovery is a state government responsibility, although the federal government often also provides valuable support. An emergency response is based on emergency management plans which rely on integration of government and non-government agencies at all levels.
Australian Emergency Management (EM) is an Australian federal government agency tasked with coordinating governmental responses to emergency incidents in Australia. EM has produced a series of free community awareness and education publications which provide background information and advice on preparing for and coping with major hazards.
Each state and territory must arrange for the preparation of a state (or territory) emergency response plan. Responsibility for the plan and its implementation is usually delegated to a single person such as the Chief Commissioner of Police.
State emergency response plans identify the organisational arrangements for managing responses to emergencies (real and potential) within the state or territory for which it is developed. These plans provide the framework within which specific agency or multi-agency response and recovery plans are developed and operate. Psychosocial recovery is often not well covered in these plans but must be considered as part of every component.
The Australian Red Ross works to assist individuals, households and communities to respond to emergencies across Australia. The specific role for Red Cross and other comparable organisations is determined by state and territory emergency management plans.
Psychological First Aid (PFA) is useful as the first thing that you might do with individuals or families following a disaster. It is most widely used in the first hours, days and weeks following an event.
PFA is based on an understanding that people affected by disasters will experience a range of early reactions (physical, psychological, emotional, behavioural) that may interfere with adaptive coping. These reactions are normal and understandable given people's experiences. For some people, these reactions may cause enough distress to interfere with adaptive coping. Then, recovery may be helped by the provision of PFA. For a minority of an affected population, further support and mental health interventions may be necessary to facilitate recovery, but the majority of people recover well on their own, or with the support of compassionate and caring disaster responders, family and friends.
This document was developed following roundtable discussions on 15 December 2009, co-hosted by Australian Red Cross and the Australian Psychological Society. The purpose of the guide is to provide an overview for people working in disaster preparedness, response and recovery about best-practice in psychological first aid following disasters and traumatic events.
The National Child Traumatic Stress Network (USA) provides Psychological First Aid Online, a six-hour interactive course that puts the participant in the role of a provider in a post-disaster scene. This professionally narrated course is for individuals new to disaster response who want to learn the core goals of PFA, as well as for seasoned practitioners who want a review.
The World Health Organization (WHO), the War Trauma Foundation (WTF) and World Vision International (WVI) have developed a Psychological First Aid Guide for Fieldworkers. This guide was developed in order to have widely agreed upon psychological first aid materials for use in low and middle income countries. Endorsed by many international agencies it reflects the emerging science and international consensus on how to support people in the immediate aftermath of extremely stressful events. The guide is available in different languages at this web address:
This is the centre of excellence for research and education on the prevention, understanding, and treatment of PTSD. The centre conducts research and provides training and resources to the general public and to health providers and researchers. Together with the National Child Traumatic Stress Network, the NCPTSD has written Psychological First Aid: Field Operations Guide which contains essential information for dealing with people in the immediate aftermath of disasters.
The psychological and social impact of emergencies is not limited to the early phases. The experience can also undermine the long term mental health and psychosocial well-being of the affected population. Support is essential to protect and promote mental health and psychosocial well-being. Achieving this requires coordinated action among government and non-government agencies.
The IASC was set up by the United Nations to facilitate inter-agency decision-making in response to complex emergencies and natural disasters. These guidelines were developed over several years by hundreds of mental health professionals around the world. The guidelines have been endorsed by United Nations agencies and international and local non-governmental organisations involved in international humanitarian relief.
The IASC Guidelines offer essential advice on how to facilitate an integrated approach to the most urgent mental health and psychosocial issues in emergency situations. Psychologists or other mental health professionals who wish to consult or respond in international emergency situations need to be familiar with these guidelines.
The International Federation of Red Cross (IFRC) and Red Crescent Societies have published Psychosocial interventions - A handbook (2009), which provides guidance on how to plan and implement psychosocial interventions in crisis response and development work.
When attending a disaster scene as a first responder, health professionals need to recognise the importance of providing services as part of a coordinated mental health and psychosocial support response. This may mean taking on different roles from those they normally undertake.
Useful roles for health professionals acting as first responders include:
Health professionals need to familiarise themselves with common responses after a disaster, recognising that most people affected are previously ‘normally' functioning people and will recover well without the need of clinical services.
Health professionals should recognise the importance of facilitating community self-help and social support by providing access to information about positive coping methods, rather than just focusing on the provision of clinical services. They should learn about and, where appropriate, collaborate with local, indigenous and traditional healing systems.
The American Psychological Association (APA) has written a useful document for mental health professionals at disaster sites.
Providing psychosocial support and mental health care involves a number of demands on health professionals working as first responders. Meeting these demands continuously requires resilience in the face of other people's reactions to a devastating event, as well as the health professional's own response to the disaster.
Health professionals need to acknowledge and address their own psychological needs while fortifying their resilience in order to best manage the stress and be effective helpers.
Compassion fatigue is the layperson's term for what is commonly known as ‘vicarious trauma' or ‘secondary traumatic stress.' Vicarious trauma occurs when you become overwhelmed by hearing about other people's traumatic experiences and it begins to affect your cognition and skills as a health professional. Secondary traumatic stress mimics the effects of posttraumatic stress disorder and occurs when you are exposed to other people's traumatic experiences.