Psychological First Aid:

Supporting people affected

by disaster in Australia
 Psychological First Aid:
Supporting people affected
by disaster in Australia
© Australian Red Cross
Third edition published by:
Australian Red Cross 2020
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
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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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.

4 5
 6
7

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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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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

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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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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.

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 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
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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

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• 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?

28 29
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.
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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.

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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
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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.
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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
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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
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Carver, C 1999, ‘Resilience and thriving: Red Crescent Societies 2009, Psychosocial publication No. 02-5138, US Government Ruzek, JI, Brymer, MJ, Jacobs, AK, Layne,
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community disaster’. Journal of American D et al. 1997, ‘Post-traumatic stress Stress – The Gulf War and the Israeli
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Stevens, G & Raphael, B 2008a, CBRN SAFE: World Health Organization, War Trauma
Psychosocial Guidance for Emergency Foundation and World Vision International
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Incident Pocket Guide, University of Western Income Countries Guide to Psychological First
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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,
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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 Professor Beverley Raphael
Australian Psychological Society and included updated information on using by participants at the 2009 roundtable University of Western Sydney and the
Australian Red Cross in 2011. The first psychological first aid in the field. This and those that have provided subsequent Australian National University
edition was developed following roundtable information was reproduced courtesy of comments, including: Associate Professor Joseph Reser
discussions on 15 December 2009, co-hosted the World Health Organization, War Trauma Professor Richard Bryant Griffith University
by Australian Red Cross and the Australian Foundation and World Vision International University of New South Wales Professor Kevin Ronan
Psychological Society. The roundtable from the document Psychological First Aid:
Brigid Clarke University of Central Queensland
was attended by representatives of both Guide for field Workers. The second edition
Victorian Department of Health Dr Sally Wooding
organisations, the National Mental Health supported Psychological First Aid training
Disaster Response Taskforce, Australian developed by Australian Red Cross in 2013. Andrew Coghlan University of Western Sydney
Centre for Post traumatic Mental Health and The principal authors of the second edition Charmaine O’Brien
Sally Paynter The second edition was informed by the
the Victorian Department of Human Services. were Dr Susie Burke (Australian Psychological
Australian Red Cross work of:
The first edition of the guide was based on Society), John Richardson and Shona Whitton
(Australian Red Cross). Professor Mark Creamer Alison Schafer
discussions at the roundtable and material
Australian Centre for Post Traumatic World Vision Australia/International
developed in the United States by the National This third edition, updated in 2019, includes
Child Traumatic Stress Network (NCTSN) Mental Health Mark van Ommeran
further guidance on using psychological
and National Center for Posttraumatic Stress Greg Eustace World Health Organisation
first aid in the field. This edition is informed
Disorder, the Substance Abuse and Mental by new material from the International Queensland Health Leslie Snider
Health Services Administration (SAMHSA) Federation of Red Cross and Red Crescent Dr Rob Gordon War Trauma Foundation
and the paper ‘Five essential elements of Societies (IFRC) Reference Centre for Consultant Psychologist to Department of
immediate and mid-term mass trauma The third edition was informed by the work
Psychosocial Support and six years of Human Services Victoria, and Australian
intervention: Empirical evidence’ by Stevan of IFRC Psychosocial Reference Centre.
experience providing psychological first aid Red Cross
Hobfoll and colleagues in 2007. The principal after crises in Australia. Heather Gridley
authors of the first edition were, Dr Susie
The principle authors of the third edition Craig Wallace
Burke (Australian Psychological Society) and
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
www.redcross.org.au ACT NT TAS
Red Cross House CASCOM Centre 146 Elizabeth St
Red Cross National Office 3 Dann Cl Level 1, 13 Scaturchio St Hobart TAS 7000
23-47 Villiers St Garran ACT 2605 Casuarina NT 0810 T +61 3 6235 6077
North Melbourne VIC 3051 T +61 2 6234 7600 T +61 8 8924 3900
T +61 3 9345 1800 VIC
NSW QLD 23-47 Villiers St
St Andrews House 49 Park Rd North Melbourne VIC 3051
Level 3, 464 Kent St Milton QLD 4064 T +61 3 9345 1800
Sydney NSW 2000 T +61 7 3367 7222
T +61 2 9229 4111 WA
SA 110 Goderich St
U5 12 Percy Court East Perth WA 6004
Adelaide 5000 SA T +61 8 9225 8888
T +61 8 8100 4500