Through the Smoke

Seeing Systems, Finding Home

Category: Crisis Intervention (Page 1 of 2)

On Becoming a Wildland Firefighter at 60

July 27, 2018 /

Friends who know me as a software and intelligence product manager and executive have asked how I ended up doing wildland firefighting with Spring Valley Fire Department. Believe me, I’ve asked myself the same question. It tends to pop into my head in situations such as hauling a 45-lb. pack up a steep hill in 90 degree weather and the air filled with smoke. I joke that that’s when I question my life choices. (Okay, it’s not entirely a joke.) Here’s how it happened.

Public safety is not new to me. I took a break from college decades ago and worked a few years as a paramedic. When I returned to school, I volunteered with the Salvation Army’s Emergency Disaster Services, which included feeding and caring for firefighters in Pittsburgh and surrounding areas. One of my friends from that group was a volunteer firefighter who was killed in the line of duty. His funeral had a profound effect on me, particularly the words, “Greater love has no one than this, to lay down one’s life for one’s friends” (John 15:13).

Fourteen years ago I found myself at another line-of-duty-death funeral – for our niece’s husband, a U.S. Marine who was killed in action in Fallujah, Iraq. That helped me realize that I was still carrying a heavy “stress backpack” from things that happened long ago. I met Janet Childs, the director of the Bay Area Critical Incident Stress Management Team (CISM), who helped me begin to let go of some of that weight. I accepted her invitation to join the team, received training and began volunteering in crisis intervention.

One of our CISM team members, who became my mentor and spiritual director, was serving as a fire chaplain for a large agency. When he decided to step down, he asked if I would replace him. After a couple of weeks of debating, I said yes. During my chaplain training, I became friends with members of the CAL FIRE Employee Support Services team. I was part of a group of chaplains who responded to the Rocky Fire in Lake County in 2015. The enormous Valley Fire, also in Lake County, started a short time later and CAL FIRE hired me as a contractor for peer support.

After the Valley Fire, I decided I wanted more wildland fire training, for safety’s sake, so I joined the local CAL FIRE Volunteers in Prevention program. Our duties include operating a mobile command vehicle (I have a ham radio license, which is part of skills required), staffing the Copernicus Peak fire lookout tower (the highest point in the Bay Area, a wonderfully relaxing place) and various public relations events.

Meanwhile, satisfying jobs in product management seemed to become much more difficult to find. I’m most at home in smaller companies and turn-around situations. The problem with those is that the company will nearly always either outgrow me or fail. Either way, I was getting laid off every few years. At some point, I decided that I was done with the high-tech industry, at least as a product guy. I am looking at bringing stress management and resilience wisdom from public safety into the private sector. It’s needed.

Ten years ago, I first met Spring Valley Fire Department, which protects about 200,000 acres of wildland east of Milpitas and San Jose. I led a critical incident stress debriefing for firefighters involved in a difficult response to a traffic accident. The debriefing became horribly memorable – I had asked a Santa Clara County firefighter to assist me, but he decided he needed a “mental health day” instead. While we were doing the debriefing, while bicycling, he was struck and killed by racing motorcyclists.

I joined Spring Valley last spring after talking to a couple of the chiefs while I was recruiting for the CAL FIRE VIP program. Since CAL FIRE was hiring me periodically for peer support at big fires, I wanted more training and experience with wildland fire. I didn’t realize that although Spring Valley is primarily a volunteer fire department, our firefighters can work for pay covering CAL FIRE stations when extra help is needed. (This year, a whole lot of help has been needed compared to past years.) I jumped at the opportunity. Meanwhile, I’ve also qualified as a federal firefighter/EMT to be able to work as a fireline EMT for Wilderness Medics, but I’m still waiting for my first assignment.

Along the way, I published the Pocket Guide to Stress Management and Crisis Intervention, which is now used by hundreds of public safety agencies, became an instructor for CISM, CPR and related topics, and I’m working on a book titled “The Resilience Recipe.” I’m thinking the subtitle might be “Your Brain Will Do That,” because it is mostly about how our brains respond to stress and trauma, and what they need in order to bounce back (spoiler – we need physical, social and spiritual connections).

Those are the events that led me here. At the risk of boasting, I’ll say that it’s been difficult, physically and mentally. Wildland firefighting is extremely demanding – we have to be able to do hard work in extreme conditions. At 61, it was no easy task to get in shape to be any good at all (and I won’t pretend that I’m anything more than adequate). To qualify for federal incidents, I had to pass the “Arduous Work Capacity Test” – hike (no running) three miles in 45 minutes carrying a 45-lb. pack. Although it’s not that difficult for a young person in good condition, the first few times I tried it, I wondered if I would ever get there.

When I look back at the physical training I’ve maintained over the last two years – typically hiking 2-3 miles with a heavy pack at least every other day, weight training at the fitness center every other day – I’m somewhat amazed. Although I was a backpacker and rock climber in my 20s and biked to work for a while, regular exercise was never much more than the thought, “I should do that one of these days.”

To be honest, I was somewhat scared into this self-disciple. A couple of years ago, to my surprise, a routine physical showed that I was pre-diabetic. The exercise has really paid off – my blood sugar is nearly normal and my doctor says I’m the healthiest 61-year-old he has seen. That doesn’t mean I can keep up with the 20- and 30-year-olds I’m working with, but I hold my own. And I keep looking for ways to do better. For motivation, all I have to do is recall hiking up a steep hill with a heavy pack at a fire.

In my writing and teaching, I’m focusing on resilience – our ability to bounce back from adversity. I’ve learned that stress and trauma are enemies of resilience because the “alarm center” in our brains, triggered by stress, will drown out our sources of willpower and motivation unless we do things to quiet it.

Without everything I’ve learned and done about managing stress and unpacking the trauma backpack, I’d never have been able to stick to the discipline that has enabled me to beat back diabetes and become a wildland firefighter/EMT at nearly 62 years old.

Spartacus, a 120-lb. Akita with K9 First Responders, visiting Las Vegas Fire after the October 1 mass shooting.

Let’s use more dogs!

March 4, 2018 /

Yesterday I led a workshop on integration of dogs with crisis response, CISM and peer support, which arose from the successes and relationships that we had with dog teams when I was working for CAL FIRE on the North Bay fires and others. Here are some quick notes on ideas and insights.

Spartacus, a 120-lb. Akita with K9 First Responders, visiting Las Vegas Fire after the October 1 mass shooting.

Our big take-away was that we should follow up with further networking and communications, so that we can increase the number of trained teams and deployments. A number of the attendees have been working with dogs for other purposes and are interested in expanding into crisis response. For example. Search and Rescue (SAR) dogs end up being comfort dogs anyway, so formalizing the training and activities would a natural expansion.

  • When you have a dog, you are forced to take breaks.
  • Background checks (for handlers) are necessary before taking dogs into sensitive areas such as dispatch centers.
  • Dog visits for first responders who are forced off of work for any reason, but especially when injured (physically or psychologically) could be powerful. So often, responders feel abandoned or betrayed when they are not permitted to work.
  • Dogs are “outsiders” – they aren’t firefighters, cops, medics, dispatchers, etc. – but they are able to provide comfort anyway. That’s a lesson for every “outsider.” If you are just present and responsive to emotions, you can be a support. You don’t have to understand the job.
  • Comfort dogs have participated in West Coast Post-Trauma Retreat – great to hear! WCPR, where I’ve served as a peer, is a wonderful thing.
  • CAL FIRE had approximately 18,000 per support contacts in 2017. Wow.
  • We heard about comfort dogs that help witnesses and victims of violent crimes, such as domestic violence, take the stand and testify despite their fears.
  • In Sonoma County, dogs routinely take part in the anti-drunk driving high school program, Every 15 Minutes.
  • Dogs were visiting the helibases at the North Bay fires – one Aussie shepherd was informally adopted as a mascot!
  • Damage inspectors and investigators have some of the toughest jobs at large fires.
  • The amount of scientific evidence supporting the use of comfort or trauma dogs is extensive and strongly supports the practice.

Every time I’m involved in one of these discussions, my heart longs to have a comfort dog that I can take along when I’m deployed for peer support or crisis intervention. I hate to think about losing either of our dogs, but I know they probably won’t last as long as I will, so I start thinking about what’s next for our family. And there’s also the possibility of comfort horse, too – my wife spent yesterday at an equine therapy workshop, learning how she might use our horse or others. Horses are big! Perhaps a miniature… (which are recognized as therapy animals by the government).

Who’s disconnected?

February 18, 2018 /

I found hope in a Reader’s Digest article last week about school shootings, just when I needed it. On the day of the Florida shooting (which was also Valentine’s Day – and Ash Wednesday), our crisis intervention team had gotten a call from a school principal, asking if we could send someone to a staff meeting early the next morning. She was concerned because several teachers were having strong reactions to the Florida incident. I spent part of the morning with the staff. I’m usually fairly calm and confident when I lead interventions, but this was different. I was struggling to stay positive. Hope and optimism were difficult to find. How can things really change, I wondered? The calls for gun control have risen up again, stronger than ever, but there are so many guns in circulation that it’s hard to imagine any new law will have a significant impact (not that I’m opposed to trying).

I fear that it is no more likely that gun control will reduce shootings any more than our efforts to control access to narcotics has reduced addiction. Access to either guns or narcotics does not seem to be the important factor. We also need to look at these problems (and many others) as a societal failure to raise resilient people. Violence and drugs are only appealing when important sources of strength, resistance and resilience are lacking.

At the risk of seeming to agree with the NRA’s political absolutism (I do not),  they have a point when they observe that there are other nations with easy access to guns, but people aren’t killing themselves and others as they are here in the United States. Reducing violence by outlawing access to weapons will probably work as well as outlawing narcotics (it hasn’t; addiction is growing, not shrinking).

In nations where narcotics are available over the counter, the rate of addiction is low. The United States used to be one of those countries – until around the turn of the century, narcotics were legal here, often consumed by children and adults, yet few of those people became addicted. In modern times, more than 20 percent of Vietnam vets said they were addicted to heroin, which was easily available there (around 40 percent had tried it), but an overwhelming majority stopped using it – around 95 percent – when they returned home. Similarly, access to guns was even more free in our nation’s early decades than today, but we didn’t have the kind of gun violence of today. Access – to guns or drugs – clearly isn’t the root problem.

The key factor in addiction is social support, many now argue (for more, read Gabor Mate’s In the Realm of Hungry Ghosts). In other words, disconnected people are more likely to turn to and become hooked on narcotics. Most gun violence is being committed by disconnected people (the stereotypical “loner” or bullied person). My writing research has led me to believe that resilience arises in our social, physical and spiritual relationships. The more I understand how we can become disconnected and what it does to our brains, bodies and spirits, the more signs I see that our culture is deeply disconnected. On Thursday, as I heard the frustrations of the staff of a school in a neighborhood with myriad problems and few resources, it was hard to see what might bring about change. But then I found the article, which a friend had posted on Facebook.

This teacher asks her fifth-graders every Friday to write down the names of four classmates with whom they’d like to sit the following week. They also name one student who they see as an exceptional class citizen. What she does with those slips of paper is simply brilliant.


She looks for patterns.

Who is not getting requested by anyone else?

Who can’t think of anyone to 
request?

Who never gets noticed enough to be nominated?

Who had a million friends last week and none this week?

She figures out who needs extra attention or coaching, who is a bully and who is bullied. She see who is disconnected from the most crucial source of resilience – social support.

We should be asking why our society is producing an increasing number of people who don’t have effective inhibitions against violence, addiction and other failures of self-regulation. Only when we are realistic (and optimistic) about what we have lost – the connections that make us strong – can we see a path back. Let’s follow the guidance of those who have figured this out. The teacher in this article is one of them.

When did this wise woman begin polling her students? Right after the Columbine school shooting.

Hope AACR team at the North Bay Fires

Trauma Dogs

January 9, 2018 /

K9 First Responders Brad Cole and Spartacus (showing off) at LV Fire & Rescue.

If you follow me, you know that I’ve been looking at the role of dogs in critical incident and trauma responses. A couple of years ago, while working for CAL FIRE at the big Lake County fires, I noticed, as did the rest of the peer support team, that dogs are excellent

icebreakers. The fact is that few firefighters will stop and talk to peer support ordinarily – but that changes when dogs are involved. Nobody judges when you play with a dog.

 

As I wrote last month, we invited many dog teams (a team is a dog and handler) to Santa Rosa during the North Bay fires in October. They certainly proved their worth. We could see people relax and open up while petting or playing with the K9s. A couple of weeks ago, one of the line supervisors, Bill B., told me how he had been doing paperwork in camp, exhausted and cranky, when he saw a dog team approaching. Go away, he thought. I’m too busy. But the team – Michael Jacobs and Molly from Hope AACR – came over to him.

Sharon Martin and Abby from Hope AACR

A minute or later, Bill said, he was relaxed and grateful that they stopped by. That’s the kind of story we want to hear!

Last Thursday, I spent the day visiting Las Vegas Fire and Rescue stations with Brad Cole, the founder of Connecticut-based K9 First Responders (KFR), and his trauma dog, Spartacus. Brad and Spartacus, along with other KFR teams, were deployed to the October 1st mass shootings. KFR has also responded to Newtown for the Sandy Hook shootings and many other crises.

We can learn a lot from dogs about crisis response. They are quite sensitive to our emotions. Recent research demonstrates how well they can read us. Many dogs instinctively go to a person in distress – Brad, others and I have seen this happen many times. It happens in my home, too – when I get frustrated, usually by a computer – Kairo, our Maltese, often comes running to me.

Our dogs, Kasha (Bichon) and Kairo (a very big Maltese)

In other words, the first thing we teach in crisis intervention – to acknowledge emotions – comes naturally to dogs. Equally important, they don’t do things many of us, especially in public safety, have a hard time resisting – they don’t give advice, try to “fix” the person or make it better. They are simply present. The fact that they can’t do anything makes dogs non-threatening; safe to be with.

Dogs don’t understand what happened, but they don’t need to. They just know when we are hurting. They show us that it isn’t necessary to understand what happened. Perhaps responders can tell family and friends that the best way to support them is to act like a dog – just be present.

PALS (Paws As Loving Support) dogs at the Valley Fire, Lake County 2015.

The helpfulness of animals for emotionally distressed people is being researched – primarily horses and dogs, but also dolphins and even cats, despite their aloofness. Eye contact and touch play big roles in helping our nervous systems calm down. Dogs and horses are sensitive to danger, so when they are calm, we know we are safe.

A 2015 literature review of research on animal-assisted intervention concluded that although research is still in early stages, “All reported positive outcomes” for traumatized people. Studies showed reduced depression and reduced PTSD symptoms.

Here in the San Francisco Bay Area, after seeing how effective dogs are, we are increasing our collaboration and integration of K9 teams in crisis response.

 

15 Days (with dogs) on the North Bay fires

November 2, 2017 /

I’m still decompressing from the North Bay fires, but here are some thoughts on the experience.

  • I’m grateful for CAL FIRE’s trust. It is a privilege to work with its Employee Support Services team and CISM leads. They are devoted, compassionate, hard-working people, without exception.
  • If there was a big story coming out of our deployment, it was the dogs. Two years ago, chaplains brought their personal PTSD service dogs to the Rocky and Valley fires (also in the North Bay). We saw what a great comfort and ice-breaker they can be. So this time, we invited just about every trained service, therapy or comfort dog we knew about. The result
    Hope AACR dogs outside breakfast in fire camp.

    Hope AACR dogs outside breakfast in fire camp.

    was that we had dogs present in base camp (which peaked at about 6,000 people) every day. We even took the most highly trained dogs, from Hope AACR, whose handlers were former first responders, out to public safety agencies and neighborhoods that burned. We also had a great response from PALS and others whose names I don’t have. The dogs helped people relax and sometimes seemed to be the key to lowering anxiety about telling their painful stories. As a result, all of us are thinking about how to integrate dogs – and their handlers, of course – into our responses (large or small).

  • Hearing “thank you” from people who lost their homes and entire neighborhoods, was often difficult. For a few days, a crowd of up to 200 people with signs and
    Tree snapped off in Coffey Park.

    Coffey Park – tree snapped off.

    noisemakers stood on the corner by the fire camp at the county fairgrounds, cheering and waving at every fire vehicle that came or left. It was so overwhelming sometimes that I could not even look at them. I think the gratitude is hard because people in public safety tend to be perfectionists – it makes us good at the work – so we focus on what we did not accomplish.  I found myself repeatedly urging firefighters, EMTs and others to “let it be both” – sadness at the tremendous losses, but pride in what was accomplished. My most difficult thank-you came from a little girl in Coffey Park, perhaps six years old. I gave her a CAL FIRE badge sticker and she looked me in the eye, saying, “Thank you for saving our houses and lives.” I had to turn around, take about 15 steps breathing deeply, before I could turn back, smile and say, “You’re welcome.” I really just wanted to go somewhere and cry. They deserve our tears.

    Coffey Park – note aluminum from a structure caught high in tree.

  • I communicated back and forth with Angela Leath, who heads peer support for the Las Vegas Fire Department. She is dealing with the aftermath of their horrendous shooting incident, so we traded ideas – what’s working, what’s not – about responding to a large incident. Our conversation helped me remember that we can expect many people too struggle with feelings of guilt – that they didn’t do enough, that they made wrong decisions, that they were not there. We know we can’t save every house and every life, but part of us – a good part – will always whisper that we should have.
  • Exercise really helps, even when you are worn out. Eight or nine days into our deployment, I decided that the best thing I could do for myself would be the kind of hiking I ordinarily do every two or three days – three miles, with at least 25 lbs in my pack, at a fast pace (this keeps me in shape for firefighting and has done wonders for my health). Afterwards, I felt almost normal again. It was as if I’d punched a “reset” button in my body and brain.
  • It was an incredible privilege to help distribute cash gift cards from the California Professional Firefighters’ foundation. We could give them to anyone who lost at least 25 percent of their home. Although a  few people accepted them matter-of-factly, most seemed stunned when I explained what was in the envelope. Many big hugs resulted. Thousands of them have been given to fire victims in the North Bay.
  • It seemed as though nearly everybody wanted to tell us their stories. That’s unprecedented, in my experience. Almost everybody – firefighters on the line, doing damage inspection, mopping up, in overhead management – stopped for a while to talk about how they were doing (especially when we had dogs!). That speaks both to the magnitude of the fires and the changing public safety culture. It is becoming okay to acknowledge how difficult this work can be.
  • After doing and teaching this kind of work – crisis intervention and peer support – for more than a dozen years, I usually have some kind and gentle words for any situation. But three times in Coffey Park, I met firefighters who lost their own or family homes. For them, I had no words, just a lot of eye contact and big hugs. And that’s okay – if there is any time no words are needed, that’s it.
  • We will be talking about, and healing from these fires for a long time. Until last month, the “career fire” for most people was the Valley fire in 2015. More than once, our team and others mentioned that we are still dealing with it. This year’s fires killed many more people and destroyed more than three times as many homes. And more than once, I heard someone ask the rhetorical – and scary – question, “Is this the new normal?”
  • Something to be grateful for – because the fire happened at night, when people are home, most of their pets survived. That’s really good.

Peer support act is dead (for now) in California Senate

September 20, 2017 /

AB 1116, which would have created privilege (legal confidentiality) for CISM and peer support, is dead for this session of the California legislature. However, it is expected to come back in the 2018 session.

Although the bill passed the Assembly and several Senate committees, no agreement had been reached on how to define the training standards required for CISM or peer support team members to be protected. The current version specifies that the state Office of Emergency Services (OES) would create a new class – and nobody in state emergency services (apparently including OES) thought that was a good idea. But there was not enough time in this legislative session to work out the definition, so the bill went to the inactive file.

Hopefully the relevant state agencies (corrections, CHP, CAL FIRE, OES) will work out a training requirements strategy before the bill comes around again, so that it can pass next year.

Passed CA Assembly – Peer Support and Crisis Referral Services Act

June 1, 2017 /

California Assembly Bill 1116, formerly called the Critical incident Stress Management Services Act, has passed the state assembly and is on its way to the Senate. If it becomes law, the act would protect the confidentiality of public safety peer support team interactions except in the case of criminal proceedings. To be covered, team members would have to have completed a peer support training course to be developed by the Office of Emergency Services, the California Firefighter Joint Apprenticeship Committee or the Commission on Correctional Peace Officer Standards and Training.

This legislation would not give the level of protection that a therapist or ordained clergy has, but it will raise the bar considerably – unlike states that have passed similar laws, peer support and CISM teams in California currently have no protection against being subpoenaed. However, in the context of non-criminal proceedings, the legal “privilege” would be the same as between a psychotherapist and patient. The only exception would be “gross negligence or intentional misconduct.”

All of the components of a CISM program along with grief support and substance abuse are named as topics the law would cover.

The bill includes the phrase “toxic stress,” which I believe we should strike from our vocabulary. Stress can be toxic, but it doesn’t have to be, and the phrase “toxic stress” carries a strong connotation that all stress is toxic. That can be a self-fulfilling expectation – if you think stress is toxic, it probably will be.

This is a great step forward for California. I would have preferred that the state also recognize ICISF-approved training, rather than only requiring new courses, but “peer support” covers more than ICISF encompasses, so it is understandable.

If you’re in California, urge your senator to vote in favor. Let’s get the law in place, develop the classes and take the training.

CISM Protection Bill Introduced in California

March 2, 2017 /

California may join Michigan and other states that have made CISM activities “privileged” communications, meaning they could not be subpoenaed or otherwise demanded by a court. Michigan’s legislature unanimously passed the “First Responder Privileged Communications Act” a year ago.Subpoena protection for California CISM

California will consider AB 1116, the Critical Incident Stress Management Services Act.

Here is the key provision.

Except as otherwise provided in this section, a communication made by an emergency service provider to a CISM team member while the emergency service provider receives CISM services is confidential and shall not be disclosed in a civil, criminal, or administrative proceeding. A record kept by a CISM team member relating to the provision of CISM services to an emergency service provider by the CISM team or a CISM team member is confidential and is not subject to subpoena, discovery, or introduction into evidence in a civil, criminal, or administrative proceeding.

The exceptions are not problematic – they cover referrals, events where most of us are already mandated reporters, imminent threats and waivers.

The bill was introduced last month by Assemblyman Tim Grayson, former mayor of Concord, California, who is also a Concord Police Department “Critical Response Chaplain.” He undoubtedly knows a thing or two about this issue.

In my dozen years in CISM I’ve dealt with this through our team’s policy of never keeping written records and my own lousy memory for what other people say during interventions.

Pocket Guide to Stress Management and Crisis Intervention

February 18, 2017 /

Until now, nobody has offered a pocket guide covering all of the protocols and methods that we use in stress management and crisis intervention.

Good news! Now there is one.

I have written and published a 60-page pocket guide (spiral-bound with durable, Stress Management and Crisis Responsewaterproof covers), including essential references for self-care, peer support, psychological first aid, critical incident stress management (CISM), suicide, death and trauma notification and more. I’ve included sections on helping children and grieving people, and what to keep in mind when dealing with various faiths and cultures – the essentials to review and remember.

In the back of the book, I’ve included a guide on when and how to make referrals, with contact information for national crisis lines and online resources, plus plenty of space for you to write in your own contact and referral information.

For more information, including the Table of Contents, see the Pocket Guides page, where you’ll also find testimonials from the expert reviewers who helped me ensure that this is  a high-quality reference guide.

You can order the guide on Amazon, where you will also find a Kindle version.

Paper: Psychological First Aid: Rapid proliferation and the search for evidence

December 8, 2016 /

Psychological First Aid (PFA) – there are many different protocols, great confusion about its relationship to Critical Incident Stress Management (PFA is part of it), and it is increasingly recommended by people and organizations who often don’t seem to recognize that PFA has multiple meanings, is limited in scope and hasn’t yet been confirmed as effective in field evaluations.

I’m not a PFA skeptic – I use it and teach it – but it needs more, careful investigation.

A recent report took a look at PFA’s popularity and lack of field evaluation. The authors are from  two academic centers focused on emergencies and mental health:

The authors give a nod to the down-to-earth nature of PFA guidelines, which are “evidence-informed,” meaning that they are based on related research:

[PFA is] documenting and operationalizing good common sense – those activities that sensible, caring human beings would do for each other anyway.

As the authors observe, the lack of proof that PFA works doesn’t mean it is ineffective. It means that PFA’s effectiveness hasn’t been demonstrated.

They identified forty-eight PFA courses and materials! Yet, oddly, they failed to include one that has been around for quite a while, the SAFER-R model developed by George Everly and incorporated in ICISF CISM training.

Now the bad news.

PFA’s popularity, promotion, and proliferation have not been matched with a commensurate pursuit of evidence demonstrating its effectiveness. Not only is there a dearth of data regarding the benefits of PFA, but there is limited demonstration of widespread commitment to generate such data.

However, like other kinds of crisis intervention, PFA is difficult to study. With nearly 50 different approaches, it is hard for researchers to know exactly what care is being given. There is no way to create control groups – they have to be observed, which is daunting.

The writers offer five recommendations.

  1. Evaluating PFA with first responders, rather than disaster survivors, “may be a good place to start.”
  2. Hospital emergency rooms or other controlled settings might be good places to begin to evaluate PFA for civilians.
  3. We need to figure out how to test its effectiveness for civilians in real disasters. “Predictable disasters” such as annual flooding might create opportunities.
  4. International coordination will make evaluation most effective – agreement on methods and techniques.
  5. PFA should be adapted as the field of trauma evolves. The authors are working on an approach that suggests that early intervention can be tailored to the nature of an incident.

A similar report, by an international group of researchers for the Belgian Red Cross-Flanders, reviewed literature the literature on PFA and came to essentially the same conclusion:

The scientific literature on psychological first aid available to date, does not provide any evidence about the effectiveness of PFA interventions. Currently it is impossible to make evidence-based guidelines about which practices in psychosocial support are most effective to help disaster and trauma victims.

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