PFA focuses on enhancing natural resilience rather than preventing clinical disorders
By Chief Ronald J. Siarnicki

Following is the third in a series of seven articles that describe a new approach to mental and behavioral health in the fire service. Read the other articles:
• Keep Your Head in the Game
• Get the Help You Need After a Traumatic Event

Firefighters and EMTs confront people in distress on a daily basis. During natural disasters or an individual’s personal medical emergency, first responders are looked to for reassurance, hope and solace in addition to their technical skills. It is therefore important that all first responders be prepared with the knowledge, skills and resources to address the emotional aspects of our work and our experiences.

Psychological First Aid (PFA) is a conceptual approach to providing immediate intervention and support after exposure to potentially traumatic events (PTEs). It’s analogous to first aid concepts in general medicine; as such, it’s not a specific technique but rather, it’s a collection of approaches intended to provide quick care for cuts and scrapes, immediate stop-gap management of more pronounced illness and injury, and prompt access to definitive care when indicated. Even more than in other treatment efforts, there’s a strong emphasis on the Hippocratic directive, “Primum non nocere,” which means, “First, do no harm.”

How It’s Different
The National Center for Posttraumatic Stress Disorder (NCPTSD), with sponsorship and participation from a number of researchers and organizations, has developed an evidence-informed, best-practices approach to PFA that has been adapted for use by the military, the Medical Reserve Corps, spiritual care providers and others who work with people exposed to PTEs. The NFFF and the Everyone Goes Home project are contracting with principals in the PFA project to prepare special adaptations for the first responder community.

PFA represents a very different set of notions and assumptions from those that grounded the debriefing and Critical Incident Stress Management (CISM) models that once dominated early intervention in fire and EMS. Those approaches were very prescriptive, protocol-driven and rigid. There were set rules for what would be said, by whom and in what order—sometimes even for such minute details as how chairs would be arranged and who should sit where. The techniques were tied to presumptions that the people were at a relatively high risk for developing PTSD and coupled with suggestions that these approaches could prevent its development.

PFA, on the other hand, specifically avoids the now well-established pitfalls of a one- size-fits-all intervention. It’s directed toward enhancing natural resilience rather than preventing clinical disorders. It embraces a wide range of techniques and anticipates that methods will change as evidence develops. Its strength is in its flexibility.

PFA Basic Principles
In keeping with a growing body of empirical evidence, PFA principles assume that people are typically resilient, that their concerns are principally instrumental and adaptive, and that their reactions are generally transient and situational in nature—in short, that most will get better as their situation gets better.

If that’s the case—and empirical evidence suggests that it is for the vast majority of persons—then the best way to provide emotional support is to do so in the context of activities and interactions taking place to address their practical concerns. That’s not to say that there aren’t times when the direct help of a counselor or social worker will prove needed and valuable. What it does suggest is that emotional support, especially in the beginning, is better received in the context of these primary roles and relationships rather than through separate providers conducting separate interventions.

The basic principles of Psychological First Aid are really quite straightforward:
• Contact and engagement: Making contact with those in need of assistance; providing practical, instrumental assistance with compassion and care.
• Safety and comfort: Taking steps to provide as safe an environment as situations permit; providing as much comfort as circumstances allow.
• Stabilization: Attenuating anxiety, providing a calming presence, helping ground and orient the distraught, referring for emergency care where clearly indicated.
• Information gathering (current needs and concerns): Determining what the pressing needs are, as perceived by the person in need; tailoring assistance efforts to address current needs while anticipating emerging situations.
• Practical assistance: Providing practical, instrumental help with identified needs; assisting with problem-solving strategies and access to helping resources.
• Connection to social supports: Helping those affected make contact with sources of social support important to them (e.g., friends, family, community, spiritual resources); integrating their support into problem solving and recovery.
• Information on coping: Simple, practical, proven tips on managing stress and coping with demands of recovery—timed to match the situations and challenges at hand at any given juncture—can be useful and well received, especially when delivered in the context of practical assistance and social support.
• Link to collaborative services: Because many persons may be unfamiliar with resources available to help with their various needs, assistance in navigating the resource network community can be particularly important.

Coming Soon
NFFF and the Everyone Goes Home project will soon have two modules available. The first, Psychological First Aid for First Responders, will include a 3-hour training curriculum for use in continuing education blocks, supplemented by appropriate instructor materials and backed by a complementary online curriculum module. The second will address Stress First Aid for Firefighters, which is designed to build on basic PFA principles and is specifically geared toward peer support personnel working with the behavioral health programs in fire and EMS organizations. It will also contain instructional materials for both workshop and online presentation.
Visit www.everyonegoeshome.com for updates on the progress of these components.

Chief Ronald J. Siarnicki is the executive director of the National Fallen Firefighters Foundation.

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