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Dec 1, 2008 (CIDRAP News) – A training program under way through the Minnesota Department of Health (MDH) aims to reduce the psychological impact of emergencies and disasters in a process that has similarities to delivering physical first aid.
Since September 11, 2001, there has been a growing understanding of the psychological impact of terrorism and disasters. Thus more professional and lay responders have learned a range of ways to address the psychological needs of people affected by terrorism and disasters. One type of training, called psychological first aid (PFA), is increasingly used as a first step in assisting people caught in disasters.
Nancy Carlson, the behavioral health preparedness coordinator at the MDH, began teaching PFA in Minnesota more than 4 years ago. The training program offers basic courses for disaster behavioral health responders and addresses the needs of specific local audiences.
"Our main goal is to have psychological first aid become one of the programs in Minnesota like the physical first aid that everybody can do." Carlson said.
Short, efficient training
"Although the federal government recommended psychological first aid shortly after September 11, 2001," Carlson said, "there was no training for first responders or healthcare providers."
One of the only PFA courses available at that time was taught by the International Red Cross in Africa. It was designed for communities that were short of mental health professionals. "It didn't fit in with our needs." said Carlson.
The length of the course—for example, 40 hours from the International Red Cross—was another barrier.
"No one here could take that kind of time off to do the training," Carlson said. So she and her colleagues brought in mental health professionals and experienced agencies and then created their own Minnesota model, a 2- to 4-hour training class for emergency responders.
They identified several priorities for improving disaster mental health response, including communicating with people about their spiritual needs, helping people to feel safe in uncertain circumstances and surroundings, and providing people a safe environment to allow them to talk openly.
The PFA training in Minnesota is delivered mainly by presentation, with content adapted to the target audience. For example, in the presentation tailored to K-12 school staff, a scenario involving a student killed in a car accident is provided in addition to the basic PFA curriculum. The presentation for hospital staff addresses hospital surge and the influx of patients during a disaster.
This training is free to recipients. The cost is covered through the federal Department of Health and Human Services healthcare system preparedness program grant, Carlson said.
Minnesota it is not the only state teaching PFA. Several other state health departments, including Florida, Nebraska, and Texas, also provide this training. Some online self-study programs are available as well.
Although PFA responders are not necessarily licensed behavioral health professionals, they do provide important interventions following a disaster. PFA responders listen with compassion, provide any needed referrals, and encourage healthy coping strategies, such as eating healthfully and getting rest and exercise. It is a role that anybody can play provided they have received PFA training.
"In addition, people are trained to identify the situation that is too serious and pressing for them," Carlson said. "They also need to know how to help people to get access to the professional mental health services."
In Minnesota, trainees receive a PFA card with the information on:
- Promoting safety
- Fostering calm and comfort
- Promoting connectedness
- Encouraging self empowerment
- Offering prevention strategies
- Teaching self-care
"It's really a very simple concept," Carlson said, "and it is now part of the personal and family emergency preparedness training, a course designed for the preparedness of emergencies in Minnesota."
Using PFA in disasters
Although the training was years in the making, it was put to use quickly. The collapse of the Interstate 35W bridge in Minneapolis in 2007, which resulted in 13 deaths and 127 injuries, is a good example.
"We designed a family assistance center after the disaster," Carlson said. "People were brought in and provided a safe place. They talked with us, saying that they felt comfortable and connected with the other survivors.
"It worked really well," Carlson said. "People felt like their needs were being met. Since then, we got lots of people who said they want to get this training."
Unlike pulling people in during the bridge disaster, responders pushed service out during flooding last August in Southeastern Minnesota.
Rose Olmsted, MS, is the social services supervisor in Freeborn County, Minn. She helped coordinate the MDH's southeastern Minnesota behavioral response in the flood, bringing volunteers into the flood-affected areas right after the disaster. Responders included local public health employees and county human services and community mental health center staff. Almost all the lay volunteers received PFA training before they responded.
"I think the PFA training did affect responders," said Olmsted a licensed social worker. "They started to realize that listening is very important, and they saw the power of being able to give choices, and then people were empowered by making choices."
Much of the responders' work amounted to listening to people. In at least one case, a responder used the PFA training to understand when a person's situation needed more expert attention. "There was one time when local citizens in the shelter asked for help to get someone who was able to talk about suicide with them. It was too difficult to think about life going on at that time," Olmsted said.
Olmsted and her colleagues didn't have an opportunity to follow up with flood victims to measure the effectiveness of the PFA training, although anecdotal evidence suggests it was valuable. "We have had good response from the survivors," she said.
The training also helped responders realize they needed to take care of themselves. For example, many conservation officers who were used to rescuing animals had to adjust to the stress of rescuing people instead. And some responders were themselves victims of the flooding.
"So the self-care for every responder is critical," Olmsted noted, mentioning that trainers had provided self-care cards to responders.
In addition to training the volunteers from other parts of the state, Minnesota's PFA program also gets local community responders involved, which "is vital for community resilience after a disaster," Carlson said.
New goals, new challenges
According to the statistics from the MDH's Nancy Carlson, more than 20,000 people from all over Minnesota have been trained in PFA. And the training is ongoing throughout the state.
Not solely designed for disasters, PFA training can be used anywhere, such as during seasonal flu and even pandemic influenza.
"A few years ago, when we had a shortage of flu vaccine, there were a lot of people calling in, and they were upset," Carlson said.
The big difference during a flu pandemic would be that the responders could not have individual, face-to-face conversations, she said, "But it would be the same skills. We are still able to use the PFA via phones such as hotlines, and [in] training family members and community groups."
Public awareness of the availability and usefulness of PFA training continues to lag, especially when there is no sign of disaster, and this lack of awareness concerns Carlson.
"But we can hit our target audience by going through different community groups. And our next goal is developing a program for kids to train the youth on how to help each other deal with their emotions, through which we can promote the training program further," Carlson said.
View tools and reviewers' comments from the "Minnesota Psychological First Aid Training" practice