# Presentation: 519493

**United States Department of State**
*Office of Medical Services*
- Released January 2006
- Printed in Washington D.C.  A/RPS/MMS 2006-00962 (100)

## FSI CRISIS SURVEY (done 3/2004 – 3,200 surveyed)

**45% of respondents experienced a crisis**
**87% of Generalists serving 15 yrs or more stated they had been directly affected by a crisis...**
**There are 138 critical or high threat terrorism posts.  More than a dozen posts are now unaccompanied**
**Since 8/98 DOS has approved a post draw down averaging one every 19 days...**

## What is the Environment?

**Auto accidents kill more F.S. personnel per year than by any other cause**
**30% of posts have a F.S. Medical Provider**
**Medevac of injured person takes 48-72 hrs**
**VERY IMPORTANT TO KNOW INITIAL **
**EMERGENCY CARE**

**M/MED/FSHP 2/05 **
**FSI/LMS/CMT 3/05 **

**Security Environment Threat List 2/04**
**DS Proposal to the DG on Mandatory DSAC Training, 1/05**

## Slide 4

## What You Will Learn In This Course

**To identify immediate life threatening injuries and know how to treat them**
**To prioritize victims using the START Triage method**
**To identify serious injuries and initiate treatment**
**Principles of search and rescue**

## You Will Also Learn...

**How to carry an injured victim to safety**
**To recognize and treat some common medical emergencies:**
**Diabetic Emergency**
**Severe Allergic Reaction**
**Automatic Electronic Defibrillator use (AED)**
**Choking **

## Mass Casualty Incident(MCI)

**NATURAL: **
**Earthquake, Fire**
**Hurricane, Flood, Tsunami**
**HUMAN:  **
**Airplane Crash, Auto Accident **
**Riot, Terrorist Attack/Bombing**

**“****Any event that overwhelms existing resources”**

## How many injured would it take to constitute a MCI at your post? 

## Would You Know What To Do?

**Your neighbor has just been shot in the chest**
**Your friend walks through your patio glass door and is bleeding heavily**
**Following a bomb blast your office co-worker has a gaping abdominal wound and pain in the hip**
**After an automobile accident your spouse is unconscious with a severe head and neck injury**

## The Golden Rules of Mass Casualty Incident Management (MCI)

**Be Prepared**
**Be as Safe as Possible**
**Do the Greatest Good for the Greatest Number!**
**Manage Scarce Resources**
**Do Not Relocate the Disaster**

## Principles of MCI Medical Care

**Not every injured person can be saved**
**Simple Triage And Rapid Treatment (START) **
**CPR is (generally) not performed in a disaster**
**PROTECT YOURSELF FIRST!**

## START -  Simple Triage and Rapid Treatment

**TRIAGE**
**Identify and separate the victims rapidly according to the**
**severity of their injuries and their need for intervention**

## Perform a Primary Survey on everyone

**Be as Safe as possible!**
**Floor, ceiling**
**Fire, smoke, power lines**
**Bullets, assailants**
**Gloves**
**Assess Each Victim**
**Preferably in the position found **
**Move if danger to victim or the rescuer**

## Primary Survey

**R**** – Respiration/Breathing**
**P**** – Pulse/Serious Bleeding**
**M ****– Mental Status**
**These problems must be corrected rapidly or the victim will die!**

## Primary Survey - START Triage                           R.P.M.  Assessment

**Open the Airway**
**Look for chest rise and/or abdominal rise**
**Listen for air exchange**
**Feel for chest & abdominal movement**
**If victims respond ~**** **
**they are breathing, have a pulse and are conscious**

## Open The Airway

**Place one hand on the forehead**
**Place two fingers of the other hand under the chin and tilt the jaw upward while tilting the head back slightly ****(Head tilt-chin lift)**
**Look, listen and feel for air exchange**

**Head Tilt / Chin Lift**

## Primary Survey                                 R.P.M.  Assessment

**If victim is not breathing ~ **
**Look for an airway obstruction **
**Airway obstructions can be corrected.**
**The most common airway obstruction is the tongue.**

**Time is critical! Brain damage is possible after **
**4-6 minutes without oxygen**

**Blocked Airway**

## If The Victim Begins Breathing

**If the victim is not fully conscious, you may have to maintain the airway**
**Assign a rescuer to hold open the airway (if available)**
**Elevate the shoulders slightly (soft object)**
**Use an oral airway tube (if available) **

## Are they breathing - Yes or No?

If YES
Assess the next immediate life threat 
Look for bleeding = P - (Pulse/Circultation/bleeding)

If NO 
reposition the head... 
still no breathing = BLACK (Dead)

**If YES**
**Assess the next immediate life threat **
**Look for bleeding = P - (Pulse/Circultation/bleeding)**
**If NO **
**reposition the head... **
**still no breathing = ****BLACK (Dead)**

**Primary Survey - START Triage****	****	****	**_**R.**_**P.M.  Assessment**

## Primary Survey - START Triage			R.P.	M.  Assessment

**Pulse / Circulation / Bleeding**
**Heavy bleeding = ****RED (Immediate)**
**Look for and STOP any heavy bleeding!**
**If it looks like a lot – it is a lot...**

## Bleeding(Covered in Next Hour)

**Severe bleeding is life threatening and **
**MUST BE STOPPED!!**
**External – First Responders MUST treat.**
**Internal - (Abdomen, thigh, chest)**
**Immobilize**
**Treat for Shock**

## Primary Survey - START Triage			R.P.M.  Assessment

**Mental/Neurological Status**
**Is the patient conscious and/or able to follow simple commands?**
**If NO to either = ****RED Immediate **

## Primary Survey - START Triage			      Review

**The only medical interventions allowed during START**
**Triage are:**
**Opening the airway:**
**Head tilt/Jaw Thrust**
**Stop heavy bleeding**

## Primary Survey - START Triage			      Review

**The primary survey is completed**
**Breathing**
**Serious Bleeding**
**Mental Status**
*** no more than 30 seconds per patient**

## Complete A Primary Survey On Everyone BEFORE You Begin A Secondary Survey On Anyone...

## Secondary Survey

**Head-To-Toe Assessment**
**Question and examine the victim**
**Determine what exact injury has occurred**
**Take your time**
**Primary survey has been completed**
**The victim is not in immediate danger of death**

## How To Begin?

**Talk to the Victim**
**What hurts?  Ask!  (Alert victims will tell you.)**
**Ask about Past Medical History **
**	****       *****Note:  You may be the only person who will be able to obtain  ******	******this information***
**Examine the Victim**
**Head to toe, front to back search **
**BE SYSTEMATIC**

## Slide 28

## But I Don’t Know How To Do A Physical Examination!

**Keep the victim (and the rescuer) calm**
**Tell the victim what you are going to do**
**This is a “hands-on” experience ...so ask permission **
**Conduct examination even if victim is awake**
**Look and feel.  Identify anything that doesn’t’ look right  (we all know what normal looks like!)**
**Compare sides**
**Remove clothing only as necessary**

## Secondary Survey

**VICTIM CONSCIOUS?**
**Neck:     palpate vertebrae, watch face, veins**
**Head:    soft spot, laceration, bleeding**
**Eyes:     pupils, foreign bodies**
**Nose:     deformed, blood**
**Mouth:  food, dentures, teeth, blood, tobacco**
**Collar bone **

## Secondary Survey

**Breast bone:  should bounce back**
**Ribs:   pain, deformity**
**COUNT NUMBER OF BREATHS PER MINUTE****Is it more than 30 per minute? = Immediate Red Tag**
**Abdomen:  swelling, bruising, pain**
**Hips:  press**
**Legs:  swelling, deformity, pain (groin)**
**Arms:  swelling, deformity, pain**
**CHECK PRESENCE OF RADIAL PULSE**
**Back:  roll victim over**

## At The End Of The Secondary SurveyYou Should Know...

**Is the victim conscious? **
**Can they follow simple commands? If no =**** RED **
**How many times per minute is the victim breathing? **
**Greater than 30/minute =**** RED**
**Does the victim have a radial pulse? **
**If pulse is absent, greater than 100 or very faint =**** RED **
**	**
**What is the capillary refill? **
**If greater than > 2 seconds**** = RED**
**-**

## External Bleeding And Shock

## Control Of External Bleeding

**Direct Local Pressure**
**Elevation**
**Pressure Points**
**Tourniquet (last resort)**

## Bleeding: Direct Local Pressure

**Direct pressure over the wound **
**Press firmly (6-8 minutes)**
**Apply pressure bandage**

## Bleeding: Elevation

**Elevate bleeding part above the level of the heart**
**Check first for fracture above the bleeding**** **

**95% of bleeding can be controlled by direct pressure combined with elevation**

## Bleeding: Pressure Points

**Brachial artery = upper extremity**
**Femoral artery = lower extremity**
**Use 2-3 fingers to press artery against bone**
**Maintain pressure point for 6-8 minutes**
**Release pressure slowly (over 30-60 seconds)**

**Use combination of pressure dressing and pressure points if needed**

## Pressure Points

## Bleeding: Tourniquet

**A tourniquet is **_**almost never**_** required**
**Only used as a last resort to save a life**
**Might use for yourself if alone or if no other methods control the bleeding**
**Consider for crushing-type injuries or partial amputations**

## Bleeding: Tourniquet

**Bleeding: Tourniquet**

**Expect the loss of the limb if tourniquet applied**
**Leave it in plain sight (don’t bandage over it), and mark the victim’s forehead with “T” and the time the tourniquet was applied**
**DON’T TAKE IT OFF ONCE APPLIED!!**

**Stop Bleeding**

## Amputation

**Apply a pressure dressing**
**Save the amputated limb**
**Put limb in dry plastic bag**
**Place in 2nd plastic bag with ice**
**Give bag to victim to hold**

## Shock

**EVERY VICTIM SHOULD BE TREATED FOR SHOCK!!**

## Shock

**Body’s attempt to compensate for loss of blood flow and**
**oxygen to vital organs **
**Vital Organs are waist to head – not extremities**
**Must continually monitor - shock may not be apparent initially as body compensates**
**Organ death will occur if not treated!**

## Symptoms Of Shock

**R**** – Respirations/Breathing = Rapid, shallow (rate > 30/min)**
**P**** - Pulse = Radial pulse is absent, weak or rapid**
**Skin - Cold, pale, clammy skin (with capillary refill greater than 2 seconds)**
**M**** - Mental Status = Unable to follow simple commands**

## How To Treat Shock

**Control bleeding!!**
**Lay the victim on his/her back.  Elevate feet above the heart**
**Alleviate pain – avoid excessive or rough handling**
**Splinting**
**Pain medication**
**Allay anxiety**
**Maintain body temperature (e.g., cover the ground and the victim with a blanket)**
**Give oxygen**

## Summary     Start the START Triage 

**DO a PRIMARY SURVEY on Everyone first**
**Open airway**
**Control bleeding**
**Assess mental status**
**Begin Secondary Survey **
**Only after treating all airway or bleeding problems**
**Treat problems detected on secondary survey**
**TREAT FOR SHOCK**

## Head and Neck Injuries

## Suspect A Head Or Neck Injury

**Obvious skull injury**
**In all unconscious victims (especially with alcohol)**
**Structure collapse, fall or explosion (MOI)**
**Seizure or unequal pupils**
**Swelling or discoloration beneath eyes or ears**
**Blood or clear fluid in ears or nose**
**Pain in the neck**
**No feeling or movement in arm or legs**

## Head Injury Precautions

**Minimize movement of the head and neck while treating other life-threatening conditions.**
**Keep victim lying down**

## Neck Fracture Low Risk Criteria

**NO midline spine cervical spine tenderness**
**NO evidence of intoxication**
**NO alteration of mental status**
**NO neurological defects**
**NO painful distracting injuries**

## Apply A Neck Brace -  (if available) For All Head and Neck Injuries 

**Correct Application requires 2 Rescuers **
**One rescuer at head of victim – stabilize head and neck **
**Second rescuer applies neck brace**
**Total neck immobilization requires a backboard (litter) and a neck brace**

## Scalp Laceration

**DIAGNOISIS**
**Wounds bleed heavily**
**Look for skull fracture**
**       **
**TREATMENT**
**Use gauze pads and apply pressure 6-8 minutes (carefully if skull fx)**
**Secure dressing with roller bandage**

## Serious Fractures

## Serious Fractures

**UPPER LEG AND PELVIS**
**UPPER ARM**
**Often associated with internal injuries and bleeding**

## Diagnosing A Fracture

**Pain**
**Bruising and swelling**
**Deformity**
**Inability to use the limb**
**Victim heard it break**
**Open vs. closed fracture**
**Don’t turn a closed fracture into an open one**

## Fractures

**Principles:**
**Remove clothing and jewelry**
**Check pulses**
**Check skin color/temperature**
**Check feeling**
**Control bleeding**
**Cover wounds**

## Fractures

## Principles of Splinting

**To immobilize a bone – splint joints above and below**
**To immobilize a joint – splint bones above and below**

## Upper Leg And Pelvis

**Hint:  **
**Shortened leg and foot rotated**
**out suggest hip fracture**

## Upper Leg And Pelvis

**Slip four bandages under legs**
**Note:  Avoid back of knee**
**Place bulky pad between legs (blanket) **
**Move good leg towards bad**
**Start ties from the ankle**
**Tie a surgeon’s knot in the middle of each bandage**
**Note:  Don’t raise legs for shock**
**Consider sheet bandage for pelvic fracture**

## Pelvic Fracture

**Consider sheet bandage for pelvic fracture**
**Splint legs the same as for hip fracture**

## Upper Arm

**PLACE ARM IN SLING**
**PUT SWATH AROUND UPPER ARM**
**Note:  Don’t tie swath over fracture site**

## Special Injuries

**Blast Effects**
**Rib Fractures**
**Penetrating Chest Wounds**
**Impaled Objects**
**Burns**
**Abdominal Wounds**

## Blasts

**Primary – blast wave**
**Blast lung, bowel & spleen perforation**
**Ear drum rupture**
**Secondary – flying debris**
**Eye penetration, impaled objects**
**Tertiary – victims throw by blast**
**Fractures, amputations, brain injuries**
**Others**
**Burns, crush injuries, smoke inhalation**

## Rib Fractures

**DIAGNOSIS**
**Pain, tenderness**
**Hurts to breathe**
**TREATMENT**
**Not major problem unless lung is punctured**
**Elastic or cravat wrap may help**

## Chest Injuries – Normal Anatomy

## Penetrating Chest Wound

**DIAGNOSIS**
**Hole in chest wall - Pain**
**Difficulty Breathing**
**Coughing up bright frothy blood**
**Unequal expansion of chest**
**Shock symptoms**

## Chest Injuries

## Penetrating Chest Wounds

**Inhalation Sucks Air Into Chest But Not Into Lung**
**Cover hole – Look for exit wound**
**Vaseline gauze (impermeable bandage)**
**Airtight - tape down all four sides**
**Give oxygen**
**Roll victim to side of injury**
**If victim develops difficulty breathing or has distended neck veins “burp” the dressing**

## Eye Injuries

**Causes **
**Ruptured Globe**
**Foreign body not removable with irrigation**
**Other – chemical and thermal burns**
**Problems**
**Pain**
**Blindness**
**Fear and panic **

## Treatment Of Eye Injuries

**Ruptured globe, foreign body**
**Place a cup over the injured eye**
**Cup must rest on bony structures**
**Cover the other eye with gauze**
**Eyes move in tandem**
**Secure with gauze wrap**
**Do not cover the nose**
**Place victim in sitting position**
**Have someone sit with victim **

## Considerations - Eye Injuries

**Victim is blind**
**Physical and psychological injury**
**Victim requires guidance and reassurance when ambulating**

## Impaled Objects

**Don’t pull out**
**Stabilize and secure**
**Don’t cover**
**Treat for shock**

## Burns

## Burns

**Mechanisms**
**Radiation**
**Fire**
**Chemical**
**Electrical**
**Hot water/liquids**

## Burns

**1st Degree (superficial) – redness, pain**

## Burns

**2nd Degree (partial thickness) - blisters, pain**

## Burns

**3rd Degree– full thickness – charred, no pain!**

## Burn Treatment

**Stop the burning**
**FLUSH with cold water (tar, chemicals)**
**Remove jewelry and affected clothing**
**Cover with dressing – (sterile)**
**Put dressing between fingers.  Keep hand in  position of function**
**If rescue delayed, moisten dressing with sterile water**
**Treat for shock and pain**
**MOST PATIENTS WILL REQUIRE INTENSIVE MEDICAL CARE**
**No butter, grease or oil**

## Abdominal Wounds

**Cover exposed organs with moist dressing (sterile water)**
**Cover dressing with inner surface of plastic wrapper from trauma pads.**
**Secure pads with cravats**
**DO NOT TIE CRAVATS OVER ORGANS**
**Bend knees**
**Treat for shock**

## Take Care of Your Family First

**Have a plan for reuniting all family members**
**A place to meet **
**Phone contacts**
**Water**
**One gallon per person per day (3 days)**
**Boil for 3-5 minutes or add 4 drops of bleach per quart and let stand for 30 minutes**
**Food**
**Ready to eat, 3 day supply: Canned meat, fruits, vegetables, peanut butter, granola bars, trail mix, (lollipops, tea)**
**Can opener, plates, cups, spoons, knives**

## Take Care of Your Family First

**First Aid Kit**
**Bandages, tape, scissors, handi-wipes, aspirin or ibuprofen, prescription drugs, glasses/contact lens**
**Personal hygiene needs ****(tampons, diapers, toilet paper, soap)**
**Family Records**
**Passport, telephone numbers, ****(photograph album),**** insurance**
**Money, credit cards, checks ****(bank number)**
**Emergency Equipment**
**Flashlight, portable radio, fire extinguisher, cell phone/radio, website, blankets, rain gear**
**Gas/water/electricity shut-offs, escape routes**
**IF YOUR HOME IS UNSAFE, GET EVERYONE OUT**

## Search And Rescue

## Search And Rescue

**“****Golden Day”  In the first 24 hours after a disaster injured**
**or trapped victims have an 80% chance of survival if rescued**
**Rescue the greatest number of people in the shortest amount of time**
**Rescue lightly trapped victims first**

## Rescuer Safety

**Buddy System**
**Work in pairs with third person for communication/runner**
**Safety Equipment**
**Helmet, goggles, mask, whistle, gloves, shoes**
**#1 Rescuer problem is breathing dust**
**Be Alert for Hazards**
**Sharp objects, dust, power lines, high water, fire, smoke, unstable structure**
**Team Care**
**Rest, food, water, relief shifts**
**Fatigue leads to injury **

## Rescuer SafetyAssess Building Damage

**	****“****Take a lap” – secondary collapse is the most common cause of rescuer death**

## Rescuer SafetyAssess The Structure

**Light Damage – superficial or cosmetic damage, broken windows, fallen plaster, furniture and contents damage**
**Locate, treat, triage and evacuate**
**Moderate Damage -  questionable structure stability, tilting walls or foundation**
**Locate, stabilize and evacuate, limit number of rescuers**
**Heavy Damage – obvious structure instability, partial or total wall collapse, ceiling failure, major fire or smoke**
**Untrained but well-intentioned volunteer should not enter**

## Search Methodology

**Call Out **
**“****If anyone can hear my voice, call out”**
**Search Bottom-Up/Top-Down**
**Move Systematically Along the Wall**
**If disoriented, reverse steps to the doorway**
**Maintain voice contact with partner (web belt?)**

## Systematic Room-Search Pattern

## Search Methodology

**Search Entrapment Areas**
**Lean-To Void – collapsed floor leaning against wall**
**Individual Void – Under desks, in bathtubs**
**Exit Routes**

## Victim Transport

**One-person carries**
**Arm Carry**
**Pack-strap carry**
**Back carry**
**Drag**
**Blanket Drag**

**Two-person carries**
**Two person lift**
**Two-hand swing carry**
**Four-hand seat carry**
**Two-person chair carry**

## One-Person Carry

**Must be physically strong or small victim to carry victim by yourself**
**Reach around the victims back and under the knees, and lift with your legs**
**Victim may be able to assist by placing an arm around your shoulder**

## One-Person Pack-Strap Carry

**Stand with your back to the victim**
**Place the victim’s arms over your shoulders and grab the hands in front of your chest**
**Hoist the victim onto your back by bending forward slightly, so his or her feet just clear the floor**

## One-Person Back Carry

**With your buddy on his or her belly, straddle the victim and lock your hands together under the chest**
**As you walk backward, lift your victim to his or her knees**
**Keep walking backward until your buddy’s legs straighten and the knees lock**

## One-Person Drag Carry

**Drag the victim out of the confined area by grasping either under the arms or by the feet and pulling across the floor**
**Remember to use safe lifting procedures**

## One-Person Blanket Drag

**Wrap the victim in a blanket**
**Squat down and grasp the edge of the blanket**

## Two-Person Lift

**Rescuer 1: Squat at the victim's head and grasp the victim from behind around the midsection**
**Rescuer 2: Squat between the victims knees facing either towards or away from the victim. Grasp the outside of the victim's legs at the knees**
**Lift using your legs, not your back**

## Two-Person Swing Carry

**Place your victim on his or her back with arms at the side**
**Kneel next to the victims hips**
**Place one hand under the arms and back**
**Grab the wrists of your other carrier**
**Raise your victim to a sitting position & lift together**

## Four-Hand Seat Carry

**Grab your left wrist with your right hand. Next, each carrier grabs the other carriers right wrist with the left hand**
**Lower yourself so your victim can sit on the on your joined hand and tell your victim to hold each carriers shoulders**

## Two-Person Chair Carry

**Place the victim in a sturdy chair**
**Rescuer 1: Face the back of the chair, grasp the chair back uprights**
**Rescuer 2: Facing forward, reach back and grasp the chair legs**
**Tilt the chair back, lift using your legs, not your back. **

## Litter Loading

## Litter Loading

**First rescuer maintains neck stabilization.  Victim’s near arm moved over his head**
**Second rescuer tucks chest and leg straps under victim’s side and moves stretcher as close to victim as possible**
**Thee additional rescuers roll victim to one side**
**Second rescuer slides stretcher under victim**
**Victim is rolled back onto the stretcher and restraints applied**
**Note: Conscious litter victims may become extremely anxious**
**at being totally immobilized**

## START Triage ReviewSimple Triage and Rapid Treatment

## START Triage Review

**Separate the ‘Walking Wounded’ or the Uninjured **
**Call Out Loudly:**
**“****Everyone who can hear me, move over to this side of the room.”**
**Tag – ****GREEN (minor)**** **

## Remember: 
Your goal is to do the greatest good for the greatest
number of victims possible

**Your goal is to do the greatest good for the greatest**
**number of victims possible**

**Primary Survey - START Triage****	****	****	**_**R.**_**P.M.  Assessment**

## START Triage ReviewR.P.M

**CHECK BREATHING **
**Look, listen and feel for air exchange**
**Open the airway, If the victim does not breathe after opening the airway again, move on to the next victim.  **
**    ****TAG – ****DEAD (black) **

## START Triage Review R.P.M

**CHECK BREATHING **
**If the victim is breathing over 30 times per minute = early shock**
**Tag = ****RED (Immediate)**** **

## START Triage 			R.P.M.  Assessment

## START Triage Review R.P.M

**CHECK the PULSE**
**If radial pulse is weak or irregular **
**If the skin is cool and moist**
**If the capillary refill is greater than 2 seconds **
**If you treated a serious bleed**
**      ****Tag = ****RED (Immediate)**** **

## Primary Survey - START Triage			R.P.M.  Assessment

## START Triage Review R.P.M

**CHECK the Mental Status**
**If the person cannot follow simple commands**
**Tag = ****RED (Immediate)****  **

## START Triage Review R.P.M

**EVERYTHING ELSE **
**TAG –                                  ****DELAYED**

## What Color Tag?

**Victim is unconscious with a severe head and neck injury**
**After a bomb blast victim has a fractured hip**
**Victim has first and secondary burns on his right arm**
**Victim has a penetrating shrapnel wound in the chest**
**Victim has a leg laceration and is bleeding heavily**
**Victim is not breathing after neck positioning**

## Disaster Psychology

## Disaster Psychology

**Remember...**
**No one is untouched by a disaster**
**Communities and individuals are affected**
**Disaster stress and grief reactions are normal responses**
**Unusual psychological experiences and feelings  should be expected****	**
**Anticipate...**
**Hypervigilance, anger, despair, irritability, fear, depression,**
**loss of concentration, loss of appetite, difficulty sleeping,**
**nightmares, etc**

## Helping Survivors Deal with Stress

**Establish Rapport**
**Listen**
**Empathize**
**Confidentiality**

## Disaster Psychology Acute Stress Reactions

**Emotional numbing**
**Being in a daze**
**A feeling that things are unreal**
**Feeling like you are not yourself**
**Inability to recall an important aspect of the trauma**

## Post Traumatic Stress Syndrome(PTSD)

**If the Acute Stress**
**Symptoms persist for more**
**than one month consider**
**contact with mental health**
**professional**

## Do Say:

**It wasn’t their fault**
**Things will not be the same; but they will get better over time**
**These are normal reactions**
**I understand this is the way you feel**

## Don’t Say:

**It could be worse**
**It’s best if you stay busy**
**I know how you feel**
**Just relax**
**You can replace what you lost**

## Disaster PsychologyYou Can Help Others by:

**Listen**
**Help them identify problems **
**Help them to devise a plan**
**Help them to identify resources**
**Help them to assess how they are coping**
**You cannot solve the problems for the victim**

## Disaster PsychologyEmotional 1st Aid for Workers:

**Brief Personnel**
**Emphasize teamwork**
**Encourage breaks**
**Provide adequate food and water**
**Rotate personnel as teams (duties, breaks)**
**Phase out workers gradually**

## Disaster PsychologyEmotional 1st Aid for Workers:

**Organize out briefing after operation**
**Seek out counselor to out brief**
**Monitor own stress reaction**
**Don’t be afraid to ask for assistance**

## Slide 124

## Slide 125