PSYCHOLOGICAL 

FIRST AID 

Field Operations Guide 

2nd Edition 

National Child Traumatic Stress Network 

National Center for PTSD 
National Child Traumatic Stress Network 

Established by Congress in 2000, the National Child Traumatic Stress Network (NCTSN) is a unique 

collaboration of academic and community-based service centers whose mission is to raise the standard of 

care and increase access to services for traumatized children and their families across the United States. 

Combining knowledge of child development, expertise in the full range of child traumatic experiences, and 

attention to cultural perspectives, the NCTSN serves as a national resource for developing and disseminating 

evidence-based interventions, trauma-informed services, and public and professional education. 

National Center for PTSD 

VA’s National Center for PTSD is a world leader in research and education programs focusing on PTSD 

and other psychological and medical consequences of traumatic stress. Mandated by Congress in 1989, 

the Center is a consortium of seven academic centers of excellence providing research, education and 

consultation in the field of traumatic stress. 

The views, opinions, and content are those of the authors, and do not necessarily reflect those of SAMHSA or 

HHS. 

Copyright © 2006 Brymer M, Jacobs A, Layne C, Pynoos R, Ruzek J, Steinberg A, Vernberg E, Watson 

P, (National Child Traumatic Stress Network and National Center for PTSD). All rights reserved. You are 

welcome to copy or redistribute this material in print or electronically provided the text is not modified, the 

authors and the National Child Traumatic Stress Network (NCTSN) and National Center for PTSD (NCPTSD) 

are cited in any use, and no fee is charged for copies of this publication. Unauthorized commercial publication 

or exploitation of this material is specifically prohibited. Anyone wishing to use any of this material for 

commercial use must request and receive prior written permission from the NCTSN. Permission for such use 

is granted on a case-by-case basis at the sole discretion of NCTSN. If you would like permission to adapt or 

license these materials, please contact Melissa Brymer, Psy.D. at mbrymer@mednet.ucla.edu. Other inquires 

can be directed to the NCTSN National Resource Center at info@nctsn.org or (919) 682-1552. 
Acknowledgements...............................................................................................................................1
 


Introduction.and.Overview..................................................................................................................5
 


Preparing.to.Deliver.Psychological.First.Aid...................................................................................13
 


Core.Actions........................................................................................................................................19
 


1. Contact and Engagement .....................................................................................................23
 


2. Safety and Comfort..............................................................................................................27
 


3. Stabilization (if needed).......................................................................................................49
 


4. Information Gathering: Needs and Current Concerns .........................................................57
 


5. Practical Assistance ..............................................................................................................65
 


6. Connection with Social Supports.........................................................................................69
 


7. Information on Coping.........................................................................................................77
 


8. Linkage with Collaborative Services...................................................................................93
 


LIST.OF.APPENDICES:...................................................................................................................97
 


Appendix.A:.

Overview of Psychological First Aid .............................................................................................99
 


Appendix.B:.

Service Delivery Sites and Settings .............................................................................................103
 


Appendix.C:.

Psychological First Aid Provider Care .........................................................................................109
 


Appendix.D:.

Psychological First Aid Worksheets ............................................................................................119
 


Appendix.E:.

Handouts for Survivors................................................................................................................125
 


Appendix.F:.

Duplicate Handouts to Copy and Distribute 

Psychological First Aid 

Table of Contents 

Psychological First Aid - Field Operations Guide I 
.This.page.intentionally.left.blank. 
Acknowledgements 

This Psychological First Aid Field Operations Guide was developed by the National Child 
 

Traumatic Stress Network and the National Center for PTSD. Members of the National 
 

Child Traumatic Stress Network and the National Center for PTSD, as well as other 
 

individuals involved in coordinating and participating in disaster response, have contributed 
 

to the current document.
 


The principal authors (in alphabetical order) included: Melissa Brymer, Christopher Layne, 
 

Anne Jacobs, Robert Pynoos, Josef Ruzek, Alan Steinberg, Eric Vernberg, and Patricia 
 

Watson.
 


Special contributors included: Steve Berkowitz, Dora Black, Carrie Epstein, Julian Ford, 
 

Laura Gibson, Robin Gurwitch, Jack Herrmann, Jessica Hamblen, Russell Jones, Robert 
 

Macy, William Saltzman, Janine Shelby, Merritt Schreiber, Betty Pfefferbaum, Rose 
 

Pfefferbaum, Margaret Samuels, Cynthia Whitham, Bonita Wirth, and Bruce Young. 
 

Additional material for this Psychological First Aid Field Operations Guide was drawn 
 

from an adaptation by the Medical Reserve Corps (MRC). Principal authors for the MRC 
 

adaptation (in alphabetical order) included: Abbe Finn, Jack Herrmann, John Hickey, 
 

Edward Kantor, Patricia Santucci, and James Shultz. Additional content was provided by 
 

members of the Clergy Adaptation Group, including from Fuller Theological Seminary 
 

(in alphabetical order): David Augsburger, Cynthia Eriksson, David Foy, Peter Kung, 
 

Doug McConnell, Kathy Putnam, Dave Scott, and Jennifer Orona; from the HealthCare 
 

Chaplaincy (in alphabetical order): Nathan Goldberg, George Handzo, Yusuf Hasan, Martha 
 

Jacobs, Jon Overvold, and Eun Joo Kim; and from the Adolescent Trauma Treatment 
 

Development Center of the North Shore Long Island Jewish Health System (in alphabetical 
 

order): Christine DiBenedetto, Sandra Kaplan, Victor Labruna, Ayme Turnbull, and Juliet 
 

Vogel. Additional content was also provided by the University of California, San Francisco 
 

(in alphabetical order): Chandra Ghosh Ippen, Alicia Lieberman, and Patricia Van Horn.
 


A SAMHSA-supported expert review panel was convened on March 31-April 1, 2005. 
 

Participants made invaluable contributions. Those attending included: Miksha Nation, 
 

Cecilia Revera-Casale, Kerry Crawford, Rosemary Creeden, Daniel Dodgen, Darrin 
 

Donato, William Eisenberg, Mary Fetchet, Ellen Gerrity, Richard Gist, Ian Gordon, 
 

Susan Hamilton, Seth Hassett, Jack Herrmann, Stevan Hobfoll, Stacia Jepson, Sandra 
 

Kaplan, Susan Ko, Linda Ligenza, Steven Marans, Christina Mosser, April Naturale, 
 

Elana Newman, Bonnie O’Neill, Dori Reissman, Gilbert Reyes, Janine Shelby, and Robert 
 

Ursano. 
 

For citation: Brymer M, Jacobs A, Layne C, Pynoos R, Ruzek J, Steinberg A, Vernberg 
 

E, Watson P, (National Child Traumatic Stress Network and National Center for PTSD), 
 

Psychological First Aid: Field Operations Guide, 2nd Edition. July, 2006. Available on: 
 

www.nctsn.org and www.ncptsd.va.gov.
 


Acknowledgements
 


Psychological First Aid - Field Operations Guide  
.This.page.intentionally.left.blank. 

 National Child Traumatic Stress Network National Center for PTSD 
Psychological First Aid 

Field Operations Guide

2nd Edition 

Introduction and Overview: 

 What is Psychological First Aid?
 


 Who is Psychological First Aid for?
 


 Who Delivers Psychological First Aid?
 


 When Should Psychological First Aid Be Used?
 


 Where Should Psychological First Aid Be Used?
 


 Strengths of Psychological First Aid
 


 Basic Objectives of Psychological First Aid
 


 Delivering Psychological First Aid
 

.This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 
Introduction and Overview 

What is Psychological First Aid? 

Psychological First Aid is an evidence-informed1 modular approach to help children, 

adolescents, adults, and families in the immediate aftermath of disaster and terrorism. 

Psychological First Aid is designed to reduce the initial distress caused by traumatic 

events and to foster short- and long-term adaptive functioning and coping. Principles and 

techniques of Psychological First Aid meet four basic standards. They are: 

1. Consistent with research evidence on risk and resilience following trauma 

2. Applicable and practical in field settings 

3. Appropriate for developmental levels across the lifespan 

4. Culturally informed and delivered in a flexible manner 

Psychological First Aid does not assume that all survivors will develop severe mental 

health problems or long-term difficulties in recovery. Instead, it is based on an 

understanding that disaster survivors and others affected by such events will experience 

a broad range of early reactions (for example, physical, psychological, behavioral, 

spiritual). Some of these reactions will cause enough distress to interfere with adaptive 

coping, and recovery may be helped by support from compassionate and caring disaster 

responders. 

Who is Psychological First Aid For? 

Psychological First Aid intervention strategies are intended for use with children, 

adolescents, parents/caretakers, families, and adults exposed to disaster or terrorism. 

Psychological First Aid can also be provided to first responders and other disaster relief 

workers. 

Who Delivers Psychological First Aid? 

Psychological First Aid is designed for delivery by mental health and other disaster 

response workers who provide early assistance to affected children, families, and adults 

as part of an organized disaster response effort. These providers may be imbedded 

in a variety of response units, including first responder teams, incident command 

systems, primary and emergency health care, school crisis response teams, faith-based 

organizations, Community Emergency Response Teams (CERT), Medical Reserve Corps, 

the Citizens Corps, and other disaster relief organizations. 

1

Psychological First Aid is supported by disaster mental health experts as the “acute intervention of choice” when responding to the psychosocial needs of children, adults and families affected by disaster and terrorism. At the time of this 

writing, this model requires systematic empirical support; however, because many of the components have been guided 

by research, there is consensus among experts that these components provide effective ways to help survivors manage 

post-disaster distress and adversities, and to identify those who may require additional services. 

Psychological First Aid - Field Operations Guide  

Introduction and Overview
 

When Should Psychological First Aid Be Used? 

Psychological First Aid is a supportive intervention for use in the immediate aftermath of 

disasters and terrorism. 

Where Should Psychological First Aid Be Used? 

Psychological First Aid is designed for delivery in diverse settings. Mental health and 

other disaster response workers may be called upon to provide Psychological First 

Aid in general population shelters, special needs shelters, field hospitals and medical 

triage areas, acute care facilities (for example, Emergency Departments), staging areas 

or respite centers for first responders or other relief workers, emergency operations 

centers, crisis hotlines or phone banks, feeding locations, disaster assistance service 

centers, family reception and assistance centers, homes, businesses, and other community 

settings. For more information on the challenges of providing Psychological First Aid in 

various service settings, see Appendix B. 

Strengths of Psychological First Aid 

	 

	 

	 	

	 	

Psychological First Aid includes basic information-gathering techniques to help 

providers make rapid assessments of survivors’ immediate concerns and needs, and 

to implement supportive activities in a flexible manner. 

Psychological First Aid relies on field-tested, evidence-informed strategies that can 

be provided in a variety of disaster settings. 

Psychological First Aid emphasizes developmentally and culturally appropriate 

interventions for survivors of various ages and backgrounds. 

Psychological First Aid includes handouts that provide important information for 

youth, adults, and families for their use over the course of recovery. 

Basic Objectives of Psychological First Aid 

	 Establish a human connection in a non-intrusive, compassionate manner. 

	 Enhance immediate and ongoing safety, and provide physical and emotional 

comfort. 

	 Calm and orient emotionally overwhelmed or distraught survivors. 

	 Help survivors to tell you specifically what their immediate needs and concerns are, 

and gather additional information as appropriate. 

	 	 Offer practical assistance and information to help survivors address their immediate 

needs and concerns. 

	 	 National Child Traumatic Stress Network National Center for PTSD 

Introduction and Overview
 

	 	 Connect survivors as soon as possible to social support networks, including family 

members, friends, neighbors, and community helping resources. 

	 	 Support adaptive coping, acknowledge coping efforts and strengths, and empower 

survivors; encourage adults, children, and families to take an active role in their 

recovery. 

	 	 Provide information that may help survivors cope effectively with the psychological 

impact of disasters. 

	 	 Be clear about your availability, and (when appropriate) link the survivor to another 

member of a disaster response team or to local recovery systems, mental health 

services, public-sector services, and organizations. 

Delivering Psychological First Aid 

Professional Behavior 

 Operate only within the framework of an authorized disaster response system.
 

 Model healthy responses; be calm, courteous, organized, and helpful. 
 

 Be visible and available. 
 

 Maintain confidentiality as appropriate.
	
 

 Remain within the scope of your expertise and your designated role.
 


 Make appropriate referrals when additional expertise is needed or requested by the 
 

survivor. 

 Be knowledgeable and sensitive to issues of culture and diversity. 

 Pay attention to your own emotional and physical reactions, and practice self-care. 

Guidelines for Delivering Psychological First Aid 

 Politely observe first; don’t intrude. Then ask simple respectful questions to 

determine how you may help. 

	 	 Often, the best way to make contact is to provide practical assistance (food, water, 

blankets). 

	 	 Initiate contact only after you have observed the situation and the person or family, 

and have determined that contact is not likely to be intrusive or disruptive. 

 Be prepared that survivors will either avoid you or flood you with contact. 

 Speak calmly. Be patient, responsive, and sensitive. 

Psychological First Aid - Field Operations Guide	 	  

Introduction and Overview
 

Guidelines for Delivering Psychological First Aid - continued 

	 Speak slowly, in simple concrete terms; don’t use acronyms or jargon. 

	 If survivors want to talk, be prepared to listen. When you listen, focus on hearing 

what they want to tell you, and how you can be of help. 

	 Acknowledge the positive features of what the survivor has done to keep safe. 

	 Give information that directly addresses the survivor’s immediate goals and clarify 

answers repeatedly as needed. 

	 Give information that is accurate and age-appropriate for your audience. 

	 When communicating through a translator or interpreter, look at and talk to the 

person you are addressing, not at the translator or interpreter. 

	 Remember that the goal of Psychological First Aid is to reduce distress, assist with 

current needs, and promote adaptive functioning, not to elicit details of traumatic 

experiences and losses. 

Some Behaviors to Avoid 

	 	 Do not make assumptions about what survivors are experiencing or what they have 

been through. 

	 	 Do not assume that everyone exposed to a disaster will be traumatized. 

	 	 Do not pathologize. Most acute reactions are understandable and expectable given 

what people exposed to the disaster have experienced. Do not label reactions as 

“symptoms,” or speak in terms of “diagnoses,” “conditions,” “pathologies,” or 

“disorders.” 

	 	 Do not talk down to or patronize the survivor, or focus on his/her helplessness, 

weaknesses, mistakes, or disability. Focus instead on what the person has done 

that is effective or may have contributed to helping others in need, both during the 

disaster and in the present setting. 

	 	 Do not assume that all survivors want to talk or need to talk to you. Often, being 

physically present in a supportive and calm way helps affected people feel safer and 

more able to cope. 

	 	 Do not “debrief” by asking for details of what happened. 

	 	 Do not speculate or offer possibly inaccurate information. If you cannot answer a 

survivor’s question, do your best to learn the facts. 

Introduction and Overview
 


	 National Child Traumatic Stress Network National Center for PTSD 
Working With Children and Adolescents 

	 	 For young children, sit or crouch at the child’s eye level. 

	 	 Help school-age children verbalize their feelings, concerns and questions; provide 

simple labels for common emotional reactions (for example, mad, sad, scared, 

worried). Do not use extreme words like “terrified” or “horrified” because this may 

increase their distress. 

	 	 Listen carefully and check in with the child to make sure you understand him/her. 

	 	 Be aware that children may show developmental regression in their behavior and 

use of language. 

	 	 Match your language to the child’s developmental level. Younger children typically 

have less understanding of abstract concepts like “death.” Use direct and simple 

language as much as possible. 

	 	 Talk to adolescents “adult-to-adult,” so you give the message that you respect their 

feelings, concerns, and questions. 

	 	 Reinforce these techniques with the child’s parents/caregivers to help them provide 

appropriate emotional support to their child. 

Working with Older Adults 

 Older adults have strengths as well as vulnerabilities. Many older adults have 

acquired effective coping skills over a lifetime of dealing with adversities. 

	 	 For those who may have a hearing difficulty, speak clearly and in a low pitch. 

	 	 Don’t make assumptions based only on physical appearance or age, for example, 

that a confused elder has irreversible problems with memory, reasoning, 

or judgment. Reasons for apparent confusion may include: disaster-related 

disorientation due to change in surroundings; poor vision or hearing; poor 

nutrition or dehydration; sleep deprivation; a medical condition or problems with 

medications; social isolation; and feeling helpless or vulnerable. 

	 	 An older adult with a mental health disability may be more upset or confused 

in unfamiliar surroundings. If you identify such an individual, help to make 

arrangements for a mental health consultation or referral. 

Working With Survivors with Disabilities 

	 	 When needed, try to provide assistance in an area with little noise or other 

stimulation. 

	 	 Address the person directly, rather than the caretaker, unless direct communication 

is difficult. 

Psychological First Aid - Field Operations Guide	 	  

Introduction and Overview
 

Working With Survivors with Disabilities - continued 

	 	 If communication (hearing, memory, speech) seems impaired, speak simply and 

slowly. 

	 	 Take the word of a person who claims to have a disability–even if the disability is 

not obvious or familiar to you. 

	 	 When you are unsure of how to help, ask, “What can I do to help?” and trust what 

the person tells you. 

	 	 When possible, enable the person to be self-sufficient. 

	 	 Offer a blind or visually impaired person your arm to help him/her move about in 

unfamiliar surroundings. 

	 	 If needed, offer to write down information and make arrangements for the person to 

receive written announcements. 

	 	 Keep essential aids (such as medications, oxygen tank, respiratory equipment, and 

wheelchair) with the person. 

Introduction and Overview
 


0	 	 National Child Traumatic Stress Network National Center for PTSD 
Psychological First Aid 

Field Operations Guide

2nd Edition 

Preparing to Deliver Psychological First Aid: 

 Entering the Setting 

 Providing Services 

 Group Settings 

 Maintain a Calm Presence 

 Be Sensitive to Culture and Diversity 

 Be Aware of At-Risk Populations 
This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 
Preparing to Deliver 
 

Psychological First Aid
 

In order to be of assistance to disaster-affected communities, the Psychological First Aid 

provider must be knowledgeable about the nature of the event, current circumstances, and the 

type and availability of relief and support services. 

Planning and preparation are important when working as a Psychological First Aid provider. 

Up-to-date training in disaster mental health and knowledge of your incident command 

structure are critical components in undertaking disaster relief work. You may also be working

Preparing to Deliver
 


with children, older adults and special populations, all of which require additional in-depth 

knowledge. In deciding whether to participate in disaster response, you should consider your 

comfort level with this type of work, your current health, your family and work circumstances,

and be prepared to engage in appropriate self-care. See Appendix C for more guidance in 

regard to these topics. 

Entering the Setting 

Psychological First Aid begins when a disaster response worker enters an emergency 

management setting in the aftermath of a disaster (See Appendix B for descriptions of 

various service delivery sites). Successful entry involves working within the framework of an 

authorized Incident Command System (ICS) in which roles and decision-making are clearly 

defined. It is essential to establish communication and coordinate all activities with authorized 

personnel or organizations that are managing the setting. Effective entry also includes learning 

as much as you can about the setting, for example, leadership, organization, policies and 

procedures, security, and available support services. You need to have accurate information 

about what is going to happen, what services are available, and where they can be found. This 

information needs to be gathered as soon as possible, given that providing such information is 

often critical to reducing distress and promoting adaptive coping. 

Providing Services 

In some settings, Psychological First Aid may be provided in designated areas. In other 

settings, providers may circulate around the facility to identify those who might need 

assistance. Focus your attention on how people are reacting and interacting in the setting. 

Individuals who may need assistance include those showing signs of acute distress, including 

individuals who are: 

 Disoriented 

 Confused 

 Frantic or agitated 

Psychological First Aid - Field Operations Guide 3
Providing Services - continued 

	 Panicky 

	 Extremely withdrawn, apathetic, or “shut down” 

	 Extremely irritable or angry 

	 Exceedingly worried 

Group Settings 

While Psychological First Aid is primarily designed for working with individuals and 

families, many components can be used in group settings, such as when families gather 

together for information about loved ones and for security briefings. The components of 

providing information, support, comfort, and safety can be applied to these spontaneous group

Preparing to Deliver
 
 situations. For groups of children and adolescents, offering games for distraction can reduce 

anxiety and concern after hours and days in a shelter setting. 

When meeting with groups, keep the following in mind: 

	 Tailor the discussion to the group’s shared needs and concerns. 

	 	 Focus the discussion on problem-solving and applying coping strategies to immediate 

issues. 

	 Do not let discussion about concerns lapse into complaints. 

	 	 If an individual needs further support, offer to meet with him/her after the group 

discussion. 

Maintain a Calm Presence 

People take their cue from how others are reacting. By demonstrating calmness and clear 

thinking, you can help survivors feel that they can rely on you. Others may follow your lead 

in remaining focused, even if they do not feel calm, safe, effective, or hopeful. Psychological 

First Aid providers often model the sense of hope that survivors cannot always feel while they 

are still attempting to deal with what happened and current pressing concerns. 

Be Sensitive to Culture and Diversity 

Providers of Psychological First Aid must be sensitive to culture, ethnic, religious, racial, and 

language diversity. Whether providing outreach or services, you should be aware of your own 

values and prejudices, and how these may agree with or differ from those of the community 

being served. Training in cultural competence can facilitate this awareness. Helping to 

maintain or reestablish customs, traditions, rituals, family structure, gender roles, and social 

bonds is important in helping survivors cope with the impact of a disaster. Information about 

the community being served, including how emotions and other psychological reactions are 

4	 	 National Child Traumatic Stress Network National Center for PTSD 
expressed, attitudes toward government agencies, and receptivity to counseling, should be 

gathered with the assistance of community cultural leaders who represent and best understand 

local cultural groups. 

Be Aware of At-Risk Populations 

Individuals that are at special risk after a disaster include: 

 Children, especially those: 

 Separated from parents/caregivers 

 Whose parents/caregivers, family members, or friends have died 

 Whose parents/caregivers were significantly injured or are missing 

 Involved in the foster care system 

 Those who have been injured 

 Those who have had multiple relocations and displacements 

 Medically frail children and adults 

 Those with serious mental illness 

 Those with physical disability, illness, or sensory deficit 

 Adolescents who may be risk-takers 

 Adolescents and adults with substance abuse problems 

 Pregnant women 

 Mothers with babies and small children 

 Disaster response personnel 

 Those with significant loss of possessions (for example, home, pets, family 

memorabilia) 

 Those exposed first hand to grotesque scenes or extreme life threat 

Especially in economically disadvantaged groups, a high percentage of survivors may have 

experienced prior traumatic events (for example, death of a loved one, assault, disaster). 

As a consequence, minority and marginalized communities may have higher rates of preexisting trauma-related mental health problems, and are at greater risk for developing 

problems following disaster. Mistrust, stigma, fear (for example, of deportation), and lack of 

knowledge about disaster relief services are important barriers to seeking, providing, and 

receiving services for these populations. Those living in disaster-prone regions are more 

likely to have had prior disaster experiences. 

Psychological First Aid - Field Operations Guide  

Preparing to Deliver
 

This.page.intentionally.left.blank. 

 National Child Traumatic Stress Network National Center for PTSD 
Psychological First Aid 

Field Operations Guide

2nd Edition 

Core Actions: 

 Contact and Engagement 

 Safety and Comfort 

 Stabilization 

 Information Gathering: Current Needs and Concerns 

 Practical Assistance 

 Connection with Social Supports 

 Information on Coping 

 Linkage with Collaborative Services 
This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 
Core Actions 

Psychological First Aid Core Actions 

1. Contact and Engagement 

Goal: To respond to contacts initiated by survivors, or to initiate contacts in a nonintrusive, compassionate, and helpful manner. 

2. Safety and Comfort 

Goal: To enhance immediate and ongoing safety, and provide physical and 
 

emotional comfort.
 

3. Stabilization (if needed) 

Goal: To calm and orient emotionally overwhelmed or disoriented survivors. 

4. Information Gathering: Current Needs and Concerns 

Goal: To identify immediate needs and concerns, gather additional information, 

and tailor Psychological First Aid interventions. 

5. Practical Assistance 

Goal: To offer practical help to survivors in addressing immediate needs and 

concerns. 

6. Connection with Social Supports 

Goal: To help establish brief or ongoing contacts with primary support persons 

and other sources of support, including family members, friends, and community 

helping resources. 

7. Information on Coping 

Goal: To provide information about stress reactions and coping to reduce distress 

and promote adaptive functioning. 

8. Linkage with Collaborative Services 

Goal: To link survivors with available services needed at the time or in the future. 

These core actions of Psychological First Aid constitute the basic objectives of providing 

early assistance within days or weeks following an event. Providers should be flexible, 

and base the amount of time they spend on each core action on the survivors’ specific 

needs and concerns. 

Psychological First Aid - Field Operations Guide  

Core Actions
 

This.page.intentionally.left.blank. 

0 National Child Traumatic Stress Network National Center for PTSD 
Psychological First Aid 

Field Operations Guide

2nd Edition 

Contact and Engagement: 

 Introduce Yourself/Ask about Immediate Needs 

 Confidentiality 
.This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 
. Contact and Engagement 

Goal:.To.respond.to.contacts.initiated.by.survivors,.or.to.initiate.contacts.in.a.nonintrusive,.compassionate,.and.helpful.manner.

Your first contact with a survivor is important. If managed in a respectful and 

compassionate way, you can establish an effective helping relationship and increase the 

person’s receptiveness to further help. Your first priority should be to respond to survivors 

who seek you out. If a number of people approach you simultaneously, make contact with 

as many individuals as you can. Even a brief look of interest and calm concern can be 

grounding and helpful to people who are feeling overwhelmed or confused. 

Culture.Alert: The type of physical or personal contact considered appropriate may vary 

from person to person and across cultures and social groups, for example, how close to 

stand to someone, how much eye contact to make or whether or not to touch someone, 

especially someone of the opposite sex. Unless you are familiar with the culture of the 

survivor, you should not approach too closely, make prolonged eye contact, or touch. You 

should look for clues to a survivor’s need for “personal space,” and seek guidance about 

cultural norms from community cultural leaders who best understand local customs. 

In working with family members, find out who is the spokesperson for the family and 

initially address this person. 

Some survivors may not seek your help, but may benefit from assistance. When you 

identify such persons, timing is important. Do not interrupt conversations. Do not assume 

that people will respond to your outreach with immediate positive reactions. It may take 

time for some survivors or bereaved persons to feel some degree of safety, confidence, 

and trust. If an individual declines your offer of help, respect his/her decision and indicate 

when and where to locate a Psychological First Aid provider later on. 

Introduce Yourself/Ask about Immediate Needs 

Introduce yourself with your name, title, and describe your role. Ask for permission to 

talk to him/her, and explain that you are there to see if you can be of help. Unless given 

permission to do otherwise, address adult survivors using last names. Invite the person to 

sit, try to ensure some level of privacy for the conversation, and give the person your full 

attention. Speak softly and calmly. Refrain from looking around or being distracted. Find 

out whether there is any pressing problem that needs immediate attention. Immediate 

medical concerns have the utmost priority. 

When making contact with children or adolescents, it is good practice to first make a 

connection with a parent or accompanying adult to explain your role and seek permission. 

If you speak with a child in distress when no adult is present, find a parent or caregiver as 

soon as possible to let him/her know about your conversation. 

Psychological First Aid - Field Operations Guide 3

Contact and Engagement
 

Introduce Yourself/Ask about Immediate Needs - continued 

For example, in making initial contact, you might say: 

Contact and Engagement 

Adult/Caregiver Hello. My name is ___________. I work with __________. 

I’m checking in with people to see how they are doing, and 

to see if I can help in any way. Is it okay if I talk to you for a 

few minutes? May I ask your name? Mrs. Williams, before 

we talk, is there something right now that you need, like some 

water or fruit juice? 

Adolescent/Child And is this your daughter? (Get on child’s eye level, smile 

and greet the child, using her/his name and speaking softly.) 

Hi Lisa, I’m ___________ and I’m here to try to help you and 

your family. Is there anything you need right now? There is 

some water and juice over there, and we have a few blankets 

and toys in those boxes. 

Confidentiality

Protecting the confidentiality of your interactions with children, adults, and families 

after a disaster can be challenging, especially given the lack of privacy in some postdisaster settings. However, maintaining the highest level of confidentiality possible in 

any conversation you have with survivors or disaster responders is extremely important. 

If you are a professional who belongs to a category of mandated reporters, you should 

abide by state abuse and neglect reporting laws. You should also be aware of the Health 

Insurance Portability and Accountability Act (HIPAA) and the provisions related to 

disaster and terrorism. If you have questions about releasing information, discuss this 

with a supervisor or an official in charge. Talking to co-workers about the challenges of 

working in the post-disaster environment can be helpful, but any discussions organized 

for this purpose also need to preserve strict confidentiality. 

4 National Child Traumatic Stress Network National Center for PTSD 
Psychological First Aid 

Field Operations Guide

2nd Edition 

Safety and Comfort: 
 

 Ensure Immediate Physical Safety 

 Provide Information about Disaster Response Activities and 

Services 

	 Attend to Physical Comfort 

	 Promote Social Engagement 

	 Attend to Children Who Are Separated from their Parents/

Caregivers 

	 Protect from Additional Traumatic Experiences and Trauma 

Reminders 

 Help Survivors Who Have a Missing Family Member 

 Help Survivors When a Family Member or Close Friend has Died 

 Attend to Grief and Spiritual Issues 

 Provide Information about Casket and Funeral Issues 

 Attend to Issues Related to Traumatic Grief 

 Support Survivors Who Receive Death Notification 

 Support Survivors Involved in Body Identification 

 Help Caregivers Confirm Body Identification to a Child or

Adolescent 
.This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 
. Safety and Comfort 

Goal:.To.enhance.immediate.and.ongoing.safety,.and.provide.physical.and.

emotional.comfort.

Restoration of a sense of safety is an important goal in the immediate aftermath of 

disaster and terrorism. Promoting safety and comfort can reduce distress and worry. 

Assisting survivors in circumstances of missing loved ones, death of loved ones, death 

notification and body identification is a critical component of providing emotional 

comfort and support. 

Comfort and safety can be supported in a number of ways, including helping survivors: 

	 	 Do things that are active (rather than passive waiting), practical (using available 

resources), and familiar (drawing on past experience). 

	 	 Get current, accurate and up-to-date information, while avoiding survivors’ 

exposure to information that is inaccurate or excessively upsetting. 

	 Get connected with available practical resources. 

	 Get information about how responders are making the situation safer. 

	 Get connected with others who have shared similar experiences. 

Ensure Immediate Physical Safety 

Make sure that individuals and families are physically safe to the extent possible. If 

necessary, reorganize the immediate environment to increase physical and emotional 

safety. For example: 

	 Find the appropriate officials who can resolve safety concerns that are beyond your 

control, such as threats, weapons, etc. 

	 	 Remove broken glass, sharp objects, furniture, spilled liquids, and other objects that 

could cause people to trip and fall. 

	 	 Make sure that children have a safe area in which to play and that they are 

adequately supervised. 

	 Be aware and ensure the safety of survivors in a particular subgroup that may be 

targeted for persecution based on their ethnicity, religion, or other affiliations. 

To promote safety and comfort for survivors who are elderly or disabled, you can: 

	 	 Help make the physical environment safer (for example, try to ensure adequate 

lighting, and protect against slipping, tripping, and falling). 

	 Ask specifically about his/her needs for eyeglasses, hearing aids, wheelchairs, 

walkers, canes, or other devices. Try to ensure that all essential aids are kept with 

the person. 

Psychological First Aid - Field Operations Guide	 	  

Safety and Comfort
 

Ensure Immediate Physical Safety - continued 

	 	 Ask whether the survivor needs help with health-related issues or daily activities (for 

example, assistance with dressing, use of bathroom, daily grooming, and meals). 

	 	 Inquire about current need for medication. Ask if he/she has a list of current medications or 

where this information can be obtained, and make sure he/she has a readable copy of this 

information to keep during the post-disaster period. 

	 	 Consider keeping a list of survivors with special needs so that they can be checked on more 

frequently. 

	 	 Contact relatives, if they are available, to further ensure safety, nutrition, medication, and 

rest. Make sure that the authorities are aware of any daily needs that are not being met. 

If there are medical concerns requiring urgent attention or immediate need for medication, 

contact the appropriate unit leader or medical professional immediately. Remain with the affected 

person or find someone to stay with him/her until you can obtain help. Other safety concerns 

involve: 

	 	 Threat of harm to self or others–Look for signs that persons may hurt themselves or others 

(for example, the person expresses intense anger towards self or others, exhibits extreme 

agitation). If so, seek immediate support for containment and management by medical, 

EMT assistance, or a security team. 

	 	 Shock–If an individual is showing signs of shock (pale, clammy skin; weak or rapid pulse; 

dizzy; irregular breathing; dull or glassy eyes; unresponsive to communication; lack of 

bladder or bowel control; restless, agitated, or confused), seek immediate medical support. 

Providing Information about Disaster Response Activities and Services 

To help reorient and comfort survivors, provide information about: 

	 What to do next 

	 What is being done to assist them 

	 What is currently known about the unfolding event 

	 Available services 

	 Common stress reactions 

	 Self-care, family care, and coping 

In providing information: 

	 Use your judgment as to whether and when to present information. Does the individual 

appear able to comprehend what is being said, and is he/she ready to hear the content of the 

messages? 

	 	 National Child Traumatic Stress Network National Center for PTSD 

Safety and Comfort
 

Adult/Caregiver/	 From what I understand, we will start transporting people to the 

Safety and Comfort 
 Adolescent	 shelter at West High School in about an hour. There will be food, 
 

clean clothing, and a place to rest. Please stay in this area. A member of the team will look for you here when we are ready to go.
 

Child	 Here’s what’s going to happen next. You and your mom are going 
 

together soon to a place called a shelter, which really is just a safe 
 

building with food, clean clothing, and a place to rest. Stay here 
 

close to your mom until it’s time to go.
 

Do not reassure people that they are safe unless you have definite factual information that this 

is the case. Also do not reassure people of the availability of goods or services (for example, 

toys, food, medicines) unless you have definite information that such goods and services will 

be available. However, do address safety concerns based on your understanding of the current 

situation. For example, you may say: 

Adult/Caregiver Mrs. Williams, I want to assure you that the authorities are responding as well as they can right now. I am not sure that the fire 

has been completely contained, but you and your family are not in 

danger here. Do you have any concerns about your family’s safety 

right now? 

Adolescent We’re working hard to make you and your family safe. Do you 

have any questions about what happened, or what is being done to 

keep everyone safe? 

Child Your mom and dad are here, and many people are all working 

hard together so that you and your family will be safe. Do you 

have any questions about what we’re doing to keep you safe? 

	 	 Address immediate needs and concerns to reduce fears, answer pressing questions, 

and support adaptive coping. 

	 	 Use clear and concise language, while avoiding technical jargon. 

Ask survivors if they have any questions about what is going to happen, and give simple 

accurate information about what they can expect. Also, ask whether he/she has any special 

needs that the authorities should know about in order to decide on the best placement. Be 

sure to ask about concerns regarding current danger and safety in their new situation. Try to 

connect survivors with information that addresses these concerns. If you do not have specific 

information, do not guess or invent information in order to provide reassurance. Instead, 

develop a plan with the person for ways you and he/she can gather the needed information. 

Examples of what you might say include: 

Psychological First Aid - Field Operations Guide	 	 
Attend to Physical Comfort 

Look for simple ways to make the physical environment more comfortable. If possible, 

consider things like temperature, lighting, air quality, access to furniture, and how 

the furniture is arranged. In order to reduce feelings of helplessness or dependency, 

encourage survivors to participate in getting things needed for comfort (for example, 

offer to walk over to the supply area with the person rather than retrieving supplies for 

him/her). Help survivors to soothe and comfort themselves and others around them. 

For children, toys like soft teddy bears that they can hold and take care of can help 

them to soothe themselves. However, avoid offering such toys if there are not enough 

to go around to all children who may request them. You can help children learn how to 

take care of themselves by explaining how they can “care” for their toy (for example, 

“Remember that she needs to drink lots of water and eat three meals a day–and you can 

do that, too”). 

When working with the elderly or people with disabilities, pay attention to factors that 

may increase their vulnerability to stress or worsen medical conditions. When attending 

to the physical needs of these survivors, be mindful of: 

	 Health problems, such as physical illness, problems with blood pressure, fluid and 

electrolyte balance, respiratory issues (supplemental oxygen dependency), frailty 

(increased susceptibility to falls, minor injuries, bruising, and temperature extremes) 

	 Age-related sensory loss: 

	 Visual loss, which can limit awareness of surroundings and add to confusion 

	 Hearing loss, resulting in gaps in understanding of what others are saying 

	 Cognitive problems, such as difficulty with attention, concentration, and memory 

	 Lack of mobility 

	 Unfamiliar or over-stimulating surroundings 

	 Noise that can limit hearing and interfere with hearing devices 

	 	 Limited access to bathroom facilities or mass eating areas, or having to wait in long 

lines (A person who has not needed a wheelchair before the event may need one 

now.) 

	 Concern for the safety of a service animal 

Promote Social Engagement 

Facilitate group and social interactions as appropriate. It is generally soothing and 

reassuring to be near people who are coping adequately with the situation. On the 

other hand, it is upsetting to be near others who appear very agitated and emotionally 

National Child Traumatic Stress Network National Center for PTSD 

Safety and Comfort
 


30 
overwhelmed. If survivors have heard upsetting information or been exposed to rumors, 

help to clarify and correct misinformation. 

Children, and to some extent adolescents, are particularly likely to look to adults for 

cues about safety and appropriate behavior. When possible, place children near adults 

or peers who appear relatively calm, and when possible, avoid putting them too close to 

individuals who are extremely upset. Offer brief explanations to children and adolescents 

who have observed extreme reactions in other survivors. 

Child/Adolescent That man is so upset that he can’t calm down yet. Some people 

take longer to calm down than others. Someone from our team is 

coming over to help him calm down. If you feel upset, it is important for you to talk to your mom or dad, or someone else who can 

help you feel better. 

As appropriate, encourage people who are coping adequately to talk with others who are 

distressed or not coping as well. Reassure them that talking to people, especially about 

things they have in common (for example, coming from nearby neighborhoods or having 

children about the same age), can help them support one another. This often reduces 

a sense of isolation and helplessness in both parties. For children, encourage social 

activities like reading out loud, doing a joint art activity, and playing cards, board games, 

or sports. 

Attend to Children Who Are Separated from their Parents/Caregivers 

Parents and caregivers play a crucial role in children’s sense of safety and security. 

If children are separated from their caregivers, helping them reconnect quickly is a 

high priority. If you encounter an unaccompanied child, ask for information (such as 

their name, parent/caregiver and sibling names, address, and school), and notify the 

appropriate authorities. Provide children accurate information in easy-to-understand 

terms about who will be supervising them and what to expect next. Do not make any 

promises that you may not be able to keep, such as promising that they will see their 

caregiver soon. You may also need to support children while their caregivers are being 

located or during periods when caregivers may be overwhelmed and not emotionally 

accessible to their children. This support can include setting up a child-friendly space. 

Set Up a Child-Friendly Space 

 Help to create a designated child-friendly space, such as a corner or a room that is 

safe, out of high traffic areas, and away from rescue activities. 

	 	 Arrange for this space to be staffed by caregivers with experience and skill in 

working with children of different ages. 

	 	 Monitor who comes in and out of the child area to ensure that children do not leave 

with an unauthorized person. 

Psychological First Aid - Field Operations Guide	 	 3 

Safety and Comfort
 

Set Up a Child-Friendly Space - continued 

	 	 Stock the child-friendly space with materials for all age ranges. This can include 

kits with toys, playing cards, board games, balls, paper, crayons, markers, books, 

safety scissors, tape, and glue. 

	 	 Activities that are calming include playing with Legos, wooden building blocks, or 

play dough, doing cut-outs, working on coloring books (containing neutral scenes 

of flowers, rainbows, trees, or cute animals) and playing team games. 

	 	 Invite older children or adolescents to serve as mentors/role models for younger 

children, as appropriate. They can do this by helping you conduct group play 

activities with younger children, or by reading a book to them or playing with them. 

	 	 Set aside a special time for adolescents to get together to talk about their concerns, 

and to engage in age-appropriate activities like listening to music, playing games, 

making up and telling stories, or making a scrapbook. 

Protect from Additional Traumatic Experiences and Trauma Reminders 

In addition to securing physical safety, it is also important to protect survivors from 

unnecessary exposure to additional traumatic events and trauma reminders, including 

sights, sounds, or smells that may be frightening. To help protect their privacy, shield 

survivors from reporters, other media personnel, onlookers, or attorneys. Advise 

adolescents that they can decline to be interviewed by the media, and that if they wish to 

be interviewed, they may want to have a trusted adult with them. 

If survivors have access to media coverage (for example, television or radio broadcasts), 

point out that excessive viewing of such coverage can be highly upsetting, especially 

for children and adolescents. Encourage parents to monitor and limit their children’s 

exposure to the media, and to discuss any concerns after such viewing. Parents can let 

their children know that they are keeping track of information, and to come to them for 

updates instead of watching television. Remind parents to be careful about what they 

say in front of their children, and to clarify things that might be upsetting to them. For 

example, you might say: 

Adult/Caregiver You’ve been through a lot, and it’s a good idea to shield yourself 

and your children from further frightening or disturbing sights and 

sounds as much as possible. Even televised scenes of the disaster 

can be very disturbing to children. You may find that your children 

feel better if you limit their television viewing of the disaster. It 

doesn’t hurt for adults to take a break from all the media coverage, 

too. 

Safety and Comfort
 


3	 	 National Child Traumatic Stress Network National Center for PTSD 
Adolescent/Child You’ve been through a lot already. People often want to watch TV or 

go to the internet after something like this, but doing this can be pretty 

scary. It’s best to stay away from TV or radio programs that show this 

stuff. You can also tell your mom or dad if you see something that 

bothers you. 

Safety and Comfort
 

Help Survivors Who Have a Missing Family Member 

Coping while a loved one is missing is extremely difficult. Family members may experience a 

number of different feelings: denial, worry, hope, anger, shock, or guilt. They may alternate between 

certainty that the person is alive—even in the face of contradictory evidence—and hopelessness 

and despair. They may blame authorities for not having answers, for not trying hard enough, or for 

delays. They may also feel vengeful against those that they consider responsible for locating their 

missing relative or friend. It is extremely important to reassure children that the family, police, and 

other first responders are doing everything possible to find the missing loved one. 

Assist family members who have a missing loved one by helping them obtain updated information 

about missing persons, direct them to locations for updated briefings, and tell them the plan in 

place for connecting/reuniting survivors. The American Red Cross has established a “Disaster 

Welfare Information System” to support family communication and reunification, and a “Safe and 

Well” website located at www.redcross.org. It provides a variety of tools and services needed to 

communicate with loved ones during times of emergency. Try to identify other official sources 

of updated information (police, official radio and television channels, etc.) and share these with 

survivors. 

You may want to take extra time with survivors worried over a missing family member. Just being 

there to listen to survivors’ hopes and fears, and being honest in giving information and answering 

questions is often deeply appreciated. To help locate a missing family member, you can make an 

initial review with the family of any pre-disaster plans for post-disaster contact, including school or 

workplace evacuation plans; plans for tracking transport of students or co-workers for medical care; 

out-of-state telephone numbers to be used by schools, workplaces, or families in case of emergency; 

and any pre-arranged or likely meeting places (including homes of relatives), both within and 

outside the disaster perimeter. 

Some family members may want to leave a safe area to attempt to find or rescue a missing loved 

one. In this case, inform the survivor about the current circumstances in the search area, specific 

dangers, needed precautions, the efforts of first responders, and when updated information may be 

available. Discuss specific concerns they may have (for example, an elderly parent who recently 

had hip surgery, or a child who needs special medications), and offer to inform the appropriate 

authorities. 

In some cases, authorities may ask survivors to give information or other evidence to help the 

search. Authorities may have family members file a missing persons report or provide information 

about when and where the missing person was last seen, who else was there, and what he/she was 

wearing. It is best to limit the exposure of younger children to this process. 

Psychological First Aid - Field Operations Guide 33
Help Survivors Who Have a Missing Family Member - continued 

It can be disturbing and confusing for a child to be present at a caregiver’s interview 

with authorities or to hear adult speculations about what might have happened to the 

missing person. Authorities may ask a family member to collect DNA from a loved one’s 

personal effects, for example, hair from a hairbrush. In rare cases, a child may need to be 

interviewed because he/she was the last one to see the missing person. A mental health 

or forensic professional trained to interview children should conduct the interview or 

be present. A supportive family member or you should accompany the child. Talk to the 

child simply and honestly. For example, you might say: 

Adolescent/Child Uncle Mario is missing. Everyone is working very hard to find out 

what happened. The police are helping too and they need to ask 

you some questions. It’s okay if you do not remember something. 

Just tell them that you don’t remember. Not remembering something will not hurt Uncle Mario. Your mom will stay with you the 

whole time, and I can stay too, if you want. Do you have any questions? 

Sometimes in the case of missing persons, the evidence will strongly suggest that the 

person is dead. There may be disagreement among family members about the status of 

their loved one. You should let family members know that these differences (some giving 

up hope, some remaining hopeful) are common in a family when a loved one is missing, 

and not a measure of how much they love the person or each other. You can encourage 

family members to be patient, understanding, and respectful of each other’s feelings until 

there is more definite news. Parents/caregivers should not assume that it is better for a 

child to keep hoping that the person is alive, but instead honestly share the concern that 

the loved one may be dead. Parents/caregivers should check with children to make sure 

that they have understood, and ask what questions they have. 

Help Survivors When a Family Member or Close Friend has Died 

Culture.Alert: Beliefs and attitudes about death, funerals, and expressions of grief are 

strongly influenced by family, culture, religious beliefs, and rituals related to mourning. 

Learn about cultural norms with the assistance of community cultural leaders who best 

understand local customs. Even within cultural and religious groups, belief and practices 

can vary widely. Do not assume that all members of a given group will believe or behave 

the same way. It is important for families to engage in their own traditions, practices, and 

rituals to provide mutual support, seek meaning, manage a range of emotional responses 

and death-related adversities, and honor the dead person. 

Safety and Comfort
 


34 National Child Traumatic Stress Network National Center for PTSD 
Acute.Grief.Reactions are likely to be intense and prevalent among those who have 

suffered the death of a loved one or close friend. They may feel sadness and anger over 

the death, guilt over not having been able to prevent the death, regret about not providing 

comfort, or having a proper leave-taking, missing the deceased, and wishing for reunion 

(including dreams of seeing the person again). Although painful to experience at first, 

grief reactions are healthy responses that reflect the significance of the death. Over time, 

grief reactions tend to include more pleasant thoughts and activities, such as telling 

positive stories about a loved one, and comforting ways of remembering him/her. You 

should remember: 

	 	 Treat acutely bereaved children and adults with dignity, respect, and compassion. 

	 	 Grief reactions vary from person to person. 

	 	 There is no single “correct” course of grieving. 

	 	 Grief puts people at risk for abuse of over-the-counter medications, increased 

smoking, and consumption of alcohol. Make survivors aware of these risks, the 

importance of self-care, and the availability of professional help. 

In working with survivors who have experienced the death of a family member or close 

friend, you can: 

	 	 Discuss how family members and friends will each have their own special set 

of reactions; no particular way of grieving is right or wrong, and there is not a 

“normal” period of time for grieving. What is most important for family members 

and friends is to respect and understand how each may be experiencing their own 

course of grief. 

	 	 Discuss with family members and friends how culture or religious beliefs influence 

how people grieve and especially how rituals may or may not satisfy current 
 

feelings of each family member.
 

	 	 Keep in mind that children may only show their grief for short periods of time each 

day, and even though they may play or engage in other positive activities, their grief 

can be just as strong as that of any other family member. 

To emphasize how important is it for family members to understand and respect each 

other’s course of grief, you may say: 

Adult/Adolescent/ It is important to know that each family member may express their 

Child grief differently. Some may not cry, while others might cry a lot. 

Family members should not feel badly about this or think there is 

something wrong with them. What is most important is to respect 

the different ways each feels, and help each other in the days and 

weeks ahead. 

Safety and Comfort
 


Psychological First Aid - Field Operations Guide	 	 3
Help Survivors When a Family Member or Close Friend has Died - continued 

Some children and adolescents will not have words to describe their feelings of grief and may 

resist talking with others about how they feel. Sometimes, distracting activities will be more 

calming than conversation, for example, drawing, listening to music, reading, etc. Some may wish 

to be alone. If safe, provide them with some privacy. When a survivor does want to talk with you 

about the loved one, you should listen quietly, and not feel compelled to talk a lot. Do not probe. 

Do:

	 

	 

	 

	 

	 

Reassure grieving individuals that what they are experiencing is understandable and 

expectable. 

Use the deceased person’s name, rather than referring to him/her as “the deceased.” 

Let them know that they will most likely continue to experience periods of sadness, 

loneliness, or anger. 

Tell them that if they continue to experience grief or depression that affects daily 

functioning, talking to a member of the clergy or a counselor who specializes in grief is 

advisable. 

Tell them that their doctor, their city or county department of mental health, or their local 

hospital can refer them to appropriate services. 

Don’t.say:





























I know how you feel.
 


It was probably for the best.
 


He is better off now. 
 

It was her time to go.
 


At least he went quickly.
 


Let’s talk about something else.
 


You should work towards getting over this.
 


You are strong enough to deal with this.
 


You should be glad he passed quickly.
 


That which doesn’t kill us makes us stronger.
 


You’ll feel better soon.
 


You did everything you could.
 


You need to grieve.
 


You need to relax.
 


3	 	 National Child Traumatic Stress Network National Center for PTSD 

Safety and Comfort
 















It’s good that you are alive. 

It’s good that no one else died. 

It could be worse; you still have a brother/sister/mother/father. 

Everything happens for the best according to a higher plan. 

We are not given more than we can bear. 

(To a child) You are the man/woman of the house now. 

Someday you will have an answer. 

If the grieving person says any of the above things, you can respectfully acknowledge the 

feeling or thought, but don’t initiate a statement like these yourself. 

Child.and.adolescent.understanding.of.death varies depending on age and prior experience 

with death, and is strongly influenced by family, religious, and cultural values. 

	 

	 

	 

Pre-school children may not understand that death is permanent, and may believe that 

if they wish it, the person can return. They need help to confirm the physical reality of a 

person’s death–that he/she is no longer breathing, moving or having feelings–and has no 

discomfort or pain. They may be concerned about something bad happening to another 

family member. 

School-age children may understand the physical reality of death, but may personify 

death as a monster or skeleton. In longing for his/her return, they may experience 

upsetting feelings of the “ghostlike” presence of the lost person, but not tell anyone. 

Adolescents generally understand that death is irreversible. Losing a family member or 

friend can trigger rage and impulsive decisions, such as quitting school, running away, or 

abusing substances. These issues need prompt attention by the family or school. 

The.death.of.a.parent/caregiver.affects children differently depending on their age. 

	 	

	 	

	 	

Pre-school children need consistent care and a predictable daily routine as soon as 

possible. They can be easily upset by change: food prepared differently, their special 

blanket missing, or being put into bed at night without the usual person or in a different 

way. Caregivers (including the surviving parent) should ask the child if they are doing 

something differently or something “wrong” (for example, “Am I not doing this the way 

Mommy did?”). 

A school-age child loses not only his/her primary caregiver, but also the person who 

would normally be there to comfort him/her and help with daily activities. Other 

caregivers should try, as best they can, to assume these roles. Children may be angry at a 

substitute caregiver, especially when disciplined. Caregivers should acknowledge that the 

child is missing his/her parent/caregiver, and then provide extra comfort. 

Adolescents may experience an intense sense of unfairness, and protest over the death. 

They may have to take on greater responsibilities within their family and resent not being 

Safety and Comfort
 


Psychological First Aid - Field Operations Guide	 	 3
Help Survivors When a Family Member or Close Friend has Died - continued

Safety and Comfort
 


able to have more independence or do the things that adolescents normally do. Over 

time, caregivers should discuss how to balance these different needs. 

You may give parents/caregivers some suggestions.for.talking.with.children.and.

adolescents.about.death. These include: 

 Assure children that they are loved and will be cared for.
 


 Watch for signs that the child may be ready to talk about what happened.
 


 Do not make the child feel guilty or embarrassed about wanting or not wanting to talk.
 


 Do not push children to talk.
 


 Give short, simple, honest, and age-appropriate answers to their questions.
 


 Listen carefully to their feelings without judgment.
 


 Reassure them that they did not cause the death, that it was not their fault, and that it 
 

was not a punishment for anything that anyone did “wrong.” 

 Answer questions honestly about funerals, burial, prayer, and other rituals. 

 Be prepared to respond to the child’s questions over and over again. 

 Do not be afraid to say that you don’t know the answer to a question. 

You should give information to parents/caregivers and children about reactions to the death 

that they might experience. The handout, When Terrible Things Happen (Appendix E), 

describes common reactions to the death of a loved one and ways of coping. When speaking 

to parents/caregivers, you can say: 

Parent/Caregiver It can be helpful to think about times when your children will 

miss their father, like at mealtime or bedtime. If you say something like, “It is hard not to have daddy here with us right now,” 

you can ease the discomfort everyone is feeling, make children 

feel less alone, and help them to better handle these difficult 

times. 

When you see a sudden change in your children–looking kind of 

lost or sad or even angry–and you suspect that they are missing 

their father, let them know that you, too, have times when you 

feel that way. Say something like, “You seem really sad. I’m wondering if you are thinking about your dad. Sometimes I feel very 

sad about dad, too. It’s okay to tell me when you are feeling bad 

so maybe I can help.” Help by giving them some time alone with 

those feelings, sitting quietly with them, and giving them a hug. 

3 National Child Traumatic Stress Network National Center for PTSD 
Children and adolescents sometimes feel guilty that they survived while other family 

members did not. They may believe that they caused the death in some way. Families 

need to help dispel children’s sense of responsibility and assure them that, in events 

like this, they are not to blame for what happened. For example, you may suggest that a 

caregiver say: 

Parent/Caregiver We all did what we could to try to save everybody. Daddy would 

be so happy that we are all okay. You did not do anything wrong. 

Note: Saying this once may not be enough; feelings of guilt 

may come up again and again, and a parent may need to provide 

constant assistance with a child’s ongoing worries and confusion 

about guilt. 

Attend to Grief and Spiritual Issues 

In order to assist survivors with spiritual needs after a death, you should become familiar 

with clergy who may be part of the disaster response team on-site, and with ways to 

obtain contact information for clergy of local religious groups to whom you can refer 

survivors. It is common for people to rely on religious and spiritual beliefs/practices as a 

way to cope with the death of a loved one. Survivors may use religious language to talk 

about what is happening or want to engage in prayer or other religious practices. It is not 

necessary for you to share these beliefs in order to be supportive. You are not required to 

do or say anything that violates your own beliefs. Often, simply listening and attending is 

all that is required. Things to keep in mind include: 

	 	 A good way to introduce this topic is to ask, “Do you have any religious or spiritual 

needs at this time?” This question is not meant to lead to a theological discussion or 

to your engaging in spiritual counseling. If requested, you can refer them to a clergy 

member of their choice. 

	 	 Do not contradict or try to “correct” what a person says about his/her religious 

beliefs, even if you disagree and think that it may be causing them distress. 

	 	 Do not try to answer religious questions like, “Why was this allowed to happen?” 

These questions generally represent expressions of emotion rather than real requests 

for an answer. 

	 	 If a person is clearly religious, ask if he/she wants to see a clergy member of his/her 

faith. 

	 	 Many people rely on religious objects such as prayer beads, statues, or sacred 

texts that they may have lost or left behind. Locating an object like this can help 

to increase their level of security and sense of control. A local clergy member can 

often be of help in providing these items. 

Psychological First Aid - Field Operations Guide	 	 3 

Safety and Comfort
 

Attend to Grief and Spiritual Issues - continued 

	 	 Survivors may want to pray alone or in a group. You may help by finding a suitable 

place for them to do so. For some people, facing in the proper direction while 

praying is important. You can help to orient them. 

	 You may also provide information to officials in charge regarding space and 

religious items needed for religious observances. 

	 	 If you are asked to join in prayer, you may decline if you feel uncomfortable. Keep 

in mind that joining may only involve standing in silence while they pray. If you are 

comfortable joining in at the end with an “Amen,” this can help your relationship 

with the person and the family. 

	 	 Many people routinely light candles or incense when they pray. If not allowed in the 

setting, explain this to survivors, and assist them in finding a nearby place where an 

open flame would be allowed. 

	 	 A survivor may voice hope for a miracle, even in the face of virtual certainty that 

their loved one has died. Do not take this as evidence that he/she has lost touch with 

reality or has not heard what has been said, but as the survivor’s way of continuing 

to function in devastating circumstances. It is important to neither encourage or 

discourage such hope. 

	 	 Every religion has specific practices around death, particularly in regard to the care 

of dead bodies. These issues may be especially complicated when the body is not 

recovered. Ask survivors about their religious needs in this area. They may want a 

clergy member to advise them. 

	 	 In some cultures, expressions of grief can be very loud and may seem out of 

control. It may be helpful to move families to a more private space to prevent them 

from upsetting others. If the behavior is upsetting to you, you should find someone 

else to assist the family. 

	 	 If a survivor expresses anger associated with his/her religious beliefs (a sign of 

spiritual distress), do not judge or argue with him/her. Most people are not looking 

for an “answer,” but a willing, non-judgmental listener. If spiritual concerns are 

contributing to significant distress, guilt, or functional impairment, you can ask if 

he/she would like a referral to a clergy member. 

Provider.Alert: Many times during disaster situations, well-meaning religious people 

seek out survivors in order to proclaim their own religious beliefs. If you become aware 

of activities like this, do not try to intervene; instead notify security personnel or others in 

charge. 

Safety and Comfort
 


40 National Child Traumatic Stress Network National Center for PTSD 
Safety and Comfort
 


Provide Information about Casket and Funeral Issues
 


Local laws often govern the preparation of a body for burial and rules regarding caskets or 

internment. Sometimes exceptions are made for members of particular religious groups. In many

jurisdictions, the law requires autopsies for any victim of a traumatic death or when the cause of

death is not clear. This requirement may be upsetting, especially to members of religious groups

that normally prohibit autopsies. In some jurisdictions, autopsy requirements can be waived by 

a Medical Examiner. Families who do not want an autopsy should be helped to find out about 

local laws. 

When a body has been significantly disfigured, you may suggest that–if it is in keeping with the 

religious tradition of the family–survivors place a photograph of the deceased on the casket in 

order to allow mourners to remember the person as he/she was alive and pay their respects. 

You can assist family members with their questions.about.children’s.attendance.at.a.funeral,

memorial.service,.or.gravesite. In responding to questions, keep the following in mind: 

	 	 It can be helpful for a child to attend a funeral. Although emotionally challenging, funerals 

help children accept the physical reality of the death which is part of grieving. If not 

included, children can feel left out of something important to the family. 

	 	 Parents/caregivers should give children a choice whether or not to attend a funeral or other 

ritual. They may be encouraged, but should not be pressured. 

	 	 Before asking children to choose, tell them what to expect if they attend, including 

letting them know that adults may be upset and crying. Explain that there will be a 

special area for the family to sit together (if that is to be arranged). Let them know 

what will happen during the service. 

	 	 Give them an opportunity to choose the person that they will sit next to at the 

service. Make sure that this person can pay appropriate attention to them. 

	 	 Always provide a way for children to leave the service with that person, even 

temporarily, if they become overwhelmed. 

	 	 Tell children about alternative arrangements if they do not wish to attend, such as 

staying with a neighbor or friend of the family. 

	 	 If they choose not to attend, offer to say something or read something on their 

behalf, and explain how they can participate in memorial activities at a later time, 

including memorials of their own making. 

	 	 If possible, bring younger children to the location early so that they can explore the space. 

Describe the casket and, if they wish, join them in approaching it. Caution should be 

exercised in regard to allowing young children to view or touch the body. A young child 

can use a photograph of the person to help say goodbye. 

	 	 For younger children, reinforce that the deceased family member is not in distress. 

Psychological First Aid - Field Operations Guide	 	 4
Provide Information about Casket and Funeral Issues - continued 

You may be asked to attend funerals or other events. You may feel that this will help a family 

member or child. Attend funerals only with the permission and knowledge of the family. 

Attend to Issues Related to Traumatic Grief 

After traumatic death, some survivors may stay focused on the circumstances of the death, 

including being preoccupied with how the death could have been prevented, what the last 

moments were like, and who was at fault. These reactions may interfere with grieving, making 

it more difficult for survivors to adjust to the death. These reactions include: 

	 	 Intrusive, disturbing images of the death that interfere with positive remembering and 

reminiscing 

	 	 Retreat from close relationships with family and friends 

	 	 Avoidance of usual activities because they are reminders of the traumatic death 

	 	 For children, repetitive play that includes themes involving the traumatic circumstances 

of the death 

These reactions can change mourning, often putting individuals on a different time course than 

may be experienced by other family members. You may want to speak privately to a family 

member who was present at the time of the death in order to advise him/her about the extra 

burden of witnessing the death. Let him/her know that talking to a mental health professional 

or clergy member may be very helpful. For example, you might say: 

Adult/Adolescent It is awful to have been there when Joe died. Other family members may want to know details about what happened, but there 

may be some details that you think will be too upsetting for them. 

Discussing what you went through with a professional can help 

you decide what to share with your family and also help you with 

your grief. 

Support Survivors Who Receive Death Notification

Although it is unlikely that you will be asked to notify a family member of a death, you may 

assist family members who have been informed of a death. You may be asked by police, FBI, 

hospital personnel or Disaster Mortuary Operational Response Team (DMORT) members to be 

present at the time of death notification. In some catastrophic situations, such as airline crashes, 

the news media may report that there were no survivors of the accident before family members 

have been officially notified. As incorrect information is sometimes circulated by the media or 

other survivors–caution family members to wait for official confirmation from the authorities. 

Safety and Comfort
 


4	 	 National Child Traumatic Stress Network National Center for PTSD 
After learning of the death of a family member or close friend, people may have psychological 

and physiological reactions that vary from agitation to numbness. At the same time, they must 

cope with the continuing stress of still being in the disaster environment. In providing support, 

keep the following in mind: 

	 	 Don’t rush. Family members need time to process the news and ask questions. 

	 	 Allow for initial strong reactions: these will likely improve over time. 

	 	 When talking about a person who is a confirmed fatality, use the word “died,” not “lost” 

or “passed away.” 

	 	 Remember that family members do not want to know how YOU feel (sympathy); they 

want to know you are trying to understand how THEY feel (empathy). 

Active steps to help support survivors in dealing with death notification include: 

	 	 Seek assistance from medical support personnel if a medical need arises. 

	 	 Get help from the authorities if family members are at risk for hurting themselves or 

others. 

	 	 Make sure that social supports are available, such as family, friends, neighbors, or clergy. 

	 	 Try to work with individuals or family units. Even when officials are addressing large 

crowds, it is better to have family members assembled at their own tables with you 

present. Potentially traumatic activities–such as reviewing passenger manifests, ticket 

lists, or morgue photos–should be done in family groups, in a private location, with 

the appropriate authorities. Be careful that children and adolescents do not see morgue 

photos. 

	 	 If an unaccompanied child is told that his/her caregiver has died, stay with the child or 

ensure that another worker stays with the child until he/she is reunited with other family 

members or is attended to by an appropriate child protective service worker. 

Children may have a range of responses to being told of the death of a loved one. They may act 

as if they did not hear, they may cry or protest the news, or they may not speak for an extended 

period. They may be angry with the person who told them. You may suggest that the parent/ 

caretaker say something like: 

Parent/Caregiver It is awfully hard to hear that Aunt Julia is really dead. It’s okay 

if you want to cry or if you don’t want to cry. Anytime you want 

to talk about her and what happened, I’m going to be here for 

that. You’ll see me have lots of feelings too. We can all help each 

other. 

Safety and Comfort
 


Psychological First Aid - Field Operations Guide 43
Support Survivors Who Receive Death Notification - continued 

For adolescents, you can advise parents to caution teens about doing something risky, like 

storming off, driving while overwhelmed with such news, staying out late, engaging in 

high-risk sexual behavior, using alcohol or other drugs, or acting in some other reckless 

way. Parents/caretakers should also understand that an adolescent’s anger can turn to rage 

over the loss, and they should be prepared to tolerate some expressions of rage. However, 

they should also be firm in addressing any behavioral risks. Expression of any suicidal 

thought should be taken seriously, and appropriate additional assistance should be 

immediately sought. Expressions of revenge should also be taken seriously. Adolescents 

should be cautioned to think about the consequences of revenge, and be encouraged to 

consider constructive ways to respond to their feelings. 

Family members should address immediate questions from children and adolescents 

about their living circumstances and who will take care of them. You may suggest that 

separation of siblings be avoided, if at all possible. 

Support Survivors Involved in Body Identification

Where identifiable bodies have been recovered and family members have been asked to 

assist in the identification process, authorities may take family members to the morgue 

or an alternative location to view and identify the body. The Psychological First Aid 

provider will typically not participate in these activities, but may be of assistance prior 

to and after body identification. Some individuals may feel that they must see the body 

before they can accept that the person is dead. Adolescents and older children might ask 

to be present when the body is identified; however, in most cases, children should be 

discouraged from participating in the process. Children may not understand the extent 

to which the body has deteriorated or changed, and may find seeing the body extremely 

disturbing. Parents can say to the child: 

Parent/Caregivers You know, Uncle Bobby wouldn’t want you to see him that 

way. I’m going to go and make sure that it’s him, but I don’t 

feel that you should go and see the body. 

When the body is found, it is natural for families to want to know when and where it was 

found, and what the person experienced before dying. Family members may be more 

disturbed by unanswered questions, than by having those questions answered. You should 

expect a wide range of reactions after viewing the body, including shock, numbness, 

fainting, vomiting, trembling, screaming, or hitting something or someone. 

Safety and Comfort
 


44 National Child Traumatic Stress Network National Center for PTSD 
Help Caregivers Confirm Body Identification to a Child or Adolescent

After a family member has identified the body of a loved one, a caregiver should convey 

this to children. You may sit in to provide support and assistance. Since young children 

do not understand that death is final, a family member should make it very clear that 

the lost loved one’s body has been found, and that he/she is dead. If the identification 

was made through forensic methods, it is important to explain the certainty of the 

identification in simple direct language. Parents should reassure children that the loved 

one is not suffering, that they were very loved by him/her, and that they will be taken care 

of. Allow children to ask questions, and–if an answer is not readily available–let them 

know that the parent or you will try to get additional information. You should caution 

parents/caretakers about giving disturbing details of the physical appearance of the body. 

If the child asks about the appearance, a parent can say: 

Parent/Caregivers It was not easy to see Uncle Jack, and he would want us to remember him alive, and to think about the nice times we spent 

together. I remember going on hikes and going fishing. You 

can pick any memory of Uncle Jack that you want, too. Then 

we’ll both have good ways to think about him. 

t Safety and Comfor 
 


Psychological First Aid - Field Operations Guide 4
This.page.intentionally.left.blank. 

4 National Child Traumatic Stress Network National Center for PTSD 
Psychological First Aid 

Field Operations Guide

2nd Edition 

Stabilization: 

 Stabilize Emotionally Overwhelmed Survivors 

 Orient Emotionally Overwhelmed Survivors 

 The Role of Medications in Stabilization 
.This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 
	 









	 









3. Stabilization (if needed) 

Goal:.To.calm.and.orient.emotionally.overwhelmed.or.disoriented.survivors.

Most individuals affected by disasters will not require stabilization. Expressions of strong 

emotions, even muted emotions (for example, numb, indifferent, spaced-out, or confused) 

are expectable reactions, and do not of themselves signal the need for additional 

intervention beyond ordinary supportive contact. While expression of strong emotions, 

numbing, and anxiety are normal and healthy responses to traumatic stress, extremely 

high arousal, numbing, or extreme anxiety can interfere with sleep, eating, decisionmaking, parenting, and other life tasks. You should be concerned about those individuals 

whose reactions are so intense and persistent that they significantly interfere with a 

survivor’s ability to function. 

Stabilize Emotionally Overwhelmed Survivors 

Observe individuals for these signs of being disoriented or overwhelmed: 

Looking glassy eyed and vacant–unable to find direction 

Unresponsiveness to verbal questions or commands 

Disorientation (for example, engaging in aimless disorganized behavior) 

Exhibiting strong emotional responses, uncontrollable crying, hyperventilating, 

rocking or regressive behavior 

Experiencing uncontrollable physical reactions (shaking, trembling) 

Exhibiting frantic searching behavior 

Feeling incapacitated by worry 

Engaging in risky activities 

If the person.is.too.upset,.agitated,.withdrawn,.or.disoriented.to.talk,.or.shows.

extreme.anxiety,.fear,.or.panic, consider: 

Is the person with family and friends? If so, enlist them in comforting the distressed 

person. You may want to take a distressed individual to a quiet place, or speak 

quietly with that person while family/friends are nearby. 

What is the person experiencing? Is he/she crying, panicking, experiencing a 

“flashback,” or imagining that the event is taking place again? When intervening, 

address the person’s primary immediate concern or difficulty, rather than simply 

trying to convince the person to “calm down” or to “feel safe” (neither of which 

tends to be effective). 

Psychological First Aid - Field Operations Guide	 	 4

Stabilization
 

Stabilize Emotionally Overwhelmed Survivors - continued 

For children or adolescents, consider: 

	 	 Is the child or adolescent with his/her parents? If so, briefly make sure that the adult 

is stable. Focus on empowering the parents in their role of calming their children. 

Do not take over for the parents, and avoid making any comments that may 

undermine their authority or ability to handle the situation. Let them know that you 

are available to assist in any way that they find helpful. 

	 	 If emotionally overwhelmed children or adolescents are separated from their 

parents, or if their parents are not coping well, refer below to the options for 

stabilizing distressed persons. 

In general, the following steps will help to.stabilize.the.majority.of.distressed.

individuals:

	 	 Respect the person’s privacy, and give him/her a few minutes before you intervene. 

Say you will be available if they need you or that you will check back with them in 

a few minutes to see how they are doing and if there is anything you can do to help 

at that time. 

	 	 Remain calm, quiet, and present, rather than trying to talk directly to the person, as 

this may contribute to cognitive/emotional overload. Just remain available, while 

giving him/her a few minutes to calm down. 

	 	 Stand close by as you talk to other survivors, do some paperwork, or other tasks 

while being available should the person need or wish to receive further help. 

	 	 Offer support and help him/her focus on specific manageable feelings, thoughts, and 

goals. 

	 	 Give information that orients him/her to the surroundings, such as how the setting is 

organized, what will be happening, and what steps he/she may consider. 

Orient Emotionally Overwhelmed Survivors 

Use these points to help survivors understand their reactions: 

Adults 

	 	 Intense emotions may come and go in waves. 

	 	 Shocking experiences may trigger strong, often upsetting, “alarm” reactions in the 

body, such as startle reactions. 

	 	 Sometimes the best way to recover is to take a few moments for calming routines 

(for example, go for a walk, breathe deeply, practice muscle relaxation techniques). 

	 	 Friends and family are very important sources of support to help calm down. 

Stabilization
 


0	 	 National Child Traumatic Stress Network National Center for PTSD 














C









	 


hildren and Adolescents 

 	 After bad things happen, your body may have strong feelings that come and go like 

waves in the ocean. When you feel really bad, that’s a good time to talk to your 

mom and dad to help you calm down. 

 	 Even adults need help at times like this. 

Many adults are working together to help with what happened, and to help people 

recover. 

Staying busy can help you deal with your feelings and start to make things better. 

Caution adolescents about doing something risky or impulsive, without discussing it with 

a parent or trusted adult. For example, you might say: 

Adolescent/Child When something bad like this happens, it is really important 

to get support from adults that you trust. Is there anyone who 

helps you feel better when you talk to them? Maybe I can 

help you get in touch with them. 

If the person.appears.extremely.agitated,.shows.a.rush.of.speech,.seems.to.be.losing.

touch.with.the.surroundings,.or.is.experiencing.ongoing.intense.crying, it may be 

helpful to: 

Ask the individual to listen to you and look at you.
 


Find out if he/she knows who he/she is, where he/she is, and what is happening.
 


Ask him/her to describe the surroundings, and say where both of you are.
 


If none of these actions seems to help to.stabilize.an.agitated.individual,.a.technique.
 


called.“grounding”.may.be.helpful. You can introduce grounding by saying:
 


“After a frightening experience, you can sometimes find yourself overwhelmed with 

emotions or unable to stop thinking about or imagining what happened. You can use a 

method called ‘grounding’ to feel less overwhelmed. Grounding works by turning your 

attention from your thoughts back to the outside world. Here’s what you do....” 

Sit in a comfortable position with your legs and arms uncrossed. 

Breathe in and out slowly and deeply. 

 	 Look around you and name five non-distressing objects that you can see. For 

example you could say, “I see the floor, I see a shoe, I see a table, I see a chair, I see 

a person.” 

Breathe in and out slowly and deeply. 

Psychological First Aid - Field Operations Guide	 	 

Stabilization
 

Orient Emotionally Overwhelmed Survivors - continued 

	 	

	 	

	 

	 	

Next, name five non-distressing sounds you can hear. For example: “I hear a woman 

talking, I hear myself breathing, I hear a door close, I hear someone typing, I hear a 

cell phone ringing.” 

Breathe in and out slowly and deeply. 

Next, name five non-distressing things you can feel. For example: “I can feel this 

wooden armrest with my hands, I can feel my toes inside my shoes, I can feel my 

back pressing against my chair, I can feel the blanket in my hands, I can feel my lips 

pressed together.” 

Breathe in and out slowly and deeply. 

You might have children name colors that they see around them. For example, say to the 

child, “Can you name five colors that you can see from where you are sitting. Can you 

see something blue? Something yellow? Something green?” 

If none of these interventions aids in emotional stabilization, consult with medical or 

mental health professionals, as medication may be needed. Modify these interventions for 

a person who has difficulty with vision, hearing, or expressive language. 

The Role of Medications in Stabilization 

In most cases, the above-described ways of stabilizing survivors will be adequate. 

Medication for acute traumatic stress reactions is not recommended as a routine way 

of meeting the goals of Psychological First Aid, and medication should be considered 

only if an individual has not responded to other ways of helping. Any use of medication 

in survivors should have a specific target (for example, sleep and control of panic 

attacks), and should be time-limited. Medications may be necessary when the survivor is 

experiencing extreme agitation, extreme anxiety and panic, psychosis, or is dangerous to 

self or others. 

You should be mindful of the following: 









 	 Exposure to disaster may worsen pre-existing conditions (for example, 

schizophrenia, depression, anxiety, pre-existing PTSD). 

 	 Some survivors may be without their medications, or face uncertainty about 

continued access to medications. 

 	 Communication with their psychiatrists, physicians, or pharmacies may be 

disrupted. 

 	 Monitoring of medication blood levels may be interrupted. 

Stabilization
 


	 	 National Child Traumatic Stress Network National Center for PTSD 
Gather information that will be helpful when referring to a physician, including: 

 List of current medications 

 Current medications that require ongoing monitoring by a physician 

 Access to currently prescribed medications, doctors, and dispensing pharmacy 

 The survivor’s compliance with medication 

 Substance abuse/recovery issues 

 Ongoing medical and mental health conditions 

You may obtain more information about current medications from family and friends if 

the survivor is too distressed or confused to give an accurate report. 

Stabilization
 


Psychological First Aid - Field Operations Guide 3 
This.page.intentionally.left.blank. 

4 National Child Traumatic Stress Network National Center for PTSD 
Psychological First Aid 

Field Operations Guide

2nd Edition 

Information Gathering: 

 Nature and Severity of Experiences during the Disaster 

 Death of a Loved One 

 Concerns about Immediate Post-Disaster Circumstances and 

Ongoing Threat 

 Separation from or Concern about the Safety of Loved Ones 

 Physical Illness, Mental Health Conditions, and Need for

Medications 

 Losses (Home, School, Neighborhood, Business, Personal

Property, and Pets) 

 Extreme Feelings of Guilt or Shame 

 Thoughts about Causing Harm to Self or Others 

 Availability of Social Support 

 Prior Alcohol or Drug Use 

 Prior Exposure to Trauma and Death of Loved Ones 

 Specific Youth, Adult, and Family Concerns over Developmental 

Impact 
.This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 
4. Information Gathering:
 

Needs and Current Concerns
 Goal:.To.identify.immediate.needs.and.concerns,.gather.additional.information,.and.

tailor.Psychological.First.Aid.interventions..

You should be flexible in providing Psychological First Aid, and should adapt 

interventions for specific individuals, and their identified needs and concerns. Gather 

enough information so that you can tailor and prioritize your interventions to meet 

these needs. Gathering and clarifying information begins immediately after contact and 

continues throughout Psychological First Aid. 

Remember that in most Psychological First Aid settings, your ability to gather 

information will be limited by time, survivors’ needs and priorities, and other factors. 

Although a formal assessment is not appropriate, you may ask about: 

 Need for immediate referral 

 Need for additional services 

 Offering a follow-up meeting 

 Using components of Psychological First Aid that may be helpful 

The form, Survivor Current Needs (Appendix D), may be helpful in documenting 

the basic information gathered from survivors. Likewise, the Psychological First Aid 

Provider Worksheet (Appendix D) may be useful in documenting services provided. 

These forms are designed for use within an incident command system for evaluation 

purposes, and where there are proper safeguards for confidentiality. 

It may be especially useful for you to ask some questions to clarify the following: 

Nature and Severity of Experiences during the Disaster 

Survivors who experienced direct life-threat to self or loved ones, injury to self, or 

those who witnessed injury or death are at increased risk for more severe and prolonged 

distress. Those who felt extremely terrified and helpless may also have more difficulty in 

recovering. For information about the survivor’s experiences, you may ask: 

You’ve been through a lot of difficult things. May I ask you 

some questions about what you have been through?
 


Where were you during the disaster?
 


Did you get hurt?
 


Did you see anyone get hurt?
 


How afraid were you?
 


Information Gathering
 


Psychological First Aid - Field Operations Guide 
Nature and Severity of Experiences during the Disaster - continued 

Provider.Alert: In clarifying disaster-related traumatic experiences, avoid asking for 

in-depth descriptions that may provoke additional distress. Follow the survivor’s lead 

in discussing what happened. Don’t press survivors to disclose details of any trauma 

or loss. On the other hand, if they are anxious to talk about their experiences, politely 

and respectfully tell them that what would be most helpful now is to get some basic 

information so that you can help with their current needs, and plan for future care. Let 

them know that the opportunity to discuss their experiences in a proper setting can be 

arranged for the future. 

For survivors with these kind of experiences, provide information about post-disaster 

reactions and coping (see Information on Coping), and offer a follow-up meeting. For 

those who were injured, arrange medical consultation as appropriate. 

Death of a Loved One 

The death of loved ones under traumatic circumstances is devastating, and over time 

can greatly complicate the grieving process. Ask about the death of loved ones with a 

question like: 

Did someone close to you get hurt or die as a result of the 

disaster? Who got hurt or died? 

For those who experienced the death of a loved one, provide emotional comfort, 

information about coping, social support, and acute grief, and offer a follow-up meeting. 

Concerns about Immediate Post-Disaster Circumstances and Ongoing Threat 

Survivors may be highly concerned about immediate and ongoing danger. You may ask 

questions like: 

Do you need any information to help you better understand 
 

what has happened?
 


Do you need information about how to keep you and your 
 

family safe?
 


Do you need information about what is being done to protect 
 

the public? 
 

For those with these concerns, help them obtain information about safety and protection. 

Information Gathering
 


 National Child Traumatic Stress Network National Center for PTSD 
Separation from or Concern about the Safety of Loved Ones 

Separation from loved ones and concern about their safety is an additional source of 

distress. If not addressed earlier, get information with questions like these: 

Are you worried about anyone close to you right now? 
 

Do you know where they are?
 

Is there anyone especially important like a family member or 
 

friend who is missing? 
 

For survivors with these concerns, provide practical assistance in connecting them with 

available information sources and registries that can help locate and reunite family members. 

See Safety and Comfort and Connection with Social Supports. 

Physical Illness, Mental Health Conditions, and Need for Medications 

Pre-existing medical or mental heath conditions and need for medications are additional 

sources of post-disaster distress. Those with a history of psychological problems may 

experience a worsening of these problems, as well as more severe and prolonged postdisaster reactions. Give a high priority to immediate medical and mental health concerns. 

Ask questions like: 

Do you have any medical or mental health condition that 
 

needs attention?
 


Do you need any medications that you don’t have?
 


Do you need to have a prescription filled? 

Can you get in touch with your doctor? 

For those with medical or mental health conditions, provide practical assistance in 

obtaining medical or psychological care and medication. 

Losses (Home, School, Neighborhood, Business, Personal Property, and Pets) 

If survivors have extensive material losses and post-disaster adversities, their recovery 

may be complicated with feelings of depression, demoralization, and hopelessness. For 

information about such loss, ask questions like: 

Was your home badly damaged or destroyed?
 


Did you lose other important personal property?
 


Did a pet die or get lost?
 


Was your business, school, or neighborhood badly damaged or 
 

destroyed?
 


For those with losses, provide emotional comfort, practical assistance to help link them 

with available resources, and information about coping and social support. 

Information Gathering

Psychological First Aid - Field Operations Guide 
Extreme Feelings of Guilt or Shame 

Extreme negative emotions can be very painful, difficult, and challenging, especially for 

children and adolescents. Children and adults may be ashamed to discuss these feelings. 

Listen carefully for signs of guilt or shame in their comments. To further clarify, you may 

say: 

It sounds like you are being really hard on yourself about what 
 

happened.
 


It seems like you feel that you could have done more.
 


For those experiencing guilt or shame, provide emotional comfort and information about 

coping with these emotions. This can be found in the section, Information on Coping. 

Thoughts about Causing Harm to Self or Others 

It is a priority to get a sense of whether an individual is having thoughts about causing 

harm to self or others. To explore these thoughts and feelings, ask questions like: 

Sometimes situations like these can be very overwhelming.
 


Have you had any thoughts about harming yourself? 
 

Have you had any thoughts about harming someone else?
 


For those with these thoughts, get medical or mental health assistance immediately. If 

the survivor is at immediate risk of hurting themselves or others, stay with him/her until 

appropriate personnel arrive on the scene and assume management of the survivor. 

Availability of Social Support 

Family, friends, and community support can greatly enhance the ability to cope with 

distress and post-disaster adversity. Ask about social support as follows: 

Are there family members, friends, or community agencies 

that you can rely on for help with problems that you are facing 

as a result of the disaster? 

For those lacking adequate social support, help them connect with available resources 

and services, provide information about coping and social support, and offer a follow-up 

meeting. 

Information Gathering
 


0 National Child Traumatic Stress Network National Center for PTSD 
Provider.Alert: In clarifying prior history of substance use, prior trauma and loss, and 

prior mental health problems, you should be sensitive to the immediate needs of the 

survivor, avoid asking for a history if not appropriate, and avoid asking for in-depth 

description. Give clear reasons for asking (for example, “Sometimes events like this can 

remind individuals of previous bad times . . .” “Sometimes individuals who use alcohol to 

cope with stress will notice an increase in drinking following an event such as this . . .”) 

Prior Alcohol or Drug Use 

Exposure to trauma and post-disaster adversities can increase substance use, cause relapse 

of past substance abuse, or lead to new abuse. Get information about this by asking: 

Adult/Caregiver/ 

Adolescent 

Has your use of alcohol, prescription medications, or drugs 
 

increased since the disaster?
 


Have you had any problems in the past with alcohol or drug 
 

use?
 


Are you currently experiencing withdrawal symptoms from 
 

drug use?
 


For those with potential substance use problems, provide information about coping and 

social support, link to appropriate services, and offer a follow-up meeting. For those with 

withdrawal symptoms, seek medical referral. 

Prior Exposure to Trauma and Death of Loved Ones 

Those with a history of exposure to trauma or death of loved ones may experience more 

severe and prolonged post-disaster reactions and a renewal of prior trauma and grief 

reactions. For information about prior trauma, ask: 

Sometimes events like this can remind people of previous bad 
 

times. Have you ever been in a disaster before? 
 

Has some other bad thing happened to you in the past?
 


Have you ever had someone close to you die?
 


For those with prior exposure and/or loss, provide information about post-disaster and 

grief reactions, information about coping and social support, and offer a follow-up 

meeting. 

Information Gathering
 


Psychological First Aid - Field Operations Guide 
Specific Youth, Adult, and Family Concerns over Developmental Impact

Survivors can be very upset when the disaster or its aftermath interferes with upcoming 

special events, including important developmental activities (for example, birthdays, 

graduation, start of school or college, marriage, vacation). For information about this, 

ask: 

Were there any special events coming up that were disrupted 

by the disaster? 

For those with developmental concerns, provide information about coping and assist with 

strategies for practical help. 

It is also useful to ask a general open-ended question to make sure that you have not 

missed any important information. 

Is there anything else we have not covered that you are concerned about or want to share with me? 

If the survivor identifies multiple concerns, summarize these and help to identify which 

issues are most pressing. Work with the survivor to prioritize the order in which concerns 

should be addressed. 

Information Gathering
 


 National Child Traumatic Stress Network National Center for PTSD 
Psychological First Aid 

Field Operations Guide

2nd Edition 

Practical Assistance: 

 Offering Practical Assistance to Children and Adolescents 

 Identify the Most Immediate Needs 

 Clarify the Need 

 Discuss an Action Plan 

 Act to Address the Need 
This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 






	 







. Practical Assistance 

Goal:.To.offer.practical.help.to.survivors.in.addressing.immediate.needs.and.

concerns...

Exposure to disaster, terrorism and post-event adversities is often accompanied by a loss 

of hope. Those who are likely to have more favorable outcomes are those who maintain 

one or more of the following characteristics: 

Optimism (because they can have hope for their future) 

Confidence that life is predictable 

Belief that things will work out as well as can reasonably be expected 

Belief that outside sources act benevolently on one’s behalf (responsive 

government) 

Strong faith-based beliefs 

Positive belief (for example, “I’m lucky, things usually work out for me”) 

Resources, including housing, employment, financial 

Providing people with needed resources can increase a sense of empowerment, hope, and 

restored dignity. Therefore, assisting the survivor with current or anticipated problems 

is a central component of Psychological First Aid. Survivors may welcome a pragmatic 

focus and assistance with problem-solving. 

Discussion of immediate needs occurs throughout a Psychological First Aid contact. As 

much as possible, help the survivor address the identified needs, as problem-solving may 

be more difficult under conditions of stress and adversity. Teaching individuals to set 

achievable goals may reverse feelings of failure and inability to cope, help individuals 

to have repeated success experiences, and help to reestablish a sense of environmental 

control necessary for successful disaster recovery. 

Offering Practical Assistance to Children and Adolescents 

Like adults, children and adolescents benefit from clarifying their needs and concerns, 

developing a plan to address them, and acting on the plan. Their ability to clarify what 

they want, think through alternatives, select the best option, and follow through develops 

gradually. For example, many children can participate in problem-solving, but require the 

assistance of adolescents or adults to follow through with their plans. When appropriate, 

share the plans you have developed with parents/caregivers, or involve parents/caregivers 

in making the plans, so that they can help the child or adolescent to carry them through. 

Offering practical assistance is composed of four steps: 

Practical Assistance
 


Psychological First Aid - Field Operations Guide	 
Step 1: Identify the Most Immediate Needs 

If the survivor has identified several needs or current concerns, it will be necessary to 

focus on them one at a time. For some needs, there will be immediate solutions (for 

example, getting something to eat, phoning a family member to reassure them that the 

survivor is okay). Other problems (for example, locating a lost loved one, returning to 

previous routines, securing insurance for lost property, acquiring caregiving services 

for family members) will not be solved quickly, but the survivor may be able to take 

concrete steps to address the problem (for example, completing a missing persons report 

or insurance form, applying for caregiving services). 

As you collaborate with the survivor, help him/her select issues requiring immediate help. 

For example, you might say: 

Adult/Caregiver I understand from what you’re telling me, Mrs. Williams that your 

main goal right now is to find your husband and make sure he’s 

okay. We need to focus on helping you get in contact with him. 

Let’s make a plan on how to go about getting this information. 

Adolescent/Child It sounds like you are really worried about several different 

things, like what happened to your house, when your dad is coming, and what will happen next. Those are all important things, 

but let’s think about what is most important right now, and then 

make a plan. 

Step 2: Clarify the Need 

Talk with the survivor to specify the problem. If the problem is understood and clarified, 

it will be easier to identify practical steps that can be taken to address it. 

Step 3: Discuss an Action Plan 

Discuss what can be done to address the survivor’s need or concern. The survivor may 

say what he/she would like to be done, or you can offer a suggestion. If you know what 

services are available ahead of time, you can help obtain food, clothing, shelter, or 

medical care; mental health or spiritual care services; financial assistance; help in locating 

missing family members or friends; and volunteer opportunities for those who want to 

contribute to relief efforts. Tell survivors what they can realistically expect in terms of 

potential resources and support, qualification criteria, and application procedures. 

Step 4: Act to Address the Need 

Help the survivor to take action. For example, help him/her set an appointment with a 

needed service or assist him/her in completing paperwork. 

 National Child Traumatic Stress Network National Center for PTSD 

Practical Assistance
 

Psychological First Aid 

Field Operations Guide

2nd Edition 

Connection with Social Supports: 

 Enhance Access to Primary Support Persons (Family and 

Significant Others) 

 Encourage Use of Immediately Available Support Persons 

 Discuss Support-Seeking and Giving 

 Special Considerations for Children and Adolescents 

 Modeling Support 
.This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 














. Connection with Social Supports 

Goal:.To.help.establish.brief.or.ongoing.contacts.with.primary.support.persons.and.other.

sources.of.support,.including.family.members,.friends,.and.community.helping.resources..

Social support is related to emotional well-being and recovery following disaster and terrorism. 

People who are well connected to others are more likely to engage in supportive activities (both 

receiving and giving support) that assist with disaster recovery. Social support can come in 

many forms. These include: 

















 	 Emotional Support: hugs, a listening ear, understanding, love, acceptance 

 	 Social Connection: feeling like you fit in and have things in common with other people, 

having people to share activities 

 	 Feeling Needed: feeling that you are important to others, that you are valued, useful and 

productive, and that people appreciate you 

 	 Reassurance of Self-Worth: having people help you have confidence in yourself and 

your abilities, that you can handle the challenges you face 

 	 Reliable Support: having people reassure you that they will be there for you in case you 

need them, that you have people you can rely on to help you 

 	 Advice and Information: having people show you how to do something or give you 

information or good advice, having people help you understand that your way of reacting 

to what has happened is common, having good examples to learn from about how to cope 

in positive ways with what is happening 

Physical Assistance: having people help you perform tasks, like carrying things, fixing 

up your house or room, and helping you do paperwork 

Material Assistance: having people give you things, like food, clothing, shelter, 

medicine, building materials, or money 

Fostering connections as soon as possible and assisting survivors in developing and 

maintaining social connections is critical to recovery. Benefits of social connectedness include: 

Increased opportunities for knowledge essential to disaster recovery 

Opportunities for a range of social support activities, including:
 


Practical problem-solving
 


Emotional understanding and acceptance 
 

Sharing of experiences and concerns
 


Clarifying reactions
 


Sharing information about coping
 


Psychological First Aid - Field Operations Guide	 	 

Connection with Social Supports
 

Enhance Access to Primary Support Persons (Family and Significant Others)

An immediate concern for most survivors is to contact those with whom they have 

a primary relationship (for example, spouse/partner, children, parents, other family 

members, close friends, neighbors, and clergy). Take practical steps to assist survivors to 

reach these individuals (in person, by phone, by e-mail, through web-based databases). 

Other sources of social support may include co-workers and hobby or club members 

(such as an afterschool club, bridge club, book club, Rotary, or VFW). Survivors who 

belong to religious organizations may have access to a valuable supportive network that 

can help facilitate recovery. 

Encourage Use of Immediately Available Support Persons 

If individuals are disconnected from their social support network, encourage them to 

make use of immediately available sources of social support (for example, yourself, other 

relief workers, other survivors), while being respectful of individual preferences. It can 

help to offer reading materials (for example, magazines, newspapers, fact sheets), and 

discuss the material with them. When people are in a group, ask if they have questions. 

When members of the group are from different neighborhoods or communities, facilitate 

introductions among members. Small group discussions can provide a starting point for 

further conversations and social connectedness. When working with the frail elderly, 

you may try to connect them with a younger adult or adolescent volunteer, if available, 

who can provide social contact and assistance with daily activities. If appropriate, you 

may offer them the opportunity to assist families by spending time with younger children 

(reading to them, sitting with them while they play, or playing games with them). 

When working with youth, bring similar-age children together in a shared activity–as 

long as they know where their adult caregivers are. Provide art materials, coloring books, 

or building materials to help younger children engage in soothing, familiar activities. 

Older children and adolescents can lead younger children in activities. Children may have 

suggestions of songs to sing or classroom games that they have played at school. Several 

activities that can be done only with paper and pencil include: 











 	 Tic-tac-toe 

 	 Folding “fortune tellers” 

 	 Making paper balls and tossing them into an empty wastebasket 

 	 Air hockey: wad up a piece of paper and have children try to blow it across the table 

into the other team’s goal (Bonus: can be used to practice deep breathing exercises). 

 	 Group drawing: have children sit in a circle, the first child begins a drawing. After 

10 seconds, that child passes the drawing to the child on their right. Continue until 

everyone has added to the drawing. Then show the group the final picture. Suggest 

0	 National Child Traumatic Stress Network National Center for PTSD 

Connection with Social Supports
 











that the children draw something positive (not pictures of the disaster), something 

that promotes a sense of protection and safety. 





 	 Scribble game: pair up youth, one person makes a scribble on the paper, and their 

partner has to add to the scribble to turn it into something. 

 	 Making a paper doll chain or circle chain in which the child writes the name of 

each person in their support system on a link. For adolescents, you can also ask 

them to identify the type of support (for example, emotional support, advice and 

information, material assistance, etc.) that they receive from each person. 

Discuss Support-Seeking and Giving 

If individuals are reluctant to seek support, there may be many reasons, including:
 






















Not knowing what they need (and perhaps feeling that they should know).
 


Feeling embarrassed or weak because of needing help.
 


Feeling guilty about receiving help when others are in greater need.
 


Not knowing where to turn for help.
 


Worrying that they will be a burden or depress others.
 


Fearing that they will get so upset that they will lose control.
 


Doubting that support will be available or helpful.
 


Thinking, “No one can understand what I’m going through.”
 


Having tried to get help and finding that help wasn’t there (feeling let down or 
 

betrayed). 

Fearing that the people they ask will be angry or make them feel guilty for needing 

help. 

In helping survivors to appreciate the value of social support and to engage with others, 
 

you may need to address some of the above concerns. 
 

For those who have become withdrawn or socially isolated, you can be of assistance by 
 

helping them to:
 


Think about the type of support that would be most helpful.
 


Think about whom they can approach for that type of support.
 


Choose the right time and place to approach the person.
 


Talk to the person and explain how he/she can be of help.
 


Afterwards, thank the person for his/her time and help.
 


Psychological First Aid - Field Operations Guide	 	 

Connection with Social Supports
 

Discuss Support-Seeking and Giving - continued 

Let survivors know that, following a disaster, some people choose not to talk about their 

experiences, and that spending time with people one feels close to without talking can 

feel good. For example, your message might be: 

Adult/Caregiver	 When you’re able to leave the Assistance Center you may just 

want to be with the people you feel close to. You may find it 

helpful to talk about what each of you has been through. You can 

decide when and what to talk about. You don’t have to talk about 

everything that occurred, only what you choose to share with each 

person. 

Adolescent	 When something really upsetting like this happens, even if you 

don’t feel like talking, be sure to ask for what you need. 

Child	 You are doing a great job letting grown-ups know what you 

need. It is important to keep letting people know how they 

can help you. The more help you get, the more you can make 

things better. Even grown-ups need help at a time like this. 

For those who would like to provide support to others, you can help them to: 

	 

	 

	 

	 



Identify ways that they can be helpful to others (volunteer in the shelter or 

community, help children or older adults). 

Identify a person or persons that they can help.
 
 Find an uninterrupted time and place to talk or to help them.
 


Show interest, attention, and care.
 


Offer to talk or spend time together as many times as needed.
 


The focus should not be on discussing disaster-related experiences or loss, but rather on 
 

providing practical assistance and problem-solving current needs and concerns.
 


Special Considerations for Children and Adolescents 

You can help children and adolescents problem-solve ways in which they can ask for, and 

give support to, others around them. Here are some suggestions: 

	 	

	 	

Talk with your parents/caregivers or other trusted adults about how you are feeling, 

so that they better understand how and when to help you. 

Do enjoyable activities with other children, including playing sports, games, board 

games, watching movies, and so forth. 

	 	 National Child Traumatic Stress Network National Center for PTSD 

Connection with Social Supports




























	 

	 

	 

Spend time with your younger brothers or sisters. Help them to calm down, play 

with them, and keep them company. 

Help with cleaning, repairs, or other chores to support your family and community. 

Share things with others, including activities and toys. 

In some cases, children and adolescents will not feel comfortable talking with others. 

Engaging them in social or physical activities or merely being present can be comforting. 

Parents and you can be supportive by going for a walk, throwing a ball, playing a game, 

thumbing through magazines together, or simply sitting together. 

Modeling Support 

As a provider, you can model positive supportive responses, such as:
 


Reflective comments: 
 

“From what you’re saying, I can see how you would be . . .” 
 

“It sounds like you’re saying . . .”
 


“It seems that you are . . .”
 


Clarifying comments:
 


“Tell me if I’m wrong ... it sounds like you . . .”
 


“Am I right when I say that you . . .”
 


Supportive comments:
 


“No wonder you feel . . .”
 


“It sounds really hard . . .”
 


“It sounds like you’re being hard on yourself.”
 


“It is such a tough thing to go through something like this.”
 


“I’m really sorry this is such a tough time for you.”
 


“We can talk more tomorrow if you’d like.”
 


Empowering comments and questions:
 


“What have you done in the past to make yourself better when things got difficult?”
	
 

“Are there any things that you think would help you to feel better?”
 


“I have an information sheet with some ideas about how to deal with difficult 
 

situations. Maybe there is an idea or two here that might be helpful for you.” 

Connection with Social Supports
 


Psychological First Aid - Field Operations Guide	 	 3


Modeling Support - continued 

“People can be very different in what helps them to feel better. When things get 

difficult, for me, it has helped me to . . . Do you think something like that would 

work for you?” 

If appropriate, distribute handouts, Connecting with Others: Seeking Social Support and 

Giving Social Support provided in Appendix E. These handouts are intended for adults 

and older adolescents. 

Connection with Social Supports
 


4 National Child Traumatic Stress Network National Center for PTSD 
Psychological First Aid 

Field Operations Guide

2nd Edition 

Information on Coping: 

 Provide Basic Information about Stress Reactions 

 Review Common Psychological Reactions to Traumatic 

Experiences and Losses 

 Talking with Children about Body and Emotional Reactions 

 Provide Basic Information on Ways of Coping 

 Teach Simple Relaxation Techniques 

 Coping for Families 

 Assisting with Developmental Issues 

 Assist with Anger Management 

 Address Highly Negative Emotions 

 Help with Sleep Problems 

 Address Alcohol and Substance Abuse 
.This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 
. Information on Coping 

Goal:.To.provide.information.about.stress.reactions.and.coping.to.reduce.distress.and.

promote.adaptive.functioning..

Disasters can be disorienting, confusing, and overwhelming, putting survivors at risk for 

losing their sense of competence to handle problems that they face. Feeling one can cope 

with disaster-related stress and adversity is beneficial to recovery. 

Various types of information can help survivors manage their stress reactions and deal 

more effectively with problems. Such information includes: 

 What is currently known about the unfolding event 

 What is being done to assist them 

 What, where, and when services are available 

 Post-disaster reactions and how to manage them 

 Self-care, family care, and coping 

Provide Basic Information about Stress Reactions 

If appropriate, briefly discuss common stress reactions experienced by the survivor. Stress 

reactions may be alarming. Some will be frightened or alarmed by their own responses; 

some may view their reactions in negative ways (for example, “There’s something 

wrong with me” or “I’m weak”). You should take care to avoid pathologizing survivor 

responses; do not use terms like “symptoms” or “disorder.” You may also see positive 

reactions, including appreciating life, family, and friends, or strengthening of spiritual 

beliefs and social connections. 

Provider.Alert. While it may be helpful to describe common stress reactions and to 

note that intense reactions are common but often diminish over time, it is also important 

to avoid providing “blanket” reassurance that stress reactions will disappear. Such 

reassurances may set up unrealistic expectations about the time it takes to recover. 

Review Common Psychological Reactions to Traumatic Experiences and Losses 

For survivors who have had significant exposure to trauma and have sustained significant 

losses, provide basic psychoeducation about common distress reactions. You can review 

these, emphasizing that such reactions are understandable and expectable. Inform 

survivors that, if these reactions continue to interfere with their ability to function 

adequately for over a month, psychological services should be considered. The following 

basic information is presented as an overview for the Psychological First Aid provider so 

that you can discuss issues arising from survivors’ post-disaster reactions. 

Information on Coping
 


Psychological First Aid - Field Operations Guide 
Review Common Psychological Reactions to Traumatic Experiences and Losses 

- continued 

There are three types of posttraumatic stress reactions: 

1.	 Intrusive reactions are ways in which the traumatic experience comes back to 

mind. These reactions include distressing thoughts or mental images of the event 

(for example, picturing what one saw), or dreams about what happened. Among 

children, bad dreams may not be specifically about the disaster. Intrusive reactions 

also include upsetting emotional or physical reactions to reminders of the experience. Some people may feel and act like one of their worst experiences is happening all over again. This is called a “flashback.” 

2.	 Avoidance and withdrawal reactions are ways people use to keep away from, or 

protect against, distress. These reactions include trying to avoid talking, thinking, 

and having feelings about the traumatic event, and avoiding any reminders of the 

event, including places and people connected to what happened. Emotions can 

become restricted, even numb, to protect against distress. Feelings of detachment 

and estrangement from others may lead to social withdrawal. There may be a loss 

of interest in usually pleasurable activities. 

3.	 Physical arousal reactions are physical changes that make the body react as if 

danger is still present. These reactions include constantly being “on the lookout” 

for danger, startling easily or being jumpy, irritable or having outbursts of anger, 

difficulty falling or staying asleep, and difficulty concentrating or paying attention. 

It is also useful to discuss the role of trauma reminders, loss reminders, change reminders, 

and hardships in contributing to distress. 

Trauma Reminders can be sights, sounds, places, smells, specific people, the time of day, 

situations, or even feelings, like being afraid or anxious. Trauma reminders can evoke 

upsetting thoughts and feelings about what happened. Examples include the sound of 

wind, rain, helicopters, screaming or shouting, and specific people who were present at the 

time. Reminders are related to the specific type of event, such as hurricane, earthquake, 

flood, tornado, or fire. Over time, avoidance of reminders can make it hard for people to 

do what they normally do or need to do. 

Loss Reminders can also be sights, sounds, places, smells, specific people, the time of 

day, situations, or feelings. Examples include seeing a picture of a lost loved one, or 

seeing their belongings, like their clothes. Loss reminders bring to mind the absence of a 

loved one. Missing the deceased can bring up strong feelings, like sadness, nervousness, 

uncertainty about what life will be without them, anger, feeling alone or abandoned, or 

hopelessness. Loss reminders can also lead to avoiding things that people want to do or 

need to do. 

Change Reminders can be people, places, things, activities, or hardships that remind 

someone of how life has changed as a result of the disaster. This can be something like 

waking up in a different bed in the morning, going to a different school, or being in a 

	 National Child Traumatic Stress Network National Center for PTSD 

Information on Coping
 

different place. Even nice things can remind a survivor of how life has changed, and make 

the person miss what has been lost. 

Hardships often follow in the wake of disasters and can make it more difficult to recover. 

Hardships place additional strains on survivors and can contribute to feelings of anxiety, 

depression, irritability, uncertainty, and mental and physical exhaustion. Examples of 

hardships include: loss of home or possessions, lack of money, shortages of food or 

water, separations from friends and family, health problems, the process of obtaining 

compensation for losses, school closures, being moved to a new area, and lack of fun 

activities. 

Other kinds of reactions include grief reactions, traumatic grief, depression, and physical 

reactions. 

Grief Reactions will be prevalent among those who survived the disaster but have suffered 

many types of losses, including the death of loved ones, and loss of home, possessions, 

pets, schools, and community. Loss may lead to feelings of sadness and anger, guilt or 

regret over the death, missing or longing for the deceased, and dreams of seeing the person 

again. More information on grief reactions and how to respond to survivors experiencing 

acute grief reactions can be found in the section on Safety and Comfort. 

Traumatic Grief Reactions occur when children and adults have suffered the traumatic 

death of a loved one. Some survivors may stay focused on the circumstances of the death, 

including being preoccupied with how the death could have been prevented, what the last 

moments were like, and who was at fault. These reactions may interfere with grieving, 

making it more difficult for survivors to adjust to the death over time. More information 

on traumatic grief reactions and how to respond can be found in the section on Safety and 

Comfort. 

Depression is associated with prolonged grief reactions and strongly related to the 

accumulation of post-disaster adversities. Reactions include persistent depressed or 

irritable mood, loss of appetite, sleep disturbance, greatly diminished interest or pleasure 

in life activities, fatigue or loss of energy, feelings of worthlessness or guilt, feelings 

of hopelessness, and sometimes thoughts about suicide. Demoralization is a common 

response to unfulfilled expectations about improvement in post-disaster adversities and 

resignation to adverse changes in life circumstances. 

Physical Reactions may be commonly experienced, even in the absence of any underlying 

physical injury or illness. These reactions include headaches, dizziness, stomachaches, 

muscle aches, rapid heart beat, tightness in the chest, hyperventilation, loss of appetite, 

and bowel problems. 

Several handouts found in Appendix E may be useful. When Terrible Things Happen 

describes common adult and adolescent reactions, and positive/negative coping. Parent 

Tips for Helping Infants and Toddlers; Parent Tips for Helping Preschool-Age 

Children; Parent Tips for Helping School-Age Children; Parent Tips for Helping 

Adolescents; and Tips for Adults are for adults to help themselves and their children. 

Psychological First Aid - Field Operations Guide 

Information on Coping
 

Talking with Children about Body and Emotional Reactions 

Children vary in their capacity to make connections between events and emotions. Many 

children will benefit from a basic explanation of how disaster-related experiences produce 

upsetting emotions and physical sensations. Suggestions for working with children 

include: 

	 	 Don’t ask children directly to describe their emotions (like telling you that they feel 

sad, scared, confused, or angry), as they often have a hard time finding the words. 

Instead, ask them to tell you about physical sensations, for example: “How do 

you feel inside? Do you feel something like butterflies in your stomach or tight all 

over?” 

	 	 If they are able to talk about emotions, it is helpful to suggest different feelings and 

ask them to pick one (“Do you feel sad right now, or scared, or do you feel okay?”) 

rather than asking open-ended questions (“How are you feeling?”). 

	 	 You can draw (or ask the child to draw) an outline of a person and use this to help 

the child talk about his/her physical sensations. 

The following gives a basic explanation that helps children to talk about common 

emotional and physical reactions to disaster. 

Adolescent/Child When something really bad happens, kids often feel funny, 

strange, or uncomfortable, like their heart is beating really fast, 

their hands feel sweaty, their stomach hurts, or their legs or arms 

feel weak or shaky. Other times kids just feel funny inside their 

heads, almost like they are not really there, like they are watching 

bad things happening to someone else. 

Sometimes your body keeps having these feelings for a while even 

after the bad thing is over and you are safe. These feelings are 

your body’s way of telling you again how bad the disaster was. 

Do you have any of these feelings, or other ones that I didn’t talk 

about? Can you tell me where you feel them, and what they feel 

like? 

Sometimes these strange or uncomfortable feelings come up when 

kids see, hear, or smell things that remind them of what happened, 

like strong winds, glass breaking, the smell of smoke, etc. It can 

be very scary for kids to have these feelings in their bodies, especially if they don’t know why they are happening or what to do 

about them. If you like, I can tell you some ways to help yourself 

feel better. Does that sound like a good idea? 

Information on Coping
 


0	 	 National Child Traumatic Stress Network National Center for PTSD 










































Provide Basic Information on Ways of Coping 

You can discuss a variety of ways to effectively cope with post-disaster reactions and 

adversity. 

Adaptive coping actions are those that help to reduce anxiety, lessen other distressing 

reactions, improve the situation, or help people get through bad times. In general, coping 

methods that are likely to be helpful include: 

Talking to another person for support 

Getting needed information 

Getting adequate rest, nutrition, exercise 

Engaging in positive distracting activities (sports, hobbies, reading) 

Trying to maintain a normal schedule to the extent possible 

Telling yourself that it is natural to be upset for some period of time 

Scheduling pleasant activities 

Eating healthful meals 

Taking breaks 

Spending time with others 

Participating in a support group 

Using relaxation methods 

Using calming self talk 

Exercising in moderation 

Seeking counseling 

Keeping a journal 

Focusing on something practical that you can do right now to manage the situation 

better 

Using coping methods that have been successful for you in the past 

Maladaptive coping actions tend to be ineffective in addressing problems. Such actions 

include:
 


Using alcohol or drugs to cope
 


Withdrawing from activities
 


Withdrawing from family or friends
 


Psychological First Aid - Field Operations Guide 

Information on Coping
 

























Provide Basic Information on Ways of Coping - continued 

Working too many hours 

Getting violently angry 

Excessive blaming of self or others 

Overeating or undereating 

Watching too much TV or playing too many computer games 

Doing risky or dangerous things 

Not taking care of yourself (sleep, diet, exercise, etc.) 

The aim of discussing positive and negative forms of coping is to: 

Help survivors consider different coping options 

Identify and acknowledge their personal coping strengths 

Think through the negative consequences of maladaptive coping actions 

Encourage survivors to make conscious goal-oriented choices about how to cope 

Enhance a sense of personal control over coping and adjustment 

To help children and adolescents identify positive and negative forms of coping, you can 

write on slips of paper ways that the child is currently using to cope. Then talk with the 

child about adaptive and maladaptive coping strategies. Have the child sort the pieces 

of paper into each category and then discuss ways the child can increase their adaptive 

coping strategies. For younger children, play a memory game in which each coping 

strategy is written on two pieces of paper. Place the blank sides of each paper face up, and 

have the child find matching pairs. Once the child gets a pair, discuss with them if this is 

a good or bad strategy to feel better. 

The handout, When Terrible Things Happen (Appendix E), reviews positive and 

negative coping for adult and adolescent survivors. 

Teach Simple Relaxation Techniques 

Breathing exercises help reduce feelings of over-arousal and physical tension which, 

if practiced regularly, can improve sleep, eating, and functioning. Simple breathing 

exercises can be taught quickly. It is best to teach these techniques when the survivor is 

calm and can pay attention. It may also be helpful for family members to prompt each 

other to use and practice these techniques regularly. The handout, Tips for Relaxation 

(Appendix E), can be provided to reinforce the use and practice of relaxation techniques. 

To teach a breathing exercise, you might say: 

 National Child Traumatic Stress Network National Center for PTSD 

Information on Coping
 

Information on Coping 

Adult/Caregiver/ Inhale slowly (one-thousand one; one-thousand two; one-thouAdolescent sand three) through your nose, and comfortably fill your lungs all 

the way down to your belly. Silently and gently say to yourself, 

“My body is filling with calm.” Exhale slowly (one-thousand one; 

one-thousand two; one-thousand three) through your mouth, and 

comfortably empty your lungs all the way down to your abdomen. 

Silently and gently say to yourself, “My body is releasing tension.” Repeat five times slowly. 

Child Let’s practice a different way of breathing that can help calm our 

bodies down. Put one hand on your stomach, like this [demonstrate]. Okay, we are going to breathe in through our noses. When 

we breathe in, we are going to fill up with a lot of air and our 

stomachs are going to stick out like this [demonstrate]. 

Then, we will breathe out through our mouths. When we breathe 

out, our stomachs are going to suck in and up like this [demonstrate]. We can pretend that we are a balloon, filling up with air, 

and then letting the air out, nice and slow.
 


We are going to breathe in really slowly while I count to three. I’m 
 

also going to count to three while we breathe out really slowly. 
 

Let’s try it together. Great job!
 


If you find out that a survivor has previously learned some relaxation technique, try to 

reinforce what he/she has already learned rather than teaching new skills. 

Coping for Families 

Reestablishing.family.routines to the extent possible after a disaster is important for 

family recovery. Encourage parents and caregivers to try to maintain family routines such 

as meal times, bedtime, wake time, reading time, and play time, and to set aside time for 

the family to enjoy activities together. 

If a family member has a pre-existing emotional or behavioral problem that has been 

worsened by the current events, discuss with the family strategies that they may have 

learned from a therapist to manage these problems. Discuss ways that these strategies 

may be adapted for the current setting. If the family member continues to have 

difficulties, consider a mental health consultation. 

It is especially important to assist family members in developing a mutual understanding 

of their different experiences, reactions, and course of recovery, and to help develop a 

family plan for communicating about these differences. For example, you might say: 

Psychological First Aid - Field Operations Guide 3
Coping for Families - continued 

Often, due to differences in what each of you experienced during and after the disaster, each family member will have different 

reactions and different courses of recovery. These differences 

can be difficult to deal with, and can lead to family members not 

feeling understood, getting into arguments, or not supporting each 

other. For example, one family member may be more troubled by 

a trauma or loss reminder than other family members. 

You should encourage.family.members.to.be.understanding,.patient,.and.tolerant.of.

differences.in.their.reactions, and to talk about things that are bothering them, so the 

others will know when and how to support them. Family members can help each other in 

a number of ways, like listening and trying to understand, comforting with a hug, doing 

something thoughtful like writing a note, or getting his/her mind off things by playing 

a game. Parents need to pay special attention to how their children may be troubled by 

reminders and hardships, because they can strongly affect how their children react and 

behave. For example, a child may look like he/she is having a temper tantrum, when 

actually he/she has been reminded of a friend who was hurt or killed. 

When disasters confront adults with danger and loss, adolescents may find afterwards that 

their parents/caretakers have become more anxious about their safety and, consequently, 

more restrictive in what they allow adolescents to do. You can help.adolescents.

understand.the.increase.in.their.caregivers’.protective.behaviors–such as earlier 

curfews, not letting adolescents go off by themselves without adult supervision, insisting 

that they call in frequently, or not letting adolescents do things that involve some 

“everyday” risk, like driving a car or doing skateboarding tricks. Remind adolescents that 

this “strictness” is normal and usually temporary. This will help them avoid unnecessary 

conflict as the family recovers. You may say: 

Information on Coping
 

Adolescent When disasters like this happen, parents/caregivers often become 

more anxious about their kids’ safety, so they often have more 

restrictions. So, while your parents feel the need to keep you on 

a tighter leash to make sure you are safe, try to give them some 

slack. This is usually only temporary, and will probably decrease 

as things start to settle down. 

4 National Child Traumatic Stress Network National Center for PTSD 
Assist with Developmental Issues 

Children, adolescents, adults, and families go through stages of physical, emotional, 

cognitive, and social development. The many stresses and adversities in the aftermath of 

a disaster may result in key interruptions, delays, or reversals in development. The loss 

of anticipated opportunities or achievements can be a major consequence of the disaster. 

Developmental progression is often measured by these milestones. 

Examples of Developmental Milestones 

Toddlers and •	 becoming toilet trained 

Preschool-Age •	 entering daycare or preschool 

Children •	 learning to ride a tricycle 

•	 sleeping through the night 

•	 learning or using language 

School-Age •	 learning to read and do arithmetic 

Children •	 being able to play by rules in a group of children 

•	 handling themselves safely in a widening scope of unsupervised 

time 

Early •	 having friends of the opposite sex 

Adolescents •	 pursuing organized extracurricular activities 

•	 striving for more independence and activities outside of the 

home 

Older •	 learning to drive 

Adolescents •	 getting a first job 

•	 dating 

•	 going to college 

Adults •	 starting or changing a job or career 

•	 getting engaged or married 

•	 having a child 

•	 having children leave home 

Families •	 buying a new home or moving 

•	 having a child leave home 

•	 going through a separation or divorce 

•	 experiencing the death of a grandparent 

All Ages •	 graduations 

•	 birthdays 

•	 special events 

Information on Coping
 


Psychological First Aid - Field Operations Guide	  












	 

	 

	 

Assist with Developmental Issues - continued 

Children and families should also be given an opportunity to attend to the disaster’s 

impact on development. It can be helpful to ask children and families directly: 

Information on Coping 

Parent/Caregiver	 Are there any special events that the family was looking forward 

to? Was anyone about to do something important, like starting 

school, graduating from high school, or entering college? 

Adult	 Are there any goals you were working towards that this disaster has, or might interfere with, like a promotion at work or 

getting married? 

Child/Adolescent	 Were there things before the disaster that you were looking 

forward to, like a birthday, a school activity, or playing on a 

sport team? 

You should try to increase the family’s appreciation of these issues, so that they 

understand the challenge to each individual, as well as the whole family. Help find 

alternative ways for family members to handle the interruption or delay. In helping to 

develop a plan to address these concerns, consider whether the family can: 

Postpone the event to a later date 

Relocate the event to a different place 

Change expectations, so that the postponement becomes tolerable 

Assist with Anger Management 

Stressful post-disaster situations can make survivors feel irritable and increase their 

difficulty in managing their anger. In addressing anger, you can: 

Explain that feelings of anger and frustration are common to survivors after disaster. 

Discuss how the anger is affecting their life (for example, relationship with family 

members and friends, and parenting). 

Normalize the experience of anger, while discussing how anger can increase 

interpersonal conflict, push others away, or potentially lead to violence. 

Ask survivors to identify changes that they would like to make to address their 

anger. 

Compare how holding on to the anger can hurt them, versus how coping with, 

letting go of anger or directing it toward positive activities can help. 

Emphasize that some anger is normal and even helpful, while too much anger can 

undermine what they want to do. 

	 	 National Child Traumatic Stress Network National Center for PTSD 
Some anger management skills that you can suggest include: 





















Take a “time out” or “cool down” (walk away and calm down, do something else 

for a while). 

 	 Talk to a friend about what is angering you. 

 	 Blow off steam through physical exercise (go for a walk, jog, do pushups). 

 	 Keep a journal in which you describe how you feel and what you can do to change 

the situation. 

 	 Remind yourself that being angry will not help you achieve what you want, and 

may harm important relationships. 

 	 Distract yourself with positive activities like reading a book, praying or meditating, 

listening to upbeat music, going to religious services or other uplifting group 

activities, helping a friend or someone in need, etc. 

Look at your situation in a different way, see it from another’s viewpoint, or find 

reasons your anger may be over the top. 

 	 For parents/caregivers, have another family member or other adult temporarily 

supervise your children’s activities while you are feeling particularly angry or 

irritable. 

 	 Children and adolescents often like activities that help them express their feelings, 

such as drawing pictures, writing in a journal, playing out the situation with toys, 

and composing a song. 

 	 Help children and adolescents to problem-solve a situation that is angering or 

frustrating them (like helping them settle a dispute with another child, helping them 

obtain books or toys, etc.). 

If the angry person appears uncontrollable or becomes violent, seek immediate medical/ 

mental health attention and contact security. 

Address Highly Negative Emotions (Guilt and Shame) 

In the aftermath of disasters, survivors may think about what caused the event, how they 

reacted, and what the future holds. Attributing excessive blame to themselves or others 

may add to their distress. You should listen for such negative beliefs, and help survivors 

to look at the situation in ways that are less upsetting. You might ask: 

	 	 How could you look at the situation that would be less upsetting and more helpful? 

What’s another way of thinking about this? 

Information on Coping
 


Psychological First Aid - Field Operations Guide	 	 
Address Highly Negative Emotions (Guilt and Shame) - continued 

 	 How might you respond if a good friend was talking to himself/herself like this? 

What would you say to him/her? Can you say the same things to yourself? 

Tell the survivor that even if he/she thinks he/she is at fault, that does not make it true. If 

the survivor is receptive, offer some alternative ways of looking at the situation. Help to 

clarify misunderstandings, rumors, and distortions that exacerbate distress, unwarranted 

guilt, or shame. For children and adolescents who have difficulty labeling thoughts, 

you can write the negative thoughts on a piece of paper (for example, “I did something 

wrong,” “I caused it to happen,” “I was misbehaving”) and have the child add to them. 

You can then discuss each one, clarify any misunderstandings, discuss more helpful 

thoughts, and write them down. Remind the child or adolescent that he/she is not at fault, 

even if he/she has not expressed these concerns. 

Help with Sleep Problems 

Sleep difficulties are common following a disaster. People tend to stay on alert at night, 

making it hard to fall asleep and causing frequent awakenings. Worries about adversities 

and life changes can also make it hard to fall asleep. Disturbance in sleep can have a 

major effect on mood, concentration, decision-making, and risk for injury. Ask whether 

the survivor is having any trouble sleeping and about sleep routines and sleep-related 

habits. Problem-solve ways to improve sleep. For example the survivor might try to: 

	 

	 

	 

	 

	 

	 

Go to sleep at the same time and get up at the same time each day. 

Reduce alcohol consumption, alcohol disrupts sleep. 

Eliminate consumption of caffeinated beverages in the afternoon or evening. 

Increase regular exercise, though not too close to bedtime. 

Relax before bedtime by doing something calming, like listening to soothing music, 

meditating, or praying. 

Limit daytime naps to 15 minutes and limit napping later than 4 PM. 

Discuss that worry over immediate concerns and exposure to daily reminders can make 

it more difficult to sleep, and that being able to discuss these and get support from others 

can improve sleep over time. 

Remind parents that it is common for children to want to remain close to their parents at 

nighttime, and even to want to sleep in bed with them. Temporary.changes.in.sleeping.

arrangements.are.okay, as long as parents make a plan with their children to negotiate 

a return to normal sleeping arrangements. For example, a parent might say, “We have all 

been scared by what happened. You can stay in our bedroom for the next couple of nights. 

Then you will sleep in your bed, but we will sit with you in your bedroom for a while 

before you go to sleep so you will feel safe. If you get scared again, we can talk about it.” 

	 National Child Traumatic Stress Network National Center for PTSD 

Information on Coping
 

Address Alcohol and Substance Use 

When use of alcohol and other substances is a concern: 

 Explain to the survivor that many people (including adolescents) who experience 

stress reactions choose to drink or use medications or drugs to reduce their bad 

feelings. 

 Ask the individual to identify what he/she sees as the positives and negatives of 

using alcohol or drugs to cope. 

 Discuss and mutually agree on abstinence or a safe pattern of use. 

 Discuss anticipated difficulties in changing behavior. 

 If appropriate and acceptable to the person, make a referral for substance abuse 

counseling or detoxification. 

	 If the individual has previously received treatment for substance abuse, encourage 

him/her to once again seek treatment to get through the next few weeks and months. 

The handout, Alcohol, Medication, and Drug Use after Disasters (Appendix E) gives an 

overview of this information, and is intended for adults and adolescents with concerns in 

this area. 

Information on Coping
 


Psychological First Aid - Field Operations Guide	 
This.page.intentionally.left.blank. 

0 National Child Traumatic Stress Network National Center for PTSD 
Psychological First Aid 

Field Operations Guide

2nd Edition 

Collaborative Services: 

 Provide Direct Link to Additional Needed Services 

 Referrals for Children and Adolescents 

 Referrals for Older Adults 

 Promote Continuity in Helping Relationships 
.This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 

















 

















. Linkage with Collaborative Services 

Goal:.To.link.survivors.with.available.services.needed.at.the.time.or.in.the.future.

Provide Direct Link to Additional Needed Services 

As you provide information, also discuss which of the survivor’s needs and current 

concerns require additional information or services. Do what is necessary to ensure 

effective linkage with those services (for example, walk the survivor over to an 

agency representative who can provide a service, set up a meeting with a community 

representative who may provide appropriate referrals). Examples of situations requiring a 

referral include: 

An acute medical problem that needs immediate attention 

An acute mental health problem that needs immediate attention 

Worsening of a pre-existing medical, emotional, or behavioral problem 

Threat of harm to self or others 

Concerns related to the use of alcohol or drugs 

Cases involving domestic, child, or elder abuse (be aware of reporting laws) 

When medication is needed for stabilization 

When pastoral counseling is desired 

Ongoing difficulties with coping (4 weeks or more after the disaster) 

Significant developmental concerns about children or adolescents 

When the survivor asks for a referral 

In addition, reconnect survivors to agencies that provided them services before the 

disaster including: 
 

Mental health services
 


Medical services
 


Social support services
 


Child welfare services
 


Schools
 


Drug and alcohol support groups
 


Psychological First Aid - Field Operations Guide 3

Collaborative Services
 

Provide Direct Link to Additional Needed Services - continued 

When making a referral: 











Summarize your discussion with the person about his/her needs and concerns. 

Check for the accuracy of your summary. 

Describe the option of referral, including how this may help, and what will take 

place if the individual goes for further help. 

Ask about the survivor’s reaction to the suggested referral. 

Give written referral information, or if possible, make an appointment then and 

there. 

Referrals for Children and Adolescents 

Remember that children and adolescents under the age of 18 will need parental consent 

for services outside of immediate emergency care. Youth may be less likely to self-refer 

when they are experiencing difficulties, and are less likely to follow through on referrals 

without an adult who is engaged in the process. To maximize the likelihood that youth 

will follow through with a referral, you should: 

	 	

	 	

	 

Recommend that any follow-up services for the family include (at least) a brief 

evaluation of child and adolescent adjustment. 

Make your interactions with children and adolescents positive and supportive to 

help them develop a positive attitude towards future care providers. 

Remember that children and adolescents have an especially difficult time telling 

and retelling information related to traumatic events. When working with youth, 

summarize in writing the basic information about the event that you have gathered 

and communicate this information to the receiving professional. This will help 

minimize the number of times that they will have to retell the story of their 

experiences. 

Referrals for Older Adults 

Help with plans for an elder who is going home or needs access to alternative housing. 

Make sure the elder has referral sources for the following, if needed: 

	 

	 

	 

	 

A primary care physician 

A local senior center 

Council on Aging programs 

Social support services 

4	 	 National Child Traumatic Stress Network National Center for PTSD 

Collaborative Services
 

	 

	 

	 

Meals on Wheels 

Senior housing or assisted living 

Transportation services 

Promote Continuity in Helping Relationships 

A secondary, but important concern for many survivors is being able to keep in contact 

with responders who have been helpful. In most cases, continuing contact between 

survivors and you will not be possible because survivors will leave triage sites or family 

assistance centers and go to other sites for continuing services. However, loss of contacts 

made during the acute aftermath of disasters can lead to a sense of abandonment or 

rejection. You can create a sense of continuing care if you: 





 	 Give the names and contact information for the local public health and public 

mental health service providers in the community. There may also be other local 

providers or recognized agencies who have volunteered to provide post-disaster 

follow-up services for the community. (Be wary of referring to unknown volunteer 

providers.) Such information may not be known for several hours or days, but once 

available, it can be helpful to disaster survivors. 

 	 Introduce survivors to other mental health, health care, family service, or relief 

workers, so that they know several other helpers by name. 

Sometimes, survivors feel as if they are meeting a never-ending succession of helpers, 

and that they have to go on explaining their situation and telling their story to each one 

in turn. To the extent possible, minimize this. If you are leaving a response site, let the 

survivor know, and if possible, ensure a direct “hand-off” to another provider, one who 

will be in a position to maintain an ongoing helping relationship with the person. Orient 

the new provider to what he/she needs to know about the person, and if possible, provide 

an introduction. 

Collaborative Services
 


Psychological First Aid - Field Operations Guide	 	 
.This.page.intentionally.left.blank. 

 National Child Traumatic Stress Network National Center for PTSD 
Psychological First Aid 

Field Operations Guide
 

2nd Edition
 


LIST OF APPENDICES: 

Appendix A: Overview of Psychological First Aid 

Appendix B: Service Delivery Sites and Settings 

Appendix C: Psychological First Aid Provider Care 

Appendix D: Psychological First Aid Worksheets 

Appendix E: Handouts for Survivors 
.This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 
Psychological First Aid 

Field Operations Guide

2nd Edition 

Appendix A: 

 Overview of Psychological First Aid 
.This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 
Overview of Psychological First Aid
 


Section Headers 

Preparing to Deliver 1. Entering the setting 

Psychological First 2. Providing services 

Aid 3. Group settings 

4. Maintain a calm presence 

5. Be sensitive to culture and diversity 

6. Be aware of at-risk populations 

Contact and 1. Introduce yourself/ask about immediate needs 

Engagement 2. Confidentiality 

Safety and Comfort 1. Ensure immediate physical safety 

2. Provide information about disaster response activities and services 

3. Attend to physical comfort 

4. Promote social engagement 

5. Attend to children who are separated from their parents/caregivers 

6. Protect from additional traumatic experiences and trauma reminders 

7. Help survivors who have a missing family member 

8. Help survivors when a family member or close friend has died 

9. Attend to grief and spiritual issues 

10. Provide information about casket and funeral issues 

11. Attend to issues related to traumatic grief 

12. Support survivors who receive death notification 

13. Support survivors involved in body identification 

14. Help caregivers confirm body identification to a child or adolescent 

Stabilization 1. Stabilize emotionally overwhelmed survivors 

2. Orient emotionally overwhelmed survivors 

3. The role of medications in stabilization 

Information 1. Nature and severity of experiences during the disaster 

Gathering: Current 2. Death of a loved one 

Needs and Concerns 3. Concerns about immediate post-disaster circumstances and ongoing threat 

4. Separations from or concern about the safety of loved ones 

5. Physical illness, mental health conditions, and need for medications 

6. Losses (home, school, neighborhood, business, personal property, and pets) 

7. Extreme feelings of guilt or shame 

8. Thoughts about causing harm to self or others 

9. Availability of social support 

10. Prior alcohol or drug use 

11. Prior exposure to trauma and death of loved ones 

12. Specific youth, adult, and family concerns over developmental impact 

Psychological First Aid - Field Operations Guide 0
Overview of Psychological First Aid - continued 

Section Headers 

Practical Assistance 1. Offering practical assistance to children and adolescents 

2. Identify the most immediate needs 

3. Clarify the need 

4. Discuss an action plan 

5. Act to address the need 

Connection with 

Social Supports 

1. Enhance access to primary support persons (family and significant others) 

2. Encourage use of immediately available support persons 

3. Discuss support-seeking and giving 

4. Special considerations for children and adolescents 

5. Modeling support 

Information on 1.	 	Provide basic information about stress reactions 

Coping 2.	 	Review common psychological reactions to traumatic experiences and 

losses 

• Intrusive reactions
	 

• Avoidance and withdrawal reactions
	 

• Physical arousal reactions
	 

• Trauma reminders
	 

• Loss reminders
	 

• Change reminders
	 

• Hardships
	 

• Grief reactions
	 

• Traumatic grief reactions 
 

• Depression
	 

• Physical reactions
	 

3.	 Talking with children about physical and emotional reactions 

4.	 Provide basic information on ways of coping 

5.	 Teach simple relaxation techniques 

6.	 Coping for families 

7.	 Assist with developmental issues 

8.	 Assist with anger management 

9.	 Address highly negative emotions 

10. Help with sleep problems 

11. Address alcohol and substance use 

Linkage with 

Collaborative 

1. Provide direct link to additional needed services 

2. Referrals for children and adolescents 

Services 3. Referrals for older adults 

4. Promote continuity in helping relationships 

0	 	 National Child Traumatic Stress Network National Center for PTSD 
Psychological First Aid 

Field Operations Guide

2nd Edition 

Appendix B: 

 Service Delivery Sites and Settings 
.This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 
Service Delivery Sites and Settings 

Service Site Challenges in Delivering Psychological First Aid 

You can face many challenges in delivering services to disaster survivors and disaster relief workers. These challenges are often related to the specific disaster characteristics (for example, natural 

vs. human caused, size, location) and those of the individuals involved (for example, populations of 

special consideration–those with disabilities, youth, disadvantaged groups, individuals with pre-existing medical or mental health conditions). Other challenges pertain to the multiple settings in which 

you may be deployed. The following information will be helpful in anticipating and understanding the 

unique challenges of some disaster-related service sites. 

General Population Shelters 

When it is determined that a community or area of the community must be evacuated because of dangerous or threatening conditions, General Population Shelters are opened for the temporary housing 

of individuals. General Population Shelters are usually located in schools, community and recreation 

centers, or in other large facilities. Shelters usually have limited space for people to sleep, as well as 

an area for meals to be served. Typical challenges include establishing shelter rules (for example, 

lights out, regulated use of showers when in limited supply, meal times), addressing the socio-cultural 

and ethnic issues that arise when bringing diverse populations together, managing public health issues 

(for example, sanitation, medication dispensing, isolating the sick), and resolving disputes that arise 

among shelter residents or between shelter residents and staff. 

Service Centers 

Service Centers may be opened by a local or federal governmental agency or by disaster relief organizations to meet the initial needs of disaster survivors. These centers typically offer assistance with 

locating temporary housing or providing for the immediate personal needs of disaster survivors, such 

as food, clothing, and clean-up materials. Depending on the size and magnitude of the disaster, you 

may encounter large numbers of survivors seeking services, and anger and frustration expressed by 

survivors in circumstances where there are inadequate supplies. 

Community Outreach Teams 

Community Outreach Teams are usually established in the event of disasters that affect a large geographic area and/or a significant percentage of the population. These teams are often necessary to 

avoid long lines at Service Centers or when transportation services for the general population are 

limited. The teams are usually composed of two or more individuals that can provide comprehensive 

services to disaster survivors. For example, a disaster mental health or spiritual care professional may 

be teamed up with a representative from the American Red Cross who can provide assistance in meeting the survivors’ food, clothing, and shelter needs. 

Psychological First Aid - Field Operations Guide 0
Family Reception Centers 

Family Reception Centers are typically opened in the immediate aftermath of a disaster involving mass casualties or fatalities. There is a common recognition that after such disasters, individuals may be trying to locate family or other loved ones specifically involved in the disaster 

or separated during the evacuation process. Often these are temporary holding sites until a more 

structured and operational Family Assistance Center can be opened. Family Reception Centers 

may be established in close proximity to the immediate disaster scene where individuals arrive in 

search of family and other loved ones involved in the incident, or in healthcare facilities where 

the injured have been transported. 

Family Assistance Centers 

Family Assistance Centers are commonly opened in the event of a disaster involving mass casualties or fatalities. These centers usually offer a range of services in an effort to meet the needs of 

individuals under these circumstances. Mental health services, spiritual care, and crime victims’ 

services, as well as the services of law enforcement, the medical examiner, disaster relief agencies, and other local, state, and federal agencies are also offered on site. Family Assistance 

Centers are usually located away from the immediate disaster site. Family members may request 

visits to the affected site or memorial services. Therefore, the Family Assistance Centers should 

be close enough to facilitate those activities. 

Points of Dispensing (POD) Centers 

PODs might be established by local, state, or federal public health agencies in the event of a public health emergency. These centers may be established to provide mass distribution of medications or vaccinations in an effort to prevent or mitigate the spread of any communicable disease 

or other public health risk. Healthcare facilities may open PODs with the goal of vaccinating or 

distributing necessary medications to their own personnel or to reduce the burden on the community POD sites. 

Phone Banks and Hotlines 

Communities and healthcare systems may wish to set up a Phone Bank to address and respond to 

numerous calls with questions that typically arise after a disaster. These Phone Banks are likely 

to be overwhelmed in the first few hours or days, with many questions regarding such issues as 

locating missing or injured family members or healthcare concerns. Community hotlines may 

encounter similar questions and address additional information such as the availability of shelter 

locations, mass food distribution sites, and other disaster relief services. 

0 National Child Traumatic Stress Network National Center for PTSD 
Emergency First Aid Stations 

Emergency First Aid Stations provide basic medical services to disaster survivors as well as 

responders who may suffer minor injuries in the rescue and recovery efforts. They are usually 

located in close proximity to the direct impact of a disaster. In the event of a disaster resulting in 

mass casualties, makeshift emergency first aid stations may be set up near a healthcare facility in 

an effort to relieve the burden on emergency room services and ensure that such high level care 

is available to the seriously injured. 

Hospitals and Hospital Emergency Room Settings 

During a mass casualty event, survivors who are triaged on site and listed as “immediate” will 

be brought to a hospital. In addition, many others will self-transport to the hospital wanting to 

be seen in the Emergency Room. This is likely to create a surge on medical resource capacity. 

Survivors may arrive in large numbers, many with both psychological and physical reactions. 

One important goal is to facilitate the treatment of injured survivors by removing individuals 

who do not require immediate medical care from the patient flow. However, increased physical 

symptoms have frequently been reported after disasters, particularly among those who witness 

injury and death, and those who may have had toxic exposure to a chemical or biological attack. 

As a result, differential diagnosis may at times be difficult, since signs and symptoms may be 

nonspecific and/or status may change over time. News or rumors of such an attack may generate 

an influx of those who fear they have been exposed, and rapidly overwhelm the system. Along 

with a system of triage, hospitals may set up a “support center” where Psychological First Aid 

providers can refer those in need to a spectrum of medical, psychological, behavioral, and pharmacological interventions. 

Respite Centers 

Respite Centers are locations where first responders can rest and obtain food, clothing, and other 

basic support services. They are usually opened where prolonged rescue and recovery efforts are 

necessary. Respite Centers are usually located in close proximity to the direct impact of a disaster. Typical challenges for Psychological First Aid include limited time to interact with responders who are extremely busy and tired, and feel a sense of urgency to continue working. 

Psychological First Aid - Field Operations Guide 0 
.This.page.intentionally.left.blank. 

0 National Child Traumatic Stress Network National Center for PTSD 
Psychological First Aid 

Field Operations Guide

2nd Edition 

Appendix C: 

 Psychological First Aid Provider Care 
.This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 
Psychological First Aid Provider Care 

Providing care and support in the immediate aftermath of disaster can be an enriching 

professional and personal experience that enhances satisfaction through helping others. 

It can also be physically and emotionally exhausting. The following sections provide 

information to consider before, during, and after engaging in disaster relief work. 

Before Relief Work 

In deciding whether to participate in disaster response, you should consider your comfort 

level with this type of work and your current health, family, and work circumstances. These 

considerations should include the following: 

Personal Considerations 

Assess your comfort level with the various situations you may experience while providing 

Psychological First Aid: 



















Working with individuals who are experiencing intense distress and extreme 

reactions, including screaming, hysterical crying, anger, or withdrawal 

Working with individuals in non-traditional settings 

Working in a chaotic, unpredictable environment 

Accepting tasks that may not initially be viewed as mental health activities (e.g., 

distributing water, helping serve meals, sweeping the floor) 

Working in an environment with minimal or no supervision or conversely, micromanaged 

Working with and providing support to individuals from diverse cultures, ethnic 

groups, developmental levels, and faith backgrounds 

Working in environments where the risk of harm or exposure is not fully known 

Working with individuals who are not receptive to mental health support 

Working with a diverse group of professionals, often with different interaction 

styles 

Health Considerations 

Assess your current physical and emotional health status, and any conditions that may 

influence your ability to work long shifts in disaster settings, including: 





Recent surgeries or medical treatments
 


Recent emotional or psychological challenges or problems
 


Psychological First Aid - Field Operations Guide 
Health Considerations - continued 











Any significant life changes or losses within the past 6-12 months 

Earlier losses or other negative life events 

Dietary restrictions that would impede your work 

Ability to remain active for long periods of time and endure physically exhausting 

conditions 

If needed, enough medication available for the total length of your assignment plus 

some extra days 

Family Considerations 

Assess your family’s ability to cope with your providing Psychological First Aid in a 

disaster setting: 











Is your family prepared for your absence, which may span days or weeks? 

 	 Is your family prepared for you to work in environments where the risk of harm or 

exposure to harm is not fully known? 

 	 Will your support system (family/friends) assume some of your family 

responsibilities and duties while you are away or working long hours? 

 	 Do you have any unresolved family/relationship issues that will make it challenging 

for you to focus on disaster-related responsibilities? 

 	 Do you have a strong, supportive environment to return to after your disaster 

assignment? 

Work Considerations 

Assess how taking time off to provide Psychological First Aid might affect your work life: 









	 	

Is your employer supportive of your interest and participation in Psychological First 

Aid? 

Will your employer allow “leave” time from your job? 

Will your employer require you to utilize vacation time or “absence-without-pay 

time” to respond as a disaster mental health worker? 

Is your work position flexible enough to allow you to respond to a disaster 

assignment within 24-48 hours of being contacted? 

Will your co-workers be supportive of your absence and provide a supportive 

environment upon your return? 

	 	 National Child Traumatic Stress Network National Center for PTSD 
Personal, Family, Work Life Plan 

If you decide to participate in disaster response, take time to make preparations for the 

following: 











Family and other household responsibilities 

Pet care responsibilities 

Work responsibilities 

Community activities/responsibilities 

Other responsibilities and concerns 

During Relief Work 

In providing Psychological First Aid, it is important to recognize common and extreme 

stress reactions, how organizations can reduce the risk of extreme stress to providers, and 

how best to take care of yourself during your work. 

Common Stress Reactions 

Providers may experience a number of stress responses, which are considered common 

when working with survivors: 





















Increase or decrease in activity level 

Difficulties sleeping 

Substance use 

Numbing 

Irritability, anger, and frustration 

Vicarious traumatization in the form of shock, fearfulness, horror, helplessness 

Confusion, lack of attention, and difficulty making decisions 

Physical reactions (headaches, stomachaches, being easily startled) 

Depressive or anxiety symptoms 

Decreased social activities 

Psychological First Aid - Field Operations Guide 3
Extreme Stress Reactions 

Providers may experience more serious stress responses that warrant seeking support from a 

professional or monitoring by a supervisor. These include: 











	 	







Compassion stress: helplessness, confusion, isolation 

Compassion fatigue: demoralization, alienation, resignation 

Preoccupation or compulsive re-experiencing of trauma experienced either directly 

or indirectly 

Attempts to over-control in professional or personal situations 

Withdrawal and isolation 

Preventing feelings by relying on substances, becoming overly preoccupied by 

work, or drastic changes in sleep (avoidance of sleep or not wanting to get out of 

bed) 

Serious difficulties in interpersonal relationships, including domestic violence 

Depression accompanied by hopelessness (which has the potential to place 

individuals at a higher risk for suicide) 

Unnecessary risk-taking 

Organizational Care of Providers 

Organizations that recruit providers can reduce the risk of extreme stress by putting supports and 

policies in place. These include: 













Limiting work shifts to no more than 12 hours and encouraging work breaks 

Rotating of providers from the most highly exposed assignments to lesser levels of exposure 

Mandating time off 

Identifying enough providers at all levels, including administration, supervision, and support 

Encouraging peer partners and peer consultation 

Monitoring providers who meet certain high risk criteria, such as: 









Survivors of the disaster 

Those having regular exposure to severely affected individuals or communities 

Those with pre-existing conditions 

Those with multiple stresses, including those who have responded to multiple 

disasters in a short period of time 

4	 	 National Child Traumatic Stress Network National Center for PTSD 




Establishing supervision, case conferencing, and staff appreciation events 

Conducting trainings on stress management practices 

Provider Self-Care 

Activities that promote self-care include: 









Managing personal resources 

Planning for family/home safety, including making child care and pet care plans 

Getting adequate exercise, nutrition, and relaxation 

Using stress management tools regularly, such as: 























Accessing supervision routinely to share concerns, identifying difficult 

experiences, and strategizing to solve problems 

 Practicing brief relaxation techniques during the workday 

 Using the buddy system to share upsetting emotional responses 

Staying aware of limitations and needs 

Recognizing when one is Hungry, Angry, Lonely or Tired (HALT), and taking 

the appropriate self-care measures 

Increasing activities that are positive 

Practicing religious faith, philosophy, and spirituality 

Spending time with family and friends 

Learning how to “put stress away” 

Writing, drawing, and painting 

Limiting caffeine, tobacco, and substance use 

As much as possible, you should make every effort to: 











Self-monitor and pace your efforts 

Maintain boundaries: delegate, say no, and avoid working with too many survivors in a 

given shift
 

Perform regular check-ins with colleagues, family, and friends
 

Work with partners or in teams
 

Take relaxation/stress management/bodily care/refreshment breaks
 

 Utilize regular peer consultation and supervision 
 

Psychological First Aid - Field Operations Guide  
Provider Self-Care - continued 





Try to be flexible, patient, and tolerant
	
 

Accept that you cannot change everything 
 

You should avoid engaging in:
 












Extended periods of solo work without colleagues
 


Working “round the clock” with few breaks
 


Negative self-talk that reinforces feelings of inadequacy or incompetency
 


Excessive use of food/substances as a support
 


Common attitudinal obstacles to self-care:
 












“It would be selfish to take time to rest.”
	
 

“Others are working around the clock, so should I.”
 


“The needs of survivors are more important than the needs of helpers.”
 


“I can contribute the most by working all the time.”
 


“Only I can do x, y, and z.”
 


After Relief Work 

Expect a readjustment period upon returning home. You may need to make personal 

reintegration a priority for a while. 

Organizational Care of Providers 

Organizations should: 













Encourage time off for providers who have experienced personal trauma or loss. 

Institute exit interviews to help providers with their experience–this should include 

information about how to communicate with their families about their work. 

Encourage providers to seek counseling when needed, and provide referral 

information. 

Provide education on stress management. 

Facilitate ways providers can communicate with each other by establishing 

listservs, sharing contact information, or scheduling conference calls. 

Provide information regarding positive aspects of the work. 

 National Child Traumatic Stress Network National Center for PTSD 
Provider Self-Care 

Make every effort to: 





































Seek out and give social support.
 


Check in with other relief colleagues to discuss relief work.
 


Increase collegial support.
 


Schedule time for a vacation or gradual reintegration into normal life.
 


Prepare for worldview changes that may not be mirrored by others in your life.
 


Participate in formal help to address your response to relief work if extreme stress 
 

persists for greater than two to three weeks. 

Increase leisure activities, stress management, and exercise. 

Pay extra attention to health and nutrition. 

Pay extra attention to rekindling close interpersonal relationships. 

Practice good sleep routines. 

Make time for self-reflection. 

Practice receiving from others. 

Find activities that you enjoy or that make you laugh. 

Try at times not to be in charge or the “expert.” 

Increase experiences that have spiritual or philosophical meaning to you. 

Anticipate that you will experience recurring thoughts or dreams, and that they will 

decrease over time. 

Keep a journal to get worries off your mind. 

Ask help in parenting if you feel irritable or are having difficulties adjusting to 

being back at home. 

Make every effort to avoid: 









Excessive use of alcohol, illicit drugs, or excessive amounts of prescription drugs. 

Making any big life changes for at least a month. 

Negatively assessing your contribution to relief work. 

Worrying about readjusting. 

Psychological First Aid - Field Operations Guide 
Provider Self-Care - continued 

 Obstacles to better self-care: 







Keeping too busy 

Making helping others more important than self-care 

Avoiding talk about relief work with others 

 National Child Traumatic Stress Network National Center for PTSD 
Psychological First Aid 

Field Operations Guide

2nd Edition 

Appendix D: 

 Psychological First Aid Worksheets 
This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 


































I

c

l

I

c

r

Provider Worksheets 


Survivor Current Needs 

Date: _______ Provider: _________________________ 

Survivor Name:___________________________________ 

Location: ________________________________________ 

This session was conducted with (check all that apply): 

 Child  Adolescent  Adult  Family  Group 

Provider: Use this form to document what the survivor needs most at this time. This form can be 

used to communicate with referral agencies to help promote continuity of care. 

1. Check the boxes corresponding to difficulties the survivor is experiencing. 

Behavioral 



















Extreme 

disorientation 

Excessive drug, 

alcohol, or 

prescription drug 

use 

Isolation/ 

withdrawal 

High risk behavior 

Regressive 

behavior 

Separation anxiety 

Violent behavior 

Maladaptive 

coping 

Other __________ 

Emotional 

Acute stress 

reactions 

Acute grief 

reactions 

Sadness, 

tearfulness 

Irritability, anger 

Feeling anxious, 

fearful 

Despair, 

hopelessness 

Feelings of guilt or

shame 

Feeling 

emotionally numb, 

disconnected 

Other __________ 

Physical 

Headaches 

Stomachaches 

Sleep difficulties 

Difficulty eating 

Worsening of 

health conditions 

Fatigue/exhaustion 

Chronic agitation 

Other __________ 

Cognitive 

nability to accept/ 

ope with death of 

oved one(s) 

Distressing dreams 

or nightmares 

ntrusive thoughts 

or images 

Difficulty 

oncentrating 

Difficulty 

emembering 

Difficulty making 

decisions 

Preoccupation with 

death/destruction 

Other __________ 

















Psychological First Aid - Field Operations Guide  
2. Check the boxes corresponding to difficulties the survivor is experiencing.
	 

 Past or preexisting trauma/psychological problems/substance abuse problems 

 Injured as a result of the disaster 

 At risk of losing life during the disaster 

 Loved one(s) missing or dead 

 Financial concerns 

 Displaced from home 

 Living arrangements 

 Lost job or school 

 Assisted with rescue/recovery 

 Has physical/emotional disability 

 Medication stabilization 

 Concerns about child/adolescent 

 Spiritual concerns 

 Other: __________________________________________________________________ 

3. Please.make.note.of.any.other.information.that.might.be.helpful.in.making.a.referral.

___________________________________________________________________________ 

___________________________________________________________________________ 

4. Referral

 Within project (specify) _______________  Substance abuse treatment
 


 Other disaster agencies  Other community services
 


 Professional mental health services  Clergy
 


 Medical treatment  Other: _______________
 


5. Was.the.referral.accepted.by.the.individual?

 Yes 
 

 No 
 

 National Child Traumatic Stress Network National Center for PTSD
Contact and Engagement 

 Initiated contact in an appropriate manner  Asked about immediate needs 

Safety and Comfort 

 Took steps to ensure immediate physical  Gave information about the disaster/risks 

safety 

 Attended to physical comfort  Encouraged social engagement 

 Attended to a child separated from parents  Protected from additional trauma 

 Assisted with concern over missing loved one  Assisted after death of loved one 

 Assisted with acute grief reactions  Helped with talking to children about death 

 Attended to spiritual issues regarding death  Attended to traumatic grief 

 Provided information about funeral issues  Helped survivor after body identification 

 Helped survivors regarding death notification  Helped with confirmation of death to child 

Stabilization 

 Helped with stabilization  Used grounding technique 

 Gathered information for medication referral 

for stabilization 

Information Gathering 

 Nature and severity of disaster experiences  Death of a family member or friend 

 Concerns about ongoing threat  Concerns about safety of loved one(s) 

 Physical/mental illness and medications(s)  Disaster-related losses 

 Extreme guilt or shame  Thoughts of harming self or others 

 Availability of social support  Prior alcohol or drug use 

 History of prior trauma and loss  Concerns over developmental impact 

 Other _______________ 

Provider Worksheets 

Psychological First Aid Components Provided 

Date: _______ Provider: _________________________ 

Location: ________________________________________ 

This session was conducted with (check all that apply): 

 Child  Adolescent  Adult  Family  Group 

Place a checkmark in the box next to each component of Psychological First Aid that you provided 

in this session. 

Psychological First Aid - Field Operations Guide 3 
Practical Assistance 

 Helped to identify most immediate need(s)  Helped to clarify need(s)
 


 Helped to develop an action plan  Helped with action to address the need
 


Connection with Social Supports 

 Facilitated access to primary support persons  Discussed support seeking and giving 

 Modeled supportive behavior  Engaged youth in activities 

 Helped problem-solve obtaining/giving 

social support 

Information of Coping 

 Gave basic information about stress  Gave basic information on coping 

reactions 

 Taught simple relaxation techniques(s)  Helped with family coping issues 

 Assisted with developmental concerns  Assisted with anger management 

 Addressed negative emotions (shame/guilt)  Helped with sleep problems 

 Addressed substance abuse problems 

Linkage with Collaborative Services 

 Provided link to additional service(s) _______________________________________ 

 Promoted continuity of care _______________________________________ 

 Provided handout(s) _______________________________________ 

4 National Child Traumatic Stress Network National Center for PTSD 
Psychological First Aid 

Field Operations Guide

2nd Edition 

Appendix E: 

	 Handouts for Survivors 

 Connecting with Others: Seeking Social Support (for adults and 

adolescents) 

 Connecting with Others: Giving Social Support (for adults and adolescents) 

 When Terrible Things Happen (for adults and adolescents) 

 Parent Tips for Helping Infants and Toddlers (for parents/caregivers) 

 Parent Tips for Helping Preschool-Age Children (for parents/caregivers) 

 Parent Tips for Helping School-Age Children (for parents/caregivers) 

 Parent Tips for Helping Adolescents (for parents/caregivers) 

 Tips for Adults (for adult survivors) 

 Basic Relaxation Techniques (for adults, adolescents, and children) 

 Alcohol and Drug Use after Disasters (for adults and adolescents) 
.This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 
Connecting with Others
 


Seeking Social Support 







Making contact with others can help reduce feeling of distress 

Children and adolescents can benefit from spending some time with similar-age peers 

Connections can be with family, friends, or others who are coping with the same traumatic event 

Social Support Options 







Spouse/partner or parents 	 

	 

	 

Clergy 





Support group 

Trusted family member Doctor or nurse Co-worker/Teacher/Coach 

Close friend Crisis/School counselor or Pet 

other counselor 

Do . . . 







Decide carefully whom to 





Start by talking about 





Ask others if it’s a good 

talk to practical things time to talk 

Decide ahead of time what Let others know you need to Tell others you appreciate 

you want to discuss talk or just to be with them them listening 

Choose the right time and Talk about painful thoughts Tell others what you need 

place and feelings when you’re or how they could help–one 

ready main thing that would help 

you right now 

Don’t . . . 

	 	

	 	

Keep quiet because you don’t want to upset 



Assume that others don’t want to listen 

others 

Keep quiet because you’re worried about Wait until you’re so stressed or exhausted 

being a burden that you can’t fully benefit from help 

Ways to Get Connected 







Calling friends or family on the phone 



Getting involved with a support group 

 	 Increasing contact with existing Getting involved in community/school 

acquaintances and friends recovery activities 

 	 Renewing or beginning involvement in 

religious group activities 

Psychological First Aid - Field Operations Guide	 	 
.This.page.intentionally.left.blank. 

 National Child Traumatic Stress Network National Center for PTSD
Connecting with Others
 


Giving Social Support 

You can help family members and friends cope with the disaster by spending time with them and listening carefully. Most people recover better when they feel connected to others who care about them. 

Some people choose not to talk about their experiences very much, and others may need to discuss 

their experiences. For some, talking about things that happened because of the disaster can help 

those events seem less overwhelming. For others, just spending time with people they feel close to 

and accepted by, without having to talk, can feel best. Here is some information about giving social 

support to other people. 

Reasons Why People May Avoid Social Support 







Not knowing what they need 





Not wanting to burden others 





	 	 Wanting to avoid thinking or 
 

feeling about the event
 

 	 Feeling embarrassed or Doubting it will be helpful, or Assuming that others will be 
 

“weak” that others will understand disappointed or judgmental
 

Fearing they will lose control 	 	 Having tried to get help and Not knowing where to get 
 

feeling that it wasn’t there help
 


Good Ways to Give Support 







Show interest, attention, and 





Show respect for the person’s 





Talk about expectable 
 

care reactions and ways of coping reactions to disasters, and 
 

healthy coping
 


Find an uninterrupted time Acknowledge that this type Express belief that the person 

and place to talk of stress can take time to is capable of recovery 

resolve 

Be free of expectations or Help brainstorm positive Offer to talk or spend time 
 

judgments ways to deal with reactions together as many times as is 
 

needed
 


Psychological First Aid - Field Operations Guide	 	 
Behaviors That Interfere with Giving Support 

	 

	 

	 

Rushing to tell someone the he/she will be okay 





Acting like someone is weak or exaggerating 

or that they should just “get over it” because he or she isn’t coping as well as you 

are 

Discussing your own personal experiences Giving advice without listening to the person’s 

without listening to the other person’s story concerns or asking the person what works for 

him or her 

Stopping people from talking about what is Telling them they were lucky it wasn’t worse 

bothering them 

When Your Support is Not Enough 





 	 Let the person know that experts think that 



Encourage the person to talk with a counselor, 

avoidance and withdrawal are likely to increase clergy, or medical professional, and offer to 

distress, and social support helps recovery. accompany them. 

 	 Encourage the person to get involved in a Enlist help from others in your social circle so 

support group with others who have similar that you all take part in supporting the person. 

experiences. 

30	 	 National Child Traumatic Stress Network National Center for PTSD 
When Terrible Things Happen - What You May

Experience
 


Immediate Reactions 

There are a wide variety of positive and negative reactions that survivors can experience during and 

immediately after a disaster. These include: 

Domain Negative Responses Positive Responses 

Cognitive Confusion, disorientation, worry, intrusive thoughts and images, self-blame Determination and resolve, sharper 

perception, courage, optimism, faith 

Emotional Shock, sorrow, grief, sadness, fear, anger, numb, irritability, guilt and shame 

Feeling involved, challenged, mobilized 

Social Extreme withdrawal, interpersonal 

conflict 

Social connectedness, altruistic helping 

behaviors 

Physiological Fatigue, headache, muscle tension, 

stomachache, increased heart rate, exaggerated startle response, difficulties 

sleeping 

Alertness, readiness to respond, increased energy 

Common negative reactions that may continue include: 

Intrusive reactions 







Distressing thoughts or images of the event while awake or dreaming 

Upsetting emotional or physical reactions to reminders of the experience 

Feeling like the experience is happening all over again (“flashback”) 

Avoidance and withdrawal reactions 











Avoid talking, thinking, and having feelings about the traumatic event 

Avoid reminders of the event (places and people connected to what happened) 

Restricted emotions; feeling numb 

Feelings of detachment and estrangement from others; social withdrawal 

Loss of interest in usually pleasurable activities 

Psychological First Aid - Field Operations Guide 3
Physical arousal reactions 







Constantly being “on the lookout” for danger, startling easily, or being jumpy 

Irritability or outbursts of anger, feeling “on edge” 

Difficulty falling or staying asleep, problems concentrating or paying attention 

Reactions to trauma and loss reminders 

	 

	 

	 

Reactions to places, people, sights, sounds, smells, and feelings that are reminders of 

the disaster 

Reminders can bring on distressing mental images, thoughts, and emotional/physical 

reactions 

Common examples include sudden loud noises, sirens, locations where the disaster 

occurred, seeing people with disabilities, funerals, anniversaries of the disaster, and 

television/radio news about the disaster 

Positive changes in priorities, worldview, and expectations 











Enhanced appreciation that family and friends are precious and important 

Meeting the challenge of addressing difficulties (by taking positive action steps, 

changing the focus of thoughts, using humor, acceptance) 

Shifting expectations about what to expect from day to day and about what is 

considered a “good day” 

Shifting priorities to focus more on quality time with family or friends 

Increased commitment to self, family, friends, and spiritual/religious faith 

When a Loved One Dies, Common Reactions Include: 









Feeling confused, numb, disbelief, bewildered, or lost 

Feeling angry at the person who died or at people considered responsible for the death 

Strong physical reactions such as nausea, fatigue, shakiness, and muscle weakness 

Feeling guilty for still being alive 

3	 	 National Child Traumatic Stress Network National Center for PTSD 














Intense emotions such as extreme sadness, anger, or fear 

Increased risk for physical illness and injury 

Decreased productivity or difficulty making decisions 

Having thoughts about the person who died, even when you don’t want to 

Longing, missing, and wanting to search for the person who died 

Children are particularly likely to worry that they or a parent might die 

Children may become anxious when separated from caregivers or other loved ones 

What Helps 



























Talking to another person for support or spending time with others 

Engaging in positive distracting activities (sports, hobbies, reading) 

Getting adequate rest and eating healthy meals 

Trying to maintain a normal schedule 

Scheduling pleasant activities 

Taking breaks 

Reminiscing about a loved one who has died 

Focusing on something practical that you can do right now to manage the situation 

better 

Using relaxation methods (breathing exercises, meditation, calming self-talk, 

soothing music) 

Participating in a support group 

Exercising in moderation 

Keeping a journal 

Seeking counseling 

Psychological First Aid - Field Operations Guide 33
What Doesn’t Help 























Using alcohol or drugs to cope 

Extreme avoidance of thinking or talking about the event or a death of a loved one 

Violence or conflict 

Overeating or failing to eat 

Excessive TV or computer games 

Blaming others 

Working too much 

Extreme withdrawal from family or friends 

Not taking care of yourself 

Doing risky things (driving recklessly, substance abuse, not taking adequate 

precautions) 

Withdrawing from pleasant activities 

34 National Child Traumatic Stress Network National Center for PTSD 
If Your Child Understand Ways to Help 

. . has problems 	 	 When children are scared, they want to be with people  If you want, let your child sleep with you. Let him know this is just 

sleeping, doesn’t who help them feel safe, and they worry when you are not for now. 

want to go to bed, together.  Have a bedtime routine: a story, a prayer, cuddle time. Tell him the 

won’t sleep alone, 	 If you were separated during the disaster, going to bed routine (every day), so he knows what to expect. 

wakes up at night alone may remind your child of that separation.  Hold him and tell him that he is safe, that you are there and will not 

screaming. 	 Bedtime is a time for remembering because we are not leave. Understand that he is not being difficult on purpose. This may 

busy doing other things. Children often dream about take time, but when he feels safer, he will sleep better.
 


things they fear and can be scared of going to sleep. 

. . worries something 	 It is natural to have fears like this after being in danger.  Remind your child and yourself that right now you are safe. 
 

bad will happen to 	 These fears may be even stronger if your child was  If you are not safe, talk about how you are working to keep her safe. 
 

you. separated from loved ones during the disaster.  Make a plan for who would care for your child if something did 
 

(You may also have happen to you. This may help you worry less.
 


worries like this.)  Do positive activities together to help her think about other things.
 


. . cries or complains 	 Children who cannot yet speak or say how they feel may  Try to stay with your child and avoid separations right now. 
 

whenever you leave show their fear by clinging or crying.  For brief separations (store, bathroom), help your child by naming his 
 

him, even when you 	 Goodbyes may remind your child of any separation you feelings and linking them to what he has been through. Let him know 
 

go to the bathroom. had related to the disaster. you love him and that this goodbye is different, you’ll be back soon. 
 

	 Children’s bodies react to separations (stomach sinks, “You’re so scared. You don’t want me to go because last time I was 
 

. . can’t stand to be heart beats faster). Something inside says, “Oh no, I can’t gone you didn’t know where I was. This is different, and I’ll be right 
 

away from you. lose her.” back.” 
 

	 Your child is not trying to manipulate or control you. He  For longer separations, have him stay with familiar people, tell him 
 

is scared. where you are going and why, and when you will come back. Let him 
 

	 He may also get scared when other people (not just you) know you will think about him. Leave a photo or something of yours 
 

leave. Goodbyes make him scared. and call if you can. When you come back, tell him you missed him, 
 

thought about him, and did come back. You will need to say this over 
 

and over.
 


. . has problems 	 Stress affects your child in different ways, including her  Relax. Usually, as your child’s level of stress goes down, her eating 
 

eating, eats too much appetite. habits will return to normal. Don’t force your child to eat. 
 

or refuses food.  Eating healthfully is important, but focusing too much on  Eat together and make meal times fun and relaxing. 
 

eating can cause stress and tension in your relationship.  Keep healthy snacks around. Young children often eat on the go.
 


 If you are worried, or if your child loses a significant amount of 

weight, consult a pediatrician. 

Parent Tips for Helping Infants and Toddlers after Disasters
 


Psychological First Aid - Field Operations Guide	 	 3
If Your Child Understand Ways to Help 

. . is not able to do  Often when young children are stressed or scared, they  Avoid criticism. It makes him worried that he’ll never learn. 

things he used to do temporarily lose abilities or skills they recently learned.  Do not force your child. It creates a power struggle. 

(like use the potty).  This is the way young children tell us that they are not okay and  Instead of focusing on the ability (like not using the potty), help your child 

need our help. feel understood, accepted, loved, and supported. 

. . does not talk like he  Losing an ability after children have gained it (like starting to  As your child feels safer, he will recover the ability he lost. 

used to. wet the bed again) can make them feel ashamed or embarrassed. 

Caregivers should be understanding and supportive. 

 Your child is not doing this on purpose. 

. . is reckless, does  It may seem strange, but when children feel unsafe, they often  Keep her safe. Calmly go and get her and hold her if necessary. 

dangerous things. behave in unsafe ways.  Let her know that what she is doing is unsafe, that she is important, and you 

 It is one way of saying, “I need you. Show me I’m important by wouldn’t want anything to happen to her. 

keeping me safe.”  Show her other more positive ways that she can have your attention. 

. . is scared by things  Young children believe their parents are all-powerful and can  When your child is scared, talk to her about how you will keep her safe. 

that did not scare her protect them from anything. This belief helps them feel safe.  If things remind your child of the disaster and cause her to worry that it is 

before.  Because of what happened, this belief has been damaged, and happening again, help her understand how what is happening now (like rain 

without it, the world is a scarier place. or aftershocks) is different from the disaster. 

 Many things may remind your child of the disaster (rain,  If she talks about monsters, join her in chasing them out. “Go away, monster. 

aftershocks, ambulances, people yelling, a scared look on your Don’t bother my baby. I’m going to tell the monster boo, and it will get 

face), and will scare her. scared and go away. Boo, boo.” 

 It is not your fault–it was the disaster.  Your child is too young to understand and recognize how you did protect her, 

but remind yourself of the good things you did. 

. . seems “hyper,”  Fear can create nervous energy that stays in our bodies.  Help your child to recognize his feelings (fear, worry) and reassure your child 

can’t sit still, and  Adults sometimes pace when worried. Young children run, that he is safe. 

doesn’t pay attention to jump, and fidget.  Help your child get rid of nervous energy (stretching, running, sports, 

anything.  When our minds are stuck on bad things, it is hard to pay breathing deep and slow). 

attention to other things.  Sit with him and do an activity you both enjoy (throw a ball, read books, play, 

 Some children are naturally active. draw). Even if he doesn’t stop running around, this helps him. 

 If your child is naturally active, focus on the positive. Think of all the energy 

he has to get things done, and find activities that fit his needs. 

. . plays in a violent  Young children often talk through play. Violent play can be their  If you can tolerate it, listen to your child when he “talks.” 

way. way of telling us how crazy things were or are, and how they  As your child plays, notice the feelings he has and help him by naming 

feel inside. feelings and being there to support him (hold him, soothe him). 

. . keeps talking about  When your child talks about what happened, strong feelings  If he gets overly upset, spaces out, or he plays out the same upsetting scene, 

the disaster and the bad may come up both for you and your child (fear, sadness, anger). help him calm down, help him feel safe, and consider getting professional 

things he saw. help. 

Parent Tips for Helping Infants and Toddlers after Disasters
 


3 National Child Traumatic Stress Network National Center for PTSD 
If Your Child Understand Ways to Help 

. .is now very  Between the age of 18 months to 3 years, young children  Remember your child is not controlling or bad. This is normal, but 

demanding and often seem “controlling.” may be worse right now because she feels unsafe. 

controlling.  It can be annoying, but it is a normal part of growing up  Let your child have control over small things. Give her choices over 

and helps them learn that they are important and can make what she wears or eats, games you play, stories you read. If she has 

. . seems “stubborn” things happen. control over small things, it can make her feel better. Balance giving 

insisting that things  When children feel unsafe, they may become more her choices and control with giving her structure and routines. She will 

be done her way. controlling than usual. This is one way of dealing with feel unsafe if she “runs the show.” 

fears. They are saying, “Things are so crazy I need control  Cheer her on as she tries new things. She can also feel more in control 

over something.” when she can put her shoes on, put a puzzle together, pour juice. 

. . tantrums and is  Even before the disaster, your child may have had  Let him know you understand how hard this is for him. “Thing are 

cranky. tantrums. They are a normal part of being little. It’s really bad right now. It’s been so scary. We don’t have your toys or TV, 

frustrating when you can’t do things and when you don’t and you’re mad.” 

. .yells a lot – more have the words to say what you want or need.  Tolerate tantrums more than you usually would, and respond with love 

than usual.  Now, your child has a lot to be upset about (just like you) rather than discipline. You might not normally do this, but things are 

and may really need to cry and yell. not normal. If he cries or yells, stay with him and let him know you 

are there for him. Reasonable limits should be set if tantrums become 

frequent or are extreme. 

. . hits you.  For children, hitting is a way of expressing anger.  Each time your child hits, let her know that this is not okay. Hold her 

 When children can hit adults they feel unsafe. It’s scary to hands, so she can’t hit, have her sit down. Say something like, “It’s 

be able to hit someone who’s supposed to protect you. not okay to hit, it’s not safe. When you hit, you are going to need to sit 

 Hitting can also come from seeing other people hit each down.” 

other.  If she is old enough, give her the words to use or tell her what she 

needs to do. Tell her, “Use your words. Say, I want that toy.” 

 Help her express anger in other ways (play, talk, draw). 

 If you are having conflict with other adults, try to work it out in 

private, away from where your child can see or hear you. If needed, 

talk with a friend or professional about your feelings. 

. . says “Go away, I  The real problem is the disaster and everything that  Remember what your child has been through. He doesn’t mean 

hate you!” followed, but your child is too little to fully understand everything he is saying; he’s angry and dealing with so many difficult 

that. feelings. 

 . . says “This is all  When things go wrong, young children often get mad  Support your child’s feeling of anger, but gently redirect the anger 

your fault.” at their parents because they believe they should have towards the disaster. “You are really mad. Lots of bad things have 

stopped it from happening. happened. I’m mad too. I really wish it didn’t happen, but even 

 You are not to blame, but now is not the time to defend mommies can’t make hurricanes not happen. It’s so hard for both of 

yourself. Your child needs you. us.” 

Parent Tips for Helping Infants and Toddlers after Disasters
 


Psychological First Aid - Field Operations Guide 3
If Your Child Understand Ways to Help 

. . doesn’t want to  Your child needs you. So much has happened and he may  Sit by your child and keep him close. Let him know you care. 
 

play or do anything. be feeling sad and overwhelmed.  If you can, give words to his feelings. Let him know it’s okay to feel 
 

 When children are stressed, some yell and others shut sad, mad, or worried. “It seems like you don’t want to do anything. I 
 

. . seems to not really down. Both need their loved ones. wonder if you are sad. It’s okay to be sad. I will stay with you.” 
 

have any feelings  Try to do things with your child, anything he might like (read a book, 
 

(happy or sad). sing, play together).
 


. . cries a lot. 	 	 Your family may have experienced difficult changes  Allow your child to express feelings of sadness. 
 

because of the disaster, and it is natural that your child is  Help your child name her feelings and understand why she may feel 
 

sad. that way. “I think you’re sad. A lot of hard things have happened” 
 

	 	 When you let your child feel sad and provide her with  Support your child by sitting with her and giving her extra attention. 
 

comfort, you help your child even if she remains sad. Spend special time together. 
 

	 	 If you have strong feelings of sadness, it may be good for  Help your child feel hopeful about the future. Together think and talk 
 

you to get support. Your child’s well-being is connected about how your lives will continue and the good things you will do, 
 

to your well-being. like go for a walk, go to the park or zoo, play with friends. 
 

 Take care of yourself.
 


. . misses people you  Even though young children do not always express how  For those that have moved away, help your child stay in touch in 
 

are no longer able to they feel, be aware that it is difficult for them when they some way (for example, sending pictures or cards, calling). 
 

see after the disaster. lose contact with important people.  Help your child talk about these important people. Even when we are 
 

 If someone close to your child died, your child may show apart from people, we can still have positive feelings about them by 
 

stronger reactions to the disaster. remembering and talking about them. 
 

 Young children do not understand death, and may think  Acknowledge how hard it is to not be able to see people we care for. 
 

that the person can come back. It is sad. 
 

 Where someone has died, answer your child’s questions simply and 
 

honestly. When strong reactions last longer than two weeks, seek help 
 

from a professional.
 


. . misses things you 	 	 When a disaster brings so much loss to a family and  Allow your child to express feelings of sadness. It is sad that your 
 

have lost because of community, it is easy to lose sight of how much the loss child lost her toy or blanket. 
 

the disaster. of a toy or other important item (blanket) can mean to a  If possible, try to find something that would replace the toy or blanket 

child. that would be acceptable and satisfying to your child. 

	 	 Grieving for a toy is also your child’s way of grieving for  Distract your child with other activities. 

all you had before the disaster. 

Parent Tips for Helping Infants and Toddlers after Disasters
 


3	 	 National Child Traumatic Stress Network National Center for PTSD 
Parent Tips for Helping Preschool-Age Children after Disasters
 


Reactions/Behavior Responses Examples of things to do and say 

Helplessness and passivity: Young children know 	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

Provide comfort, rest, food, water, and 	 

	 

	 

	 

	 

	 

	 

	 

	 

Give your child more hugs, hand holding, or time 

they can’t protect themselves. In a disaster, they feel opportunities for play and drawing. in your lap. 

even more helpless. They want to know their parents Provide ways to turn spontaneous drawing or Make sure there is a special safe area for your 

will keep them safe. They might express this by being playing about traumatic events to something that child to play with proper supervision. 

unusually quiet or agitated. would make them feel safer or better. In play, a four year old keeps having the blocks 

Reassure your child that you and other grownups knocked down by hurricane winds. Asked, “Can 

will protect them. you make it safe from the winds?” the child 

quickly builds a double block thick wall and says, 

“Winds won’t get us now.” A parent might respond 

with, “That wall sure is strong,” and explain, 

“We’re doing a lot of things to keep us safe.” 

General fearfulness: Young children may become Be as calm as you can with your child. Try not to Be aware when you are on the phone or talking 

more afraid of being alone, being in the bathroom, voice your own fears in front of your child. to others, that your child does not overhear you 

going to sleep, or otherwise separated from parents. Help children regain confidence that you aren’t expressing fear. 

Children want to believe that their parents can protect leaving them and that you can protect them. Say things such as, “We are safe from the 

them in all situations and that other grownups, such as Remind them that there are people working to earthquake now, and people are working hard to 

teachers or police officers, are there to help them. keep families safe, and that your family can get make sure we are okay.” 

more help if you need to. Say, “If you start feeling more scared, come and 

If you leave, reassure your children you will be take my hand. Then I’ll know you need to tell me 

back. Tell them a realistic time in words they something.” 

understand, and be back on time. 

Give your child ways to communicate their fears 

to you. 

Confusion about the danger being over: Young children Give simple, repeated explanations as needed, Continue to explain to your child that the disaster 

can overhear things from adults and older children, even every day. Make sure they understand the has passed and that you are away from the danger 

or see things on TV, or just imagine that it is happen- words you are using. Draw, or show on a map, how far away you are 

ing all over again. They believe the danger is closer to Find out what other words or explanations they from the disaster area, and that where you are is 

home, even if it happened further away. have heard and clarify inaccuracies. safe. “See? The disaster was way over there, and 

If you are at some distance from the danger, it is we’re way over here in this safe place.” 

important to tell your child that the danger is not 

near you. 

Returning to earlier behaviors: Thumb sucking, bed- Remain neutral or matter-of-fact, as best you can, If your child starts bedwetting, change her clothes 

wetting, baby-talk, needing to be in your lap. as these earlier behaviors may continue a while and linens without comment. Don’t let anyone 

after the disaster. criticize or shame the child. 

Psychological First Aid - Field Operations Guide	 	 3
Reactions/Behavior Responses Examples of things to do and say 

Fears the disaster will return: When having remind- 	 



	 

	 

	 

	 

	 

	 

	 



Explain the difference between the event and 























“Even though it’s raining, that doesn’t mean 
 

ers—seeing, hearing, or otherwise sensing something reminders of the event. the hurricane is happening again. A rainstorm 
 

that reminds them of the disaster. Protect children from things that will remind is smaller and can’t wreck stuff like a hurricane 
 

them as best you can. can.”
 


Keep your child from television, radio, and 
 

computer stories of the disaster that can trigger 
 

fears of it happening again.
 


Not talking: Being silent or having difficulty saying Put common feelings into words, such as anger, Draw simple “happy faces” for different feelings 
 

what is bothering them. sadness, and worry about the safety of parents, on paper plates. Tell a brief story about each one, 
 

friends, and siblings. such as, “Remember when the water came into 
 

Do not force them to talk, but let them know they the house and you had a worried face like this?” 
 

can talk to you any time. Say something like, “Children can feel really sad 
 

when their home is damaged.” 
 

Provide art or play materials to help them express 
 

themselves. Then use feeling words to check 
 

out how they felt. “This is a really scary picture. 
 

Were you scared when you saw the water?”
 


Sleep problems: Fear of being alone at night, sleep- Reassure your child that he is safe. Spend extra Provide calming activities before bedtime. Tell a 
 

ing alone, waking up afraid, having bad dreams. quiet time together at bedtime. favorite story with a comforting theme. 
 

Let the child sleep with a dim light on or sleep At bedtime say, “You can sleep with us tonight, 
 

with you for a limited time. but tomorrow you’ll sleep in your own bed.” 
 

Some might need an explanation of the “Bad dreams come from our thoughts inside 
 

difference between dreams and real life. about being scared, not from real things 
 

happening.”
 


Not understanding about death: Preschool age chil- Give an age-appropriate consistent explanation– Allow children to participate in cultural and 
 

dren don’t understand that death is not reversible. that does not give false hopes–about the reality religious grieving rituals. 
 

They have “magical thinking” and might believe of death. Help them find their own way to say goodbye by 

their thoughts caused the death. The loss of a pet may Don’t minimize feelings over a loss of a pet or a drawing a happy memory or lighting a candle or 

be very hard on a child. special toy. saying a prayer for the deceased. 

Take cues from what your child seems to want to “No, Pepper won’t be back, but we can think 

know. Answer simply and ask if he has any more about him and talk about him and remember 

questions. what a silly doggy he was.” 

“The firefighter said no one could save Pepper 

and it wasn’t your fault. I know you miss him 

very much.” 

Parent Tips for Helping Preschool-Age Children after Disasters 


40	 	 National Child Traumatic Stress Network National Center for PTSD 
Reactions Responses Examples of things to do and say 

Confusion about what happened 



















 	 Give clear explanations of what happened 



















“I know other kids said that more tornadoes are 

whenever your child asks. Avoid details that would coming, but we are now in a safe place.” 

scare your child. Correct any misinformation that Continue to answer questions your children have 

your child has about whether there is a present (without getting irritable) and to reassure them the 

danger. family is safe. 

 	 Remind children that there are people working to Tell them what’s happening, especially about 

keep families safe and that your family can get issues regarding school and where they will be 

more help if needed. living. 

 	 Let your children know what they can expect to 

happen next. 

Feelings of being responsible: School-age children 	 Provide opportunities for children to voice their Take your child aside. Explain that, “After a 

may have concerns that they were somehow at fault, or concerns to you. disaster like this, lots of kids–and parents too–keep 

should have been able to change what happened. They 	 Offer reassurance and tell them why it was not thinking, ‘What could I have done differently?’ or 

may hesitate to voice their concerns in front of others. their fault. ‘I should have been able to do something.’ That 

doesn’t mean they were at fault.” 

“Remember? The firefighter said no one could 

save Pepper and it wasn’t your fault.” 
 

Fears of recurrence of the event and reactions to 	 Help identify different reminders (people, places, When they recognize that they are being reminded, 
 

reminders sounds, smells, feelings, time of day) and clarify say, “Try to think to yourself, I am upset because 
 

the difference between the event and the reminders I am being reminded of the hurricane because it 
 

that occur after it. is raining, but now there is no hurricane and I am 
 

 	 Reassure them, as often as they need, that they are safe.” 
 

safe. “I think we need to take a break from the TV right 
 

 	 Protect children from seeing media coverage of now.”
 


the event, as it can trigger fears of the disaster Try to sit with your child while watching TV. Ask 
 

happening again. your child to describe what they saw on the news. 
 

Clarify any misunderstandings. 
 

Retelling the event or playing out the event over and 	 Permit the child to talk and act out these reactions. “You’re drawing a lot of pictures of what 
 

over Let him know that this is normal. happened. Did you know that many children do 
 

 	 Encourage positive problem-solving in play or that?” 
 

drawing. “It might help to draw about how you would like 
 

your school to be rebuilt to make it safer.” 
 

Parent Tips for Helping School-Age Children after Disasters 


Psychological First Aid - Field Operations Guide	 	 4
Reactions Responses Examples of things to do and say 

Fear of being overwhelmed by their feelings 



















	 	 Provide a safe place for her to express her fears, 



















“When scary things happen, people have strong 

anger, sadness, etc. Allow children to cry or be feelings, like being mad at everyone or being very 

sad; don’t expect them to be brave or tough. sad. Would you like to sit here with a blanket until 

you’re feeling better?” 

Sleep problems: Bad dreams, fear of sleeping alone, 	 	 Let your child tell you about the bad dream. “That was a scary dream. Let’s think about some 

demanding to sleep with parents. Explain that bad dreams are normal and they will good things you can dream about and I’ll rub 

go away. Do not ask the child to go into too many your back until you fall asleep.” 

details of the bad dream. “You can stay in our bedroom for the next couple 

	 	 Temporary sleeping arrangements are okay; of nights. After that we will spend more time with 

make a plan with your child to return to normal you in your bed before you go to sleep. If you get 

sleeping habits. scared again, we can talk about it.” 

Concerns about the safety of themselves and others. 	 	 Help them to share their worries and give them Create a “worry box” where children can write 

realistic information. out their worries and place them in the box. Set a 

time to look these over, problem-solve, and come 

up with answers to the worries. 

Altered behavior: Unusually aggressive or restless 	 	 Encourage the child to engage in recreational “I know you didn’t mean to slam that door. It 

behavior. activities and exercise as an outlet for feelings must be hard to feel so angry.” 

and frustration. “How about if we take a walk? Sometimes 

getting our bodies moving helps with strong 

feelings.” 

Somatic complaints: Headaches, stomachaches, 	 	 Find out if there is a medical reason. If not, Make sure the child gets enough sleep, eats well, 

muscle aches for which there seem to be no reason. provide comfort and assurance that this is normal. drinks plenty of water, and gets enough exercise. 

	 	 Be matter-of-fact with your child; giving these “How about sitting over there? When you feel 

complaints too much attention may increase better, let me know and we can play cards.” 

them. 

Closely watching a parent’s responses and recovery: Give children opportunities to talk about their “Yes, my ankle is broken, but it feels better since 

Not wanting to disturb a parent with their own feelings, as well as your own. the paramedics wrapped it. I bet it was scary 

worries. Remain as calm as you can, so as not to increase seeing me hurt, wasn’t it?” 

your child’s worries. 

Concern for other survivors and families. 	 	 Encourage constructive activities on behalf Help children identify projects that are ageof others, but do not burden them with undue appropriate and meaningful (clearing rubble from 

responsibility. school grounds, collecting money or supplies for 

those in need). 

Parent Tips for Helping School-Age Children after Disasters
 


4	 	 National Child Traumatic Stress Network National Center for PTSD
Reactions Responses Examples of things to do and say 

Detachment, shame, and guilt 	 	

	 	





	 	





	 	

	 	

	 	

Provide a safe time to discuss with your teen the 















“Many teens–and adults–feel like you do, angry 

events and their feelings. and blaming themselves that they could have 

Emphasize that these feelings are common, done more. You’re not at fault. Remember even 

and correct excessive self-blame with realistic the firefighters said there was nothing more we 

explanations of what actually could have been could have done.” 

done. 

Self-consciousness: About their fears, sense of vul- Help teens understand that these feelings are “I was feeling the same thing. Scared and 

nerability, fear of being labeled abnormal. common. helpless. Most people feel like this when a 

Encourage relationships with family and peers disaster happens, even if they look calm on the 

for needed support during the recovery period. outside.” 

“My cell phone is working again, why don’t 

you see if you can get a hold of Pete to see how 

he’s doing.” 

“And thanks for playing the game with your 

little sister. She’s much better now.” 

Acting out behavior: Using alcohol or drugs, sexu- Help teens understand that acting out behavior “Many teens–and some adults–feel out of 

ally acting out, accident-prone behavior. is a dangerous way to express strong feelings control and angry after a disaster like this. 

(like anger) over what happened. They think drinking or taking drugs will help 

Limit access to alcohol and drugs. somehow. It’s very normal to feel that way–but 

Talk about the danger of high-risk sexual it’s not a good idea to act on it.” 

activity. “It’s important during these times that I know 

On a time-limited basis, keep a closer watch where you are and how to contact you.” Assure 

on where they are going and what they are them that this extra checking-in is temporary, 

planning to do. just until things have stabilized. 

Fears of recurrence and reactions to reminders Help to identify different reminders (people, “When you’re reminded, you might try saying 

places, sounds, smells, feelings, time of day) to yourself, ‘I am upset now because I am being 

and to clarify the difference between the event reminded, but it is different now because there 

and the reminders that occur after it. is no hurricane and I am safe.’” 

Explain to teens that media coverage of the Suggest, “Watching the news reports could 

disaster can trigger fears of it happening again. make it worse, because they are playing the 

same images over and over. How about turning 

it off now?” 

Parent Tips for Helping Adolescents after Disasters
 


Psychological First Aid - Field Operations Guide	 	 43
Reactions Responses Examples of things to do and say 

Abrupt shifts in interpersonal relationships: Teens  Explain that the strain on relationships is  Spend more time talking as a family about how 

may pull away from parents, family, and even from expectable. Emphasize that everyone needs everyone is doing. Say, “You know, the fact 

peers; they may respond strongly to parent’s reac- family and friends for support during the that we’re crabby with each other is completely 

tions in the crisis. recovery period. normal, given what we’ve been through. I think 

 Encourage tolerance for different family we’re handling things amazingly. It’s a good 

members’ courses of recovery. thing we have each other.” 

 Accept responsibility for your own feelings.  You might say, “I appreciate your being calm 

when your brother was screaming last night. I 

know he woke you up, too.” 

 “I want to apologize for being irritable with you 

yesterday. I am going to work harder to stay 

calm myself.” 

Radical changes in attitude  Explain that changes in people’s attitudes after a  “We are all under great stress. When people’s 

disaster are common, but often return back over lives are disrupted this way, we all feel more 

time. scared, angry–even full of revenge. It might not 

seem like it, but we all will feel better when we 

get back to a more structured routine.” 

Premature entrance into adulthood: (wanting to  Encourage postponing major life decisions.  “I know you’re thinking about quitting school 

leave school, get married). Find other ways to make the teens feel more in and getting a job to help out. But it’s important 

control. not to make big decisions right now. A crisis 

time is not a great time to make major changes.” 

Concern for other survivors and families  Encourage constructive activities on behalf of  Help teens to identify projects that are ageothers, but do not let them burden themselves appropriate and meaningful (clearing rubble 

with undue responsibility. from school grounds, collecting money or 

supplies for those in need). 

Parent Tips for Helping Adolescents after Disasters 

44 National Child Traumatic Stress Network National Center for PTSD 
Reactions/Behavior Responses Examples of things to do and say 

High anxiety/arousal: Tension and anxiety are com- 	 	 Use breathing and/or other relaxation skills.  Breathing exercise: Inhale slowly through your 

mon after disasters. Adults may be excessively worried 	 	 Take time during the day to calm yourself through nose and comfortably fill your lungs all the way 

about the future, have difficulties sleeping, problems relaxation exercises. These can make it easier to down to your stomach, while saying to yourself, 

concentrating, and feel jumpy and nervous. These reac- sleep, concentrate, and will give you energy. “My body is filled with calm.” Exhale slowly 

tions can include rapid heart beat and sweating. through your mouth and empty your lungs, while 

silently saying to yourself, “My body is letting 

go.” Do this five times slowly, and as many times 

a day as needed. 

Concern or shame over your own reactions. Many  Find a good time to discuss your reactions with a  When talking with someone, find the right time 

people have strong reactions after a disaster, including family member or trusted friend. and place, and ask if it is okay to talk about your 

fear and anxiety, difficulty concentrating, shame about  Remember that these reactions are common and it feelings. 

how they reacted, and feeling guilty about something. takes time for them to subside.  Remind yourself that your feelings are expectable 

It is expectable and understandable to feel many emo-  Correct excessive self-blame with realistic and you are not “going crazy,” and that you are not 

tions in the aftermath of an extremely difficult event. assessment of what actually could have been done. at fault for the disaster. 

 If these feelings persist for a month or more, you 

may wish to seek professional help. 

Feeling overwhelmed by tasks that need to be accom-  Identify what your top priorities are.  Make a list of your concerns and decide what to 

plished (housing, food, paperwork for insurance, child  Find out what services are available to help get tackle first. Take one step at a time. 

care, parenting). your needs met.  Find out which agencies can help with your needs 
 

 Make a plan that breaks down the tasks into and how to access them. 
 

manageable steps.  Where appropriate, rely on your family, friends, 
 

and community for practical assistance. 
 

Fears of recurrence and reactions to reminders: It is 	 	 Be aware that reminders can include people,  When you are reminded, try saying to yourself, 
 

common for survivors to fear that another disaster will places, sounds, smells, feelings, time of day. “I am upset because I am being reminded of the 
 

occur, and to react to things that are reminders of what 	 	 Remember that media coverage of the disaster can disaster, but it is different now because the disaster 
 

happened. be a reminder and trigger fears of it happening is not happening and I am safe.” 
 

again.  Limit your viewing of news reports so you just get 
 

the information that you need.
 


Changes in attitude, view of the world and of  Postpone any major unnecessary life changes in  Getting back to a more structured routine can help 
 

oneself: Strong changes in people’s attitudes after the immediate future. improve decision-making. 
 

a disaster are common, including questioning one’s  Remember that dealing with post-disaster  Remind yourself that going through a disaster can 
 

spiritual beliefs, trust in others and social agencies, difficulties increases your sense of courage and have positive effects on what you value and how 
 

and concerns about one’s own effectiveness, and effectiveness. you spend your time. 
 

dedication to helping others.  Get involved with community recovery efforts. 

Tips for Adults
 


Psychological First Aid - Field Operations Guide	 	 4
Reactions/Behavior Responses Examples of things to do and say 

Using alcohol and drugs, or engaging in gambling or 	 	 Understand that using substances and engaging 	 	 Remember that substance use and other addictive 

high-risk sexual behaviors: Many people feel out of in addictive behaviors can be a dangerous way to behaviors can lead to problems with sleep, 

control, scared, hopeless, or angry after a disaster and cope with what happened. relationships, jobs, and physical health. 

engage in these behaviors to feel better. This can espe- 	 	 Get information about local support agencies. 

cially be a problem if there was pre-existing substance 

abuse or addiction. 

Shifts in interpersonal relationships: People may feel 	 	 Understand that family and friends are a major 	 	 Don’t withdraw from others because you feel you 

differently towards family and friends; for example, form of support during the recovery period. might burden them. Most people do better after 

they may feel overprotective and very concerned for 	 	 It is important to understand and tolerate different disasters turning to others. 

each other’s safety, frustrated by the reactions of a courses of recovery among family members. 	 	 Ask your friends and family how they are doing, 

family member or friend, or they may feel like pulling 	 	 Rely on other family members for help with rather than just giving advice, or telling them 

away from family and friends. parenting or other daily activities when you are to “get over it.” Offer a supportive ear or lend a 

upset or under stress. helping hand. 

	 	 Say, “We’re crabby with each other and that 

is completely normal, given what we’ve been 

through. I think we’re handling things amazingly. 

It’s a good thing we have each other.” 

Excessive anger: Some degree of anger is understand- 	 	 Find ways to manage your anger that help you 	 	 Take time to cool down, walk away from stressful 

able and expected after a disaster, especially when rather than hurt you. situations, talk to a friend about what is making 

something feels unfair. However, when it leads to you angry, get physical exercise, distract yourself 

violent behavior, extreme anger is a serious problem. with positive activities, or problem-solve the 

situation that is making you angry. 

	 	 Remind yourself that being angry may harm 

important relationships. 

	 	 If you become violent, get immediate help. 

Sleep difficulties: Trouble falling asleep and frequent 	 	 Make sure you have good sleep routines. 	 	 Go to sleep at the same time every day. 

awakening is common after a disaster, as people are on 	 	 Don’t have caffeinated drinks in the evening. 

edge and worried about adversities and life changes. 	 	 Reduce alcohol consumption. 

	 	 Increase daytime exercise. 

	 	 Relax before bedtime. 

	 	 Limit daytime naps to 15 minutes, and do not nap 

later than 4 pm. 

Tips for Adults 


4	 	 National Child Traumatic Stress Network National Center for PTSD 
Tips for Relaxation
 


Tips for Relaxation 

Tension and anxiety are common after disasters. Unfortunately, they can make it more difficult to cope with the many things that must be done to recover. There is no easy solution to 

coping with post-disaster problems, but taking time during the day to calm yourself through 

relaxation exercises may make it easier to sleep, concentrate, and have energy for coping 

with life. These can include muscle relaxation exercises, breathing exercises, meditation, 

swimming, stretching, yoga, prayer, exercise, listening to quiet music, spending time in 

nature, and so on. Here are some basic breathing exercises that may help: 

For Yourself: 

1. Inhale slowly (one-thousand one; one-thousand two; one-thousand three) through your 

nose and comfortably fill your lungs all the way down to your belly. 

2.	 Silently and gently say to yourself, “My body is filled with calmness.” Exhale slowly 

(one-thousand one; one-thousand two; one-thousand three) through your mouth and 

comfortably empty your lungs all the way down to your stomach. 

3.	 Silently and gently say to yourself, “My body is releasing the tension.” 

4.	 Repeat five times slowly and comfortably. 

5.	 Do this as many times a day as needed. 

For Children: 

Lead a child through a breathing exercise: 

1.	 “Let’s practice a different way of breathing that can help calm our bodies down. 

2.	 Put one hand on your stomach, like this [demonstrate]. 

3.	 Okay, we are going to breathe in through our noses. When we breathe in, we are going to 

fill up with a lot of air and our stomachs are going to stick out like this [demonstrate]. 

4.	 Then, we will breathe out through our mouths. When we breathe out, our stomachs are 

going to suck in and up like this [demonstrate]. 

5.	 We are going to breathe in really slowly while I count to three. I’m also going to count to 

three while we breathe out really slowly. 

6.	 Let’s try it together. Great job!” 

Make a Game of It: 

 Blow bubbles with a bubble wand and dish soap.
 


 Blow bubbles with chewing gum.
 


 Blow paper wads or cotton balls across the table. 
 

 Tell a story where the child helps you imitate a character who is taking deep breaths.
 


Psychological First Aid - Field Operations Guide	 4
This.page.intentionally.left.blank. 

4 National Child Traumatic Stress Network National Center for PTSD 








Pay attention to any change in your use of 





Consult with a healthcare professional about 
 

alcohol and/or drugs. safe ways to reduce anxiety, depression, 
 

muscle tension, and sleep difficulties.
	 

Correctly use prescription and over-the- If you find that you have greater difficulty 
 

counter medications as indicated. controlling alcohol/substance use since the 
 

disaster, seek support in doing so.
 

Eat well, exercise, get enough sleep, and use If you believe you have a problem with 
 

your family and others for support. substance abuse, talk to your doctor or 
 

counselor about it.
 

If you feel like using larger amounts of either 
 

prescribed or over-the-counter medications, 
 

consult a healthcare professional.
 








 	 Increase your attendance at substance abuse 

, 

l 



Talk with family and friends about supporting 

support groups. you to avoid use of alcohol or substances. 

 	 If you are receiving disaster crisis counseling If you have a 12-Step sponsor or substance 

talk to your counselor about your past alcoho abuse counselor, talk to him or her about your 

or drug use. situation. 

 	 If you have been forced to move out of your Increase your use of other supports that have 

local community, talk to disaster workers helped you avoid relapse in the past. 

about helping to locate nearby alcohol or 

drug recovery groups, or ask them to help 

organize a new support group. 

Alcohol, Medication, and Drug Use after Disaster 

Alcohol, Medication, and Drug Use after Disaster 

Some people increase their use of alcohol, prescription medications, or other drugs after a disaster. 

You may feel that using drugs and alcohol helps you escape bad feelings or physical symptoms 

related to stress responses (for example, headaches, muscle tension). However, they can actually 

make these worse in the long term because they interrupt natural sleep cycles, create health 

problems, interfere with relationships, and create potential dependence on the substance. If your use 

of alcohol or drugs has increased since the disaster or is causing problems for you, it is important for 

you to reduce your level of use or seek help in gaining control over your use. 

If you have had an alcohol, medication, or drug problem in the past 

For people who have successfully stopped drinking or using drugs, experiencing a disaster can 

sometimes result in strong urges to drink or use again. Sometimes it can lead them to strengthen 

their commitment to recovery. Whatever your experience, it is important to consciously choose to 

stay in recovery. 

Psychological First Aid - Field Operations Guide	 	 4
This.page.intentionally.left.blank. 

0 National Child Traumatic Stress Network National Center for PTSD 
Psychological First Aid 

Field Operations Guide

2nd Edition 

Appendix F: 

 Duplicate Handouts to Copy and Distribute 

 For Psychological First Aid Providers 

 Overview of Psychological First Aid 

 Psychological First Aid Worksheets 

 Handouts for Survivors 

 Connecting with Others: Seeking Social Support (for adults and 

adolescents) 

 Connecting with Others: Giving Social Support (for adults and adolescents) 

 When Terrible Things Happen (for adults and adolescents) 

 Parent Tips for Helping Infants and Toddlers (for parents/caregivers) 

 Parent Tips for Helping Preschool-Age Children (for parents/caregivers) 

 Parent Tips for Helping School-Age Children (for parents/caregivers) 

 Parent Tips for Helping Adolescents (for parents/caregivers) 

 Tips for Adults (for adult survivors) 

 Basic Relaxation Techniques (for adults, adolescents, and children) 

 Alcohol and Drug Use after Disasters (for adults and adolescents) 
.This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 
Overview of Psychological First Aid
 


Section Headers 

Preparing to Deliver 1. Entering the setting 

Psychological First 2. Providing services 

Aid 3. Group settings 

4. Maintain a calm presence 

5. Be sensitive to culture and diversity 

6. Be aware of at-risk populations 

Contact and 1. Introduce yourself/ask about immediate needs 

Engagement 2. Confidentiality 

Safety and Comfort 1. Ensure immediate physical safety 

2. Provide information about disaster response activities and services 

3. Attend to physical comfort 

4. Promote social engagement 

5. Attend to children who are separated from their parents/caregivers 

6. Protect from additional traumatic experiences and trauma reminders 

7. Help survivors who have a missing family member 

8. Help survivors when a family member or close friend has died 

9. Attend to grief and spiritual issues 

10. Provide information about casket and funeral issues 

11. Attend to issues related to traumatic grief 

12. Support survivors who receive death notification 

13. Support survivors involved in body identification 

14. Help caregivers confirm body identification to a child or adolescent 

Stabilization 1. Stabilize emotionally overwhelmed survivors 

2. Orient emotionally overwhelmed survivors 

3. The role of medications in stabilization 

Information 1. Nature and severity of experiences during the disaster 

Gathering: Current 2. Death of a loved one 

Needs and Concerns 3. Concerns about immediate post-disaster circumstances and ongoing threat 

4. Separations from or concern about the safety of loved ones 

5. Physical illness, mental health conditions, and need for medications 

6. Losses (home, school, neighborhood, business, personal property, and pets) 

7. Extreme feelings of guilt or shame 

8. Thoughts about causing harm to self or others 

9. Availability of social support 

10. Prior alcohol or drug use 

11. Prior exposure to trauma and death of loved ones 

12. Specific youth, adult, and family concerns over developmental impact 

Psychological First Aid - Field Operations Guide 
Overview of Psychological First Aid - continued 

Section Headers 

Practical Assistance 1. Offering practical assistance to children and adolescents 

2. Identify the most immediate needs 

3. Clarify the need 

4. Discuss an action plan 

5. Act to address the need 

Connection with 

Social Supports 

1. Enhance access to primary support persons (family and significant others) 

2. Encourage use of immediately available support persons 

3. Discuss support-seeking and giving 

4. Special considerations for children and adolescents 

5. Modeling support 

Information on 1.	 	Provide basic information about stress reactions 

Coping 2.	 	Review common psychological reactions to traumatic experiences and 

losses 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

Intrusive reactions
	 

Avoidance and withdrawal reactions
	 

Physical arousal reactions
	 

Trauma reminders
	 

Loss reminders
	 

Change reminders
	 

Hardships
	 

Grief reactions
	 

Traumatic grief reactions 
 

Depression
	 

Physical reactions
	 

3.	 Talking with children about physical and emotional reactions 

4.	 Provide basic information on ways of coping 

5.	 Teach simple relaxation techniques 

6.	 Coping for families 

7.	 Assist with developmental issues 

8.	 Assist with anger management 

9.	 Address highly negative emotions 

10. Help with sleep problems 

11. Address alcohol and substance use 

Linkage with 

Collaborative 

1. Provide direct link to additional needed services 

2. Referrals for children and adolescents 

Services 3. Referrals for older adults 

4. Promote continuity in helping relationships 

National Child Traumatic Stress Network National Center for PTSD 
r

r

t

I

f

s

S

S

h

F

















Provider Worksheets 


Survivor Current Needs 

Date: _______ Provider: _________________________ 

Survivor Name:___________________________________ 

Location: ________________________________________ 

This session was conducted with (check all that apply): 

 Child  Adolescent  Adult  Family  Group 

Provider: Use this form to document what the survivor needs most at this time. This form can be 

used to communicate with referral agencies to help promote continuity of care. 

1. Check the boxes corresponding to difficulties the survivor is experiencing. 

Behavioral 

Extreme 

disorientation 

Excessive drug, 

alcohol, or 

prescription drug 

use 

Isolation/ 

withdrawal 

High risk behavior 

Regressive 

behavior 

Separation anxiety 

Violent behavior 

Maladaptive 

coping 

Other __________ 

Emotional 

Acute stress 

eactions 

Acute grief 

eactions 

Sadness, 

earfulness 

rritability, anger 

Feeling anxious, 

earful 

Despair, 

hopelessness 

Feelings of guilt or 

hame 

Feeling 

emotionally numb, 

disconnected 

Other __________ 

Physical 

Headaches 

C

tomachaches 

leep difficulties 

Difficulty eating 

Worsening of 

ealth conditions 

atigue/exhaustion 

hronic agitation 

Other __________ 

Cognitive 

Inability to accept/ 

cope with death of 

loved one(s) 

Distressing dreams 

or nightmares 

Intrusive thoughts 

or images 

Difficulty 

concentrating 

Difficulty 

remembering 

Difficulty making 

decisions 

Preoccupation with 

death/destruction 

Other __________ 





















































Psychological First Aid - Field Operations Guide 
Other: __________________________________________________________________ 

2. Check the boxes corresponding to difficulties the survivor is experiencing. 

 Past or preexisting trauma/psychological problems/substance abuse problems 

 Injured as a result of the disaster 

 At risk of losing life during the disaster 

 Loved one(s) missing or dead 

 Financial concerns 

 Displaced from home 

 Living arrangements 

 Lost job or school 

 Assisted with rescue/recovery 

 Has physical/emotional disability 

 Medication stabilization 

 Concerns about child/adolescent 

 Spiritual concerns 



3. Please.make.note.of.any.other.information.that.might.be.helpful.in.making.a.referral.

___________________________________________________________________________ 

___________________________________________________________________________ 

4. Referral

 Within project (specify) _______________  Substance abuse treatment
 


 Other disaster agencies  Other community services
 


 Professional mental health services  Clergy
 


 Medical treatment  Other: _______________
 


5. Was.the.referral.accepted.by.the.individual?

 Yes 
 

 No 
 

National Child Traumatic Stress Network National Center for PTSD 
Provider Worksheets 

Psychological First Aid Components Provided 

Date: _______ Provider: _________________________ 

Location: ________________________________________ 

This session was conducted with (check all that apply): 

 Child  Adolescent  Adult  Family  Group 

Place a checkmark in the box next to each component of Psychological First Aid that you provided 

in this session. 

Contact and Engagement 

 Initiated contact in an appropriate manner  Asked about immediate needs 

Safety and Comfort 

 Took steps to ensure immediate physical  Gave information about the disaster/risks 

safety 

 Attended to physical comfort  Encouraged social engagement 

 Attended to a child separated from parents  Protected from additional trauma 

 Assisted with concern over missing loved one  Assisted after death of loved one 

 Assisted with acute grief reactions  Helped with talking to children about death 

 Attended to spiritual issues regarding death  Attended to traumatic grief 

 Provided information about funeral issues  Helped survivor after body identification 

 Helped survivors regarding death notification  Helped with confirmation of death to child 

Stabilization 

 Helped with stabilization  Used grounding technique 

 Gathered information for medication referral 

for stabilization 

Information Gathering 

 Nature and severity of disaster experiences  Death of a family member or friend 

 Concerns about ongoing threat  Concerns about safety of loved one(s) 

 Physical/mental illness and medications(s)  Disaster-related losses 

 Extreme guilt or shame  Thoughts of harming self or others 

 Availability of social support  Prior alcohol or drug use 

 History of prior trauma and loss  Concerns over developmental impact 

 Other _______________ 

Psychological First Aid - Field Operations Guide 
Practical Assistance 

 Helped to identify most immediate need(s)  Helped to clarify need(s)
 


 Helped to develop an action plan  Helped with action to address the need
 


Connection with Social Supports 

 Facilitated access to primary support persons  Discussed support seeking and giving 

 Modeled supportive behavior  Engaged youth in activities 

 Helped problem-solve obtaining/giving 

social support 

Information of Coping 

 Gave basic information about stress  Gave basic information on coping 

reactions 

 Taught simple relaxation techniques(s)  Helped with family coping issues 

 Assisted with developmental concerns  Assisted with anger management 

 Addressed negative emotions (shame/guilt)  Helped with sleep problems 

 Addressed substance abuse problems 

Linkage with Collaborative Services 

 Provided link to additional service(s) _______________________________________ 

 Promoted continuity of care _______________________________________ 

 Provided handout(s) _______________________________________ 

National Child Traumatic Stress Network National Center for PTSD 
Connecting with Others
 


Seeking Social Support 







Making contact with others can help reduce feeling of distress 

Children and adolescents can benefit from spending some time with similar-age peers 

Connections can be with family, friends, or others who are coping with the same traumatic event 

Social Support Options 

 Spouse/partner or parents 	 

	 

	 

Clergy 





Support group 

 Trusted family member Doctor or nurse Co-worker/Teacher/Coach 

 Close friend Crisis/School counselor or Pet 

other counselor 

Do . . . 







Decide carefully whom to 





Start by talking about 





Ask others if it’s a good 

talk to practical things time to talk 

Decide ahead of time what Let others know you need to Tell others you appreciate 

you want to discuss talk or just to be with them them listening 

Choose the right time and Talk about painful thoughts Tell others what you need 

place and feelings when you’re or how they could help–one 

ready main thing that would help 

you right now 

Don’t . . . 





 	 Keep quiet because you don’t want to upset 







Assume that others don’t want to listen 

others 

 	 Keep quiet because you’re worried about Wait until you’re so stressed or exhausted 

being a burden that you can’t fully benefit from help 

Ways to Get Connected 

	 

	 

	 

Calling friends or family on the phone Getting involved with a support group 

Increasing contact with existing Getting involved in community/school 

acquaintances and friends recovery activities 

Renewing or beginning involvement in 

religious group activities 

Psychological First Aid - Field Operations Guide 
.This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 
Connecting with Others
 


Giving Social Support 

You can help family members and friends cope with the disaster by spending time with them and listening carefully. Most people recover better when they feel connected to others who care about them. 

Some people choose not to talk about their experiences very much, and others may need to discuss 

their experiences. For some, talking about things that happened because of the disaster can help 

those events seem less overwhelming. For others, just spending time with people they feel close to 

and accepted by, without having to talk, can feel best. Here is some information about giving social 

support to other people. 

Reasons Why People May Avoid Social Support 



	 



Not knowing what they need 



	 	

Not wanting to burden others 	 	





Wanting to avoid thinking or 
 

feeling about the event
 

Feeling embarrassed or Doubting it will be helpful, or Assuming that others will be 
 

“weak” that others will understand disappointed or judgmental
 

Fearing they will lose control Having tried to get help and Not knowing where to get 
 

feeling that it wasn’t there help
 


Good Ways to Give Support 







Show interest, attention, and 





Show respect for the person’s 





Talk about expectable 
 

care reactions and ways of coping reactions to disasters, and 
 

healthy coping
 


Find an uninterrupted time Acknowledge that this type Express belief that the person 

and place to talk of stress can take time to is capable of recovery 

resolve 

Be free of expectations or Help brainstorm positive Offer to talk or spend time 
 

judgments ways to deal with reactions together as many times as is 
 

needed
 


Psychological First Aid - Field Operations Guide 
B







ehaviors That Interfere with Giving Support 

 	 Rushing to tell someone the he/she will be okay 





Acting like someone is weak or exaggerating 

or that they should just “get over it” because he or she isn’t coping as well as you 

are 

 	 Discussing your own personal experiences Giving advice without listening to the person’s 

without listening to the other person’s story concerns or asking the person what works for 

him or her 

 	 Stopping people from talking about what is Telling them they were lucky it wasn’t worse 

bothering them 

When Your Support is Not Enough 

	 	

	 	

Let the person know that experts think that 



Encourage the person to talk with a counselor, 

avoidance and withdrawal are likely to increase clergy, or medical professional, and offer to 

distress, and social support helps recovery. accompany them. 

Encourage the person to get involved in a Enlist help from others in your social circle so 

support group with others who have similar that you all take part in supporting the person. 

experiences. 

National Child Traumatic Stress Network National Center for PTSD 
When Terrible Things Happen - What You May 
 

Experience
 


Immediate Reactions 

There are a wide variety of positive and negative reactions that survivors can experience during and 

immediately after a disaster. These include: 

Domain Negative Responses Positive Responses 

Cognitive Confusion, disorientation, worry, intrusive thoughts and images, self-blame Determination and resolve, sharper 

perception, courage, optimism, faith 

Emotional Shock, sorrow, grief, sadness, fear, anger, numb, irritability, guilt and shame 

Feeling involved, challenged, mobilized 

Social Extreme withdrawal, interpersonal 

conflict 

Social connectedness, altruistic helping 

behaviors 

Physiological Fatigue, headache, muscle tension, 

stomachache, increased heart rate, exaggerated startle response, difficulties 

sleeping 

Alertness, readiness to respond, increased energy 

Common negative reactions that may continue include: 

Intrusive reactions 







Distressing thoughts or images of the event while awake or dreaming 

Upsetting emotional or physical reactions to reminders of the experience 

Feeling like the experience is happening all over again (“flashback”) 

Avoidance and withdrawal reactions 











Avoid talking, thinking, and having feelings about the traumatic event 

Avoid reminders of the event (places and people connected to what happened) 

Restricted emotions; feeling numb 

Feelings of detachment and estrangement from others; social withdrawal 

Loss of interest in usually pleasurable activities 

Psychological First Aid - Field Operations Guide 
Physical arousal reactions 







Constantly being “on the lookout” for danger, startling easily, or being jumpy 

Irritability or outbursts of anger, feeling “on edge” 

Difficulty falling or staying asleep, problems concentrating or paying attention 

Reactions to trauma and loss reminders 







 	 Reactions to places, people, sights, sounds, smells, and feelings that are reminders of 

the disaster 

 	 Reminders can bring on distressing mental images, thoughts, and emotional/physical 

reactions 

 	 Common examples include sudden loud noises, sirens, locations where the disaster 

occurred, seeing people with disabilities, funerals, anniversaries of the disaster, and 

television/radio news about the disaster 

Positive changes in priorities, worldview, and expectations 











Enhanced appreciation that family and friends are precious and important 

Meeting the challenge of addressing difficulties (by taking positive action steps, 

changing the focus of thoughts, using humor, acceptance) 

Shifting expectations about what to expect from day to day and about what is 

considered a “good day” 

Shifting priorities to focus more on quality time with family or friends 

Increased commitment to self, family, friends, and spiritual/religious faith 

When a Loved One Dies, Common Reactions Include: 









Feeling confused, numb, disbelief, bewildered, or lost 

Feeling angry at the person who died or at people considered responsible for the death 

Strong physical reactions such as nausea, fatigue, shakiness, and muscle weakness 

Feeling guilty for still being alive 

National Child Traumatic Stress Network National Center for PTSD 














Intense emotions such as extreme sadness, anger, or fear 

Increased risk for physical illness and injury 

Decreased productivity or difficulty making decisions 

Having thoughts about the person who died, even when you don’t want to 

Longing, missing, and wanting to search for the person who died 

Children are particularly likely to worry that they or a parent might die 

Children may become anxious when separated from caregivers or other loved ones 

What Helps 



























Talking to another person for support or spending time with others 

Engaging in positive distracting activities (sports, hobbies, reading) 

Getting adequate rest and eating healthy meals 

Trying to maintain a normal schedule 

Scheduling pleasant activities 

Taking breaks 

Reminiscing about a loved one who has died 

Focusing on something practical that you can do right now to manage the situation 

better 

Using relaxation methods (breathing exercises, meditation, calming self-talk, 

soothing music) 

Participating in a support group 

Exercising in moderation 

Keeping a journal 

Seeking counseling 

Psychological First Aid - Field Operations Guide 
What Doesn’t Help 























Using alcohol or drugs to cope 

Extreme avoidance of thinking or talking about the event or a death of a loved one 

Violence or conflict 

Overeating or failing to eat 

Excessive TV or computer games 

Blaming others 

Working too much 

Extreme withdrawal from family or friends 

Not taking care of yourself 

Doing risky things (driving recklessly, substance abuse, not taking adequate 

precautions) 

Withdrawing from pleasant activities 

National Child Traumatic Stress Network National Center for PTSD 
If Your Child Understand Ways to Help 

. . has problems 























 	 When children are scared, they want to be with people 



























If you want, let your child sleep with you. Let him know this is just 

sleeping, doesn’t who help them feel safe, and they worry when you are not for now. 

want to go to bed, together. Have a bedtime routine: a story, a prayer, cuddle time. Tell him the 

won’t sleep alone, 	 If you were separated during the disaster, going to bed routine (every day), so he knows what to expect. 

wakes up at night alone may remind your child of that separation. Hold him and tell him that he is safe, that you are there and will not 

screaming. 	 Bedtime is a time for remembering because we are not leave. Understand that he is not being difficult on purpose. This may 

busy doing other things. Children often dream about take time, but when he feels safer, he will sleep better.
 


things they fear and can be scared of going to sleep. 

. . worries something 	 It is natural to have fears like this after being in danger. Remind your child and yourself that right now you are safe. 
 

bad will happen to 	 These fears may be even stronger if your child was If you are not safe, talk about how you are working to keep her safe. 
 

you. separated from loved ones during the disaster. Make a plan for who would care for your child if something did 
 

(You may also have happen to you. This may help you worry less.
 


worries like this.) Do positive activities together to help her think about other things.
 


. . cries or complains 	 Children who cannot yet speak or say how they feel may Try to stay with your child and avoid separations right now. 
 

whenever you leave show their fear by clinging or crying. For brief separations (store, bathroom), help your child by naming his 
 

him, even when you 	 Goodbyes may remind your child of any separation you feelings and linking them to what he has been through. Let him know 
 

go to the bathroom. had related to the disaster. you love him and that this goodbye is different, you’ll be back soon. 
 

 	 Children’s bodies react to separations (stomach sinks, “You’re so scared. You don’t want me to go because last time I was 
 

. . can’t stand to be heart beats faster). Something inside says, “Oh no, I can’t gone you didn’t know where I was. This is different, and I’ll be right 
 

away from you. lose her.” back.” 
 

 	 Your child is not trying to manipulate or control you. He For longer separations, have him stay with familiar people, tell him 
 

is scared. where you are going and why, and when you will come back. Let him 
 

 	 He may also get scared when other people (not just you) know you will think about him. Leave a photo or something of yours 
 

leave. Goodbyes make him scared. and call if you can. When you come back, tell him you missed him, 
 

thought about him, and did come back. You will need to say this over 
 

and over.
 


. . has problems 	 Stress affects your child in different ways, including her Relax. Usually, as your child’s level of stress goes down, her eating 
 

eating, eats too much appetite. habits will return to normal. Don’t force your child to eat. 
 

or refuses food. Eating healthfully is important, but focusing too much on Eat together and make meal times fun and relaxing. 
 

eating can cause stress and tension in your relationship. Keep healthy snacks around. Young children often eat on the go.
 


If you are worried, or if your child loses a significant amount of 

weight, consult a pediatrician. 

Parent Tips for Helping Infants and Toddlers after Disasters 


Psychological First Aid - Field Operations Guide 
If Your Child Understand Ways to Help 

. . is not able to do 































Often when young children are stressed or scared, they 



































Avoid criticism. It makes him worried that he’ll never learn. 

things he used to do temporarily lose abilities or skills they recently learned. Do not force your child. It creates a power struggle. 

(like use the potty). This is the way young children tell us that they are not okay and Instead of focusing on the ability (like not using the potty), help your child 

need our help. feel understood, accepted, loved, and supported. 

. . does not talk like he Losing an ability after children have gained it (like starting to As your child feels safer, he will recover the ability he lost. 

used to. wet the bed again) can make them feel ashamed or embarrassed. 

Caregivers should be understanding and supportive. 

Your child is not doing this on purpose. 

. . is reckless, does It may seem strange, but when children feel unsafe, they often Keep her safe. Calmly go and get her and hold her if necessary. 

dangerous things. behave in unsafe ways. Let her know that what she is doing is unsafe, that she is important, and you 

It is one way of saying, “I need you. Show me I’m important by wouldn’t want anything to happen to her. 

keeping me safe.” Show her other more positive ways that she can have your attention. 

. . is scared by things Young children believe their parents are all-powerful and can When your child is scared, talk to her about how you will keep her safe. 

that did not scare her protect them from anything. This belief helps them feel safe. If things remind your child of the disaster and cause her to worry that it is 

before. Because of what happened, this belief has been damaged, and happening again, help her understand how what is happening now (like rain 

without it, the world is a scarier place. or aftershocks) is different from the disaster. 

Many things may remind your child of the disaster (rain, If she talks about monsters, join her in chasing them out. “Go away, monster. 

aftershocks, ambulances, people yelling, a scared look on your Don’t bother my baby. I’m going to tell the monster boo, and it will get 

face), and will scare her. scared and go away. Boo, boo.” 

It is not your fault–it was the disaster. Your child is too young to understand and recognize how you did protect her, 

but remind yourself of the good things you did. 

. . seems “hyper,” Fear can create nervous energy that stays in our bodies. Help your child to recognize his feelings (fear, worry) and reassure your child 

can’t sit still, and Adults sometimes pace when worried. Young children run, that he is safe. 

doesn’t pay attention to jump, and fidget. Help your child get rid of nervous energy (stretching, running, sports, 

anything. When our minds are stuck on bad things, it is hard to pay breathing deep and slow). 

attention to other things. Sit with him and do an activity you both enjoy (throw a ball, read books, play, 

Some children are naturally active. draw). Even if he doesn’t stop running around, this helps him. 

If your child is naturally active, focus on the positive. Think of all the energy 

he has to get things done, and find activities that fit his needs. 

. . plays in a violent Young children often talk through play. Violent play can be their If you can tolerate it, listen to your child when he “talks.” 

way. way of telling us how crazy things were or are, and how they As your child plays, notice the feelings he has and help him by naming 

feel inside. feelings and being there to support him (hold him, soothe him). 

. . keeps talking about When your child talks about what happened, strong feelings If he gets overly upset, spaces out, or he plays out the same upsetting scene, 

the disaster and the bad may come up both for you and your child (fear, sadness, anger). help him calm down, help him feel safe, and consider getting professional 

things he saw. help. 

Parent Tips for Helping Infants and Toddlers after Disasters 


National Child Traumatic Stress Network National Center for PTSD 
If Your Child Understand Ways to Help 

. .is now very 





















Between the age of 18 months to 3 years, young children 





















Remember your child is not controlling or bad. This is normal, but 

demanding and often seem “controlling.” may be worse right now because she feels unsafe. 

controlling. It can be annoying, but it is a normal part of growing up Let your child have control over small things. Give her choices over 

and helps them learn that they are important and can make what she wears or eats, games you play, stories you read. If she has 

. . seems “stubborn” things happen. control over small things, it can make her feel better. Balance giving 

insisting that things When children feel unsafe, they may become more her choices and control with giving her structure and routines. She will 

be done her way. controlling than usual. This is one way of dealing with feel unsafe if she “runs the show.” 

fears. They are saying, “Things are so crazy I need control Cheer her on as she tries new things. She can also feel more in control 

over something.” when she can put her shoes on, put a puzzle together, pour juice. 

. . tantrums and is Even before the disaster, your child may have had Let him know you understand how hard this is for him. “Thing are 

cranky. tantrums. They are a normal part of being little. It’s really bad right now. It’s been so scary. We don’t have your toys or TV, 

frustrating when you can’t do things and when you don’t and you’re mad.” 

. .yells a lot – more have the words to say what you want or need. Tolerate tantrums more than you usually would, and respond with love 

than usual. Now, your child has a lot to be upset about (just like you) rather than discipline. You might not normally do this, but things are 

and may really need to cry and yell. not normal. If he cries or yells, stay with him and let him know you 

are there for him. Reasonable limits should be set if tantrums become 

frequent or are extreme. 

. . hits you. For children, hitting is a way of expressing anger. Each time your child hits, let her know that this is not okay. Hold her 

When children can hit adults they feel unsafe. It’s scary to hands, so she can’t hit, have her sit down. Say something like, “It’s 

be able to hit someone who’s supposed to protect you. not okay to hit, it’s not safe. When you hit, you are going to need to sit 

Hitting can also come from seeing other people hit each down.” 

other. If she is old enough, give her the words to use or tell her what she 

needs to do. Tell her, “Use your words. Say, I want that toy.” 

Help her express anger in other ways (play, talk, draw). 

If you are having conflict with other adults, try to work it out in 

private, away from where your child can see or hear you. If needed, 
 

talk with a friend or professional about your feelings.
 

. . says “Go away, I The real problem is the disaster and everything that Remember what your child has been through. He doesn’t mean
 

hate you!” followed, but your child is too little to fully understand everything he is saying; he’s angry and dealing with so many difficult 

that. feelings. 

 . . says “This is all When things go wrong, young children often get mad Support your child’s feeling of anger, but gently redirect the anger 

your fault.” at their parents because they believe they should have towards the disaster. “You are really mad. Lots of bad things have 

stopped it from happening. happened. I’m mad too. I really wish it didn’t happen, but even 

You are not to blame, but now is not the time to defend mommies can’t make hurricanes not happen. It’s so hard for both of 

yourself. Your child needs you. us.” 

Parent Tips for Helping Infants and Toddlers after Disasters 


Psychological First Aid - Field Operations Guide 
If Your Child Understand Ways to Help 

. . doesn’t want to  Your child needs you. So much has happened and he may  Sit by your child and keep him close. Let him know you care. 
 

play or do anything. be feeling sad and overwhelmed.  If you can, give words to his feelings. Let him know it’s okay to feel 
 

 When children are stressed, some yell and others shut sad, mad, or worried. “It seems like you don’t want to do anything. I 
 

. . seems to not really down. Both need their loved ones. wonder if you are sad. It’s okay to be sad. I will stay with you.” 
 

have any feelings  Try to do things with your child, anything he might like (read a book, 
 

(happy or sad). sing, play together).
 


. . cries a lot. 	 	 Your family may have experienced difficult changes  Allow your child to express feelings of sadness. 
 

because of the disaster, and it is natural that your child is  Help your child name her feelings and understand why she may feel 
 

sad. that way. “I think you’re sad. A lot of hard things have happened” 
 

	 	 When you let your child feel sad and provide her with  Support your child by sitting with her and giving her extra attention. 
 

comfort, you help your child even if she remains sad. Spend special time together. 
 

	 	 If you have strong feelings of sadness, it may be good for  Help your child feel hopeful about the future. Together think and talk 
 

you to get support. Your child’s well-being is connected about how your lives will continue and the good things you will do, 
 

to your well-being. like go for a walk, go to the park or zoo, play with friends. 
 

 Take care of yourself.
 


. . misses people you  Even though young children do not always express how  For those that have moved away, help your child stay in touch in 
 

are no longer able to they feel, be aware that it is difficult for them when they some way (for example, sending pictures or cards, calling). 
 

see after the disaster. lose contact with important people.  Help your child talk about these important people. Even when we are 
 

 If someone close to your child died, your child may show apart from people, we can still have positive feelings about them by 
 

stronger reactions to the disaster. remembering and talking about them. 
 

 Young children do not understand death, and may think  Acknowledge how hard it is to not be able to see people we care for. 
 

that the person can come back. It is sad. 
 

 Where someone has died, answer your child’s questions simply and 
 

honestly. When strong reactions last longer than two weeks, seek help 
 

from a professional.
 


. . misses things you 	 	 When a disaster brings so much loss to a family and  Allow your child to express feelings of sadness. It is sad that your 
 

have lost because of community, it is easy to lose sight of how much the loss child lost her toy or blanket. 
 

the disaster. of a toy or other important item (blanket) can mean to a  If possible, try to find something that would replace the toy or blanket 

child. that would be acceptable and satisfying to your child. 

	 	 Grieving for a toy is also your child’s way of grieving for  Distract your child with other activities. 

all you had before the disaster. 

Parent Tips for Helping Infants and Toddlers after Disasters
 


National Child Traumatic Stress Network National Center for PTSD 
Parent Tips for Helping Preschool-Age Children after Disasters
 


Reactions/Behavior Responses Examples of things to do and say 

Helplessness and passivity: Young children know 	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

Provide comfort, rest, food, water, and 

















 	 Give your child more hugs, hand holding, or time 

they can’t protect themselves. In a disaster, they feel opportunities for play and drawing. in your lap. 

even more helpless. They want to know their parents Provide ways to turn spontaneous drawing or 	 Make sure there is a special safe area for your 

will keep them safe. They might express this by being playing about traumatic events to something that child to play with proper supervision. 

unusually quiet or agitated. would make them feel safer or better. 	 In play, a four year old keeps having the blocks 

Reassure your child that you and other grownups knocked down by hurricane winds. Asked, “Can 

will protect them. you make it safe from the winds?” the child 

quickly builds a double block thick wall and says, 

“Winds won’t get us now.” A parent might respond 

with, “That wall sure is strong,” and explain, 

“We’re doing a lot of things to keep us safe.” 

General fearfulness: Young children may become Be as calm as you can with your child. Try not to 	 Be aware when you are on the phone or talking 

more afraid of being alone, being in the bathroom, voice your own fears in front of your child. to others, that your child does not overhear you 

going to sleep, or otherwise separated from parents. Help children regain confidence that you aren’t expressing fear. 

Children want to believe that their parents can protect leaving them and that you can protect them. 	 Say things such as, “We are safe from the 

them in all situations and that other grownups, such as Remind them that there are people working to earthquake now, and people are working hard to 

teachers or police officers, are there to help them. keep families safe, and that your family can get make sure we are okay.” 

more help if you need to. 	 Say, “If you start feeling more scared, come and 

If you leave, reassure your children you will be take my hand. Then I’ll know you need to tell me 

back. Tell them a realistic time in words they something.” 

understand, and be back on time. 

Give your child ways to communicate their fears 

to you. 

Confusion about the danger being over: Young children Give simple, repeated explanations as needed, 	 Continue to explain to your child that the disaster 

can overhear things from adults and older children, even every day. Make sure they understand the has passed and that you are away from the danger 

or see things on TV, or just imagine that it is happen- words you are using. 	 Draw, or show on a map, how far away you are 

ing all over again. They believe the danger is closer to Find out what other words or explanations they from the disaster area, and that where you are is 

home, even if it happened further away. have heard and clarify inaccuracies. safe. “See? The disaster was way over there, and 

If you are at some distance from the danger, it is we’re way over here in this safe place.” 

important to tell your child that the danger is not 

near you. 

Returning to earlier behaviors: Thumb sucking, bed- Remain neutral or matter-of-fact, as best you can, 	 If your child starts bedwetting, change her clothes 

wetting, baby-talk, needing to be in your lap. as these earlier behaviors may continue a while and linens without comment. Don’t let anyone 

after the disaster. criticize or shame the child. 

Psychological First Aid - Field Operations Guide 
Reactions/Behavior Responses Examples of things to do and say 

Fears the disaster will return: When having remind- 	 	 Explain the difference between the event and  “Even though it’s raining, that doesn’t mean 
 

ers—seeing, hearing, or otherwise sensing something reminders of the event. the hurricane is happening again. A rainstorm 
 

that reminds them of the disaster.  Protect children from things that will remind is smaller and can’t wreck stuff like a hurricane 
 

them as best you can. can.”
 


 Keep your child from television, radio, and 
 

computer stories of the disaster that can trigger 
 

fears of it happening again.
 


Not talking: Being silent or having difficulty saying 	 	 Put common feelings into words, such as anger,  Draw simple “happy faces” for different feelings 
 

what is bothering them. sadness, and worry about the safety of parents, on paper plates. Tell a brief story about each one, 
 

friends, and siblings. such as, “Remember when the water came into 
 

	 	 Do not force them to talk, but let them know they the house and you had a worried face like this?” 
 

can talk to you any time.  Say something like, “Children can feel really sad 
 

when their home is damaged.” 
 

 Provide art or play materials to help them express 
 

themselves. Then use feeling words to check 
 

out how they felt. “This is a really scary picture. 
 

Were you scared when you saw the water?”
 


Sleep problems: Fear of being alone at night, sleep- 	 	 Reassure your child that he is safe. Spend extra  Provide calming activities before bedtime. Tell a 
 

ing alone, waking up afraid, having bad dreams. quiet time together at bedtime. favorite story with a comforting theme. 
 

	 	 Let the child sleep with a dim light on or sleep  At bedtime say, “You can sleep with us tonight, 
 

with you for a limited time. but tomorrow you’ll sleep in your own bed.” 
 

	 	 Some might need an explanation of the  “Bad dreams come from our thoughts inside 
 

difference between dreams and real life. about being scared, not from real things 
 

happening.”
 


Not understanding about death: Preschool age chil- 	 	 Give an age-appropriate consistent explanation–  Allow children to participate in cultural and 
 

dren don’t understand that death is not reversible. that does not give false hopes–about the reality religious grieving rituals. 
 

They have “magical thinking” and might believe of death.  Help them find their own way to say goodbye by 

their thoughts caused the death. The loss of a pet may 	 	 Don’t minimize feelings over a loss of a pet or a drawing a happy memory or lighting a candle or 

be very hard on a child. special toy. saying a prayer for the deceased. 

 Take cues from what your child seems to want to  “No, Pepper won’t be back, but we can think 

know. Answer simply and ask if he has any more about him and talk about him and remember 

questions. what a silly doggy he was.” 

 “The firefighter said no one could save Pepper 

and it wasn’t your fault. I know you miss him 

very much.” 

Parent Tips for Helping Preschool-Age Children after Disasters 


National Child Traumatic Stress Network National Center for PTSD 
Parent Tips for Helping School-Age Children after Disasters

Reactions Responses Examples of things to do and say 

Confusion about what happened 	 	 Give clear explanations of what happened  “I know other kids said that more tornadoes are 

whenever your child asks. Avoid details that would coming, but we are now in a safe place.” 

scare your child. Correct any misinformation that  Continue to answer questions your children have 

your child has about whether there is a present (without getting irritable) and to reassure them the 

danger. family is safe. 

	 	 Remind children that there are people working to  Tell them what’s happening, especially about 

keep families safe and that your family can get issues regarding school and where they will be 

more help if needed. living. 

	 	 Let your children know what they can expect to 

happen next. 

Feelings of being responsible: School-age children 	 	 Provide opportunities for children to voice their  Take your child aside. Explain that, “After a 

may have concerns that they were somehow at fault, or concerns to you. disaster like this, lots of kids–and parents too–keep 

should have been able to change what happened. They 	 	 Offer reassurance and tell them why it was not thinking, ‘What could I have done differently?’ or 

may hesitate to voice their concerns in front of others. their fault. ‘I should have been able to do something.’ That 

doesn’t mean they were at fault.” 

 “Remember? The firefighter said no one could 

save Pepper and it wasn’t your fault.” 
 

Fears of recurrence of the event and reactions to 	 	 Help identify different reminders (people, places,  When they recognize that they are being reminded, 
 

reminders sounds, smells, feelings, time of day) and clarify say, “Try to think to yourself, I am upset because 
 

the difference between the event and the reminders I am being reminded of the hurricane because it 
 

that occur after it. is raining, but now there is no hurricane and I am 
 

	 	 Reassure them, as often as they need, that they are safe.” 
 

safe.  “I think we need to take a break from the TV right 
 

	 	 Protect children from seeing media coverage of now.”
 


the event, as it can trigger fears of the disaster  Try to sit with your child while watching TV. Ask 
 

happening again. your child to describe what they saw on the news. 
 

Clarify any misunderstandings. 
 

Retelling the event or playing out the event over and 	 	 Permit the child to talk and act out these reactions.  “You’re drawing a lot of pictures of what 
 

over Let him know that this is normal. happened. Did you know that many children do 
 

	 	 Encourage positive problem-solving in play or that?” 
 

drawing.  “It might help to draw about how you would like 
 

your school to be rebuilt to make it safer.” 
 

 


Psychological First Aid - Field Operations Guide 
Reactions Responses Examples of things to do and say 

Fear of being overwhelmed by their feelings 



















	 	 Provide a safe place for her to express her fears, 



















“When scary things happen, people have strong 

anger, sadness, etc. Allow children to cry or be feelings, like being mad at everyone or being very 

sad; don’t expect them to be brave or tough. sad. Would you like to sit here with a blanket until 

you’re feeling better?” 

Sleep problems: Bad dreams, fear of sleeping alone, 	 	 Let your child tell you about the bad dream. “That was a scary dream. Let’s think about some 

demanding to sleep with parents. Explain that bad dreams are normal and they will good things you can dream about and I’ll rub 

go away. Do not ask the child to go into too many your back until you fall asleep.” 

details of the bad dream. “You can stay in our bedroom for the next couple 

	 	 Temporary sleeping arrangements are okay; of nights. After that we will spend more time with 

make a plan with your child to return to normal you in your bed before you go to sleep. If you get 

sleeping habits. scared again, we can talk about it.” 

Concerns about the safety of themselves and others. 	 	 Help them to share their worries and give them Create a “worry box” where children can write 

realistic information. out their worries and place them in the box. Set a 

time to look these over, problem-solve, and come 

up with answers to the worries. 

Altered behavior: Unusually aggressive or restless 	 	 Encourage the child to engage in recreational “I know you didn’t mean to slam that door. It 

behavior. activities and exercise as an outlet for feelings must be hard to feel so angry.” 

and frustration. “How about if we take a walk? Sometimes 

getting our bodies moving helps with strong 

feelings.” 

Somatic complaints: Headaches, stomachaches, 	 	 Find out if there is a medical reason. If not, Make sure the child gets enough sleep, eats well, 

muscle aches for which there seem to be no reason. provide comfort and assurance that this is normal. drinks plenty of water, and gets enough exercise. 

	 	 Be matter-of-fact with your child; giving these “How about sitting over there? When you feel 

complaints too much attention may increase better, let me know and we can play cards.” 

them. 

Closely watching a parent’s responses and recovery: Give children opportunities to talk about their “Yes, my ankle is broken, but it feels better since 

Not wanting to disturb a parent with their own feelings, as well as your own. the paramedics wrapped it. I bet it was scary 

worries. Remain as calm as you can, so as not to increase seeing me hurt, wasn’t it?” 

your child’s worries. 

Concern for other survivors and families. 	 	 Encourage constructive activities on behalf Help children identify projects that are ageof others, but do not burden them with undue appropriate and meaningful (clearing rubble from 

responsibility. school grounds, collecting money or supplies for 

those in need). 

Parent Tips for Helping School-Age Children after Disasters
 


National Child Traumatic Stress Network National Center for PTSD 
Reactions Responses Examples of things to do and say 

Detachment, shame, and guilt 	 	 Provide a safe time to discuss with your teen the  “Many teens–and adults–feel like you do, angry 

events and their feelings. and blaming themselves that they could have 

	 	 Emphasize that these feelings are common, done more. You’re not at fault. Remember even 

and correct excessive self-blame with realistic the firefighters said there was nothing more we 

explanations of what actually could have been could have done.” 

done. 

Self-consciousness: About their fears, sense of vul-  Help teens understand that these feelings are  “I was feeling the same thing. Scared and 

nerability, fear of being labeled abnormal. common. helpless. Most people feel like this when a 

 Encourage relationships with family and peers disaster happens, even if they look calm on the 

for needed support during the recovery period. outside.” 

 “My cell phone is working again, why don’t 

you see if you can get a hold of Pete to see how 

he’s doing.” 

 “And thanks for playing the game with your 

little sister. She’s much better now.” 

Acting out behavior: Using alcohol or drugs, sexu- 	 	 Help teens understand that acting out behavior  “Many teens–and some adults–feel out of 

ally acting out, accident-prone behavior. is a dangerous way to express strong feelings control and angry after a disaster like this. 

(like anger) over what happened. They think drinking or taking drugs will help 

 Limit access to alcohol and drugs. somehow. It’s very normal to feel that way–but 

 Talk about the danger of high-risk sexual it’s not a good idea to act on it.” 

activity.  “It’s important during these times that I know 

	 	 On a time-limited basis, keep a closer watch where you are and how to contact you.” Assure 

on where they are going and what they are them that this extra checking-in is temporary, 

planning to do. just until things have stabilized. 

Fears of recurrence and reactions to reminders 	 	 Help to identify different reminders (people,  “When you’re reminded, you might try saying 

places, sounds, smells, feelings, time of day) to yourself, ‘I am upset now because I am being 

and to clarify the difference between the event reminded, but it is different now because there 

and the reminders that occur after it. is no hurricane and I am safe.’” 

	 	 Explain to teens that media coverage of the  Suggest, “Watching the news reports could 

disaster can trigger fears of it happening again. make it worse, because they are playing the 

same images over and over. How about turning 

it off now?” 

Parent Tips for Helping Adolescents after Disasters
 


Psychological First Aid - Field Operations Guide 
Parent Tips for Helping Adolescents after Disasters 

Reactions Responses Examples of things to do and say 

Abrupt shifts in interpersonal relationships: Teens  Explain that the strain on relationships is  Spend more time talking as a family about how 

may pull away from parents, family, and even from expectable. Emphasize that everyone needs everyone is doing. Say, “You know, the fact 

peers; they may respond strongly to parent’s reac- family and friends for support during the that we’re crabby with each other is completely 

tions in the crisis. recovery period. normal, given what we’ve been through. I think 

 Encourage tolerance for different family we’re handling things amazingly. It’s a good 

members’ courses of recovery. thing we have each other.” 

 Accept responsibility for your own feelings.  You might say, “I appreciate your being calm 

when your brother was screaming last night. I 

know he woke you up, too.” 

 “I want to apologize for being irritable with you 

yesterday. I am going to work harder to stay 

calm myself.” 

Radical changes in attitude  Explain that changes in people’s attitudes after a  “We are all under great stress. When people’s 

disaster are common, but often return back over lives are disrupted this way, we all feel more 

time. scared, angry–even full of revenge. It might not 

seem like it, but we all will feel better when we 

get back to a more structured routine.” 

Premature entrance into adulthood: (wanting to  Encourage postponing major life decisions.  “I know you’re thinking about quitting school 

leave school, get married). Find other ways to make the teens feel more in and getting a job to help out. But it’s important 

control. not to make big decisions right now. A crisis 

time is not a great time to make major changes.” 

Concern for other survivors and families  Encourage constructive activities on behalf of  Help teens to identify projects that are ageothers, but do not let them burden themselves appropriate and meaningful (clearing rubble 

with undue responsibility. from school grounds, collecting money or 

supplies for those in need). 

National Child Traumatic Stress Network National Center for PTSD 
Reactions/Behavior Responses Examples of things to do and say 

High anxiety/arousal: Tension and anxiety are com- 	 	 Use breathing and/or other relaxation skills.  Breathing exercise: Inhale slowly through your 

mon after disasters. Adults may be excessively worried 	 	 Take time during the day to calm yourself through nose and comfortably fill your lungs all the way 

about the future, have difficulties sleeping, problems relaxation exercises. These can make it easier to down to your stomach, while saying to yourself, 

concentrating, and feel jumpy and nervous. These reac- sleep, concentrate, and will give you energy. “My body is filled with calm.” Exhale slowly 

tions can include rapid heart beat and sweating. through your mouth and empty your lungs, while 

silently saying to yourself, “My body is letting 

go.” Do this five times slowly, and as many times 

a day as needed. 

Concern or shame over your own reactions. Many  Find a good time to discuss your reactions with a  When talking with someone, find the right time 

people have strong reactions after a disaster, including family member or trusted friend. and place, and ask if it is okay to talk about your 

fear and anxiety, difficulty concentrating, shame about  Remember that these reactions are common and it feelings. 

how they reacted, and feeling guilty about something. takes time for them to subside.  Remind yourself that your feelings are expectable 

It is expectable and understandable to feel many emo-  Correct excessive self-blame with realistic and you are not “going crazy,” and that you are not 

tions in the aftermath of an extremely difficult event. assessment of what actually could have been done. at fault for the disaster. 

 If these feelings persist for a month or more, you 

may wish to seek professional help. 

Feeling overwhelmed by tasks that need to be accom-  Identify what your top priorities are.  Make a list of your concerns and decide what to 

plished (housing, food, paperwork for insurance, child  Find out what services are available to help get tackle first. Take one step at a time. 

care, parenting). your needs met.  Find out which agencies can help with your needs 
 

 Make a plan that breaks down the tasks into and how to access them. 
 

manageable steps.  Where appropriate, rely on your family, friends, 
 

and community for practical assistance. 
 

Fears of recurrence and reactions to reminders: It is 	 	 Be aware that reminders can include people,  When you are reminded, try saying to yourself, 
 

common for survivors to fear that another disaster will places, sounds, smells, feelings, time of day. “I am upset because I am being reminded of the 
 

occur, and to react to things that are reminders of what 	 	 Remember that media coverage of the disaster can disaster, but it is different now because the disaster 
 

happened. be a reminder and trigger fears of it happening is not happening and I am safe.” 
 

again.  Limit your viewing of news reports so you just get 
 

the information that you need.
 


Changes in attitude, view of the world and of  Postpone any major unnecessary life changes in  Getting back to a more structured routine can help 
 

oneself: Strong changes in people’s attitudes after the immediate future. improve decision-making. 
 

a disaster are common, including questioning one’s  Remember that dealing with post-disaster  Remind yourself that going through a disaster can 
 

spiritual beliefs, trust in others and social agencies, difficulties increases your sense of courage and have positive effects on what you value and how 
 

and concerns about one’s own effectiveness, and effectiveness. you spend your time. 
 

dedication to helping others.  Get involved with community recovery efforts. 

Tips for Adults
 


Psychological First Aid - Field Operations Guide 
Reactions/Behavior Responses Examples of things to do and say 

Using alcohol and drugs, or engaging in gambling or 













 	 Understand that using substances and engaging 	 	

	 	

	 	

	 	

	 	

	 	

	 	

	 	

	 	

	 	

	 	

	 	

	 	

Remember that substance use and other addictive 

high-risk sexual behaviors: Many people feel out of in addictive behaviors can be a dangerous way to behaviors can lead to problems with sleep, 

control, scared, hopeless, or angry after a disaster and cope with what happened. relationships, jobs, and physical health. 

engage in these behaviors to feel better. This can espe- 	 Get information about local support agencies. 

cially be a problem if there was pre-existing substance 

abuse or addiction. 

Shifts in interpersonal relationships: People may feel 	 Understand that family and friends are a major Don’t withdraw from others because you feel you 

differently towards family and friends; for example, form of support during the recovery period. might burden them. Most people do better after 

they may feel overprotective and very concerned for 	 It is important to understand and tolerate different disasters turning to others. 

each other’s safety, frustrated by the reactions of a courses of recovery among family members. Ask your friends and family how they are doing, 

family member or friend, or they may feel like pulling 	 Rely on other family members for help with rather than just giving advice, or telling them 

away from family and friends. parenting or other daily activities when you are to “get over it.” Offer a supportive ear or lend a 

upset or under stress. helping hand. 

Say, “We’re crabby with each other and that 

is completely normal, given what we’ve been 

through. I think we’re handling things amazingly. 

It’s a good thing we have each other.” 

Excessive anger: Some degree of anger is understand- 	 Find ways to manage your anger that help you Take time to cool down, walk away from stressful 

able and expected after a disaster, especially when rather than hurt you. situations, talk to a friend about what is making 

something feels unfair. However, when it leads to you angry, get physical exercise, distract yourself 

violent behavior, extreme anger is a serious problem. with positive activities, or problem-solve the 

situation that is making you angry. 

Remind yourself that being angry may harm 

important relationships. 

If you become violent, get immediate help. 

Sleep difficulties: Trouble falling asleep and frequent 	 Make sure you have good sleep routines. Go to sleep at the same time every day. 

awakening is common after a disaster, as people are on Don’t have caffeinated drinks in the evening. 

edge and worried about adversities and life changes. Reduce alcohol consumption. 

Increase daytime exercise. 

Relax before bedtime. 

Limit daytime naps to 15 minutes, and do not nap 

later than 4 pm. 

Tips for Adults
 


National Child Traumatic Stress Network National Center for PTSD 
Tips for Relaxation 


Tips for Relaxation 

Tension and anxiety are common after disasters. Unfortunately, they can make it more difficult to cope with the many things that must be done to recover. There is no easy solution to 

coping with post-disaster problems, but taking time during the day to calm yourself through 

relaxation exercises may make it easier to sleep, concentrate, and have energy for coping 

with life. These can include muscle relaxation exercises, breathing exercises, meditation, 

swimming, stretching, yoga, prayer, exercise, listening to quiet music, spending time in 

nature, and so on. Here are some basic breathing exercises that may help: 

For Yourself: 

1. Inhale slowly (one-thousand one; one-thousand two; one-thousand three) through your 

nose and comfortably fill your lungs all the way down to your belly. 

2.	 Silently and gently say to yourself, “My body is filled with calmness.” Exhale slowly 

(one-thousand one; one-thousand two; one-thousand three) through your mouth and 

comfortably empty your lungs all the way down to your stomach. 

3.	 Silently and gently say to yourself, “My body is releasing the tension.” 

4.	 Repeat five times slowly and comfortably. 

5.	 Do this as many times a day as needed. 

For Children: 

Lead a child through a breathing exercise: 

1.	 “Let’s practice a different way of breathing that can help calm our bodies down. 

2.	 Put one hand on your stomach, like this [demonstrate]. 

3.	 Okay, we are going to breathe in through our noses. When we breathe in, we are going to 

fill up with a lot of air and our stomachs are going to stick out like this [demonstrate]. 

4.	 Then, we will breathe out through our mouths. When we breathe out, our stomachs are 

going to suck in and up like this [demonstrate]. 

5.	 We are going to breathe in really slowly while I count to three. I’m also going to count to 

three while we breathe out really slowly. 

6.	 Let’s try it together. Great job!” 

Make a Game of It: 









Blow bubbles with a bubble wand and dish soap.
 


Blow bubbles with chewing gum.
 


Blow paper wads or cotton balls across the table. 
 

Tell a story where the child helps you imitate a character who is taking deep breaths.
 


Psychological First Aid - Field Operations Guide 
This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD 
	 Pay attention to any change in your use of  Consult with a healthcare professional about 
 

alcohol and/or drugs. safe ways to reduce anxiety, depression, 
 

muscle tension, and sleep difficulties.
	 

 Correctly use prescription and over-the-  If you find that you have greater difficulty 
 

counter medications as indicated. controlling alcohol/substance use since the 
 

disaster, seek support in doing so.
 

 Eat well, exercise, get enough sleep, and use  If you believe you have a problem with 
 

your family and others for support. substance abuse, talk to your doctor or 
 

counselor about it.
 

	 If you feel like using larger amounts of either 
 

prescribed or over-the-counter medications, 
 

consult a healthcare professional.
 


	 	 Increase your attendance at substance abuse  Talk with family and friends about supporting 

support groups. you to avoid use of alcohol or substances. 

	 	 If you are receiving disaster crisis counseling,  If you have a 12-Step sponsor or substance 

talk to your counselor about your past alcohol abuse counselor, talk to him or her about your 

or drug use. situation. 

	 	 If you have been forced to move out of your  Increase your use of other supports that have 

local community, talk to disaster workers helped you avoid relapse in the past. 

about helping to locate nearby alcohol or 

drug recovery groups, or ask them to help 

organize a new support group. 

Alcohol, Medication, and Drug Use after Disaster 

Alcohol, Medication, and Drug Use after Disaster 

Some people increase their use of alcohol, prescription medications, or other drugs after a disaster. 

You may feel that using drugs and alcohol helps you escape bad feelings or physical symptoms 

related to stress responses (for example, headaches, muscle tension). However, they can actually 

make these worse in the long term because they interrupt natural sleep cycles, create health 

problems, interfere with relationships, and create potential dependence on the substance. If your use 

of alcohol or drugs has increased since the disaster or is causing problems for you, it is important for 

you to reduce your level of use or seek help in gaining control over your use. 

If you have had an alcohol, medication, or drug problem in the past 

For people who have successfully stopped drinking or using drugs, experiencing a disaster can 

sometimes result in strong urges to drink or use again. Sometimes it can lead them to strengthen 

their commitment to recovery. Whatever your experience, it is important to consciously choose to 

stay in recovery. 

Psychological First Aid - Field Operations Guide 
.This.page.intentionally.left.blank. 

National Child Traumatic Stress Network National Center for PTSD