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What is psychological first aid?

PSYCHOLOGICAL FIRST AID is a humane and practical approach to addressing acute psychological reactions after a mass emergency. This approach is commonly used in humanitarian and foreign aid contexts. Psychological first aid can be adapted for clinical use to help physicians during the COVID-19 pandemic.

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Dr. Kostenuik has created clinical tools using elements of

• psychological first aid

• psychotherapy and emergency medicine

• trauma-informed therapy

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According to a systematic review of psychological first aid, interventions after a mass emergency should be practical, easy to learn and promote a sense of:

• safety

• self-efficacy

• empowerment

• connectedness

• calm

• hope​

Why new tools?

Physicians and patients are asking for practical tools to address acute psychological distress in themselves and others during the COVID-19 pandemic. Existing psychological and mental health first aid resources may be inappropriate or impractical for health care workers and for COVID-19 as they are designed for foreign aid workers in poor countries, are intended for specific mental illnesses, or require significant training.

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Physicians need tools that are easy to learn, use and remember, and that are immediately effective for the types of acute reactions that they and their patients are experiencing. 

Most acute psychological reactions to the pandemic are normal responses to an abnormal situation. The majority of these acute reactions can and should be addressed with supportive measures and do not require psychiatric or specialized care.

During a pandemic physicians are faced with an increased demand from patients for emotional and psychological support. Physicians on the frontlines and those responding in other care settings need tools to respond to anxiety, panic, and severe acute stress and grief reactions in patients, family members and peers. New skills and approaches are needed to help address both the VOLUME and TYPES of acute psychological reactions that occur in response to a global pandemic.

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Why trauma informed tools?

After an extreme stressor, a significant minority of individuals are at risk of developing serious disorders including post-traumatic stress disorder (PTSD) and depressive, anxiety and substance use disorders.

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The ABC123 and L.A.R.G.E. Psychological First Aid Tools address two key risk factors for the development of post-traumatic stress disorder:

• peri-traumatic dissociation

• lack of social support

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The ABC123 tool provides physicians with immediate skills to respond effectively to acute anxiety, panic and peri-traumatic or post-traumatic dissociation. The L.A.R.G.E. tool promotes social support and connection.

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Why mnemonic memory aids?

Semi-structured approaches and the use of mnemonic memory aids are common in emergency and acute care medicine and help ensure safer and more consistent delivery of care and skills. 

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The ABC123 and L.A.R.G.E. mnemonics help physicians remember the skills even when they may be under extreme stress themselves. The tools help frame an effective clinical encounter making it easier to respond to patients in an organized and safe way. Having an effective easily remembered approach can increase physician confidence in handling acute psychological distress and may reduce the risk of errors, adverse events, difficult patient encounters and complaints. 

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How can these tools help during COVID-19?

During a pandemic the increased volume of individuals needing psychosocial support risks overwhelming physicians and the health care system. The ABC123 and L.A.R.G.E. Psychological First Aid Tools can be used by physicians without specialized mental health training, as well as nurses, first responders, support staff, and non-specialized personnel. 

It is recommended by WHO and the Inter-Agency Standing Committee that all responders, community leaders, teachers, and the entire population affected by the COVID-19 pandemic be trained in basic psychological first aid. The ABC123 and L.A.R.G.E. psychological first aid tools are easy to learn, use and remember and can be rapidly disseminated for immediate use. These tools were designed specifically for the COVID-19 pandemic but may be useful in other contexts.

What if individuals need more than first aid?

After a mass emergency, a significant minority of individuals, especially those from vulnerable populations, may experience emerging, regressing or worsening mental illness and will require specialized mental health support. The tools include a triaging element to help recognize red flags indicating the need for referral to crisis services or other specialized care.

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Go To ABC123 and LARGE Tools (PDFs)

(These tools are intended for a Canadian audience.)

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Resources:

In case of crisis contact your local crisis services:

Crisis Services Canada: 1-833-456-4566 (24hrs), Text 45645 (4pm-midnight)

Mental Health Crisis Line: Barrie ON 705-728-5044, 1888-893-8333

Canadian Mental Health Association: cmha.ca

References:

WHO/PAHO Mental Health Protection and Psychosocial Support in Epidemic Settings 2016

Bisson 2020 Systematic review of Psychological First Aid

IASC Addressing Mental Health and Psychosocial Aspects of COVID-19 Outbreak

WHO Mental health and psychosocial considerations during the COVID-19 outbreak