"In the immediate aftermath of a disaster, everyone feels upset, but
not everyone goes on to develop psychological problems," said Matthew
Friedman, M.D., Ph.D. "Most people show wonderful courage and
Moreover, he noted, first responders who reduce initial distress and
fortify resilience may accelerate recovery.
Friedman is executive director of the National Center for Posttraumatic
Stress Disorder (PTSD) in White River Junction, Vt., and a professor of
psychiatry and pharmacology at Dartmouth Medical School.
For help in accomplishing those tasks, psychiatrists and others who provide
acute aid in disasters can turn to the new "Psychological First Aid
Field Operations Guide." The guide was developed by the National Center
for PTSD in collaboration with the terrorism disaster branch of the National
Child Traumatic Stress Network and an international team of disaster response
"The guide presents a pragmatic approach that exemplifies best
knowledge and best practices for first responders," said Friedman. Work
on the manual began in late 2001 in response to concerns raised about the
effectiveness of responses to the September 11, 2001, terrorist attacks in the
United States. The guide was released last month, earlier than planned, to
help responders deal with Hurricane Katrina.
Funding for the guide came from the Substance Abuse and Mental Health
As the guide details, people affected by a disaster first need a safe place
to calm down and get physical and emotional comfort, away from exposure to
reminders of the trauma such as extensive television viewing. Responders need
to help survivors connect with family, friends, and neighbors and with
community organizations offering assistance. They need to provide a steady
stream of information about what has transpired and what's being done to
restore normality. Efforts should focus on helping both children and adults
cope with the disaster and take an active role in their own recovery.
The guide emphasizes the need to work with the whole family, recognizing
developmental issues for children of different ages. "One of the major
buffers against traumatic stress after a catastrophe is social
connectedness," noted Friedman. "The family is the primary
connector. Parents serve as the bellwether of how well the child is going to
The guide also emphasizes that many people do not want to talk about what
happened to them in the first couple of days, Friedman said. It maintains that
so-called "debriefing"—immediately recounting details of
one's personal experiences—not only is unhelpful, but also may be
Delays in getting help to Katrina survivors in the New Orleans Superdome
and convention center caused considerable emotional distress, Friedman said.
Survivors suffered physical privation for five days—with lack of food
and water, little sleep, extreme heat, crowding, noise, and poor sanitation
facilities—as well as endured or feared attacks by other evacuees. Many
didn't know where some members of their families were. They experienced
continued exposure to traumatic reminders of Katrina's devastation by seeing
flood waters and corpses.
"We'd expect such situations to increase the risk of acute
psychological problems and delay recovery, but it's impossible to predict
that," Friedman stressed. "How connected or disconnected people
are may make a big difference."
High levels of psychological problems predicted among New York City
residents after the September 11 attacks, he said, never materialized.
Psychiatrists, teachers, and others working with Katrina survivors can use
the psychological first aid guide to help minimize psychological fallout, he
said, and to identify those who are unable to recover quickly and help them
The Web site of the National Center for PTSD also offers downloadable
handouts to help physicians and other medical personnel manage psychosocial
issues and pharmacological treatment and assess and respond to individuals who
may have suicidal intent. The Web site additionally offers downloadable
handouts for others working with survivors, including journalists, and for
survivors and families, along with links to additional sources of
The National Center for PTSD's "Psychological First Aid Field
Operations Guide" is posted at<www.ncptsd.va.gov/topics/katrina.html>.
The National Child Traumatic Stress Network's Web address is<www.NCTSN.org>.▪