Medicine: Psychological First Aid

People in a disaster may escape bodily injury, but they often need psychological first aid. To help physicians and civil-defense workers give the right kind of such aid in emergencies from railroad wrecks to atom-bomb attacks, the American Psychiatric Association has put out a pamphlet of do’s and don’ts.

Disaster reactions may range from short-lived disturbances, e.g., heavy sweating, trembling or nausea, to numbness and depression or overactivity, marked by joking, fast talk, an abundance of useless suggestions and activities. Occasionally, there may be physical reactions such as severe vomiting or hysterical paralysis, as well as blind panic, which is uncommon but dangerous because it is contagious. For all cases, several basic rules of mental first aid apply:

¶ “Do not blame or ridicule a person for feeling as he does. Your job is to help him cope with his feelings—not to tell him how he should feel.”

¶ “Letting a casualty know that you want to understand how he feels can be the first step toward helping him. This may be done with a few words or even a simple gesture. Do not overwhelm him with pity.”

¶ Genuinely panic-stricken disaster victims who cannot be brought around quickly should be segregated to prevent general panic, even if this means using two or three workers in good condition to isolate one frantic victim.

¶ “Restraint should be firm but not brutal or punitive. The widespread belief that a casualty in panic can be jolted out of his confusion by slapping him in the face or dousing him with cold water … is unsound.”

¶ “Do not administer sedatives … except as a last resort . . . The psychological casualty does not think clearly, [and sedatives] will . . . add to his confusion.”