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The following article is the combination of some reflections and recommendations by Dr Paul Valent and the ASTSS Management Committee (February 12th 2009). Though the current bushfire is the worst in our history, understanding responses from previous bushfires and other disasters may help in recovery. Some communities are still preparing for possible ravages of fire. Many more are reeling from the worst non-war disaster in Australian history. The greatest current anguish is for those who have perished, for those unaccounted for, and for lost houses, animals, and communities. Survival needs – food, shelter and warmth - are paramount.
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HELP at this stage involves reunification of families, provision of information about missing persons, and provision of survival needs. HELPING others Our understanding of how to help those immediately after an event has grown over the years. The model currently advocated is that of Psychological First Aid (PFA). There is currently no agreed upon ‘one model’ of PFA, yet the key elements in all models are: promote safety and calm; promote connectedness through re-engagement in routines and use of community social supports; promote self-and community efficacy and empowerment; instill hope; monitoring (and stabilizing, where necessary) mental wellbeing; referring those with longer term functional impairment (>2 weeks) for evidence based treatment (usually trauma focused or depression focused Cognitive Behaviour Therapy). Simply put: DO help organisations that provide for these needs, by following their specific instructions and requests. Currently the Salvation Army and Red Cross are providing good will - donations can be made as per their websites. DO NOT converge on affected areas. With the passage of time, once the immediate crisis is resolved and often many weeks later, organisations may request volunteer assistance (such as rebuilding infrastructure – fences etc) through their websites. Disaster Relief Workers will be providing immediate first aid, required care, information and practical comfort for survivors and their loved ones. DO understand that people respond differently to extremely stressful events such as the firestorms and bushfires occurring in Victoria this week. These are ways in which the mind reorganises priorities, protects the person and prepares for tasks at hand. These different responses also help alert people to continued threats. People will make sense of their experiences and survival differently. However, if after two to three weeks the person is still demonstrating and reporting impaired functioning then they should be treated with an evidence based trauma focussed therapy. The Australian guidelines on evidence based practice are available through the ASTSS website (http://tinyurl.com/bwmxg3). DO listen carefully to survivors. DO NOT give bland encouragement. DO remember vulnerable groups – the bereaved, the elderly, children, the evacuated, the isolated, and those who suffer other stresses. DO look after yourselves too. HELPING yourself DO trust that your responses and instincts led to as much survival as was possible under the circumstances. DO NOT bottle up what is inside you – if you want to share your feelings with loved ones do so. But, DO NOT talk more than you want to, or feel safe to – if you don’t want to share with others, don’t. DO NOT force others to speak of their traumatic experiences. DO NOT suppress your responses with alcohol, overwork, cigarettes, coffee and drugs. Because sleep and concentration are affected, and accidents are more common after disasters, DO drive more carefully. DO remember to take your usual medications. DO communicate your needs clearly. DO seek privacy when you need it. The Field Operations Guide (2nd Edition) for psychological First Aid suggests the following as generally helpful ways of coping following traumatic events: 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 where needed 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 The following are generally ineffective following traumatic events: Using alcohol or drugs to cope Withdrawing from activities Withdrawing from family or friends 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.) Finally, on the ASTSS website homepage (www.astss.org.au) and ASTSS Bushfire 2009 Resources there are links through which you can access help, including mental health services. |