Helping survivors recover from the emotional aftermath of a disaster

As a health care professional, you can expect to come into contact with emotionally traumatized patients during times of disaster. In addition to treating physical injuries, you can help by providing Psychological First Aid.

Get prepared now by learning the PFA basics:

1) Making contact. Survivors may seek you out for help. In other cases you may be the one initiating contact. Before asking questions about a patient’s mental condition, ask for permission to help. You might say something like this:

“I’m checking on everyone who was affected by the disaster. I may be able to help. Is it OK if I ask you some questions?”

2) Gathering information. In some situations, there may be many victims. Gather information quickly to prioritize needs. Some survivors may be reluctant to talk. Be careful not to press them for details about trauma. Others may be anxious to talk at length. Let them know they will be given an opportunity after you have checked on everybody else. Find out if any survivors:

  • Experienced the death of a loved-one
  • Became separated from a family member
  • Witnessed death or severe injury
  • Lost a home
  • Are experiencing severe emotional distress
  • Have a pre-existing mental health condition
  • Have a history of alcohol or drug abuse

If any survivors are having thoughts of harming self or others, get immediate help from a mental health professional.

3) Stabilizing techniques. Most survivors will calm down without intervention, but some may have reactions that interfere with their ability to function. Look for signs that indicate someone is overwhelmed and in need of stabilization:

  • Extreme agitation or panic
  • Disorientation
  • A vacant or glassy-eyed look
  • Unresponsiveness
  • Uncontrollable crying
  • Hyperventilating
  • Shaking, trembling or rocking

Rather than trying to convince a distressed person to calm down, find out what the trouble is. Show that you are concerned and willing to listen. Expressing emotions to a caring person can reduce stress significantly.

Be aware that feelings may come and go like waves. Suggest stress-relieving techniques like deep breathing, walking or “grounding.” Grounding is an exercise used to turn one’s attention away from inner thoughts and towards the external environment. Here’s how it works:

  • Find a pleasant place. Sit comfortably with arms and legs uncrossed.
  • Breathe in and out slowly and deeply.
  • Look around and name five non-distressing objects you can see, for example: I see a tree, I see clouds, I see birds, I see a squirrel, I see people walking.
  • Breathe in and out slowly and deeply again.
  • Next, name five non-distressing sounds you can hear: children playing, women talking, wind in the trees…
  • Breathe in and out slowly and deeply.
  • Then name five non-distressing things you can feel: I feel the bench I’m sitting on, I feel my toes inside my shoes, I feel the sun on my face…
  • Breathe in and out slowly and deeply.

After helping a survivor calm down, offer to make a referral to a professional crisis counselor. To find out about services in your area, contact the nearest Local Mental Health Authority.

If a patient cannot become stabilized, contact a mental health professional. Tranquilizing medications may be necessary.

4) Providing practical assistance. When survivors get help for immediate needs, they tend to be more optimistic about future recovery. Therefore, providing practical assistance should be considered an essential component of PFA. You can help by:

  • Providing treatment for a disaster-related or pre-existing medical condition.
  • Providing or finding information about food, shelter and clothing.
  • Locating sources of aid like FEMA, the American Red Cross, local disaster relief agencies and others.
  • Discussing a plan of action to prioritize needs such as:
    • repairing damaged property
    • finding day care for children
    • caring for elderly family members
    • making funeral arrangements for deceased loved-ones

5) Connecting survivors to social supports. After disasters, individuals often become disconnected from the social networks that give them a sense of belonging. It may not be possible to maintain normal contact with friends and neighbors, classmates, faith communities or other social networks.

You can help survivors find a sense of community by:

  • Keeping them connected with primary relationships via phone, email and letters.
  • Connecting survivors to familiar spiritual supports such as churches, synagogues or other faith communities.
  • Finding companions for the elderly.
  • Finding playmates for children.
  • Connecting survivors with others who enjoy similar activities or hobbies.
  • Encouraging survivors to help fellow survivors. Feeling useful gives people a sense of purpose. Some survivors may be able to volunteer in shelters, donations centers or day care facilities even on a limited basis.
  • Connecting survivors with alcohol or drug abuse histories to treatment facilities or support groups like Alcoholics Anonymous and Narcotics Anonymous.

6) Teaching Coping Skills. It’s normal to experience strong reactions to abnormal events like disasters. Many survivors – or their loved-ones – will notice changes in the way they are thinking, feeling or behaving. Help your patients cope with stress by offering the following suggestions:

  • Don’t let yourself become isolated. Seek out and maintain connections with fellow survivors, friends, co-workers and others.
  • Talk to others about how you are feeling and what you have experienced.
  • Make use of crisis counseling services that are often available free of charge following a disaster. (To find out about services in your area, contact the nearest Local Mental Health Authority.)
  • Accept that recovery will not be easy or short-term.
  • Set realistic goals and timeframes.
  • Don’t overwork yourself. Take time off from repairs to be with your family. And make time for relaxation or a favorite hobby.
  • Take action whenever possible but accept that many things are beyond your control.
  • Pay attention to your physical health as prolonged stress can take a toll on your body. Maintain a good diet, and get plenty of sleep and exercise.
  • Don’t use alcohol or drugs to cope with stress. In the long run, they will cause worse problems. (Information about prevention and treatment can be found at DSHS´s Substance Abuse Services web page.)

When victims of disaster receive early Psychological First Aid, their chances for successful recovery increase. PFA is also useful weeks and months after an event when stress levels tend to increase.

To learn more about PFA, visit DSHS’s Disaster Mental Health Services web page which includes links to recommended training.


Note: External links to other sites are intended to be informational and do not have the endorsement of the Texas Department of State Health Services. These sites may also not be accessible to people with disabilities.

Last updated August 8, 2013