• PAS-It-On

Psychological First Aid—First Things First After a Critical Incident in the Workplace

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PAS-It-On Vol 11 Issue 1

Human Resource (HR) professionals are generally well aware of the importance of, and options for, workplace response to critical incidents and traumatic events such as accidents resulting in serious injury or loss of life, natural disasters, or threats of violence. Organizations that put a priority on promoting the resilience of survivors and the organization will see the highest rates of return to productivity, wellbeing, sense of safety and quality of life.

In addition to implementing emergency safety plans, HR often calls upon specially trained EAP critical incident responders and organizational chaplains to the workplace to provide support for those most affected by a critical incident. If a workplace accident or shooting has occurred, the site may become inaccessible to outside support as a result of investigation protocols. In remote areas, it may take a few hours or more for a mental health professional to arrive onsite. In other situations, the critical incident may have had low impact on the work group but they still may benefit from support and information.

Except for those working in a first responder or military environment, most managers and HR professionals are not naturally “mentally prepared” to respond to the psychological needs of employees directly following an adverse incident. However, the burden of providing immediate support to employees until the EAP professionals and clergy arrive falls primarily on HR and the managers and supervisors that are in the closest proximity to the situation.

Psychological First Aid – HR and Management Provide the Initial Intervention

One of the most valuable, immediately available interventions with high positive impact on employees’ recovery is Psychological First Aid (PFA)—an evidence-informed, supportive intervention for use in the immediate aftermath of a traumatic event, natural disaster, public health emergency, or even a personal crisis. Built on the concept of hu- man resilience, PFA aims to reduce immediate stress symptoms for those closely impacted by a traumatic incident.

Initially conceived in the mid-2000’s by the Medical Reserve Corps and outlined by the National Center for PTSD and the National Child Traumatic Stress Network, its approach is to foster resilience, i.e. short- and long-term adaptive and coping skills. Unlike other critical incident response interventions, PFA may be utilized at any time—immediately after an event, and extending to days, or even weeks later. It is designed to be used “onsite”, in any setting, at the location of the event, if necessary. It does not require specific staging.

PFA can be administered by non-mental health professionals and is well suited for peer support teams, HR staff, managers and emergency first responders within an organization immediately following a critical incident. When EAP professionals arrive, they will provide additional individual and group assessment and intervention for employees based on their proximity to the incident and severity of stress reaction.

Providing immediate PFA reinforces the benefits of future EAP critical incident response services. The PFA intervention provides immediate support and normalization, and quickly activates the resilience of the group. EAP critical incident response offers follow-up sup- port, education and information, assessment for those who may be experiencing more profound stress reactions, and reinforcement of the already activated resilience-based behaviors of the individuals and organization.

PFA teams within the Organization

Consider the benefits and options for organizing peer response teams that are equipped to administer psychological first aid. Personal Assistance Services (PAS) is available to consult on the formation of peer response teams, team selection criteria, response protocols and other considerations. The basic components of PFA below can be provided by anyone who is willing, and understands the essential needs of trauma survivors:

  • Target those who are most distressed quickly.
  • Offer practical assistance in a calm manner—survivors take their cues from how others are reacting.
  • Help survivors feel more secure.
  • Empower survivors to harness their innate resilience traits.
  • Encourage both survivors and their family members/loved to take an active role in recovery

The National Child Traumatic Stress Network pro- vides free online training, and a complete manual is available http://www.ptsd.va.gov/professional/manuals/manual-pdf/pfa/

One of the most valuable, immediately available interventions with high positive impact on employees’ recovery is Psychological First Aid

A Quick Guide for HR and Managers Delivery of One-on-One PFA Immediately Following a Traumatic Event Target those who are most distressed quickly.

Every person will have a different reaction to the traumatic event. Not everyone will be acutely distressed however those showing signs of being disoriented, confused, frantic, agitated, shaky, or withdrawn/”shut down” may need more support.

  • Establish a human connection in a calm and compassionate manner; speak slowly. Introduce yourself, tell him/her that you are checking to see how they are doing; ask permission to speak with them for a few minutes.
  • Calm them by encouraging them to breathe in and out deeply and slowly, relax their muscles.
  • Stabilize distraught or emotionally overwhelmed survivors by helping them to focus on non-distressing sights (the floor, a shoe, a table), sounds (their own breathing, a cell phone ringing, a woman talking) and things they can feel (their back against the back of a chair, their lips pressing together, their toes inside their shoes, their fingers rubbing a blanket).
  • Those who have been more closely exposed to grotesque injury, threat of life or experienced recent prior traumas (death of a loved one, assault, disaster) are more at risk of becoming acutely distressed.

Offer practical assistance in a calm manner—survivors take their cues from how others are reacting.


  • Help those impacted communicate their immediate needs and concerns to you; ask if there is something right now that he/she needs, listen carefully to what they tell you so you can learn how you can be of specific help to them.
  • Provide practical assistance to address their immediate needs and concerns. Discuss an action plan to:

฀Provide for their physical comfort: food, water, blanket, quiet place;

฀Connect them to their social support networks (loved ones, friends, neighbors) via phone as soon as possible;

฀Connect them with other employees and managers in a designated safe place as soon as possible. Help survivors feel more secure.

  • Communicate that additional steps will be taken and that collaborative services will be offered (a plan will be put in place).
  • Communicate what is currently known about the unfolding event and response activities (transportation to a private and safe area, availability of supplies, counselors and clergy will be arriving to offer additional support, etc.).
  • Help him or her avoid engaging in in-depth descriptions of details about the traumatic event as that may provoke additional distress. Empower survivors to harness their innate resilience traits.
  • Acknowledge their efforts to cope and to help others, acknowledge their strengths.
  • Reframe complaints into concerns that can be overcome.
  • Connect survivors to social supports as soon as possible. Encourage both survivors and their family members/loved to take an active role in recovery.
  • Provide information to help survivors cope effectively with the psychological effects of trauma and re- sources for ongoing support. (Fostering resilience handouts for survivors and their families/loved ones can be found on PAS’ website.)
  • Link survivors with other community resources and employer-sponsored support services.