Psychological First Aid (PFA) During and After a Pandemic Influenza

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On this page:
Why is Psychological First Aid important for people during and after an influenza pandemic?
What reactions would I most likely see and what can I do to help?
    Ages 1-5
    Ages 6-11
    Ages 12-18
    Adults
    Older Adults
    Responders and Staff
When should someone be referred to professional mental health services?

Why is Psychological First Aid important for people during and after an influenza pandemic?

A flu pandemic (a worldwide outbreak of flu) is outside the range of day to day experience and will be upsetting for people.

  • A flu pandemic can upset daily routines. Children may be out of school and confined to their homes for extended periods. Adults may not be able to work due to workplace closures or sickness. In a worst case scenario, a family member or friend may die.

  • Children are especially vulnerable because they have less capacity to calm and reassure themselves in stressful situations.
  • Staff and disaster responders may be forced to deal with additional stressors such as: massive loss and grief; loss of self-efficacy; and community anger and stigma.
  • Providing behavioral support to family members or friends can help them cope with disasters and prevent long term emotional or psychological problems.
  • The information below are some typical ways that children, adults, and staff may react to a flu pandemic along with suggested PFA strategies that all of us can use to help our co-workers, family and friends.

What reactions would I most likely see and what can I do to help?

Ages 1-5:
What reactions would I most likely see?
Emotional reactions
• Irritability
• Anxiety
• Fear
• Angry outbursts
• Sadness
• Withdrawal
Behavioral reactions
• Resumption of bed-wetting, thumb sucking, clinging to parents
• Fear of the dark
• Avoidance of sleeping alone
• Increased crying
Physical reactions
• Loss of appetite
• Stomach aches
• Nausea
• Sleep problems, nightmares
• Speech difficulties
• Tics
What can I do to help?

• Encourage expression regarding losses
• Provide predictable bedtime routines
• Avoid unnecessary separations
• Permit the child to sleep in parents’ room temporarily
• Monitor media exposure to disaster trauma
• Encourage expression through play activities

Ages 6-11:
What reactions would I most likely see?

Emotional reactions
• School avoidance
• Withdrawal from friends, familiar activities
• Angry outbursts
• Obsessive preoccupation with disaster, safety

Behavioral reactions
• Decline in school performance
• Aggressive behavior at home or school
• Hyperactive or silly behavior
• Whining, clinging, acting like a younger child
• Increased competition with younger siblings for parents’ attention

Physical reactions
• Loss of appetite
• Stomach aches
• Nausea
• Sleep problems, nightmares
• Speech difficulties
• Tics

What can I do to help?

• Give additional attention and consideration
• Relax expectations of performance at home and at school temporarily
• Set gentle but firm limits for acting out behavior
• Provide structured but undemanding home chores and activities
• Encourage verbal and play expression of thoughts and feelings
• Involve the child in preparation of family emergency kit, home drills
• Rehearse safety measures for future disasters

Ages 12-18:
What reactions would I most likely see?

Emotional reactions
• Loss of interest in peer social activities, hobbies, recreation
• Sadness or depression
• Resistance to authority
• Feelings of inadequacy and helplessness

Behavioral reactions
• Decline in academic performance
• Rebellion at home or school
• Decline in previous responsible behavior
• Agitation or decrease in energy level, apathy
• Delinquent behavior
• Social withdrawal

Physical reactions
• Loss of appetite
• Headaches
• Gastrointestinal problems
• Sleep disorders
• Skin eruptions
• Complaints of vague aches and pains

What can I do to help?

• Give additional attention and consideration
• Relax expectations of performance at home and at school temporarily
• Encourage discussion of disaster experiences with peers, significant adults
• Avoid insistence on discussion of feelings with parents
• Encourage physical activities
• Rehearse family safety measures for future disasters

Adults:
What reactions would I most likely see?

Emotional reactions
• Depression, sadness
• Irritability, anger
• Anxiety, fear
• Despair, hopelessness
• Guilt, self doubt
• Mood swings

Behavioral reactions
• Sleep problems
• Avoidance of reminders
• Excessive activity level
• Crying easily
• Increased conflicts with family
• Hypervigilance
• Isolation, withdrawal

Physical reactions
• Fatigue, exhaustion
• Gastrointestinal distress
• Appetite change
• Somatic complaints
• Worsening of chronic conditions

What can I do to help?

• Provide supportive listening and opportunity to talk in detail about disaster experiences
• Assist with prioritizing and problem solving
• Offer assistance for family members to facilitate communication and effective functioning
• Assess and refer when indicated
• Provide information on disaster stress and coping, children’s reactions and families
• Provide information on referral resources

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Older Adults:
What reactions would I most likely see?

Emotional reactions
• Depression
• Despair about losses
• Apathy
• Confusion, disorientation
• Suspicion
• Agitation, anger
• Fears of institutionalization

Behavioral reactions
• Withdrawal and isolation
• Reluctance to leave home
• Mobility limitations
• Relocation adjustment problems

Physical reactions
• Worsening of chronic illnesses
• Sleep disorders
• Memory problems
• More susceptible to hypo and hyperthermia
• Physical and sensory limitations (sight, hearing) interfere with recovery

What can I do to help?

• Provide strong and persistent verbal assurance
• Provide orienting information
• Assist in reestablishing familial and social contacts
• Give special attention to suitable residential relocation
• Encourage discussion of disaster losses and expression of emotions
• Provide and facilitate referrals for disaster assistance
• Engage providers of transportation, chore services, meal programs, home health, and home visits as needed

Responders & Staff:
What reactions would I most likely see?

Emotional reactions
• Sadness, grief
• Anxiety
• Anger
• Frustration
• Fear of contagion and/or of transmitting disease to others
• Shock, confusion, or disbelief
• Sense of ineffectiveness and powerlessness

Behavioral reactions
• Numbness and detachment
• Absenteeism and dysfunction due to domestic pressures caused by school closures, disruptions in day care, or family illness
• Concern about receiving vaccines and/or antiviral drugs before other persons
• Refusal to relinquish control when shift is finished
• Utilizing poor coping techniques (e.g., alcohol; tobacco, sugar)

Physical reactions
• Physical, mental, and emotional exhaustion
• Difficulty maintaining self-care activities (e.g., getting sufficient rest)
• Headaches
• Muscle aches
• Worsening of chronic illnesses

What can I do to help?

• Teach common stress reaction and encourage positive coping skills
• Provide emotional support services to their family members
• Help to directly solve problems (e.g., day care issues)
• Teach common stress reaction and encourage positive coping skills
• Provide emotional support services to their family members
• Help to directly solve problems (e.g., day care issues)
• Facilitate the provision of simple accurate information regarding the disaster
• Connect with community and workplace support services
• Promote a buddy system for emotional support during the response phase
• Promote resilient workplace policies (e.g., scheduled to work for no more than 48 hours in a seven (7) period, with at least ten (10) hours off between shifts)

When should someone be referred to professional mental health services?

If you notice any of the following more serious behavioral health problems contact your Employee Assistance Program, or your local mental health crisis line right away for immediate assistance and referral information:

Disorientation – dazed, memory loss, inability to give date or time, state where he or she is, recall events of the past 24 hours or understand what is happening.

Depression – pervasive feelings of hopelessness and despair, unshakable feelings of worthlessness and inadequacy, withdrawal from others, inability to engage in productive activity.

Anxiety – constantly on edge, restless, agitated, inability to sleep, frequent frightening nightmares, flashbacks and intrusive thoughts, obsessive fears of another disaster, thinking all the time about illness or the pandemic.

Mental illness – hearing voices, seeing visions, delusional thinking, excessive preoccupation with an idea or thought, pronounced pressure of speech.

Remember – WHEN IN DOUBT CONSULT!

Updated Friday, 20-Sep-2013 14:04:51 CDT