Section 26about 5 min · no rush

A gentle note before you read: this chapter carries heavy material. Read at your own pace; stopping partway and coming back is allowed.

26

Psychological First Aid & emergencies

Nepal's counselors work in a country of earthquakes, floods, landslides, fires and bus accidents. PFA is what everyone can do in the first hours and days: humane, practical support that follows three verbs and one rule: do no harm.

Someone who is not responding, badly injured, or unable to care for themselves or their children needs medical help first: ambulance 102 or 112 / 100, then the nearest health facility. Everything on this page comes after that.

Look · Listen · Link, and what PFA is not

CTEVT PSC curriculum

LOOK

  • Check safety of the scene
  • Who has urgent basic needs?
  • Who shows serious distress reactions?

LISTEN

  • Approach calmly; introduce yourself
  • Ask about needs and concerns
  • Listen; help people feel calm: do NOT force them to talk about what happened

LINK

  • To food, shelter, water, medical care
  • To family and loved ones (reunification)
  • To accurate information and services

PFA is not:

  • Professional counselling
  • "Debriefing", making survivors retell the trauma; evidence shows this can harm
  • Diagnosing
  • Something only professionals do

Most acute reactions, crying, numbness, trembling, insomnia, are normal reactions to abnormal events and settle with safety, information, and connection. The ones to escalate:

  • Not responding at all (treat this first as a possible medical emergency: check breathing, get medical help)
  • Risk to self or others
  • Unable to care for self or children

Remember the IASC pyramid from Wellbeing & intervention: in an emergency your biggest mental-health act may be organising the water queue so it is safe for women at night.

Test yourself

A landslide has taken three houses. A woman sits silent, holding a child, not answering. Script your first five sentences of PFA: then mark which verb (look/listen/link) each sentence serves, and name two things you must NOT do.

Model answer: the five sentences

Here is a script for the same situation: a landslide has taken three houses, and a woman sits silent with a child.

Your five sentences: 1. I am here and I am not going anywhere. 2. Tell me what happened, at your pace. 3. You are safe right now. 4. Is there anyone you would like me to contact? 5. Let us get you some water and a quiet place.

Each sentence maps to a verb. Sentence 1 serves listen: you approach calmly and introduce yourself. Sentence 2 serves listen: you ask about needs and concerns. Sentence 3 serves listen: you help the person feel calm. Sentence 4 serves link: you connect to family or loved ones. Sentence 5 serves link: you connect to food, water, and shelter.

Two things you must not do. Do not force the story: making a survivor retell the trauma can cause harm. Do not diagnose: you are not there to name a disorder. Your role is presence, listening, and connection.

LOOK safety: is the place safe? urgent basic needs people in serious distress LISTEN approach, introduce yourself ask what they need help them feel calm; do not press LINK basic needs and services accurate information loved ones and social support One rule: do no harm. Not debriefing, not counselling, not diagnosis. Medical danger comes first: someone unresponsive or badly injured needs 102 / 112 before anything on this page.
Look · Listen · Link. Three verbs anyone can carry into a flood camp or a bus-crash site. The rule under them is the whole ethic of PFA: support without pushing, and never make someone retell what they are not ready to tell.
Key points
  1. PFA is humane practical support in the first hours and days: Look (safety, needs), Listen (without pressing), Link (to services and people).
  2. It is not debriefing, not counselling, not diagnosis; most acute reactions are normal responses to abnormal events.
  3. Medical danger comes first; escalate anyone unresponsive, at risk to self or others, or unable to care for themselves or children.
Quick check

Three friendly questions to settle what you just read. This is reassurance, not a test: a wrong tap is part of learning, and you can try again.

PFA's three verbs:

Making survivors retell the trauma right away (debriefing):

Crying, numbness and insomnia right after a disaster are:

Learn more

Pick one, not all.

Free guideWHO: Psychological First Aid; Guide for Field Workers; THE manual; ~60 pages, free, exists in Nepali translation.
GuidelineIASC Guidelines on MHPSS in Emergency Settings (2007): the pyramid and the do-no-harm checklists.
Video · 5 minThe psychology of PTSD (TED-Ed): what you are trying to prevent from taking root.

Learning about the mind can stir the mind. If something here sat heavily, saying it aloud to someone you trust helps.