Hello. In this video we will talk on two concrete aspects very concrete but important to the application of the psychological first aid. We will talk on when to apply them and where it is better to apply them. About the first question, about when, there is a huge discussion. Let's see. We totally agree that in crisis and emergencies the psychological first aid are the chosen technique in the first 72 hours after the impact. They are a process that helps people passing through the shock and adaptation stage that gives them information and connects them with their social network. And so no one will discuss what's the first thing we must do when we talk with the victims. The question appears when it isn't possible. This means, there are situations such as huge diseases or community crisis in poor countries where there isn't any help available in the first moment in which psychological first aids can't be applied inside this 72 initial hours period. Imagine, in example, a country devastated by an earthquake. If the important thing is being able to help people survive, rescuing the people from under the rubble, trying to assure supplies, we can't apply psychological first aid, there are things that must be done before. So three, four, five, six days pass, maybe a week, and then, what should we do? When we can finally work with the victims in the most psychological, psychosocial support, are we going to begin with the psychological first aid or we must do something else? There are two answers to this question. The first, the European one which considers that after the first 72 hours if we haven't been able to apply psychological first aid we must use another kind of processes, mostly with the processes of potentiating education, psycho-education, trying to help people to know what they can do and how can they take care of themselves. However, the other answer, the one that comes from the WHO, considers that psychological first aid are the first step of a help sequence and we must also apply them if we couldn't do it in these 72 hours, and so they are the process weeks or even months after the apparition of the critical incident or the massive emergency. This second opinion says that if we haven't been able to do them before, psychological first aid is good for people because it helps confronting what happened. You might wonder how is it possible that with the experience there already is in emergencies we don't have a concrete answer to these doubts. Usually when the experts, when the professionals pose questions, investigations are made, and with these investigations' results we find the evidences to answer. But in emergencies, in crisis psychology, in the application of the psychological first aid, we also have a problem with these evidences. Nowadays there aren't clear scientific evidences that tell us or proof us if it's good to apply psychological first aid and if it's good even when some weeks have passed after a critical incident. I guess you are surprised. If there isn't any evidence, then what are we doing in this course? Don't worry. The problem of scientific evidences is that to be so they require some strict application conditions. To allow us saying with some evidence based on a scientific methodology that a treatment is effective, we must be able to compare a group of people to which we apply a technique, in this case psychological first aid with another group of people in the same condition to which we wouldn't apply anything. And here lies the problem, this proposal of a control group of people affected by an emergency to which we wouldn't apply psychological first aid is ethically impossible, we can't experiment with humans and leave a group without being looked after simply to get some evidence. But also, emergencies, mostly the massive crisis are hard and chaotic enough to prevent granting us the rigor of collecting samples. So it doesn't mean that we don't have scientific evidences that the psychological first aid actually work, it means that we still haven't found the way to measure these evidences so that they are irrefutable. Personally, most of the experts know that applying psychological first aid helps a lot the affected people. Which is the position of the UAB's crisis center on the question I made at the beginning on what are we going to do if we can't apply the psychological first aid inside the first 72 hours recommendable interval? Well, we propose that if we can apply the psychological first aid in the 72 first hours the technique is the best and in this moment we must focus mostly in three basic objectives of the psychological first aid, which are keeping the activation level as low as we can; inform the involved people and inform them again and again, because information calms them down; and connect them with their social network. When it hasn't been possible to apply psychological first aid inside this 72 first hours interval, they can still be a good technique if we use them during the first four to six weeks, which is the stage in which people is getting used to their new reality. But when we do it in that moment, in a stage after the impact, in this transition stage while they are accepting reality, we will change a bit psychological first aid's priority. It isn't about keeping the activation levels low, but about replacing most of the information about what happened, the one they already have, with psycho-educative information on expected reactions, on how can the victims themselves be involved in their healing process and on which are the protecting factors for their recovery and which ones could be risk factors. So we are still applying psychological first aid but we have changed a bit the center and the objective. And if the available help for the affected one goes further than these 4 weeks, it would be important using another kind of techniques different from psychological first aid. There are many recovery programs and models, on resilience strengthening which would be the election technique in these cases. Well, we had a second question. Where do we have to apply psychological first aid? Emergencies, especially if they are massive, are usually conditions complicated to manage so I will pose you two conditions. The optimal condition, in which the psychological first aid application is made in a place intentionally made for the psychological first aid application. And then, as I am aware the optimal condition hardly happens, I will give you some minimal criteria that the place where we are going to apply psychological first aid should have. Let's begin with the optimal, it must be a safe place, comfortable, with a good temperature, not too cold or too hot. It must be far from the impact place, protected of the view and the noise from the impact place, but not too far, because the other victims and especially the relatives usually want to be close to their loved ones, and this need of being close is quite more psychological than physically real, so we are looking for a huge place, at 200 or 300 meters from where the accident happened and where we can look after many people. Usually, if we are talking on a massive emergency, many people will go there to inform themselves or accompany their direct relatives, and so we need a wide place. We also need the possibility of a catering in this place, of serving food and drinks, because usually we spend many hours there, and people gets tired and needs to eat and drink something, and they also need the availability of a games zone and diaper change when there are kids, and there are usually kids in most of the massive incidents. This place must be protected from the media access, as well as from their vision, because the victims have right to a total privacy. If they want to make their statements to the media they are free to do it, but we must guarantee that they aren't seen, or filmed, or bothered by the media. So it must have good barriers in this sense. And finally the optimal place will have a big place in which we can make an announcement to many people if needed, but also many small places, cubicles or small meeting rooms, so that in the ideal situation each affected family will have their own enclosed area. Of course, usually the place we use as information center and victims reception doesn't have all these characteristics, because we use civic buildings, schools, sometimes airports, any kind of place that is public and easily accessible. So which are the minimum criteria? At least it must be a safe place. The victims, injured, relatives, survivors, must feel safe in the place where we are going to inform them and give them psychological first aid. It must be a big place, as big as possible. And if it's not separated from the impact place, as usually happens with the airports, at least we must be able to cover the direct vision on what happened. That is, it isn't good for the victims to be constantly exposed to the view of, not only a plane, but also the participant units, the ambulances, the firemen, the sirens. We should be able to get, inside the place we've been assigned, a place as protected as possible from the view and the noise of what's happening. It is totally essential that we grant the access prohibition of the media. If it isn't possible because of the place's structure, we must ask the security staff to fence in and protect the affected from the media direct access. And if there isn't any private space because it's a big room and it's the only place we can we should organize some room dividers so that, at least, prevent the families from seeing each other and help them having some intimacy when they get bad news, when they ask questions, when they cry and when they feel despaired.
