Hi, I'm Elena Moreno Saldivar and I have developed most of my professional career in the Basque government working in emergencies safety, first as an active intervention responsible and then in directive positions such as emergencies service director and then as main director of the Basque police and emergencies academy. For more than 20 years I have had the chance of living all kinds of situations, of being responsible of the direction and coordination of many interventions. Today, thanks to the opportunity that the crisis center from the Autonomous University of Barcelona is bringing me, I would like to give you some thoughts on psychological first aid. A month ago, when Germanwings airplane crashed, we all lived with naturalness the psychological help given to the Spanish victims' families from an hotel in Castelldefels city. Seeing the images of this people broken in pain, accompanied by experts in psychological injuries, also comforted us. Helping was the correct thing. It was the best evidence on how psychological attention in emergencies has evolved during the last years. But getting here hasn't been easy. In 1997 we began working in the Basque Country with the professional psychologists colleges. Then the first psychological care manual for participants was published and the first collaboration agreement with them was signed. But that was seen as an eccentricity, psychologists at the street working on it, and it was not only questioned by participants, but also curiously by the own psychology professionals. When we talked about firemen, policemen or health professionals of the need of psychological attention from the professionals, they said horrified that they didn't need a psychologist, as if it was a synonym of having a disorder. But in professional colleges there was also a lot of controversy on their participation. On one side, there were the ones that came to our call and took part in missing people researches, emergency landings, urban fires with victims, road and railway accidents with multiple victims and also in terrorist attack situations and the subsequent rejection protests. But on the other side there were the ones which saw their activity as emergency psychologists in a much more critical way. And they weren't looking at his actuation in the moment of the emergency but in the victims' posterior treatment. Nowadays no one doubts of the psychologists participation, maybe this has been possible thanks to the evolution that has been produced since that internal debate in the professional colleges towards the creation of psychosocial teams, composed by socio-sanitary area staff team-working along with psychologists. To do so, it was decisive the role of Red Cross volunteer groups and after that of the DIA, which from their experience in the sanitary and socio-sanitary intervention faced the psychological first aid. This conception of teams and their performance's efficacy has been confirmed in disasters such as Madrid's 15-M, Spanair's airplane accident, the Galician Prestige [an oil tanker that shipwrecked] and Germanwings, proving their validity. To me, I must tell you it isn't relevant if teams are composed by volunteers or professionals. The important thing is that all they have specialized information on psychological first aid and that they are qualified people and experienced in emergencies. With this psychosocial teams concession we got where we are. I think that with a work very close to reality of what we demand in these situations because, what do victims demand to us when they are involved in an emergency or a disaster? We will find some people facing a lot of stress and to a strong emotional impact when facing unexpected situations. Depending on the kind of disaster, victims live a confusion situation, and abandon, vulnerability and fear feelings. They desperately seek survival and they can suffer initiative losses and others can behave in an heroic or mean way. But under my experience what is always present is the disorientation, the feeling of helplessness in front of circumstances that escape from their conception and that at the same time can be dyed with a deep pain. And during those moments they don't need huge psychological treatments. What they need is feeling accompanied and comforted. They can't feel alone. They need a referent to which they can hold on and that understands what they are living. What they need is reliable information from someone authorized and that help and support will be provided to them in a fluid way in these first moments to make, in the case of, in example, families, multiple managements and mostly the accompaniment in their pain. For these requirements psychosocial teams are the ideal answer. Psychological aid will need to be immediately given in the moment of the emergency and it must be done close to the emergency. And it will need to be very easy and simple. But also, these teams must have a global view, be able to read the place's intervention setting and knowing the management times in aim to be effective. In example, it will be important knowing how many time or which steps must be followed before the external examination in aim to foreseek needs and accompany the relatives, inform them, etc. Or knowing the keys of a triage in an incident with multiple victims to determine the evacuation times of the injured and their characteristics. Or, this is very important, knowing how to communicate bad news. I could give you many examples that say that psychological first aid requires experience and formation in emergency situations. The same way that not all doctors can operate a stomach or make a CPR on the street just because they are doctors, not all psychologists can make psychological first aid, no matter their license in psychology. And in fact we have seen in some Spain disasters how the attention given by non-experienced in emergencies psychologists have derived in themselves getting traumatic effects. And here comes another of the big conclusions: heroes are vulnerable. Until now I have referred only to the victims that can be either the ones that have suffered the direct effects of the emergency, dead, injured or unharmed such as their relatives. But it is very important taking into account the participants in our actions. We must talk about firemen, policemen, health care staff and all those who daily face emergencies and disasters. Being used to this stress they channel is what makes them act in the risk emergencies, they get to a certain physical and emotional anesthesia during the interventions. But when the emergency is over and the adrenaline goes down, it is difficult not being emotionally affected. In example, in cases with big fires with multiple victims, with known people or mostly with kids, which all professionals will say they are one of the worst of our life's experiences. Or when after putting many efforts into saving someone, the results are negative. We must be aware of the helplessness we will feel in front of many situations and this helplessness also can be aggravated with something very frequent such as the transference relatives make towards professionals or responsible. Looking for a guilty is very human. Usually as participants we will only be able to act as a palliative, because we will be able to minimize the effects of a disaster that has already happened and which wasn't in our hands avoiding or solving it. Along with this, usually we got to our position with a generalist formation, either university or not. And then we have capacitate ourselves in understanding a water line, establishing a police cordon or making a cardiopulmonary resuscitation. But in example, when we get to the moment of telling a mother we have found her son dead, all this formation is totally useless. And it is really hard not taking home all these images and other people's pain. In these moments, we must be aware of our own vulnerability. I think psychological first aid should be integrated and incorporated in the emergency services procedures, using techniques such as debriefing, memory normalization and defusing or emotional deactivation in a natural way and when we think it's necessary. But the fact is it's still hard treating this in a normal way, because we still have a big rejection. And on the other side I think that it is also very important the own formation in psychological first aid from the intervenor. In many ordinary or daily emergencies, the interlocutor with the victims will be the responsible of the intervention, either a fireman, a policeman, an intervention technician. And we are saying all this must be also applied to the own socio-psychological answer staff. To meet the requirements they must be aware of their vulnerability and be able to retreat when they begin feeling affected. The intervention processes must be aware of this. The obvious empathy with the victims is a double-edged sword. Being there during their suffering can affect us in our most intimal being and it is very human being aware of it and having resources to confront this. I don't want to finish without making a last reflection. We have gone from seeing it as an eccentricity to the fact that currently the psychologists teams' intervention is one of the most remarked sides by media when facing almost any emergency or catastrophe. And also it is one of the aspects political responsibles like to inform about the most. Under my conception, it looks as if sometimes it was being used to calm consciousnesses down and more than evaluating its appropriateness and its efficacy in the management of a concrete situation, it has the intention of pretending we are doing something. Without undervaluing its importance, when there are permanent floods in a zone, neighbors don't demand psychologists when they are evacuated, what they want is a technical solution that prevents that the next time the river overflows, their houses won't flood. But it is true that when a town, a zone, a country is caught by surprise by a disaster, the whole society is devastated. Psychological first aid will be essential to ease the confrontation of the disaster. But I would also like to remark that I think that what we should strengthen and work a lot more on is resilience, both in citizens and in the own society. Making societies that become more resilient with time, strengthening their capacity of answering as individuals, as a population and as a society in front of a catastrophe, being able to recover from it and go on. To finish, I just want to tell you that the performance of the socio-psychological teams composed by well formed staff, either volunteers or professionals, acting both in ordinary emergencies and in catastrophes and disasters, I think it's one of the key aspects for an efficient and effective emergencies managing. That's all, thank you.
