First Aid and Emergency Information

1 Fundamental Criteria for First Aid
2 Basic Measures for First Aid
3 First Aid for Special Wounds
4 First Aid for Fractures
5 First Aid for Climatic Injuries
6 First Aid for Bites and Stings
7 First Aid in Toxic Environments
8 First Aid for Psychological Reactions

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Chapter 8 - First Aid for Psychological Reactions

Introduction
During actual combat, military operations continue around the clock, at a constant pace, and often under severe weather conditions. Terrible things happen in combat. During such periods the soldier’s mental and physical endurance will be pushed to the limit. Psychological first aid will help sustain the soldier’s mental/physical performance during normal activities, and especially during military operations under extremely adverse conditions and in hostile environments.

8-1. Explanation of Term “Psychological First Aid”
Psychological first aid is as natural and reasonable as physical first aid and is just as familiar. When you were hurt as a child, the understanding attitude of your parents did as much as the psychological effect of a bandage or a disinfectant to ease the pain. Later, your disappointment or grief was eased by supportive words from a friend. Certainly, taking a walk and talking things out with a friend are familiar ways of dealing with an emotional crisis. The same natural feelings that make us want to help a person who is injured make us want to give a helping hand to a buddy who is upset. Psychological first aid really means nothing more complicated than assisting people with emotional distress whether it results from physical injury, disease, or excessive stress. Emotional distress is not always as visible as a wound, a broken leg, or a reaction to pain from physical damage. However, overexcitement, severe fear, excessive worry, deep depression, misdirected irritability and anger are signs that stress has reached the point of interfering with effective coping. The more noticeable the symptoms become, the more urgent the need for you to be of help and the more important it is for you to know HOW to help.

8-2. Importance of Psychological First Aid
First aid can be applied to stress reactions of the mind as well as to physical injuries of the body. You must know how to give psychological first aid to be able to help yourself, your buddies, and your unit in order to keep performing the mission. Psychological first aid measures are simple and easy to understand. Improvisation is in order, just as it is in splinting a fracture. Your decision of what to do depends upon your ability to observe the soldier and understand his needs. Time is on your side, and so are the resources of the soldier you are helping. Making the best use of resources requires ingenuity on your part. A stress reaction resulting in poor judgment can cause injury or even death to yourself or others on the battlefield. It can be even more dangerous if other persons are affected by the judgment of an emotionally upset individual. If it is detected early enough, the affected soldier stands a good chance of remaining in his unit as an effective member. If it is not detected early and if the soldier becomes more and more emotionally upset, he may not only be a threat to himself and to others, but he can also severely affect the morale of the unit and jeopardize its mission.

8-3. Situations Requiring Psychological First Aid
• Psychological first aid (buddy aid) is most needed at the first sign that a soldier cannot perform the mission because of emotional distress. Stress is inevitable in combat, in hostage and terrorist situations, and in civilian disasters, such as floods, hurricanes, tornadoes, industrial and aircraft catastrophes. Most emotional reactions to such situations are temporary, and the person can still carry on with encouragement. Painful or disruptive symptoms may last for minutes, hours, or a few days. However, if the stress symptoms are seriously disabling, they may be psychologically contagious and endanger not only the emotionally upset individual but also the entire unit. In such situations, you may be working beside someone who cannot handle the impact of disaster. Even when there is no immediate danger of physical injury, psychological harm may occur. For instance, if a person is unable to function because of stress, it may cause that person to lose confidence in himself. If self-confidence cannot be restored, the person then may
become psychologically crippled for life.
• Sometimes people continue to function well during the disastrous event, but suffer from emotional scars which impair their job performance or quality of life at a later time. Painful memories and dreams may recur for months and years and still be considered a normal reaction. If the memories are so painful that the person must avoid all situations which arouse these memories or if he becomes socially withdrawn, or shows symptoms of anxiety, depression, or substance abuse, he needs treatment. Experiences of police, firemen, emergency medical technicians, and others who deal with disasters has proved that the routine application of psychological first aid greatly reduces the likelihood of future serious post-traumatic stress disorders. Thus,
applying psychological first aid as self-aid and buddy aid to all the participants, including those who have functioned well, is beneficial.

8-4. Interrelation of Psychological and Physical First Aid
Psychological first aid should go hand in hand with physical first aid. The discovery of a physical injury or cause for an inability to function does not rule out the possibility of a psychological injury (or vice versa). A physical injury and the circumstances surrounding it may actually cause an emotional injury that is potentially more serious than the physical injury; both injuries need treatment. The person suffering from pain, shock, fear of serious damage to his body, or fear of death does not respond well to joking, indifference, or fearful-tearful attention. Fear and anxiety may take as high a toll of the soldier’s strength as does the loss of blood.

8-5. Goals of Psychological First Aid
The goals of psychological first aid are to–
• Be supportive; assist the soldier in dealing with his stress reaction.
• Prevent, and if necessary control, behavior harmful to him and to others.
• Return the soldier to duty as soon as possible after dealing with the stress reaction.

8-6. Respect for Others’ Feelings
a. Accept the soldier you are trying to help without censorship or ridicule. Accept his right to his own feelings. Even though your feelings, beliefs, and behavior are different, DO NOT blame or make light of him for the way he feels or acts. Your purpose is to help him in this tough situation, not to be his critic. A person DOES NOT WANT to be upset and worried; he would “snap out of it” if he could. When he seeks help, he needs and expects consideration of his fears, not abrupt dismissal or accusations. You may be impressed with the fact that you made it through in good condition. You have no guarantee that the situation will not be reversed the next time.
b. Realize that people are the products of a wide variety of factors. All persons DO NOT react the same way to the same situations. Each individual has complex needs and motivations, both conscious and unconscious, that are uniquely his own. Often, the "straw that breaks the camel’s back” the one thing that finally causes the person to be overloaded by the stressful situation is not the stressor itself, but some other problem. Thus, an injury or an emotional catastrophe will have a personal meaning for each individual. Even though you may not share the reactions or feelings of another person and even though the reactions seem foolish or peculiar, you must realize that he feels as he does for a reason. You can help him most by accepting this fact and by doing what you can for him during this difficult time. He is doing the best he can under the circumstances. Your positive assistance and trust may be what he needs to do better.

8-7. Emotional and Physical Disability
a. Accept emotional disability as being just as real as physical disability. If a soldier’s ankle is seriously sprained in a fall, no one (including the injured man himself) expects him to run right away. A soldier’s emotions may be temporarily strained by the overwhelming stress of more "blood and guts” than he can take or by a large-scale artillery attack. DO NOT demand that he pull himself together immediately and carry on without a break. Some individuals can pull themselves together immediately, but others cannot. The person whose emotional stability has been disrupted has a disability just as real as the
soldier who has sprained his ankle. There is an unfortunate tendency in many people to regard as real only what they can see, such as a wound, bleeding, or an X-ray of a diseased lung. Some people tend to assume that damage involving a person’s mind and emotions is just imagined, that he is not really sick or injured, and that he could overcome his trouble by using his will power.
b. The terms "it’s all in your head, ” “snap out of it, ” and “get control of yourself” are often used by people who believe they are being helpful. Actually, these terms are expressions of hostility because they show lack of understanding. They only emphasize weakness and inadequacy. Such terms are of no use in psychological first aid. A psychological patient or a physical patient with strong emotional reactions to his injury does not want to feel as he does. He would like to be effective, but he is temporarily overcome with either fear, anxiety, grief, guilt, or fatigue. He feels lost and unable to control his emotions. Reminding him of his failure to act as others do only makes him feel worse. What he needs is calm, positive encouragement, such as reminding him that others have confidence in his ability to pull together and are also counting on him. Often this reassurance combined with explicit instruction and encouragement to do a simple, but useful task (that he knows how to do), will restore his effectiveness quickly.

8-8. Emotional Reaction to Injury
Every physically injured person has some emotional reaction to the fact that he is injured.
a. A minor injury such as a cut finger causes an emotional reaction in most people. It is normal for an injured person to feel upset. The more severe the injury, the more insecure and fearful he becomes, especially if the injury is to a body part which is highly valued. For example, an injury to the eyes or the genitals, even though relatively minor, is likely to be extremely upsetting. An injury to some other part of the body may be especially disturbing to an individual for his own particular reason. For example, an injury of the hand may be a terrifying blow to a baseball pitcher or a pianist. A facial disfigurement may be especially threatening to an actor.
b. An injured person always feels less secure, more anxious, and more afraid not only because of what has happened to him but because of what he imagines may happen as a result of his injury. This fear and insecurity may cause him to be irritable, stubborn, or unreasonable. He also may seem uncooperative, unnecessarily difficult, or even emotionally irrational. As you help him, always keep in mind that such behavior has little or nothing to do with you personally. He needs your patience, reassurance, encouragement and support. Even though he seems disagreeable and ungrateful at first, ensure that he understands you want to help him.

8-9. Emotional Reserve Strength of Distressed Soldiers
Realize that distressed soldiers have far more strength than appears at first glance. An injured or sick person may not put his best foot forward. The strong points of his personality are likely to be hidden beneath his fear, anguish, and pain. It is easy to see only his failures even though he worked efficiently beside you only a short time ago. With your aid he will again become helpful. Whatever made him a good soldier, rifleman, or buddy is still there; he is needed.

8-10. Battle Fatigue (and Other Combat Stress Reactions [CSR])
Battle Fatigue is a temporary emotional disorder or inability to function, experienced by a previously normal soldier as a reaction to the overwhelming or cumulative stress of combat. By definition, battle fatigue gets better with reassurance, rest, physical replenishment and activities which restore confidence. Physical fatigue, or sleep loss, although commonly present, is not necessary. All combat and combat support troops are likely to feel battle fatigue under conditions of intense and/or prolonged stress. They may even become battle fatigue casualties, unable to perform their mission roles for hours or days. Other negative behaviors may be CSRs, but are not called battle fatigue because they need other treatment than simple rest, replenishment and restoration of confidence. These negative CSRs include drug and alcohol abuse, committing atrocities against enemy prisoners and noncombatants, looting, desertion, and self-inflicted wounds. These harmful CSRs can often be prevented by good psychological first aid; however, if these negative actions occur, these persons may require disciplinary action instead of reassurance and rest.

Continue to Reactions to Stress

 

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