Canadian Firefighter Magazine

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Cover story: Training connections

Providing psychological first aid

March 31, 2021
By Steve Piluso
Firefighters with Comox Fire Rescue perform emergency first-aid on a down firefighter (training dummy) for a firefighter down training scenario. By integrating psychological first aid into every training situation, we are committing it into our muscle memory as a key element in our first response. Photo:gord schreiner/comox fire rescue

For every situation you encounter in your career, you bring to it the learning and experiences from your past. You need to train the way that you respond in real life, and that means not isolating training to the technical skills you need for one specific type of response, but instead looking at each situation holistically.

This is where we need to ask ourselves, what have we learned from our training in ice rescue, fire, high angle rescue, psychological first aid, emergency medical responder training? How can we apply these to the situation we are currently facing?

You don’t want to isolate knowledge, and this is what happens when you train on skills, not situations. When you are able to draw from different training and experiences, and apply it more holistically, you are really a master at what you do.

On any given call, you may need to apply your IMS training, your leadership training, your mental health training and you need to be able to apply all of those tools while not compartmentalizing too much. I see this compartmentalization a lot at during ice rescue training. During a rescue scenario, the thought of patient care goes out the window. You see people not managing the airway appropriately because that isn’t the focus of the training. In addition to patient care, we need to consider what is going on with the patient emotionally. How are they feeling, having just fallen through the ice? Are they cold, scared, worried about their dog that they went out onto the ice to retrieve? By considering the patient’s emotional and psychological state, this makes for a less traumatizing experience for the patient. Also, these additional stresses can increase patient complications, increasing heart rate, blood pressure, releasing hormones that can speed up conditions such as circum-rescue collapse or afterdrop.

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There is one thing in common with every situation we face, and that’s people. For this reason, one area of knowledge that we should always have top-of-mind is our understanding of psychological first aid, and this means integrating it into our training. How many times have you responded to a medical call and found that there were many other factors? Human, psychological factors that you needed to consider? This applies to medical calls, rescue calls, and fires. It applies to us on the scene of an accident and on the ride back to the station with our colleagues.

Integrating psychological first aid into our training for everything we do
As a first responder, the way that we manage ourselves and the way that we interact with others has a huge impact on the mental state of those we are responding to. More and more, we are learning the impact that psychological wounds have on people, and the role that we play in responding to and impacting these wounds we cannot see. Below are five things to consider that should be applied to every situation and used across training in different skills. These five things will not only support the mental health of your patient, but also help you to get the best response and cooperation from the person you are trying to help. The first three consider how we present ourselves and the last two reflect on our inner state.

Five key considerations
This may seem like an odd topic as part of psychological first aid, but it’s not about the responder, it’s about another person’s experience with you. The way that you look and act influences those around you, especially someone you are responding to in an emergency situation.

Our deportment, body language and tone of voice have a huge impact on those we encounter, especially those who may be feeling scared or vulnerable. By making a person feel more at ease, we can create a sense of security and comfort that can encourage them to release hormones such as serotonin, which has physical effects like regulating heart rate, respiratory rate and blood pressure.

  1. Dress and deportment: This means looking professional, acting professional, and in doing so, inspiring confidence in those around you. Do you look organized or are you fumbling to find your kit? Broken zippers, dirty hat? All of these things make an impression that can create distrust in your patient and can lead to a less successful outcome.
  2. Tone of voice: Keep it slow, mellow, calm. People mirror each other’s energy level, and your tone of voice is one way to share a calm mental state. Through tone of voice, you can either match someone’s state, escalate their state (increasing tension, aggression or fear) or you can de-escalate to help them remain calm.
  3. Body language: Although similar to tone of voice and dress and deportment, body language is a subconscious reaction between people. We may not even realize how we are experiencing and reacting to someone’s body language. Some body language can feel threatening and some can be comforting. Especially when someone is feeling vulnerable, we need to approach them in a non-threatening way. Things we want to consider when training for any situation are approaching slowly, maintaining an open or neutral body position, getting down to their level, and mirroring their eye contact.
  4. Empathy: It doesn’t mean you have to fully understand what someone is feeling. It is recognizing, understanding and being sensitive to the fact that they are feeling it. Expressing empathy requires us to be comfortable with showing our own emotions and labelling them. We need to be able to express that we are being empathetic, by saying something like, “This is a scary situation. I am right here with you.” A saying that has really resonated with me is this: Sing when you don’t want to sing, because there is somebody else who can’t. This applies to the community, and to us with our colleagues. Emotions are real, important and valid. We need to be ambassadors towards those emotions.
  5. Patience: Where we can, we need to give people time and give them the feeling that we have time for them. Don’t interject on their behalf. For example, you need to do a move and it is going to be painful. If you sense the person isn’t ready, maybe they need 30 seconds or a minute to take a few deep breaths and gather their thoughts. Unless you aren’t able to give them that time, make the effort to do so.

By integrating psychological first aid into every training situation, we are committing it into our muscle memory as a key element in our first response. Whether we are responding to a fire, a medical call or a rescue, we know there are people we are going to impact and the best response we can give is one of skill, professionalism and psychological safety. 

Editor’s Note: Training Connections is a three-part series discussing training across disciplines, how to train and apply your training in a holistic way.


Steve Piluso is an experienced EMRI, AEMCA, military veteran, and multidisciplinary technical rescue instructor. He is the owner and operator of Swift Response, providing high quality, real-world training in Emergency Medical Response, First Aid, CPR/AED and Rescue. Contact Steve: Steve@SwiftResponse.ca or visit swiftresponse.ca.


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