• What is Emotional
  First Aid (EFA)?
• The Horrible Hours
• Common Reactions to
  Traumatic Events
• The 5 Emotional
  First Aid (EFA) Skills
  • Reach Out
  • Protect
  • Reassure
  • Organize
  • Reinforce
• EFA: The Finer Points
  • Acknowledge
  • Normalize
  • Expand the Survivors Story
  • Redirect
  • The Fine Art of
    Hanging Around
  • Caring Demeanor
  • Recognize Sources
    of Strength
• What to Say/Not to Say
  to Survivors of Tragedy
• Death Notification
• EFA: Guiding Principles
• Review of Major EFA Concepts
• EFA is Powerful
• Get Yourself Out of the Way
• Helping Teens & Children
• Understanding the Emergency System
• Helper: Heal Yourself
• Follow Up with Survivors
• Online Resources
• Special Circumstances
  • Dealing with Traumatic Loss
  • Domestic Violence
  • Fire Loss
  • Suicide
  • Death in the Workplace
• Print PDFs

"When we honestly ask ourselves which persons in our lives mean the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a tender and gentle hand. The friend who can be silent with us in a moment of despair and confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing, not curing, not healing, and face with us the reality of our powerlessness, that is the friend who cares."
  ~~ Henri Nouwan

Skill # 1: Reaching Out

The Goal of Reaching Out

To make contact and establish rapport with the survivor so that he feels connected to someone who cares.

How to Reach Out

Provide a Caring Presence. Being there with the survivor quietly is what is most important. Scan for the forgotten victims.

• Forgotten victims are those easily overlooked.
• They may include those who are quiet, witnesses, children or citizen rescuers.
• Acknowledge forgotten victims: "this must be very difficult for you".
• Invite the survivor to tell you his story ("Can you tell me what happened?").
• Actively Listen

  "It sounds like what you are saying is..."
  "It seems to me that you are feeling..."

• Empathize ("I’m so sorry.")
      - Use a soft tone of voice.
• Practice silence.
• Reach out non verbally. A light touch on the back or shoulder can be very comforting.
• Don’t rub or pat.
• Give the permission to hurt: "It’s ok to cry"
• Take the initiative to do the little things to help the survivor (feed a pet, for example).
• Again, remember the power of a Caring Presence. Don’t try to "fix the survivor". Just "be there".

What Not to Do/Say

"It will be better tomorrow"
"I know how you feel"

Don’t avoid the survivor because you can’t Do anything. Don’t take over. Remember, the goal is to help the survivor regain a sense of control.

Skill #2: Protecting

The Goal of Protecting

To protect the survivor from further injury (emotional, physical, financial) which can be inflicted by others or caused by the inability of the survivor to take care of himself.

How to Protect

• Be aware of and protect the survivor from outside dangers (traffic, carnage, gawkers, people trying to take advantage...).
• Protect the survivor from himself (taking impulsive action, driving when in shock, forgetfulness).
• Keep the survivor from taking dangerous action by redirecting him to an alternative action e.g. "I understand you want to go and get revenge, but you’re son needs you here now".
• Ensure that the survivor is in a safe, private, warm, and protected place.
• Attend to the survivor’s physical needs (medications, for example).
• Advise against signing contracts.
• Pay special attention to the vulnerable (children, elderly, and disabled).
• Protect the survivor from disturbing sights.
• Maintain total situational awareness. A survivor gets "tunnel vision". Be his eyes and ears.
• Be an advocate when necessary. Be the survivor’s voice and speak up for what he wants/needs.

What Not to Do

Don’t overprotect. Remember to allow the survivor to exercise as much control of the situation as possible.

Skill #3: Reassuring

The Goal of Reassuring

To help the survivor obtain the information he needs in an understandable and timely manner.

Expect denial. Even when bad news is given to the survivor he may not want to believe it. Be patient. Give the survivor time to gradually accept the "bad news".

Advocate for survivors to be able to actually "see" what happened. Survivors may want to see where an accident occurred, or they may want to see their loved one who has died or who is in a hospital bed.

Guilt is a common feeling survivors have. Deal with guilt by actively listening to the survivor’s "whole story". Then point out, for example...

"You were a wonderful wife."
"You took care of him for 10 years."
"You did everything right after he collapsed."

Normalize the survivor’s experience.

"What you are experiencing is really quite normal under these circumstances."
"This kind of situation would make just about anyone fearful."

Normalize the System

Ask emergency responders to explain what they are doing why they are doing it and what the survivor can expect.

Provide the survivor with helpful information and resources for future use.

Support the survivor’s ongoing quest for information and understanding. Days or weeks after the tragedy a survivor may want to ask questions of the first responders or of hospital personnel. Help the survivor navigate the system.

What Not to Do

Don’t over-promise - "I will get you information now"

Don’t provide false information or information you are not sure about. Get emergency officials to provide accurate information.

Don’t alienate emergency responders. Advocate for the survivor but in a quiet, gentle and diplomatic way.

Don’t minimize the survivor’s need for information e.g. "Don’t worry about it. They know what they are doing." Acknowledge the need for information. "I understand your main need now is for information. I will do what I can to help your obtain it."

How to Reassure

Acknowledge the need the survivor has for information ("I know the most important need you have right now is for information about __________________").

Don’t placate the survivor e.g. "you don’t need to know that now". Recognize how difficult it may be for the survivor to find out what happened and what’s happening from the system (police/fire/hospital personnel). Often emergency personnel do not provide information to survivors because they are busy or because they do not have the information themselves.

Be an Information Advocate. Diplomatically remind emergency responders and hospital personnel that the survivor wants information. - "When do you think you can talk to him?"

Obtain information fit for a survivor. The survivor may need for you to advocate for information that is clear, devoid of jargon, and honest. Information may need to be repeated a number of times.

Skill #4: Organizing

The Goal of Organizing

To help the survivor develop a simple plan so that he can begin taking action and can begin regaining a sense of control over his situation.

How to Organize

• Appreciate the multiple demands confronting the survivor. Survivors often have to deal with dreadful demands (what mortuary to use, for example) and at the same time everyday demands e.g. picking up the kids at school, for example.
• Be aware of the clues that tell you when to begin helping the survivor get organized "What do I do now?" or "It’s hard to know where to start."
• Acknowledge the confused feelings the survivor may be expressing e.g. "I understand that you feel overwhelmed and you don’t know where to start."
• Gently suggest "Why don’t we come up with a simple plan?"
• Make a To Do list, e.g. "Let’s write down the things you feel you need to get done."
• Help the survivor prioritize what needs to be done, e.g. "What is most important to you now?"
• Verbally summarize the plan for the survivor, e.g. "It sounds like what you want to do now is..." Leave the written plan with the survivor as a "To Do" list.
• Establish a helping partnership with the survivor, e.g. "How about if you do _____ and I’ll do ____."
• Be the survivor’s recorder. Write down important information which the survivor may forget, such as when relatives are arriving and names of doctors.

What Not to Do

Don’t over organize. Watch your rescue fantasies. Some survivors are organizers by nature and will not need help to develop an action plan

If you see that the survivor is confused and seems paralyzed, don’t be too passive. Step in and help him take the next steps.

Don’t take the survivor’s anger and frustration personally.

Skill #5: Reinforcing

The Goal of Reinforcing

To identify the survivor’s source of strength, and then to do what it takes to help him obtain or hold onto that source of strength.

How to Reinforce

Effective helpers must believe that human beings are survivors. You must trust that the survivor you are helping has a source of strength which will enable him to survive the tragic event. Before beginning to help the survivor, reinforce this belief in yourself. Listen for the survivor’s source of strength. If you listen you will obtain clues about what the survivor’s source of strength is. You may hear clues like...

"Where is my brother?"
"This must be God’s will."
"At least we are all alive."
"I can’t find my dog."

Be aware of potential sources of strength. Everyone’s source of strength differs in times of tragedy. Common sources of strength include...

• God
• Family
• Humor
• Animals
• Reminiscing
• Precious articles
• Keeping busy
• Familiar and religious cultural rituals
• Circumstances of a death ("he died doing what he loved.")

Encourage the survivor to reminisce, e.g. "Can you tell me about your husband?" or "How did you and your husband meet?"

Assist in summoning the survivor’s social support system; ask: "Who would you like to be here with you now?"

Encourage the survivor to stay in familiar surroundings with familiar people. Don’t push to have the survivor leave the scene or their home unless it’s unsafe.

Help the survivor practice their religious beliefs and cultural customs. Offer to call clergy to the home or scene. If you are in a hospital setting, advocate with the hospital for their assistance e.g. "is there a room in this hospital we can use to spend time with the deceased?"

Don’t let well intentioned helpers "steal" the survivor’s source of strength. For example, neighbors may want to take the survivor’s children or a pet away from the survivor’s home. That might have the effect of removing the survivor’s source of strength.

Assist the survivor in saying goodbye. Often after a death, survivors want to see and touch the deceased. Do what you can to support this "saying goodbye" process.

Help retrieve personal items from the deceased which have meaning for the survivor (a special piece of jewelry, for example).

Survivors want the aftermath of a tragedy to include special personal touches. For example, the survivor may want a lock of the deceased’s hair. Or the survivor may want her deceased husband to be removed from the home with his favorite shirt. Try to help the survivor in his efforts to take these special meaningful actions.

What Not to Do/Say

Don’t cheerlead. Don’t impose your own source of strength on the survivor e.g. "What you need to do to get through this is ________________ ".

Don’t judge the survivor’s source of strength, e.g. "you don’t want to do that now, you have more important things to do".

Don’t pity, e.g. "you poor, poor, poor dear".