Background
Methods
Literature search
Questionnaire development
Expert panel recruitment
The Delphi process
Results
Panel | Round 1 | Round 2 | Round 3 |
---|---|---|---|
Consumers and carers)* | 17 (4) | 15 (4) | 12 (4) |
100% | 82% | 71% | |
Professionals | 39 | 27 | 23 |
100% | 69% | 59% |
Panel | Round 1 | Round 2 | Round 3 |
---|---|---|---|
Consumers and carers* | 12 (4) | 12 (4) | 10 (4) |
100% | 100% | 83% | |
Professionals | 22 | 22 | 17 |
100% | 100% | 77% |
Item: | Round: |
Actions to be taken immediately | |
The first aider should determine whether or not it is safe to approach the person before taking any action (for example, danger from fire, weapons or debris) | 1 |
The first aider should explain to the person what their role is and why they are present. | 1 |
The first aider should create a safe environment. | 1 |
The first aider should be calm in the face of the trauma. | 1 |
The first aider should ascertain the person's basic human needs for the immediate future and attempt to meet them. | 2 |
If helping someone they do not know, the first aider should find out the person's name and use it when talking to them. | 2 |
The first aider should attempt to ascertain and meet the basic human needs of the person (for food, drink, shelter and clothing), but should not take over the role of professionals helpers better able to meet those needs. | 2 |
If the person has been a victim of crime, the first aider should consider the possibility that forensic evidence may need to be collected (for example, cheek swabs, evidence on clothing or skin) and should work with the person in preserving such evidence. | 3 |
The first aider should watch for signs that the person's physical or mental state is declining, and be prepared to seek emergency medical assistance for them (for example, an apparently uninjured person may have internal injuries which reveal themselves more slowly, or a person may suddenly become disoriented). | 2 |
Guidelines for communicating with the traumatised person
| |
The first aider should speak clearly and avoid clinical and technical language. | 1 |
The first aider should communicate with the person as an equal, rather than as a superior expert. | 1 |
The first aider should remember that behaviour such as withdrawal, irritability and bad temper may be a response to the trauma, and should avoid taking such behaviour personally. | 1 |
The first aider should be friendly, even if the person is being difficult. | 2 |
The first aider should show that they understand and care. | 1 |
The first aider should be aware that the person may not be as distressed about the trauma as might be expected. | 1 |
The first aider should remember that they are not the person's therapist. | 2 |
The first aider should tell the person that everyone has their own pace for dealing with trauma. | 1 |
The first aider should encourage the person to talk about their reactions only if the person feels ready to do so. | 2 |
The first aider should remember that providing support doesn't have to be complicated, and can involve small things like spending time together, having a cup of tea or coffee, chatting about day-to-day life or giving them a hug. | 1 |
The first aider should remember that it is more important to be genuinely caring than to say all the "right things". | 2 |
The first aider should be aware of cultural differences in the way some people respond to a traumatic event; for example, in some cultures, expressing vulnerability or grief around strangers is not considered appropriate. | 2 |
The first aider should be prepared to repeat themselves several times if the person seems unable to understand what is said. | 3 |
The first aider should ask the person how they would like to be helped. | 2 |
Talking about the trauma
| |
The first aider should not force the person to tell their story. | 1 |
The first aider should not interrupt to share their own feelings and opinions. | 2 |
The first aider should be aware that the person may need to talk repetitively about the trauma and be willing to listen. | 1 |
The first aider should avoid saying things which minimise the person's feelings, such as "don't cry" or "calm down". | 1 |
The first aider should avoid saying things which minimise the person's experience, such as "you should just be glad you're alive." | 1 |
The first aider should not tell the person how they should be feeling. | 1 |
The first aider should be aware that the person may be experiencing survivors' guilt. | 1 |
The first aider should not make promises they can't keep such as "I'll take you home soon". | 1 |
Immediate assistance at large scale traumatic events
| |
The first aider should follow the directions of professional helpers at the scene. | 1 |
The first aider should get medical help for the person if this is needed. | 1 |
The first aider should find out what emergency help is available. | 1 |
The first aider should provide truthful information and admit that they lack information if this is the case. | 1 |
The first aider should identify basic needs (food, drink, shelter and clothing) and attempt to meet them. | 1 |
The first aider should be aware of and responsive to the person's comfort and dignity, e.g., by offering the person something to cover themselves with (such as a blanket) and asking bystanders and the media to go away. | 1 |
If the person does not want more information about the event, the first aider should not try to give them any. | 2 |
The first aider should tell the person about any available sources of information which are offered to survivors (for example, information sessions, fact sheets and phone numbers for information lines). | 2 |
The first aider should try not to appear rushed or impatient. | 2 |
After trauma care at a large scale event
| |
No items accepted. | |
Coping strategies: talking
| |
The first aider should encourage the person to identify sources of support including loved ones and friends. | 1 |
The first aider should respect the person's need to be alone at times. | 1 |
The first aider should encourage the person to tell others when they need or want something, rather than assume others will know what they want. | 1 |
Coping strategies: actions
| |
The first aider should encourage the person to think about what coping strategies they have successfully used in the past and encourage them to continue to use these. | 1 |
The first aider should encourage the person to do whatever they need to do to take care of themselves. | 2 |
The first aider should encourage the person to do things that feel good to them (for example, take baths, read, exercise, watch television). | 1 |
The first aider should encourage the person to get plenty of rest when they are tired. | 1 |
The first aider should encourage the person to spend time somewhere they feel safe and comfortable. | 1 |
The first aider should discourage the person from using negative coping strategies such as working too hard, using alcohol and other drugs, or engaging in self-destructive behaviour. | 1 |
The first aider should assist the person to find local sources of support. | 2 |
The first aider should give the person information about community resources that are available (for example, crisis lines and health centres). | 2 |
The first aider should be aware that the person may not remember all the details of the event. | 2 |
The first aider should be aware that the person may suddenly or unexpectedly remember details of the event. | 2 |
When to seek professional help
| |
If at any time the person becomes suicidal, the first aider should seek professional help. | 1 |
The first aider should encourage the person to seek professional help if the post-trauma symptoms are interfering with their usual activities for 4 weeks or more. | 1 |
The first aider should encourage the person to seek professional help if they feel very upset or fearful for 4 weeks or more. | 1 |
The first aider should encourage the person to seek professional help if they are unable to escape intense ongoing distressing feelings for 4 weeks or more. | 1 |
The first aider should encourage the person to seek professional help if their important relationships are suffering as a result of the trauma (eg, if they withdraw from their carers or friends) for 4 weeks or more. | 1 |
The first aider should encourage the person to seek professional help if they abuse alcohol or other drugs to deal with the trauma at any time. | 2 |
The first aider should encourage the person to seek professional help if they feel jumpy or have nightmares because of or about the trauma for 4 weeks or more. | 1 |
The first aider should encourage the person to seek professional help if they can't stop thinking about the trauma for 4 weeks or more. | 1 |
The first aider should encourage the person to seek professional help if they are unable to enjoy life at all as a result of the trauma for 4 weeks or more. | 2 |
The first aider should be aware of the sorts of professional help which are available. | 2 |
If the person does not like the first professional they speak to, the first aider should tell the person that it is okay to try a different one. | 2 |
Item: | Round: |
Assisting the traumatised child | |
The first aider should protect the child from further harm. | 1 |
The first aider should ensure the child's physical needs (food, drink and somewhere to sleep) are met. | 1 |
The first aider should not make judgments about the child's feelings and thoughts. | 1 |
The first aider should tell the child that it is okay to feel upset when something bad or scary happens. | 1 |
The first aider should not say that someone who has died has "gone to sleep" as this may result in the child becoming fearful of sleep. | 1 |
The first aider should not make promises to the child that they cannot keep. | 1 |
The first aider should ensure that that they or another adult are available to take care of the child. | 1 |
The first aider should tell the child that they or another adult will take care of them. | 2 |
Children at large-scale traumatic events
| |
The first aider should attempt to keep the child together with loved ones and carers. | 1 |
The first aider should protect the child from traumatic sights and sounds (including media images). | 1 |
The first aider should ask bystanders and the media to stay away from the child. | 1 |
The first aider should not behave towards the child in such a way that the child feels they are still in danger. | 1 |
The first aider should reassure the child that they won't be left alone, so far as this is possible. | 1 |
If the first aider has to leave the child alone for a few minutes to attend to others, they should reassure the child that they will back as soon as possible. | 1 |
The first aider should try to appear as calm as possible. | 2 |
The first aider should direct the child away from very distressed people (e.g., people who are screaming, agitated or aggressive). | 2 |
The first aider should ask the child what would make them feel better or safer. | 2 |
Communicating with the traumatised child
| |
The first aider should talk to the child using age-appropriate language and explanations. | 1 |
The first aider should not coerce the child to talk about their feelings or memories of the trauma before they want to do so. | 1 |
The first aider should be aware that child may stop talking altogether after a trauma, and that if this happens they should not try to force or coerce the child to speak. | 1 |
The first aider should allow the child to ask questions and should answer them as truthfully as possible. | 1 |
The first aider should not make the child discuss the trauma before they are ready. | 1 |
The first aider should say that they can't answer a child's question if this is the case. | 1 |
If the child knows accurate, upsetting details, don't deny these. | 1 |
The first aider should be patient if the child asks the same question many times. | 1 |
The first aider should try to be consistent with answers and information. | 1 |
The first aider should allow the child to talk about their feelings. | 1 |
The first aider should allow the child to write or draw pictures about their feelings. | 1 |
The first aider should allow the child to express their feelings through playing with toys. | 1 |
The first aider should not tell the child how they should or shouldn't be feeling. | 1 |
The first aider should not tell the child to be brave or tough or not to cry. | 1 |
The first aider should not get angry if the child expresses strong emotions. | 1 |
The first aider should show the child that they understand and care. | 2 |
The first aider should tell the child that they will do their best to keep the child safe. | 2 |
The first aider should be patient with the child. | 2 |
The first aider should encourage the child to do things they enjoy (for example, playing with toys, reading books). | 2 |
If the first aider lives with the traumatised child
| |
The first aider should try to keep their behaviour as predictable as possible. | 1 |
The first aider should encourage the child to keep to daily routines. | 2 |
The first aider should not get angry, critical, or call the child 'babyish' if the child begins bedwetting, misbehaving, or sucking their thumb. | 1 |
The first aider should help the child to feel in control by letting them make some decisions (e.g. about meals or what to wear). | 1 |
The first aider should tell the child that their loved ones and carers love and support them. | 1 |
Dealing with avoidance behaviours and tantrums
| |
The first aider should be aware that the child may avoid things that remind them of the trauma (such as specific places, driving in the car, certain people, or separation from their carers. | 1 |
The first aider should try to discover what triggers sudden fearfulness or regression in the child. | 1 |
If the child avoids things which remind them of the trauma, but does not appear very distressed, the first aider should assure them that they are safe. | 1 |
If the child has a temper tantrum or becomes fearful, crying and clingy in order to avoid something which reminds them of the trauma the first aider should ask what they are afraid of. | 1 |
Legal issues relating to child abuse
| |
The first aider should know the local laws or regulations about reporting suspected child abuse. | 1 |
If the child discloses abuse, the first aider should contact the appropriate authorities. | 1 |
If the child discloses abuse, the first aider should remain calm and reassure the child that they have done the right thing by telling. | 1 |
If the child discloses abuse, the first aider should seek expert advice immediately. | 1 |
If the child discloses abuse, the first aider should not confront the perpetrator. | 1 |
If a child has disclosed abuse, the first aider should work with the appropriate authorities to ensure the child's safety. | 2 |
If a child has disclosed abuse, the first aider should assure the child that the abuse was not their fault. | 2 |
If a child has disclosed abuse, the first aider should tell the child that they believe what the child has told them. | 3 |
Getting professional help for a traumatised child
| |
If at any time the child becomes suicidal, the first aider should seek professional help. | 1 |
The first aider should seek professional help for the child if they display sudden severe or delayed reactions to trauma for 2 weeks or more. | 1 |
The first aider should seek professional help for the child if the post-trauma symptoms are interfering with their usual activities for 2 weeks or more. | 2 |
The first aider should seek professional help for the child if they are unable to escape intense ongoing distressing feelings for 2 weeks or more. | 1 |
The first aider should seek professional help for the child if their important relationships are suffering as a result of the trauma (eg, if they withdraw from their carers or friends) for 2 weeks or more. | 1 |
The first aider should seek professional help for the child if they are unable to enjoy life at all as a result of the trauma for 2 weeks or more. | 1 |
The first aider should seek professional help for the child if they feel very upset or fearful for 4 weeks or more. | 1 |
The first aider should seek professional help for the child if they act very differently after the trauma for 4 weeks or more. | 1 |
The first aider should seek professional help for the child if they feel jumpy or have nightmares because of or about the trauma for 4 weeks or more. | 1 |
The first aider should seek professional help for the child if they can't stop thinking about the trauma for 4 weeks or more. | 1 |
The first aider should seek professional help for the child if has temper tantrums or becomes fearful, crying and clingy in order to avoid something which reminds them of the trauma for 4 weeks or more. | 1 |
If the first aider is not a parent or guardian, they should not seek professional help for the child independently of the parent or guardian, except in an emergency. | 2 |
The first aider should be aware of the types of professional help which are available for children. | 3 |
The first aider should be aware that the symptoms associated with trauma may suddenly or unexpectedly appear months or years after the event and that if this occurs, professional help may need to be sought. | 2 |