The most important provisions in the first hours to the first weeks after a disaster are safety, comfort and the support of family and/or friends.
GPs should ensure their impacted patients are safe and have the support of family members, friends and the community.
During the first consultation with an impacted patient, GPs are advised to:
1. Listen, comfort and quietly accept information
- Offer help and comfort.
- Be quietly responsive.
- Some people may be helped by talking, for others talking may make it more difficult or, it may not be the right time. Let the individual guide you.
- Identify support systems of family, friends and local community groups.
- Remember the special things in families that may be important, e.g. pets.
2. Ensure survival, safety and security
A stunned mental state can leave people relatively unaware of their own safety and vulnerability.
A brief medical assessment allows:
- Assessment of physical injuries
- A review of changes to pre-existing physical and mental health conditions
- Time for contact and talk
- Gives reassurance and shows interest. Provision of a safe place to stay is important. If very concerned about someone's mental health, talk to a mental health professional.
3. Orient towards goals
Trauma and grief can leave a sense of chaos and fear. Activities that can help patients regain a sense of structure include:
- Basic routines (meals etc)
- An early follow-up appointment at 1 month and again if concerns at 3 months
- Being in the company of others until the acute distress/denial subsides (hours to days)
- Show patients things they can do themselves towards recovery
- Practical tasks and everyday routine are helpful.
The main issues for patients in your initial consultation are fear, grief and loss, and dislocation.
It is common to experience grief and trauma after a disaster.
Feeling dislocated from one’s home and environment, due to the loss of a house or neighbourhood, are factors that can lead to ongoing distress.
Common themes that patients might express are:
- Difficulty falling and remaining asleep
- Uncertainty about the future and what they can do to feel safe, supported and happy again
- Disruption to normal routines and patterns of life adding to uncertainty
- Irritability, anger and frustration can be common
There are ways to help people reengage with the practical aspects of their lives, including:
- Linking to others such as family, friends and neighbours. This could be done directly, through social media, or any other channels that work best for them.
- Getting the best sources of information, including local radio and newspapers, media and call centres.
- Helping people call upon their own personal strengths that they have used in the past or in difficult situations (everyone has these). This is a very powerful part of getting better.