To enhance immediate and ongoing safety, and provide physical and emotional comfort.
Restoration of a sense of safety is an important goal in the immediate aftermath of disaster and terrorism. Promoting safety and comfort can reduce distress and worry. Assisting survivors in circumstances of missing loved ones, death of loved ones, death notification and body identification is a critical component of providing emotional comfort and support.
Comfort and safety can be supported in a number of ways, including helping survivors:
Make sure that individuals and families are physically safe to the extent possible. If necessary, reorganize the immediate environment to increase physical and emotional safety. For example:
To promote safety and comfort for survivors who are elderly or disabled, you can:
If there are medical concerns requiring urgent attention or immediate need for medication, contact the appropriate unit leader or medical professional immediately. Remain with the affected person or find someone to stay with him/her until you can obtain help. Other safety concerns involve:
To help reorient and comfort survivors, provide information about:
In providing information:
Ask survivors if they have any questions about what is going to happen, and give simple accurate information about what they can expect. Also, ask whether he/she has any special needs that the authorities should know about in order to decide on the best placement. Be sure to ask about concerns regarding current danger and safety in their new situation. Try to connect survivors with information that addresses these concerns. If you do not have specific information, do not guess or invent information in order to provide reassurance. Instead, develop a plan with the person for ways you and he/she can gather the needed information. Examples of what you might say include:
Adult/ | From what I understand, we will start transporting people to the shelter at West High School in about an hour. There will be food, clean clothing, and a place to rest. Please stay in this area. A member of the team will look for you here when we are ready to go. |
Child | Here’s what’s going to happen next. You and your mom are going together soon to a place called a shelter, which really is just a safe building with food, clean clothing, and a place to rest. Stay here close to your mom until it’s time to go. |
Do not reassure people that they are safe unless you have definite factual information that this is the case. Also do not reassure people of the availability of goods or services (for example, toys, food, medicines) unless you have definite information that such goods and services will be available. However, do address safety concerns based on your understanding of the current situation. For example, you may say:
Adult/ | Mrs. Williams, I want to assure you that the authorities are responding as well as they can right now. I am not sure that the fire has been completely contained, but you and your family are not in danger here. Do you have any concerns about your family’s safety right now? |
Adolescent | We’re working hard to make you and your family safe. Do you have any questions about what happened, or what is being done to keep everyone safe? |
Child | Your mom and dad are here, and many people are all working hard together so that you and your family will be safe. Do you have any questions about what we’re doing to keep you safe? |
Look for simple ways to make the physical environment more comfortable. If possible, consider things like temperature, lighting, air quality, access to furniture, and how the furniture is arranged. In order to reduce feelings of helplessness or dependency, encourage survivors to participate in getting things needed for comfort (for example, offer to walk over to the supply area with the person rather than retrieving supplies for him/her). Help survivors to soothe and comfort themselves and others around them. For children, toys like soft teddy bears that they can hold and take care of can help them to soothe themselves. However, avoid offering such toys if there are not enough to go around to all children who may request them. You can help children learn how to take care of themselves by explaining how they can “care” for their toy (for example, “Remember that she needs to drink lots of water and eat three meals a day–and you can do that, too”).
When working with the elderly or people with disabilities, pay attention to factors that may increase their vulnerability to stress or worsen medical conditions. When attending to the physical needs of these survivors, be mindful of:
Facilitate group and social interactions as appropriate. It is generally soothing and reassuring to be near people who are coping adequately with the situation. On the other hand, it is upsetting to be near others who appear very agitated and emotionally overwhelmed. If survivors have heard upsetting information or been exposed to rumors, help to clarify and correct misinformation.
Children, and to some extent adolescents, are particularly likely to look to adults for cues about safety and appropriate behavior. When possible, place children near adults or peers who appear relatively calm, and when possible, avoid putting them too close to individuals who are extremely upset. Offer brief explanations to children and adolescents who have observed extreme reactions in other survivors.
Child/ | That man is so upset that he can’t calm down yet. Some people take longer to calm down than others. Someone from our team is coming over to help him calm down. If you feel upset, it is important for you to talk to your mom or dad, or someone else who can help you feel better. |
As appropriate, encourage people who are coping adequately to talk with others who are distressed or not coping as well. Reassure them that talking to people, especially about things they have in common (for example, coming from nearby neighborhoods or having children about the same age), can help them support one another. This often reduces a sense of isolation and helplessness in both parties. For children, encourage social activities like reading out loud, doing a joint art activity, and playing cards, board games, or sports.
Parents and caregivers play a crucial role in children’s sense of safety and security. If children are separated from their caregivers, helping them reconnect quickly is a high priority. If you encounter an unaccompanied child, ask for information (such as their name, parent/caregiver and sibling names, address, and school), and notify the appropriate authorities. Provide children accurate information in easy-to-understand terms about who will be supervising them and what to expect next. Do not make any promises that you may not be able to keep, such as promising that they will see their caregiver soon. You may also need to support children while their caregivers are being located or during periods when caregivers may be overwhelmed and not emotionally accessible to their children. This support can include setting up a child-friendly space.
Set Up a Child-Friendly Space
In addition to securing physical safety, it is also important to protect survivors from unnecessary exposure to additional traumatic events and trauma reminders, including sights, sounds, or smells that may be frightening. To help protect their privacy, shield survivors from reporters, other media personnel, onlookers, or attorneys. Advise adolescents that they can decline to be interviewed by the media, and that if they wish to be interviewed, they may want to have a trusted adult with them.
If survivors have access to media coverage (for example, television or radio broadcasts), point out that excessive viewing of such coverage can be highly upsetting, especially for children and adolescents. Encourage parents to monitor and limit their children’s exposure to the media, and to discuss any concerns after such viewing. Parents can let their children know that they are keeping track of information, and to come to them for updates instead of watching television. Remind parents to be careful about what they say in front of their children, and to clarify things that might be upsetting to them. For example, you might say:
Adult/ | You’ve been through a lot, and it’s a good idea to shield yourself and your children from further frightening or disturbing sights and sounds as much as possible. Even televised scenes of the disaster can be very disturbing to children. You may find that your children feel better if you limit their television viewing of the disaster. It doesn’t hurt for adults to take a break from all the media coverage, too. |
Adolescent/ | You’ve been through a lot already. People often want to watch TV or go to the internet after something like this, but doing this can be pretty scary. It’s best to stay away from TV or radio programs that show this stuff. You can also tell your mom or dad if you see something that bothers you. |
Coping while a loved one is missing is extremely difficult. Family members may experience a number of different feelings: denial, worry, hope, anger, shock, or guilt. They may alternate between certainty that the person is alive—even in the face of contradictory evidence—and hopelessness and despair. They may blame authorities for not having answers, for not trying hard enough, or for delays. They may also feel vengeful against those that they consider responsible for locating their missing relative or friend. It is extremely important to reassure children that the family, police, and other first responders are doing everything possible to find the missing loved one.
Assist family members who have a missing loved one by helping them obtain updated information about missing persons, direct them to locations for updated briefings, and tell them the plan in place for connecting/reuniting survivors. The American Red Cross has established a “Disaster Welfare Information System” to support family communication and reunification, and a “Safe and Well” website located at www.redcross.org. It provides a variety of tools and services needed to communicate with loved ones during times of emergency. Try to identify other official sources of updated information (police, official radio and television channels, etc.) and share these with survivors.
You may want to take extra time with survivors worried over a missing family member. Just being there to listen to survivors’ hopes and fears, and being honest in giving information and answering questions is often deeply appreciated. To help locate a missing family member, you can make an initial review with the family of any pre-disaster plans for post-disaster contact, including school or workplace evacuation plans; plans for tracking transport of students or co-workers for medical care; out-of-state telephone numbers to be used by schools, workplaces, or families in case of emergency; and any pre-arranged or likely meeting places (including homes of relatives), both within and outside the disaster perimeter.
Some family members may want to leave a safe area to attempt to find or rescue a missing loved one. In this case, inform the survivor about the current circumstances in the search area, specific dangers, needed precautions, the efforts of first responders, and when updated information may be available. Discuss specific concerns they may have (for example, an elderly parent who recently had hip surgery, or a child who needs special medications), and offer to inform the appropriate authorities.
In some cases, authorities may ask survivors to give information or other evidence to help the search. Authorities may have family members file a missing persons report or provide information about when and where the missing person was last seen, who else was there, and what he/she was wearing. It is best to limit the exposure of younger children to this process.
It can be disturbing and confusing for a child to be present at a caregiver’s interview with authorities or to hear adult speculations about what might have happened to the missing person. Authorities may ask a family member to collect DNA from a loved one’s personal effects, for example, hair from a hairbrush. In rare cases, a child may need to be interviewed because he/she was the last one to see the missing person. A mental health or forensic professional trained to interview children should conduct the interview or be present. A supportive family member or you should accompany the child. Talk to the child simply and honestly. For example, you might say:
Adolescent/ | Uncle Mario is missing. Everyone is working very hard to find out what happened. The police are helping too and they need to ask you some questions. It’s okay if you do not remember something. Just tell them that you don’t remember. Not remembering something will not hurt Uncle Mario. Your mom will stay with you the whole time, and I can stay too, if you want. Do you have any questions? |
Sometimes in the case of missing persons, the evidence will strongly suggest that the person is dead. There may be disagreement among family members about the status of their loved one. You should let family members know that these differences (some giving up hope, some remaining hopeful) are common in a family when a loved one is missing, and not a measure of how much they love the person or each other. You can encourage family members to be patient, understanding, and respectful of each other’s feelings until there is more definite news. Parents/caregivers should not assume that it is better for a child to keep hoping that the person is alive, but instead honestly share the concern that the loved one may be dead. Parents/caregivers should check with children to make sure that they have understood, and ask what questions they have.
Acute Grief Reactions are likely to be intense and prevalent among those who have suffered the death of a loved one or close friend. They may feel sadness and anger over the death, guilt over not having been able to prevent the death, regret about not providing comfort, or having a proper leave-taking, missing the deceased, and wishing for reunion (including dreams of seeing the person again). Although painful to experience at first, grief reactions are healthy responses that reflect the significance of the death. Over time, grief reactions tend to include more pleasant thoughts and activities, such as telling positive stories about a loved one, and comforting ways of remembering him/her. You should remember:
In working with survivors who have experienced the death of a family member or close friend, you can:
To emphasize how important is it for family members to understand and respect each other’s course of grief, you may say:
Adult/ | It is important to know that each family member may express their grief differently. Some may not cry, while others might cry a lot. Family members should not feel badly about this or think there is something wrong with them. What is most important is to respect the different ways each feels, and help each other in the days and weeks ahead. |
Some children and adolescents will not have words to describe their feelings of grief and may resist talking with others about how they feel. Sometimes, distracting activities will be more calming than conversation, for example, drawing, listening to music, reading, etc. Some may wish to be alone. If safe, provide them with some privacy. When a survivor does want to talk with you about the loved one, you should listen quietly, and not feel compelled to talk a lot. Do not probe.
Do:
Don’t say:
If the grieving person says any of the above things, you can respectfully acknowledge the feeling or thought, but don’t initiate a statement like these yourself.
Child and adolescent understanding of death varies depending on age and prior experience with death, and is strongly influenced by family, religious, and cultural values.
The death of a parent/caregiver affects children differently depending on their age.
You may give parents/caregivers some suggestions for talking with children and adolescents about death. These include:
You should give information to parents/caregivers and children about reactions to the death that they might experience. The handout, When Terrible Things Happen (Appendix E), describes common reactions to the death of a loved one and ways of coping. When speaking to parents/caregivers, you can say:
Parent/ | It can be helpful to think about times when your children will miss their father, like at mealtime or bedtime. If you say something like, “It is hard not to have daddy here with us right now,” you can ease the discomfort everyone is feeling, make children feel less alone, and help them to better handle these difficult times. When you see a sudden change in your children–looking kind of lost or sad or even angry–and you suspect that they are missing their father, let them know that you, too, have times when you feel that way. Say something like, “You seem really sad. I’m wondering if you are thinking about your dad. Sometimes I feel very sad about dad, too. It’s okay to tell me when you are feeling bad so maybe I can help.” Help by giving them some time alone with those feelings, sitting quietly with them, and giving them a hug. |
Children and adolescents sometimes feel guilty that they survived while other family members did not. They may believe that they caused the death in some way. Families need to help dispel children’s sense of responsibility and assure them that, in events like this, they are not to blame for what happened. For example, you may suggest that a caregiver say:
Parent/ | We all did what we could to try to save everybody. Daddy would be so happy that we are all okay. You did not do anything wrong. Note: Saying this once may not be enough; feelings of guilt may come up again and again, and a parent may need to provide constant assistance with a child’s ongoing worries and confusion about guilt. |
In order to assist survivors with spiritual needs after a death, you should become familiar with clergy who may be part of the disaster response team on-site, and with ways to obtain contact information for clergy of local religious groups to whom you can refer survivors. It is common for people to rely on religious and spiritual beliefs/practices as a way to cope with the death of a loved one. Survivors may use religious language to talk about what is happening or want to engage in prayer or other religious practices. It is not necessary for you to share these beliefs in order to be supportive. You are not required to do or say anything that violates your own beliefs. Often, simply listening and attending is all that is required. Things to keep in mind include:
Local laws often govern the preparation of a body for burial and rules regarding caskets or internment. Sometimes exceptions are made for members of particular religious groups. In many jurisdictions, the law requires autopsies for any victim of a traumatic death or when the cause of death is not clear. This requirement may be upsetting, especially to members of religious groups that normally prohibit autopsies. In some jurisdictions, autopsy requirements can be waived by a Medical Examiner. Families who do not want an autopsy should be helped to find out about local laws.
When a body has been significantly disfigured, you may suggest that–if it is in keeping with the religious tradition of the family–survivors place a photograph of the deceased on the casket in order to allow mourners to remember the person as he/she was alive and pay their respects.
You can assist family members with their questions about children’s attendance at a funeral, memorial service, or gravesite. In responding to questions, keep the following in mind:
After traumatic death, some survivors may stay focused on the circumstances of the death, including being preoccupied with how the death could have been prevented, what the last moments were like, and who was at fault. These reactions may interfere with grieving, making it more difficult for survivors to adjust to the death. These reactions include:
These reactions can change mourning, often putting individuals on a different time course than may be experienced by other family members. You may want to speak privately to a family member who was present at the time of the death in order to advise him/her about the extra burden of witnessing the death. Let him/her know that talking to a mental health professional or clergy member may be very helpful. For example, you might say:
Adult/ | It is awful to have been there when Joe died. Other family members may want to know details about what happened, but there may be some details that you think will be too upsetting for them. Discussing what you went through with a professional can help you decide what to share with your family and also help you with your grief. |
Although it is unlikely that you will be asked to notify a family member of a death, you may assist family members who have been informed of a death. You may be asked by police, FBI, hospital personnel or Disaster Mortuary Operational Response Team (DMORT) members to be present at the time of death notification. In some catastrophic situations, such as airline crashes, the news media may report that there were no survivors of the accident before family members have been officially notified. As incorrect information is sometimes circulated by the media or other survivors–caution family members to wait for official confirmation from the authorities. After learning of the death of a family member or close friend, people may have psychological and physiological reactions that vary from agitation to numbness. At the same time, they must cope with the continuing stress of still being in the disaster environment. In providing support, keep the following in mind:
Active steps to help support survivors in dealing with death notification include:
Children may have a range of responses to being told of the death of a loved one. They may act as if they did not hear, they may cry or protest the news, or they may not speak for an extended period. They may be angry with the person who told them. You may suggest that the parent/ caretaker say something like:
Parent/ | It is awfully hard to hear that Aunt Julia is really dead. It’s okay if you want to cry or if you don’t want to cry. Anytime you want to talk about her and what happened, I’m going to be here for that. You’ll see me have lots of feelings too. We can all help each other. |
For adolescents, you can advise parents to caution teens about doing something risky, like storming off, driving while overwhelmed with such news, staying out late, engaging in high-risk sexual behavior, using alcohol or other drugs, or acting in some other reckless way. Parents/caretakers should also understand that an adolescent’s anger can turn to rage over the loss, and they should be prepared to tolerate some expressions of rage. However, they should also be firm in addressing any behavioral risks. Expression of any suicidal thought should be taken seriously, and appropriate additional assistance should be immediately sought. Expressions of revenge should also be taken seriously. Adolescents should be cautioned to think about the consequences of revenge, and be encouraged to consider constructive ways to respond to their feelings.
Family members should address immediate questions from children and adolescents about their living circumstances and who will take care of them. You may suggest that separation of siblings be avoided, if at all possible.
Where identifiable bodies have been recovered and family members have been asked to assist in the identification process, authorities may take family members to the morgue or an alternative location to view and identify the body. The Psychological First Aid provider will typically not participate in these activities, but may be of assistance prior to and after body identification. Some individuals may feel that they must see the body before they can accept that the person is dead. Adolescents and older children might ask to be present when the body is identified; however, in most cases, children should be discouraged from participating in the process. Children may not understand the extent to which the body has deteriorated or changed, and may find seeing the body extremely disturbing. Parents can say to the child:
Parent/ | You know, Uncle Bobby wouldn’t want you to see him that way. I’m going to go and make sure that it’s him, but I don’t feel that you should go and see the body. |
When the body is found, it is natural for families to want to know when and where it was found, and what the person experienced before dying. Family members may be more disturbed by unanswered questions, than by having those questions answered. You should expect a wide range of reactions after viewing the body, including shock, numbness, fainting, vomiting, trembling, screaming, or hitting something or someone.
After a family member has identified the body of a loved one, a caregiver should convey this to children. You may sit in to provide support and assistance. Since young children do not understand that death is final, a family member should make it very clear that the lost loved one’s body has been found, and that he/she is dead. If the identification was made through forensic methods, it is important to explain the certainty of the identification in simple direct language. Parents should reassure children that the loved one is not suffering, that they were very loved by him/her, and that they will be taken care of. Allow children to ask questions, and–if an answer is not readily available–let them know that the parent or you will try to get additional information. You should caution parents/caretakers about giving disturbing details of the physical appearance of the body. If the child asks about the appearance, a parent can say:
Parent/ | It was not easy to see Uncle Jack, and he would want us to remember him alive, and to think about the nice times we spent together. I remember going on hikes and going fishing. You can pick any memory of Uncle Jack that you want, too. Then we’ll both have good ways to think about him |