Safety and Comfort

Goal

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:

• Do things that are active (rather than passive waiting), practical (using available resources), and familiar (drawing on past experience).
• Get current, accurate and up-to-date information, while avoiding survivors’ exposure to information that is inaccurate or excessively upsetting.
• Get connected with available practical resources.
• Get information about how responders are making the situation safer.
• Get connected with others who have shared similar experiences.

Ensure Immediate Physical Safety

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:

• Find the appropriate officials who can resolve safety concerns that are beyond your control, such as threats, weapons, etc.
• Remove broken glass, sharp objects, furniture, spilled liquids, and other objects that could cause people to trip and fall.
• Make sure that children have a safe area in which to play and that they are adequately supervised.
• Be aware and ensure the safety of survivors in a particular subgroup that may be targeted for persecution based on their ethnicity, religion, or other affiliations.

To promote safety and comfort for survivors who are elderly or disabled, you can:

• Help make the physical environment safer (for example, try to ensure adequate lighting, and protect against slipping, tripping, and falling).
• Ask specifically about his/her needs for eyeglasses, hearing aids, wheelchairs, walkers, canes, or other devices. Try to ensure that all essential aids are kept with the person.
• Ask whether the survivor needs help with health-related issues or daily activities (for example, assistance with dressing, use of bathroom, daily grooming, and meals).
• Inquire about current need for medication. Ask if he/she has a list of current medications or where this information can be obtained, and make sure he/she has a readable copy of this information to keep during the post-disaster period.
• Consider keeping a list of survivors with special needs so that they can be checked on more frequently.
• Contact relatives, if they are available, to further ensure safety, nutrition, medication, and rest. Make sure that the authorities are aware of any daily needs that are not being met.

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:

• Threat of harm to self or others–Look for signs that persons may hurt themselves or others (for example, the person expresses intense anger towards self or others, exhibits extreme agitation). If so, seek immediate support for containment and management by medical, EMT assistance, or a security team.
• Shock–If an individual is showing signs of shock (pale, clammy skin; weak or rapid pulse; dizzy; irregular breathing; dull or glassy eyes; unresponsive to communication; lack of bladder or bowel control; restless, agitated, or confused), seek immediate medical support.

Providing Information about Disaster Response Activities and Services

To help reorient and comfort survivors, provide information about:

• What to do next
• What is being done to assist them
• What is currently known about the unfolding event
• Available services
• Common stress reactions
• Self-care, family care, and coping

In providing information:

• Use your judgment as to whether and when to present information. Does the individual appear able to comprehend what is being said, and is he/she ready to hear the content of the messages?
• Address immediate needs and concerns to reduce fears, answer pressing questions, and support adaptive coping.
• Use clear and concise language, while avoiding technical jargon.

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:

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:

Attend to Physical Comfort

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:

• Health problems, such as physical illness, problems with blood pressure, fluid and electrolyte balance, respiratory issues (supplemental oxygen dependency), frailty (increased susceptibility to falls, minor injuries, bruising, and temperature extremes)
• Age-related sensory loss:
  • Visual loss, which can limit awareness of surroundings and add to confusion
  • Hearing loss, resulting in gaps in understanding of what others are saying
• Cognitive problems, such as difficulty with attention, concentration, and memory
• Lack of mobility
• Unfamiliar or over-stimulating surroundings
• Noise that can limit hearing and interfere with hearing devices
• Limited access to bathroom facilities or mass eating areas, or having to wait in long lines (A person who has not needed a wheelchair before the event may need one now.)
• Concern for the safety of a service animal

Promote Social Engagement

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.

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.

Attend to Children Who Are Separated from their Parents/Caregivers

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

• Help to create a designated child-friendly space, such as a corner or a room that is safe, out of high traffic areas, and away from rescue activities.
• Arrange for this space to be staffed by caregivers with experience and skill in working with children of different ages.
• Monitor who comes in and out of the child area to ensure that children do not leave with an unauthorized person.
• Stock the child-friendly space with materials for all age ranges. This can include kits with toys, playing cards, board games, balls, paper, crayons, markers, books, safety scissors, tape, and glue.
• Activities that are calming include playing with Legos, wooden building blocks, or play dough, doing cut-outs, working on coloring books (containing neutral scenes of flowers, rainbows, trees, or cute animals) and playing team games.
• Invite older children or adolescents to serve as mentors/role models for younger children, as appropriate. They can do this by helping you conduct group play activities with younger children, or by reading a book to them or playing with them.
• Set aside a special time for adolescents to get together to talk about their concerns, and to engage in age-appropriate activities like listening to music, playing games, making up and telling stories, or making a scrapbook.

Protect from Additional Traumatic Experiences and Trauma Reminders

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:

Help Survivors Who Have a Missing Family Member

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:

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.

Help Survivors When a Family Member or Close Friend has Died

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:

• Treat acutely bereaved children and adults with dignity, respect, and compassion.
• Grief reactions vary from person to person.
• There is no single “correct” course of grieving.
• Grief puts people at risk for abuse of over-the-counter medications, increased smoking, and consumption of alcohol. Make survivors aware of these risks, the importance of self-care, and the availability of professional help.

In working with survivors who have experienced the death of a family member or close friend, you can:

• Discuss how family members and friends will each have their own special set of reactions; no particular way of grieving is right or wrong, and there is not a “normal” period of time for grieving. What is most important for family members and friends is to respect and understand how each may be experiencing their own course of grief.
• Discuss with family members and friends how culture or religious beliefs influence how people grieve and especially how rituals may or may not satisfy current feelings of each family member.
• Keep in mind that children may only show their grief for short periods of time each day, and even though they may play or engage in other positive activities, their grief can be just as strong as that of any other family member.

To emphasize how important is it for family members to understand and respect each other’s course of grief, you may say:

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:

• Reassure grieving individuals that what they are experiencing is understandable and expectable.
• Use the deceased person’s name, rather than referring to him/her as “the deceased.”
• Let them know that they will most likely continue to experience periods of sadness, loneliness, or anger.
• Tell them that if they continue to experience grief or depression that affects daily functioning, talking to a member of the clergy or a counselor who specializes in grief is advisable.
• Tell them that their doctor, their city or county department of mental health, or their local hospital can refer them to appropriate services.

Don’t say:

• I know how you feel.
• It was probably for the best.
• He is better off now.
• It was her time to go.
• At least he went quickly.
• Let’s talk about something else.
• You should work towards getting over this.
• You are strong enough to deal with this.
• You should be glad he passed quickly.
• That which doesn’t kill us makes us stronger.
• You’ll feel better soon.
• You did everything you could.
• You need to grieve.
• You need to relax.
• It’s good that you are alive.
• It’s good that no one else died.
• It could be worse; you still have a brother/sister/mother/father.
• Everything happens for the best according to a higher plan.
• We are not given more than we can bear.
• (To a child) You are the man/woman of the house now.
• Someday you will have an answer.

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.

• Pre-school children may not understand that death is permanent, and may believe that if they wish it, the person can return. They need help to confirm the physical reality of a person’s death–that he/she is no longer breathing, moving or having feelings–and has no discomfort or pain. They may be concerned about something bad happening to another family member.
• School-age children may understand the physical reality of death, but may personify death as a monster or skeleton. In longing for his/her return, they may experience upsetting feelings of the “ghostlike” presence of the lost person, but not tell anyone.
• Adolescents generally understand that death is irreversible. Losing a family member or friend can trigger rage and impulsive decisions, such as quitting school, running away, or abusing substances. These issues need prompt attention by the family or school.

The death of a parent/caregiver affects children differently depending on their age.

• Pre-school children need consistent care and a predictable daily routine as soon as possible. They can be easily upset by change: food prepared differently, their special blanket missing, or being put into bed at night without the usual person or in a different way. Caregivers (including the surviving parent) should ask the child if they are doing something differently or something “wrong” (for example, “Am I not doing this the way Mommy did?”).
• A school-age child loses not only his/her primary caregiver, but also the person who would normally be there to comfort him/her and help with daily activities. Other caregivers should try, as best they can, to assume these roles. Children may be angry at a substitute caregiver, especially when disciplined. Caregivers should acknowledge that the child is missing his/her parent/caregiver, and then provide extra comfort.
• Adolescents may experience an intense sense of unfairness, and protest over the death. They may have to take on greater responsibilities within their family and resent not being able to have more independence or do the things that adolescents normally do. Over time, caregivers should discuss how to balance these different needs.

You may give parents/caregivers some suggestions for talking with children and adolescents about death. These include:

• Assure children that they are loved and will be cared for.
• Watch for signs that the child may be ready to talk about what happened.
• Do not make the child feel guilty or embarrassed about wanting or not wanting to talk.
• Do not push children to talk.
• Give short, simple, honest, and age-appropriate answers to their questions.
• Listen carefully to their feelings without judgment.
• Reassure them that they did not cause the death, that it was not their fault, and that it was not a punishment for anything that anyone did “wrong.”
• Answer questions honestly about funerals, burial, prayer, and other rituals.
• Be prepared to respond to the child’s questions over and over again.
• Do not be afraid to say that you don’t know the answer to a question.

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:

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:

Attend to Grief and Spiritual Issues

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:

• A good way to introduce this topic is to ask, “Do you have any religious or spiritual needs at this time?” This question is not meant to lead to a theological discussion or to your engaging in spiritual counseling. If requested, you can refer them to a clergy member of their choice.
• Do not contradict or try to “correct” what a person says about his/her religious beliefs, even if you disagree and think that it may be causing them distress.
• Do not try to answer religious questions like, “Why was this allowed to happen?” These questions generally represent expressions of emotion rather than real requests for an answer.
• If a person is clearly religious, ask if he/she wants to see a clergy member of his/her faith.
• Many people rely on religious objects such as prayer beads, statues, or sacred texts that they may have lost or left behind. Locating an object like this can help to increase their level of security and sense of control. A local clergy member can often be of help in providing these items.
• Survivors may want to pray alone or in a group. You may help by finding a suitable place for them to do so. For some people, facing in the proper direction while praying is important. You can help to orient them.
• You may also provide information to officials in charge regarding space and religious items needed for religious observances.
• If you are asked to join in prayer, you may decline if you feel uncomfortable. Keep in mind that joining may only involve standing in silence while they pray. If you are comfortable joining in at the end with an “Amen,” this can help your relationship with the person and the family.
• Many people routinely light candles or incense when they pray. If not allowed in the setting, explain this to survivors, and assist them in finding a nearby place where an open flame would be allowed.
• A survivor may voice hope for a miracle, even in the face of virtual certainty that their loved one has died. Do not take this as evidence that he/she has lost touch with reality or has not heard what has been said, but as the survivor’s way of continuing to function in devastating circumstances. It is important to neither encourage or discourage such hope.
• Every religion has specific practices around death, particularly in regard to the care of dead bodies. These issues may be especially complicated when the body is not recovered. Ask survivors about their religious needs in this area. They may want a clergy member to advise them.
• In some cultures, expressions of grief can be very loud and may seem out of control. It may be helpful to move families to a more private space to prevent them from upsetting others. If the behavior is upsetting to you, you should find someone else to assist the family.
• If a survivor expresses anger associated with his/her religious beliefs (a sign of spiritual distress), do not judge or argue with him/her. Most people are not looking for an “answer,” but a willing, non-judgmental listener. If spiritual concerns are contributing to significant distress, guilt, or functional impairment, you can ask if he/she would like a referral to a clergy member.

Provide Information about Casket and Funeral Issues

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:

• It can be helpful for a child to attend a funeral. Although emotionally challenging, funerals help children accept the physical reality of the death which is part of grieving. If not included, children can feel left out of something important to the family.
• Parents/caregivers should give children a choice whether or not to attend a funeral or other ritual. They may be encouraged, but should not be pressured.
  • Before asking children to choose, tell them what to expect if they attend, including letting them know that adults may be upset and crying. Explain that there will be a special area for the family to sit together (if that is to be arranged). Let them know what will happen during the service.
  • Give them an opportunity to choose the person that they will sit next to at the service. Make sure that this person can pay appropriate attention to them.
  • Always provide a way for children to leave the service with that person, even temporarily, if they become overwhelmed.
  • Tell children about alternative arrangements if they do not wish to attend, such as staying with a neighbor or friend of the family.
  • If they choose not to attend, offer to say something or read something on their behalf, and explain how they can participate in memorial activities at a later time, including memorials of their own making.
• If possible, bring younger children to the location early so that they can explore the space. Describe the casket and, if they wish, join them in approaching it. Caution should be exercised in regard to allowing young children to view or touch the body. A young child can use a photograph of the person to help say goodbye.
• For younger children, reinforce that the deceased family member is not in distress. You may be asked to attend funerals or other events. You may feel that this will help a family member or child. Attend funerals only with the permission and knowledge of the family.

Attend to Issues Related to Traumatic Grief

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:

• Intrusive, disturbing images of the death that interfere with positive remembering and reminiscing
• Retreat from close relationships with family and friends
• Avoidance of usual activities because they are reminders of the traumatic death
• For children, repetitive play that includes themes involving the traumatic circumstances of the death

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:

Support Survivors Who Receive Death Notification

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:

• Don’t rush. Family members need time to process the news and ask questions.
• Allow for initial strong reactions: these will likely improve over time.
• When talking about a person who is a confirmed fatality, use the word “died,” not “lost” or “passed away.”
• Remember that family members do not want to know how YOU feel (sympathy); they want to know you are trying to understand how THEY feel (empathy).

Active steps to help support survivors in dealing with death notification include:

• Seek assistance from medical support personnel if a medical need arises.
• Get help from the authorities if family members are at risk for hurting themselves or others.
• Make sure that social supports are available, such as family, friends, neighbors, or clergy.
• Try to work with individuals or family units. Even when officials are addressing large crowds, it is better to have family members assembled at their own tables with you present. Potentially traumatic activities–such as reviewing passenger manifests, ticket lists, or morgue photos–should be done in family groups, in a private location, with the appropriate authorities. Be careful that children and adolescents do not see morgue photos.
• If an unaccompanied child is told that his/her caregiver has died, stay with the child or ensure that another worker stays with the child until he/she is reunited with other family members or is attended to by an appropriate child protective service worker.

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:

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.

Support Survivors Involved in Body Identification

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:

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.

Help Caregivers Confirm Body Identification to a Child or Adolescent

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:

Outline

• Introduction and Overview
• Preparing to Deliver Psychological First Aid
• Core Actions
  • Contact and Engagement
  • Safety and Comfort 
  • Stabilization (if needed)
  • Information Gathering: Needs and Current Concerns
  • Practical Assistance
  • Connection with Social Supports
  • Information on Coping
  • Linkage with Collaborative Services
• Appendices