The first responder is the first person authorised and qualified to offer telephone support. Here are the best practices to be used during the counselling to a healthcare professional or the whole population.

INTERVENTION GUIDELINES:

Personal information (name, telephone number, place of work, job).

Introduce yourself and the supporting framework, clarifying that this is a specific and specialised intervention aimed at reducing stress.

• Presentation: “I am……………., I work in the emergency field and I am a member of………. Association”
• Introduce the goals: “The aim of this telephone support is reducing the stress you are experiencing and the emotional impact that comes from such a critical situation, in order to help you recover and come back to your normal life feeling safe. It is important for the institution/group for which you work that you have all the necessary psychological support. We will not judge what happened nor look for whom is responsible (and we will not evaluate the technical choices that were made in the intervention) but I would only like to have the opportunity to talk about your experience and your reactions before, during, and after the critical situation. Here there is no hierarchy, we talk like people involved in a tragedy. The call will not be recorded, and no notes will be taken during the conversation. Now it is your time to talk.
   

Would you like to tell me what happened to you?

How are you coping?

What were your reactions after the critical situation?  

During the days after the emergency, did you experience problems in sleeping, eating, concentrating? Did you feel more irritable? Or did you have other reactions?

All the reactions you described are normal reactions that normal people have in front of a not normal situation (psychoeducation phase, going through what has been said during the phone call).

These reactions are known as stress reactions and can last for a few days or weeks. You have already mentioned some of them. Other symptoms that people might have after a critical event are the following:

• Cognitive symptoms: memory and concentration problems, difficulty in problem solving, denial, sense of unreality, cognitive overload.
• Emotional symptoms: feeling vulnerable, rage, sadness, anxiety, depression, irritability, numbness.
• Behavioural symptoms: isolation, avoidance, hostility, change in eating habits, self-medication, problems in sleeping.

What helped you in facing the event?

Were there moments of strength?

In the following hours and days, what gave you some relief and help?

Every one of us has developed personal strategies to reduce stress in critical moments of our life. What strategies helped you during difficult moments in the past?
 

Other strategies that are helpful in reducing stress are:

• Understand the psychological and physical effects of stress and emotions, recognise the way you you react when you are alarmed.
• Keep a mental record of your past achievements.
• Do mental and practical exercises.
• Avoid saying “why?” or “if only…”.
• Eat and sleep well.
• Write / Talk about how you feel with friends, colleagues, etc.
• Give yourself enough time.
• Exercise and relax to get rid of stress in your body. Alternating physical exercise and deep relax can contribute to the elimination of chemicals released by stress and can help sleeping better.
• Go back to your daily routine, your daily tasks, and plan things to do.

Is there anything you would like to add or ask?

Thank you for having shared such a private and painful moment of your life. I am at your disposal and, if you agree, we can talk again next week about how you feel and how your reactions are evolving.

One last thing: we said that your reactions are normal, but if they persist, they do not go away or they worsen, I am available to help you recover. You can contact me directly at this number………………