Psychological First Aid as a Public Health Disaster Response Preparedness Strategy for Responders in Critical Incidents and Disasters

Disaster is exceptional in nature, unpredictable and has potential for mass destruction. It can greatly affect physical, psychological and social health of people. The lack of evidence-based psychosocial interventions and emergency preparedness contribute to the barriers of integrating psychological interventions into the routine disaster preparedness and relief protocols. Pre-deployment Psychological First Aid (PFA) is a model widely used and adopted as a community-based public health disaster response intervention. PFA training was evaluated in this thesis for its relevancy, impact, and feasibility of implementation with emergency responders. Four studies were conducted in this thesis to explore the applicability of PFA as a public health disaster response and preparedness strategy for responders in critical incidents.;The first study, systematic reviews of the PFA application and training, provided emerging evidence of the impact of the field applications and trainings of PFA as an immediate post-disaster public mental health intervention. The second study was a randomized controlled trial of 802 community-based volunteer disaster responders to evaluate the effectiveness of PFA training in preparing responders with relevant skills to cope with and offer assistance in disaster settings. Results from 3-month and 6-month follow up analyses revealed that PFA training enhances responders' self-efficacy to provide emotional comfort to survivors. However, no conclusive results on other mental health protective and promotion impacts on responders were observed in this study. On the other hand, in the third study, a post-deployment cross-sectional study in a field setting, conducted two months after a major maritime accident in Hong Kong showed more promising results. It investigated the effectiveness of pre-disaster training of PFA, in provision of emotional support to victims and first responders' post-disaster mental health, among PFA-trained and non-trained responders. This was the first study to demonstrate the potential beneficial impact of PFA training to responders' own mental health, including better coping, resilience, life satisfaction and perceived social support from friends. Trained PFA responders also showed better capacity to provide support in disasters, as shown by higher disaster mental health and PFA knowledge and self-efficacy in offering emotional support to survivors. Stakeholders' interviews with representatives in disaster responding non-governmental organizations were conducted to examine the mental health needs of frontline workers, current agency psychosocial policies and barriers encountered, and relevancy of PFA and its training to frontline workers' field experience. Results showed that most of the organizations with disasters responding mandates had inadequate measures to mitigate the adverse effects of critical incidents among the frontline workers. Nevertheless, all these stakeholders regarded PFA as a highly relevant and valuable measure to address the mental needs of the aid workers.;Given the devastating impact of disasters, this study series provided the evidence that PFA is a relevant and feasible tool to equip first responders with skills that might be beneficial for promoting their mental health and self-care when engaging in disaster response work. Organization should consider adopting PFA as a pre-deployment training option into the current field deployment practices. Future research implications and implementation strategies in post-disaster mental health intervention and preparedness strategies were also discussed.