Psychological First Aid
One of the Most Powerful Treatments Doesn't Come in a Kit
An incident is like a stone hitting a pond. The stone is the casualty, but every ripple is another layer, another person affected by the incident, everyone is a casualty.
When people think about first aid, they usually picture bandages, tourniquets, CPR or defibrillators.
They rarely think about words.
Yet in many emergencies, one of the most important treatments you can provide is helping someone feel safe, heard and less alone.
Psychological First Aid (PFA) isn't counselling. It isn't therapy. It doesn't require a psychology degree. It is simply another part of good casualty care.
As wilderness medicine has evolved, organisations such as the Wilderness Medical Society (WMS) and clinicians including Dr Patrick Fink have increasingly highlighted that treating the person is just as important as treating the injury.
The casualty in front of you is more than an injury
Whether you're dealing with a horse rider thrown from the saddle, a climber with a broken ankle, a mountain biker after a heavy crash or a colleague suffering chest pain at work, the physical injury is only part of the picture.
Many casualties experience:
Fear
Confusion
Loss of control
Embarrassment
Guilt
Panic
Uncertainty about what happens next
Those emotions aren't separate from the injury.
They directly influence breathing, heart rate, pain perception, decision-making and cooperation.
A calm casualty is often easier to assess, easier to treat and more able to help themselves.
Calm is contagious
One of the simplest principles I teach is this:
People often borrow the emotional state of the rescuer.
If you appear rushed, panicked or uncertain, your casualty is likely to become more anxious.
If you remain calm, organised and confident, they are far more likely to settle.
This doesn't mean pretending everything is fine.
It means being honest, calm and reassuring.
Simple phrases such as:
"I'm here with you."
"We're going to work through this together."
"You're safe."
can have a surprisingly powerful effect.
A simple ABCDE approach to Psychological First Aid
Dr Patrick Fink teaches an easy-to-remember **ABCDE** approach that can be used alongside your normal casualty assessment. It doesn't replace good medical care—it enhances it.
A – Acknowledge
Recognise both the incident and the person's emotional response.
Simple phrases such as:
"That was quite a fall."
"I can see this is frightening."
"I'm here with you."
Acknowledging what has happened builds trust and reassures the casualty that they are not facing the situation alone.
B – Breathing
Fear and anxiety often lead to rapid, shallow breathing, which can make pain and panic feel even worse.
Encourage slow, controlled breathing where appropriate. Rather than telling someone to "calm down", slow your own breathing and encourage them to follow your pace.
Often, your calm becomes their calm.
C – Cognitive Shift
Help the casualty move away from catastrophic thinking and focus on the present.
Instead of allowing thoughts to spiral towards "What if...?", gently redirect them:
"You've done the right thing."
"Help is on its way."
"Let's deal with one step at a time."
A small change in thinking can make a significant difference to how someone copes.
D – Distract
Appropriate distraction can reduce both pain and anxiety.
Talk about their horse, the walk they were doing, their family, or the plans they had for the day. With children, involve them in conversation or simple tasks where appropriate.
The aim isn't to ignore the injury; it's to stop the injury becoming their entire focus.
E – Explain
Uncertainty often fuels fear.
Tell the casualty what you're doing and why.
"I'm checking your circulation."
"I'm going to support your ankle to make it more comfortable."
"The ambulance has been called and help is on its way."
Keeping people informed restores a sense of control at a time when they may feel they have lost it.
Two ABCDEs working together
One of the reasons I like Dr Patrick Fink's approach is that it fits naturally alongside the medical **ABCDE** assessment we already teach.
While you're assessing:
Airway
Breathing
Circulation
Disability
Exposure
you can also be thinking about:
Acknowledge
Breathing
Cognitive Shift
Distract
Explain
One keeps your casualty alive.
The other helps them cope.
Together they provide better care.
It matters even more outdoors
Remote environments add another layer of stress.
Help may be an hour away.
The weather may be deteriorating.
The casualty may be worried about their horse, their friends, their equipment or simply how they're going to get home.
Psychological First Aid helps reduce that sense of helplessness.
It restores something incredibly valuable:
Control.
Even small choices can help.
"Would you like your jacket on?"
"Would you rather sit or lie down?"
"Can I explain what I'm doing next?"
Giving someone appropriate choices reminds them they are still part of the process rather than simply something being treated.
Confidence, not just compliance
At Invenio Training, we don't just teach people how to stop bleeding or recognise shock.
We teach them how to care for another human being.
Because first aid isn't simply about keeping somebody alive.
It's about reducing suffering.
Sometimes that means applying a dressing.
Sometimes it means holding a hand.
Sometimes it means saying exactly the right thing—and sometimes knowing when to say nothing at all.
This is another example of the difference between **compliance and capability**.
A certificate may tell you what to do.
Capability is having the confidence to do it with calmness, compassion and humanity when somebody genuinely needs you.
That's what we aim to develop.
Because being Adventure Ready means preparing for both the physical and the psychological aspects of an emergency.
References
World Health Organization, War Trauma Foundation & World Vision International. Psychological First Aid: Guide for Field Workers. Geneva: WHO, 2011.
World Health Organization. Psychological First Aid: Facilitator's Manual for Orienting Field Workers. Geneva: WHO, 2013.
Patrick Fink. Teaching on Psychological First Aid and the ABCDE model within wilderness medicine education.
Wilderness Medical Society. Educational resources and conference presentations on Psychological First Aid, human factors and patient-centred care in remote environments.
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