First Aid for Scuba Divers
If your buddy was injured on a dive, what would you do? Probably help them as best you can and call for help! You may have done some training in first aid for scuba divers that would help you know what to do. But what if the issue was not physical? What if they were showing signs of mental distress or post-traumatic stress? Are you familiar with Psychological First Aid?
What is Psychological First Aid?
Psychological First Aid (PFA) is an evidence-based strategy used to support people immediately after experiencing a traumatic event. The aim is to help individuals manage immediate stress effectively and cope with what happened to them in the long-term. PFA is valuable for many individuals, including disaster responders, hospital staff, and volunteers. It’s also beneficial for those navigating personal crises at work, within their community, or among family members. In diving, we can think of where it may be useful after an adverse event, of any magnitude ranging from a distressing failure in skills training or a major incident, where a diver(s) are hurt.
What does it involve?
PFA encompasses several key actions: creating a sense of safety, offering comfort, and providing practical help. It also involves connecting individuals to social supports and sharing information on coping strategies. Essentially, it’s about stabilising the person and helping them regain control and a sense of normalcy.
One of the fundamental principles of PFA is to listen without pushing the individual to talk. This means being present and attentive, allowing them to share their feelings at their own pace. Active listening can help them feel heard and understood, which is needed for their emotional recovery.
Another critical aspect of PFA is helping individuals identify their immediate needs and concerns. This might involve ensuring access to basics like food, water, and shelter, as well as medical care if required. It could be as basic as giving a coat or blanked! Providing clear and timely information about the situation can also help reduce anxiety and confusion.
PFA also highlights the importance of connecting individuals to their social support networks. Encouraging them to reach out to family, friends, or community resources can provide essential emotional support and practical assistance. Social connections are vital for building resilience and promoting recovery after a traumatic event.
Finally, PFA includes offering information on coping strategies and stress management techniques. This might involve direction to resources such as relaxation exercises, encouraging healthy routines, and promoting self-care practices. The aim is to equip individuals with tools to manage stress and enhance their overall well-being.
What Psychological First Aid is not
PFA is not professional counseling or therapy, but rather a supportive and compassionate presence that can be provided by anyone trained in its principles. It is a set of basic, supportive actions designed to help individuals in the immediate aftermath of a stressful or traumatic event. PFA does not involve diagnosing mental health conditions or providing long-term treatment plans. It is meant to offer immediate support and stabilization, not to replace professional mental health care. It is not about forcing people to talk about their feelings or experiences if they are not ready. PFA respects the individual’s pace and readiness to share, focusing instead on offering a compassionate presence and practical assistance.
PFA is not a one-size-fits-all approach. It requires sensitivity to the unique needs and circumstances of each individual, rather than applying a standardized set of procedures. It does not include giving unsolicited advice or making decisions for the affected person. PFA aims to empower individuals by helping them regain a sense of control and encouraging them to make their own informed choices.
How is psychological first aid different from trauma-focused debrief
Psychological First Aid (PFA) and trauma-focused debriefing each play unique roles in the aftermath of trauma, catering to different needs and moments in time. PFA is an immediate, short-term intervention aimed at stabilising individuals right after a traumatic event. Its primary goal is to alleviate initial distress and support both short- and long-term adaptive functioning and coping mechanisms. Unlike trauma-focused debriefing, which delves deeply into the traumatic event by encouraging detailed recounting, PFA concentrates on meeting basic needs, offering emotional support, and linking individuals to additional resources. The focus is on creating a sense of safety, calm, and hope, without probing for detailed descriptions of the trauma itself.
Why PFA is recommended over trauma-focused debriefs
Trauma-focused debriefing is not generally recommended (by guidelines, e.g. WHO and NICE) because it can sometimes exacerbate stress and trauma symptoms rather than alleviate them. Trauma-focused debriefs are controversial because some research suggests that they may inadvertently reinforce traumatic memories. Some methods involves asking individuals to recount and relive the traumatic event in detail shortly after it occurs, which can be overwhelming and counterproductive. Some research has shown that trauma-focused debriefing can interfere with the natural recovery process. Immediately after a traumatic event, individuals need time to process their emotions and experiences at their own pace. Forcing them to discuss the event in detail can hinder this natural coping mechanism and potentially lead to increased anxiety and stress.
Another concern is that trauma-focused debriefing can create a sense of pressure to share personal and distressing details before individuals are ready. This can lead to feelings of vulnerability and helplessness, which are counterproductive to recovery. It is essential to allow individuals to choose when and how they discuss their experiences. Trauma-focused debriefing can also inadvertently reinforce negative memories and emotions associated with the traumatic event. By repeatedly recounting the incident, individuals may become more fixated on the distressing aspects, which can prevent them from moving forward and finding healthier ways to cope. Current best practices in psychological first aid emphasize providing support, ensuring safety, and promoting a sense of calm and self-efficacy. These approaches focus on stabilising the individual and helping them regain a sense of control, rather than delving into the traumatic details prematurely. This method is more effective in fostering resilience and long-term recovery.
The topic of trauma-focused debriefs is complex, and some argue for it usefulness, though recognised guidelines recommend alternatives like Psychological First Aid, because this is known to be helpful and unlikely to cause further harm. More information on different forms of debriefing is available here.
The Role of Psychological First Aid in Scuba Diving
Psychological first aid (PFA) plays a crucial role in scuba diving by addressing the immediate emotional and psychological needs of divers who may experience stress, anxiety, or trauma during or after a dive. The underwater environment can be inherently stressful due to factors such as depth, visibility, marine life encounters, and equipment malfunctions. PFA helps to mitigate these stressors and promotes mental well-being, ensuring that divers can continue to enjoy the sport safely.
One of the primary roles of PFA in scuba diving is to provide immediate support and stabilization to divers who have experienced a distressing event. This can include incidents such as near-drowning, equipment failure, or unexpected encounters with marine life. By offering a calm and reassuring presence, PFA helps to reduce acute stress reactions and prevent the development of more severe psychological issues such as panic attacks or post-traumatic stress disorder (PTSD).
PFA also plays a preventative role by equipping divers with coping strategies and mental resilience techniques before they even enter the water. This includes educating divers on stress management, relaxation techniques, and the importance of mental preparation. By fostering a proactive approach to mental health, PFA helps divers to handle potential stressors more effectively and maintain a positive mindset throughout their diving experiences.
Post-Dive Support: First Aid for Scuba Divers Process Their Experience
In the event of an emergency, PFA provides a structured approach to helping divers process their experiences and emotions. This involves active listening, offering practical assistance, and encouraging divers to express their feelings. By creating a supportive environment, PFA facilitates emotional recovery and helps divers to regain a sense of control and confidence.
Building a Supportive Dive Community
Another important aspect of PFA in scuba diving is the promotion of social support among divers. Diving often takes place in groups, and fostering a sense of community and mutual support can significantly enhance psychological resilience. PFA encourages divers to look out for one another, share their experiences, and provide emotional support, which can strengthen the overall safety and enjoyment of the diving experience.
Understanding and applying PFA can help divers create a supportive and communicative environment. This encourages open discussions about fears, concerns, and experiences, which can mitigate feelings of isolation and helplessness. By fostering a culture of openness, divers are more likely to seek help when needed and support each other effectively.
Recognising and Addressing Post-Traumatic Stress in Divers
Psychological First Aid (PFA) equips individuals with the skills to recognize signs of distress in scuba divers, such as changes in behavior, mood swings, or withdrawal from group activities. By being vigilant and observant, divers can identify early indicators of stress or anxiety, which can prevent more serious psychological issues from developing underwater or post-dive.
PFA provides divers with the tools to offer immediate support and reassurance to their peers. This can involve active listening, offering a calm presence, and validating the distressed diver’s feelings. Such support can help alleviate anxiety and promote a sense of safety and security, which is important in a potentially high-stress environment like scuba diving.
The Impact of Psychological First Aid for Scuba Divers on Long-Term Dive Enjoyment
Research has shown that scuba divers may experience symptoms of post-traumatic stress (PTS) following an adverse event in diving. This lead to various problems in future diving with anxiety, increased risk of panic, communication or clear thinking and problem-solving. It can also mean divers leave the activity. PFA can help to reduce the likelihood of developing PTS conditions through stabilisation and safety, supporting of processing the experience (via safety, rest and connection) and, where needed, directing to early professional support.
Another important impact of PFA on long-term enjoyment is its role in promoting resilience. By teaching divers coping strategies and stress management techniques, PFA equips them with the tools they need to handle future challenges more effectively. This resilience not only helps divers recover from immediate distress but also prepares them to face potential difficulties with greater confidence and composure, thereby enhancing their overall diving experience.
Finally, PFA helps in normalizing the emotional responses that divers may experience after a distressing event. By validating their feelings and providing appropriate support, PFA reduces the stigma associated with seeking help for psychological issues. This normalization encourages divers to address their emotional well-being proactively, leading to a healthier and more enjoyable long-term relationship with diving.
Resources and Courses on Psychological First Aid
One way to learn psychological first aid (PFA) in the UK is through online courses offered by reputable organizations. The British Red Cross, for example, provides a comprehensive online course on psychological first aid that covers the basics and more advanced techniques. These courses are designed to be accessible and can be completed at your own pace.
Another option is to attend in-person workshops and training sessions. Organizations such as Mental Health First Aid (MHFA) England offer various courses that include elements of psychological first aid. These sessions often provide hands-on experience and the opportunity to practice skills in a supportive environment.
Universities and academic institutions also offer courses and certifications in psychological first aid. For instance, King’s College London has a range of mental health and psychological support courses that might include PFA as part of their curriculum. Checking the course offerings of local universities can be a good way to find specialized training.
The WHO have also produced a field guide for workers, that outlines the steps of psychological first aid. This may be useful to diving professionals with limited access to healthcare support.
The WHO Field Guide for Psychological First Aid
The WHO Field Guide for Psychological First Aid (PFA) is a comprehensive manual designed to offer practical guidance for providing psychological support in the aftermath of a crisis. It is especially useful for non-mental health professionals who find themselves in situations where immediate psychological assistance is needed. The guide emphasizes the importance of ‘Look, Listen, and Link’ as the core principles of PFA. ‘Look’ involves assessing the situation and identifying individuals who may need support. ‘Listen’ focuses on providing a compassionate ear and understanding the needs and concerns of those affected. ‘Link’ is about connecting individuals with the necessary services and support systems.
One of the key aspects of the WHO Field Guide is its focus on cultural sensitivity and adaptability. It encourages responders to be aware of cultural norms and values, ensuring that the support provided is respectful and appropriate to the affected individuals’ backgrounds. The guide also outlines the importance of self-care for those providing PFA. It stresses that responders should be aware of their own emotional and physical well-being, and seek support if they find themselves overwhelmed by the demands of providing psychological first aid.
Another critical component of the WHO Field Guide is its emphasis on ethical considerations. It advises responders to maintain confidentiality, obtain consent before providing assistance, and respect the autonomy and dignity of those they are helping. The WHO Field Guide for PFA is designed to be a flexible tool that can be adapted to various contexts and crises, making it an invaluable resource for anyone involved in emergency response, including scuba divers who may encounter individuals in distress during their activities.
Psychological First Aid in Scuba Diving
Training in(physical/medical) First Aid is generally promoted and provided for all levels of scuba divers. A First Aid qualification is often a pre-requesite for professional level training. However, Psychological First Aid is not nearly as integrated in scuba diving. I know that PADI’s Emergency First Response courses include a distinctive specialty in Mental Health Awareness, written by Dr Richard Castle, a Clinical Psychologist. This is an awareness-level course, and then can lead onto psychological first aid courses. At this time I am not aware of PFA integration diver or dive-professional training in any of the larger diving agencies/organisations. Let me know if you have seen any!
What can we do?
We can ask dive centres to provide access to mental health resources and support. Dive centers and organizations can offer information about local mental health professionals, helplines, and online resources. Having these resources readily available can make it easier for divers to seek help when needed. The Fit To Dive website had a diver-specific resource with information and signposting for those involved in any distressing or traumatic event in diving. There are also wider help sources, such as the NHS mental health line (111, option 2). Such resources do not necessarily need to be posted on the front door of the dive centre, but can certainly be recorded within safety plans/procedures, available to provide if needed.
We can create a culture of mental health awareness within the diving community. This does not need to be a major effort, and can be done by simple changes, such as checking in on how divers are feeling before the dive (something many instructors/centres/clubs may already do routinely). This can also be achieved through workshops, seminars, and regular discussions about the importance of mental health. Encouraging experienced divers to share their experiences can also help in reducing stigma and promoting a supportive environment. This is something I have seen more commonly in recent years, for example on the British Sub Aqua Club website, and various podcasts and magazines.
Training Scuba Diving Instructors in Psychological First Aid?
Professional diving (guides, instructors) development does include training to ensure the safety and well-being of students. This training primarily focuses on physical safety, diving techniques, and emergency response procedures. However, the inclusion of psychological first aid (PFA) in their training can vary significantly depending on the certification agency and the specific instructor’s background. Given the unique challenges and potential psychological stressors associated with scuba diving, some instructors may seek additional training in psychological first aid independently. This can include courses offered by organizations such as the Red Cross or specialized training programs focused on mental health support in high-stress environments.
Benefits to divers and guides/instructors
Psychological first aid training equips individuals with the skills to provide immediate, compassionate support to those experiencing psychological distress. For scuba diving instructors, this can be particularly valuable in helping divers manage anxiety, panic, or trauma that may arise during or after a dive. It is not unusual for dive training to bring up a range of psychological issues for some students, with diving professionals under pressure to enter the role of a mental health care professional, something for which they are not trained, qualified, insured or paid! There are multiple risks when this happens, both for student and instructor. Regularly taking on this additional role can also contribute to burnout in diving professionals.
It’s arguable that instructors/guides with PFA training can better recognize signs of psychological distress and offer appropriate support or referrals. This would mean strengthening skills in offering immediate, compassionate responses to distress, with more confidence in the boundary of their role of diving professional.
Integration of PFA into dive professional training is a discussion for the diving agencies/organisations and the wider diving community. In its absence, it may be helpful for dive leaders and instructors to be trained in PFA and are prepared to handle psychological emergencies. They should be able to provide immediate support, such as calming a panicked diver, and know when to seek professional help. This training can be part of their certification and ongoing professional development. Given the unique challenges and potential psychological stressors associated with scuba diving, some instructors may seek additional training in psychological first aid independently. This can include courses offered by organizations such as the Red Cross or specialized training programs focused on mental health support in high-stress environments.
Look-Listen-Link
The ‘Look, Listen, Link’ model is a structured approach to providing psychological first aid (PFA) that can be particularly useful for scuba divers. The first step, ‘Look,’ involves observing the environment and the individuals within it. This means being aware of any potential hazards, signs of distress, or unusual behavior that might indicate someone is struggling psychologically. For scuba divers, this could involve noting if a diver appears unusually anxious, disoriented, or is exhibiting signs of panic either underwater or on the surface.
‘Listen’ is the second step and focuses on active listening and empathetic communication. This involves giving the distressed individual your full attention, listening to their concerns without interrupting, and validating their feelings. For scuba divers, this might mean taking the time to listen to a buddy who is expressing fear or anxiety about a dive, or who has just experienced a stressful underwater situation. It’s important to create a safe space where they feel heard and understood.
The final step, ‘Link,’ involves connecting the individual to appropriate support and resources. This could mean providing immediate practical help, such as assisting with equipment, or offering emotional support through reassurance and encouragement. For scuba divers, linking might also involve guiding the distressed diver to professional help if needed, such as a dive medic or a mental health professional. Additionally, it could include suggesting known coping strategies such as grounding, see more.
(This article was written with Reword AI co-writer. It is a mix of human and AI generated writing, based in a human idea to be conveyed. It has passed a plagiarism check and we are willing to revise credits/references.)
blog.fittodive.org 