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How to Do Emotional and Spiritual Triage in an Emergency - The Wordsmith's Forge
The Writing & Other Projects of Elizabeth Barrette
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How to Do Emotional and Spiritual Triage in an Emergency
While researching conventional triage systems, I also found this empath triage system. It's aimed at everyday encounters, however, rather than disaster scenes. I have personally handled emotional first aid at a disaster scene, so let me create a basic triage routine for that:


* The first thing you do in an emergency is case the scene. The second is pick a job. If you have selected Emotional First Aid, then:

* Do a wide sweep of the whole scene looking for people who are obviously melting down. If these are present, treat emotional meltdown first. These are the people most likely to go into shock, run into traffic, or otherwise suffer bad outcomes without immediate aid. In a mass-casualty incident, you will need to judge who needs your help the worst and who you can help the most. Probably you can treat just one severe emotional casualty. These people need the most help because they are invisibly bleeding out. Some won't be able to talk, and the ones who can, usually can't think clearly. They need someone to keep them physically safe and mentally buffered until they calm down enough to make their own decisions or you can hand them off to a friend or professional. Regrettably local-America doesn't offer much emergency psychological care unless the person is trying to hurt themselves or someone else, but helplines and a few other resources do exist.

* If nobody is melting down, make another sweep looking for people who are crying, throwing up, or otherwise showing moderate signs of distress. Sometimes you can get several of these to come together a little distance from ground zero so you can talk to them all at once. Stay calm, say reassuring things, and help them regain their emotional equilibrium if possible. Refer them to outside sources if those become available. This group has fairly consistent needs, mainly someone to lean on, and you can usually get them settled enough to begin self-care, which is mostly what they need to recover.

* If there are no obvious signs of distress, move through the crowd and look for people who are quietly upset. Try to identify who witnessed the event and/or knows someone involved, as they are likely to be upset even if they don't show it. If you pass the word that you're offering EFA, the "walking wounded" can come gather around you. Should the incident be big enough to last a while and involve supplies, put up a sign saying "Emotional First Aid." In local-America you may be the only one with those skills, but occasionally a professional may show up and take over for you. Among this group of people needing help, what some of them need will be a practical task to do. Look around, there's almost always something that needs done at a disaster scene. Some people can minimize their risk of crystallizing intrusive memories if they ram in something more positive. Others need to talk or sit quietly. You'll see the most diversity in this group, and you need to talk with them to find out what each person needs.

* Keep an eye out for secondary casualties. In a bad scene, sometimes one of the citizen responders or first responders will stagger away to go throw up, cry, or lean against a tree trying to pretend they're not freaking out. It's most prone to happen if they lose a patient, especially a child, but sometimes sheer overload or something else will do it. Ask how they are and if they need help. Responders of any type are more likely to have enough coping skills to say what they need. They're also more likely to snap "I'm fine!" Well, at least you tried.

* After you have taken care of other people's emotional needs, do a self-check. How are you feeling psychologically and physically? Do you need to use the bathroom, eat, drink, or lie down? How do you plan to process your experiences? Depending on the situation, you may feel relatively okay, somewhat stressed, or freaked out. Try to estimate the amount of damage you have taken, if any, and treat it accordingly. Here's a checklist for when you feel awful that covers most of the basics.

Remember, if all you do is keep someone from getting hit by a car or developing PTSD, you probably just saved a life. Go you.


Now here's a routine for ushers, soul workers, and other people with gifts relevant to helping the dying or dead instead of the living:

* Case the scene and select a job. If you have selected soul assistance, be as discreet as possible! It is not widely practiced in most modern societies, and if people catch you doing it, they may well knock the mop out of your hands before you can finish up. Consider these steps:

* If you can help the dying, start there. (See combat triage tips for physical clues to impending death, but most people who choose this task have subtle senses for that purpose.) You can prevent the most damage in this position. Just because they are "expectant" doesn't mean it's okay to let them suffer.
** If you can get close enough to touch them, try to find a relatively undamaged hand or other body part to hold. Talk to the person and work to keep them calm. They are more likely to have trouble transitioning if they are panicking. (In this, it's exactly like childbirth, and some of the same techniques help.) If they can breathe well, you can coach them on calm breathing or pain control breathing. If they're struggling to breathe, you can try muscle relaxation or invite them to listen to your breathing. Different techniques will work depending on why they are dying. What matters most is making sure they know they're not alone, and offering them something to focus on. If they can speak, ask about their religion if any. Knowing that lets you make a specific call for assistance from the death escort(s) of that tradition, or provide passing prayers if you or the victim know them. Otherwise you'll have to rely on your own.
** If you can't get close to the dying person, which is common with emergency personnel on scene, then you can still help by making a call to whatever death escort(s) you work with. It's basically like calling an ambulance, just for a later stage in the journey. If you're on good working terms with the most common religion in that locale, ask for their assistance too. In addition to spirit work, you also have the option of notifying a nearby church or prayer circle, which is a good idea with a messy incident that's going to hit tomorrow's papers. Some congregations have established methods for handling this stuff.
** Ethics vary by tradition and individual regarding whether or not to assist in the direction of a soul's travel. However, the majority seems to consider it acceptable to help the soul in whichever direction it is striving toward, whether it is trying to kick free of a mangled body or cling as long as possible. Sometimes souls make a choice that might have fraught outcomes, but it's their choice. It is advisable to know your stance before encountering this dilemma, as some individuals are only comfortable helping in one direction and others not at all.

* If nobody is actively dying, check for the recently dead. Quite often, a sudden violent death confuses the soul, and they're prone to getting stuck instead of moving on. You can help them and everyone else by assisting them on their way.
** If a soul is obviously panicking, first try to calm them down. Discourage them from wandering away at random, attaching to the spot of demise, or trying to crawl back into their dead body.
** If you can read the "ticket" that comes with religious affiliation, you can put them directly on that "route" yourself. People with strong faith typically know what they should expect upon death, but sudden death is as disorienting as a whack over the head and anyone can be knocked off course by it. This group of souls is easiest to help because all they need is a reminder and a nudge -- they'll usually snap out of the daze and make a beeline for their beloved destination.
** If you can open a door between worlds, just doing that is often sufficent to attract newly deceased souls to go through it; if not, you can gently shoo them along. If they have a preset destination, it will automatically take them there; if not, it lets out into the collective "bus station" where they will quite probably have no idea what to do, but that's okay because there are death escorts whose job it is to gather up the lost ones and help them figure out where to go. All you really need to do is get them through the gate. Remember that opening this door tends to be exhausting and is likely the last thing you'll be able to do. Make sure you have appropriate backup before doing it.
** If you can't do either of the more advanced things above, then call whatever death escort(s) you work with and ask them to handle the situation. They have more resources than you do.

* If you're not sure whether or not someone has died on scene, follow your tradition's guidelines for that situation. Souls who bounce well may fall out of their body and go right to their chosen route, even after an unexpected departure, and those rarely leave a trace. But some traditions have stuff you're supposed to say or do to keep the area clean and safe after any major mayhem or possible death.

* Sometimes the dying or the dead may give you a message to pass along. This may or may not be possible, but do your best.

* After taking care of others, check your own spiritual and other welfare. Apply self-care as needed.

* After leaving the scene, you may wish to plan for prayer, ritual, or other spiritual activities to soothe the soul(s) of the departed and the bereaved.

Remember that many people are afraid of dying in general and dying alone most of all. If what you can do is ease that passage, you've done a good job.

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