In order to develop effective plans Care for People Teams should identify the range of incident to prepare for and the range of people likely to be affected.

Range of Incidents

Care for People arrangements should follow the Integrated Emergency Management Principles outlined in the Preparing Scotland suite of guidance and focus on consequences not causes.

For instance, care for people issues can arise from a wide range of incidents which share few other characteristics. A flood, a terrorist attack or an industrial incident can all lead to similar requirements for shelter and support to a local community. As a result, many aspects of preparation can be generic in nature, focussing on mitigating the consequences of an emergency whilst, from a planning perspective, paying relatively little attention to the cause of the disruption. This all-risks approach, concentrating on consequences rather than causes, allows a process of generic planning which can be adapted readily to fit to a wide range of issues around response and recovery.

Range of people affected

People who are affected by emergencies frequently respond with great fortitude and resilience. Statutory responders should recognise this and should actively promote the fullest participation of local, affected populations.

People affected by emergencies will be drawn from all walks of life and backgrounds and fall into broad categories. They include:

• those physically injured in the emergency
• those directly involved in the emergency who are physically uninjured but who may be in emotional or psychological distress
• the bereaved, families and friends of those involved
• vulnerable people (including those with disabilities, medical conditions, learning difficulties, children and young people and elderly people)
• affected communities, which could be geographical or characterised by common interests, identity or demographic features
• those indirectly involved in the emergency who need support or reassurance
• rescuers and members of the public involved in the rescue effort, response workers and staff providing support in the aftermath of the emergency.

However, the list is not, and cannot be, comprehensive, as the impact on people's welfare will depend on the individual and the particular circumstances of an emergency. It is important to remember that there will be people made vulnerable by the emergency and those who were vulnerable before it happened.

It is recognised that there are sensitivities related to the use of generic terms to describe people affected by emergencies. In this guidance the term "those affected" is used simply as a means of describing the many categories of people affected by emergencies including responders.

Vulnerable People

Caring for vulnerable people in emergencies needs careful consideration and where possible, plans and arrangements should establish in advance the mechanisms for identifying those in the community who are known to be vulnerable, e.g. older people or those with disabilities. This may best be done by working with those agencies that have up to date records of individuals and an awareness of their needs. In some cases people may become vulnerable as a result of the incident (especially in an extended event), or may be vulnerable but not appear on any formal lists such as those without transport, elderly or frail people in their homes or people with temporary medical conditions. Plans and arrangements should consider how such people can be identified or contacted.

In addition, responding agencies should gather information about people who may have been made vulnerable by their direct involvement in the emergency.

The following factors are associated with an increased likelihood of distress and risk of developing mental health problems:

• perception of high threat to life;
• physical injury;
• circumstances of low controllability and predictability;
• the possibility that the emergency might recur;
• an experience of disproportionate distress at the time;
• experience of multiple losses (of relatives, friends or property);
• exposure to dead bodies or grotesque scenes;
• a high degree of destruction of community infrastructure and social networks;
• perceptions of limited social support and/or actual lack of this;
• pre-existing or previous mental disorder.

Recording systems should include the facility to collect relevant information on those people considered to be at risk of psychological distress, so that follow-up support can be offered.

Children and Young People

The specific needs of children who are affected by emergencies should be addressed and support and advice should be provided for parents and/or carers. Education services have an important role in restoring and normalising community life for children and their families.

Responders should be trained to recognise and respond to the needs of children affected by emergencies, whether or not they work with children normally. Reuniting children with a parent or other familiar/trusted adult should be a priority. Responders should begin from the assumption that parents (and carers) are the best placed to support their children and should empower them to do so. Professionals should not work directly with children without the consent of a parent or guardian. They should do so only if there is no familiar and trusted adult who is able to provide the necessary care, for example if the parents’ own reactions to the emergency overwhelm their ability to provide effective parenting. Schools and youth groups will have an important role in restoring and normalising community life for children.

Range of activities

Emergencies can affect people’s personal, social and economic lives and the impact may be transient or prolonged.

It is important for the Care for People Team to recognise the wide range and diversity of activities required to support and assist those affected by emergencies. In addition to immediate shelter and practical assistance, there may be a need to provide psychosocial support for a number of years. Survivors, the bereaved and others affected will expect a seamless response.

Utilising the Community Risk Register, the Regional Risk and Preparedness Assessment and their planning assumptions, the Team should consider the impacts of emergencies on their functions. They should then consider the services that individuals and communities will need as a result and the management arrangements that will be necessary to deliver them. They may include:

• administrative processes and the means of recording and tracking those affected and their needs;
• shelter and physical wellbeing;
• practical support and advice;
• emotional and psychological support;
• community wellbeing, regeneration and recovery;
• wellbeing and support for response staff; and
• effective communication with those affected and the public.

A stepped care model should be used that begins by attending to basic needs (such as safety, security, food, shelter, acute medical problems); it should then proceed through requests made by people, families and communities to non-specialised support services; and lastly to specialist mental health care service.

The stepped model of care should be based on the principles that of Psychological First Aid (PFA). There are a number of components of effective PFA, on page 11. The components should be modified to match the needs of each individual. A child, for example, will require a different explanation of trauma reactions than an adult. There is no particular order to follow, as this will depend on the people affected and on the emergency.

Key Components of Effective Psychological First Aid

• provide immediate care for physical needs
• protect from further threat and distress
• provide comfort and consolation for people in distress
• provide practical help and support for real-world-based tasks (e.g. arranging funerals, information gathering)
• provide information on coping and accessing additional support
• facilitate reunion with loved ones where possible and/or connection with social supports
• provide education about normal responses to trauma exposure including two essential elements:
  • recognising the range of reactions
  • respecting and validating the normality of the post-trauma reaction

The likelihood of a person developing more serious psychosocial problems or mental disorders will depend on many factors including the intensity and duration of their exposure to emergency-related stressors, certain prior experiences, and the availability, or otherwise, of social support. The stepped care model should be applied in ways that include a clear pathway for accessing specialist services for those people who are thought to be at particular risk.

As with other aspects of caring for people and managing the recovery following an emergency, the best outcomes are likely to be achieved by working in partnership with the affected people and communities, and by facilitating a high level of self- determination by those affected.

Further information and advice on psychological first aid can be found in the Preparing Scotland: Care for people affected by emergencies Supplement: Responding to the Psychosocial and Mental Health Needs of People Affected by Emergencies.