In this first video in the last week of the MOOC on psychological first aid, we will try to reflect on and mostly motivate you so that you become aware of the importance of the self-care guidelines of the people who assist, either as volunteers or as professionals in critical situations. Working in this kind of situations in daily crisis, in emergencies, in catastrophes, means exposing to some risks. These risks are basically related to five different factors. The first one is a continuous contact with an extreme pain, usually overcome from affected people, from survivors, from people indirectly affected by the critical situation. The second factor is realizing at the moment of the event that neither the affected nor us have so much control on our life as we think we have. Facing a situation such as assisting someone who has just lost a son in a traffic accident, means thinking in any moment during our way home that this might happen in our own life, which means one morning our phone might ring and we could be informed of a situation, an accident, a serious problem in our own life. So the contact with emergencies periodically reminds us that we don't have a direct control on all the fields of our lives. But also, and as a logic consequence in the third factor means we must face unexpected deaths, traumatic deaths and these deaths disrupt and twist our lives. You don't usually wake up thinking you might die, neither do I, I don't wake up thinking my kids might die. When I have to assist in an emergency, later I think of my kids and what would happen to them if I were in a situation as the people I've just worked with. This causes a wear, this causes stress. Finally there's a fourth factor which is the fact that being in contact with these situations makes us aware that although we help people recovery, although people actually recover, there are traumatic facts the consequences of which they will carry in their lives, from here to the future, probably until they die. That is, it makes us aware that not all traumatic facts are repaired in a 100% and this scares us. The fifth factor is related to the critical incidents related to violence, with the violence one person applies to another. Being aware of the damage, of the brutality a human can apply to another person, deeply worries us. And so it is also a risk for our vision of life. Synthesizing, we could say contact with critical incidents, emergencies and disasters generates two basic consequences on us. On one side our vision of life becomes more realistic but also more though, we are less confident in the fact that life is calm, tranquil and without shocks. We know life sometimes plays against us and is though. But also, when working on it assisting people who are in touch with this pain, people who suffer, we also suffer an important wear. If we add this less safe vision of life and our wear of assisting this people we have the two elements that lead us to the thing known as wear due to empathy syndrome. Before we know this syndrome better, we will stop for a moment in empathy. Empathy is absolutely necessary, not only to provide psychological first aid but also to assist in other stages people who suffer and people who have passed through and are trying to come over a critical incident. We can't work with a shield, we need empathy to understand them, to help them ask for help, to get closer to them. But it's a double-edged sword because using this empathy continuously, not being able to set an excessive emotional distance, because this makes us give a less effective assistance, it makes us vulnerable, it doesn't only wear us, it also makes us perceive the affected ones' pain better. This helps them but it is usually against us. So empathy has two sides, two edges. A positive one for affected people and another that can be against us. Let's see more deeply what is the wear due to empathy syndrome, the burn out, but first let me say I'm not trying to scare you, I'm not telling you you shouldn't do this job, I'm not telling you assisting providing psychological first aid is a high risk task, definitely not. What I want you to understand is that facing pain, critical incidents and emergencies involves the presence of a certain risk. If you are aware of this risk and the elements that compose it, you will know how to protect yourself, prevent, and mostly what I'm trying to show in this video, so you will be able to recover properly. So risk awareness here is to help you, to encourage you to take care of yourself, nothing else. We will know better the burn out syndrome. International studies demonstrate this is composed by three elements, as if we said, three backpacks, three drawers full of things that accumulate. On one side non-solved previous traumatic experiences previous to the moment when we dedicated to the field of emergencies or critical incidents. This is something most of us share. Many of us have lived a difficult or traumatic situation, we didn't know what to do and we promised that the next time that happened we would have tools to help other people. This traumatic stress previous is the first element. In ideal cases it's important to solve this before focusing in the volunteer or professional assistance in emergencies. In the second block we have secondary traumatic stress, which is the one which accumulates due to the exposition to the risk factors I previously explained as the characteristic critical incidents'. They live this secondary stress because affected people live the primary one and we pick up the secondary exposure to other's pain. And the third block is related to continuous wear due to accumulating the exhaustion and fatigue of having faced those two previous stresses, that is, if it's our case, carrying previous traumatic stress, facing secondary stress and being exhausted because of it. Which are the alert signs that you or someone you know can be suffering the burn out syndrome? A very important remark before explaining these signs. Many of them are compatible with or are even more frequent in some illnesses and symptomatology. So before resolving that you or this person you know is having this symptom due to the burn out syndrome, check health services, both medical and psychological, so that they can discard other organic diseases and can help telling you that we are actually talking on an empathy burn out. Otherwise there might be any hidden illness and so it couldn't be properly treated. Between the empathy burnout alert symptoms we have a group which are basically physical such as fatigue, muscular pain, gastrointestinal problems, sleep problems, changes in food habits, they are a group of symptoms that express certain physical discomfort. We also have the equivalents at a psychological level such as irritability, bad mood, anxiety and even some aggressiveness, frustration, a series of symptoms that express, not through the body but through other feelings. In third place there are some signs that are related to the task itself, such as concentration problems but mostly certain difficulty to begin doing what we must do, that is, people very motivated to help that suddenly begin being late, miss meetings and even generate an absenteeism standard. If you see this in yourself or in others it might be happening that they are having difficulties to face what their presence and assistance in critical incidents involves. And finally the fourth symptoms group is related to this malaise, some of these symptoms involve an isolation. Burnt out people usually isolate themselves and so begin showing less communication, isolation and even problems to socialize with their partners. If this appears in someone who wasn't like this you might also suppose we are talking on an empathy burn out. Well, what do we have to do to prevent this syndrome from happening? What do we have to do basically to take care of ourselves and avoid being worn out? There are three groups with different sizes. The first one are daily routines everybody must do, but you as a person who is occasionally or usually exposed to highly stressing situations must do it more frequently. Routines which are for every day, not only for when you come from assisting in a critical incident. The second block are some techniques and resources you will use when coming back from a critical incident. When you come back from a place in which there have been psychological first aid, in which there has been suffering, in which you have worked with people, you must incorporate certain self-care habits and routines which are special for the post-incident. And finally there's a third techniques group which we will explain in other videos and which is related to a group intervention to help you and your colleagues who have also been participating to recovery without generating sequels, which are techniques especially designed with this finality. Which are these daily routines? Each one of you must develop a toolbox full of things that help taking care of himself and empower his resilience. However there are certain factors which we know that almost universally help us during recovery process and help us facing stressful situations. A basic one, the first one maybe is planning the day, generally with an appropriate resting and disconnection time, that is, not when you come back from your job, either from critical incidents or anything else, always plan a certain disconnection and rest time, resting during weekend isn't enough. Precisely because we are under high pressure situations. Keep your social contacts, family, friends and community as they are excellent vehicles to strengthen our recovery and resilience abilities. The same happens with sports practice, mostly if they're at the outside, and cultural and leisure activities. Here each one must investigate his own interests, one will like one thing and the other will like another one, but being able to practice this kind of activities, that is, the most rudimentary part of our life helps us compensating the view of the tough things we usually have to face when we work with affected people. A factor that can be highly healing is being in contact with nature, as nature has the power of generating endorphins which are substances in our brain and help us feeling less pain and feeling better, and this is an universal phenomenon, so I understand it's a very powerful phenomenon. So try to keep contact with nature often. We also reach the same objective with meditation and relaxation techniques which are two appropriate ways to try to reduce the stress and focus on the task of not anticipating consequences, not anticipating hurries, not anticipating pressure. So if you practice these techniques don't stop doing it and if you are new applying psychological first aid, maybe you might learn some relaxation technique that will help you recovering better. It's very important for everybody to have a hobby, but for us it's even more important. The hobby is a leisure activity we like, we internalize and gives us pleasure. More specifically, we must have a hobby and spend some time on it, because almost everybody has a hobby but not everybody dedicates it some time. And it's very important that you take this time as a health increasing measure, as a prevention for burn out syndrome. And finally a very simple thing, try to be exposed to sun at least 30 daily minutes. Walking, sitting, doing sport, having a coffee, but in contact with sunlight. It also strengthens endorphins and generates mental health, and I think we all can try to be outdoors exposed to the sun 30 minutes a day. Let's now go to the self-care techniques when we come back from a critical incident. Well, these techniques basically consist on a three-step ritual. The first one is ventilation, after you have been assisting in a critical incident, you'll usually need to go out and share what you just did, what you didn't do, what impressed you. This is informally, formally there are other informal techniques we will later see. The problem is who are you going to do this ventilation with, because experience tells us when someone who is a professional or volunteer assistant sees a critical situation and then he goes back to his family, he has certain inclination to explain what he did and the family asks how did it go, what happened, what did he have to do, but here there's a really important risk, because you are trained on how to apply psychological first aid, you know what you are doing, you are learning self-care steps, you know which are the reactions, you have tools. But your family doesn't and so they start hearing things, they must deal with the same things as you: death, pain, the fact that life can't be controlled, but without these tools or a vocation, so we must be very careful when sharing this kind of situations with the family. In fact, my advice is that if you are new in this situation you should talk to your couple, kids, friends, and let them choose if they'd like you to tell them or they prefer not hearing about what you did. In our team, in example, most of us don't tell anything to our families, our families know we have been in an emergency, they know that after an emergency we like doing things, some people go to the cinema, some go to a restaurant with their couple, some go for a long walk, but no details are asked. It's good to ventilate these details with people who were in the scene and who did the same as you and knows the tools as you know them, so ventilating is good but we must always check who we're doing it with. After this ventilation, which doesn't have to be right after the incident, maybe you'll need and it would be good for you a moment of decompression. Let's see the decompression of this pain transition stage, of the extraordinary, of the emergency, of the traumatic thing to our normal life in which everything is just like before the critical incident. To do so, we all end up developing some kind of rituals. Some do the washing, others iron clothes, others wash their dog or clean the garden, others cook, but if you look at all these you will see what these routines have in common is that they take us back to our daily routine. We have been assisting people affected by, in example, a terrorist attack, for these people life has dramatically changed but it's good and necessary symbolizing that in our house doing the washing is still important, and we must wash clothes and iron them because this connects us to normal life. And this is very important for you, as you will find out what to do when you come back but this decompression is a vital step, and from here you must increase self-care guidelines you already do in your daily life. In fact, we recommend you to double it, if usually when you haven't been in a critical incident you do two or three things to take care of yourself, during the three or four days after the incident do it seven or eight times and you will see how these measures can protect you from the difficulty or the stress which assisting in this kind of situations involve. Finally, and I will just mention it because there are four videos dedicated to this, there are group techniques, defusing and debriefing, which are a structured way to recover and reprocess what you have lived in group and with the help of a session host. People who have participated in a critical incident get together to apply these protocols and ease their recovery. A last thought. you, me, all those who are doing this course are doing it because we love helping other people, because we are supportive with people's pain, so we have certain inclination to clearly see other people's pain and giving it importance. This is positive, pro-social and brought you to this course. This contains a high risk, which is that we are sensitive and open to the other's pain, when we are working in an emergency or a critical incident we always subordinate our needs to the affected ones'. And this is somehow correct, they are passing through a very bad moment and we are there to help. But doing this there might come a moment in which, due to attention and because of our will to help, that we don't feel fatigue, we don't seem to have any need, we don't feel hungry, we don't feel thirsty, we don't need to rest, we don't need anything because we have unlimited energy. Obviously it's not that way. Take into account that if you are burnt out, if you collapse helping other people we are losing someone who can do something very important and you won't be able to help people who are suffering anymore. So have a clear scheme. When you are working with critical incidents, the first thing is taking care of yourself, the second thing is that you take care of yourself, the third is that you care about yourself and there's the fact that you must care about your team and let them care about you, that you care about your coordinator and let him care about you.