A worn out individual with torn out clothes...sitting on the ground...holding his head in both hands...elbows on the knees.... Upon making eye contact, the eyes do not reveal the man's emotional state...Confused? Enraged? Detached? Dejected? All of the above?

This scene is familiar to some mental health care workers as they attend to trauma victims. How are we to approach this person if we wish to help? Along with many "ought to do's" professed by authorities, agencies and organizations, there are very important "ought NOT to do's." The list below includes a few experienced by the author during his thirty year career during the psychiatric emergencies in disaster conditions:

1) Do NOT approach this person as if s/he is a patient. S/he is THE SURVIVOR.

2) Do NOT try to complete psychiatric intake! The people in early stages of trauma are more receptive in following brief directions than answering questions.

3) Do NOT pull the survivor towards you or push him/her behind the back! Instead, lead him/her to move towards safer & more comfortable areas while you maintain shoulder-to-shoulder contact.

4) Do NOT present your CV to the survivor! Introduce yourself with your first name only until the basic rapport is established.

5) Do NOT ask open-ended questions! Ask the concrete ones at least initially to comfort the survivor. Ask him/her to reply with head nod-and-or-shake if s/he is not in shape to talk.

6) Do NOT say, "I know how you feel!" Especially if you have never been in his/her shoes before.

7) Do NOT minimize, criticize, condescend or patronize the survivor.

8) Do NOT just do something, stay there hence the reversal of the motto! BE WITH THE SURVIVOR.

9) Do NOT attempt to force him/her to wash, drink or eat without getting his/her O.K. first.

Once these are respected by the approaching health care provider, the survivor becomes more receptive to further inquiries.

References:

Barriers that Impede the Psychiatrist's Function in the Time of a Disaster American Psychiatric Association http://www.psych.org/pract_of_psych/dpc_barriers.cfm

2) Disaster Psychiatry: Principles and Practice American Psychiatric Association http://www.psych.org/pract_of_psych/principles_and_practice3201.cfm

09/17/01)

Fuat Ulus, M.D., has been the Team Psychiatrist of the Lehigh Valley Assertive Community Treatment Program, Crisis Residence, Drug & Alcohol Treatment Setting and Partial Hospitalization located in Allentown and Bethlehem, PA for more than three years. He participated in relief efforts when the devastating quake struck the Turkish Republic on August 19, 1999.