# Psychological first aid in a cross-border medical emergency drill: Detected barriers, perceptions, and opportunities for improvement

## TL;DR

This study evaluates how Psychological First Aid (PFA) was implemented during a cross-border medical emergency drill, identifying barriers and opportunities for improvement in international collaboration.

## Contribution

The study provides insights into the practical challenges and effectiveness of PFA protocols in a multi-agent, multicultural emergency setting.

## Key findings

- The Psychological Emergency Unit (PEU) performed well in clinical and ethical aspects but had operational shortcomings.
- Language barriers hindered cross-border coordination, highlighting the need for interpreters and intercultural mediation.
- PFA for healthcare personnel was not planned, preventing its implementation for this group.

## Abstract

Disasters, especially cross-border ones, represent a significant challenge for public health, with potential repercussions on the mental health of both the victims and the first responders. In this context, Psychological First Aid (PFA) interventions in a safe area near the disaster site are essential to mitigate an acute emotional impact and prevent the onset of subsequent psychological disorders. In this context, the aim of this study is to evaluate the implementation and management of a PFA protocol in an international collaboration setting, thus exploring not only the effectiveness of the training but also the coordination of these protocols in emergency situations within a multi-agent, multicultural environment. A cross-border mass casualty incident simulation was conducted, which involved emergency medical services from Spain, France, and Andorra. Agreed cross-border disaster response protocols were implemented, including the PFA protocol, which was implemented by a Psychological Emergency Unit (PEU). Both qualitative and quantitative data collection and analysis techniques were employed. Strengths, such as the clinical and ethical response, were observed for the PEU performance, though operational and coordination shortcomings were also identified, including a critical weakness in the planning phase where the need for PFA for healthcare personnel was not anticipated, thus preventing its implementation for this group. Cross-border coordination faced challenges due to language barriers, thus underscoring the importance of interpreter availability and intercultural mediation in multinational emergency responses. Strengths and weaknesses were analyzed, and suggestions for improvement were proposed. The simulation provided valuable insights into the performance and applicability of tested PFA protocols in a cross-border context. Strengthening training and operational planning will be key to optimizing the response in real-life situations.