La toma de decisiones de rescatistas y la efectividad en la primera ayuda psicológica

Abstract

The protocol on Psychological First Aid (PFA) establishes a number of actions to take on victims who are in the area of an event. Through these actions, the victims are assisted and helped to feel calm but not passive. Regarding the implementation of PFA in disaster situations, the type of decision-making, analytic or intuitive, could represent an important factor in the effectiveness of the actions of aid provided by volunteers in emergencies and disaster situations. Modifications of a PFA protocol are presented to apply to victims in the early stages of a disaster; these modifications are intended to clear the life-saving area for the rescuer and reduce the risk of post-traumatic stress disorder (PTSD). Starting from the premises of the original model of Farchi, known as the Model of the 6 Cs, a simplified version for its application in Argentina was denominated the Model of the 4 Cs. In the same way, it is considered that, when assisting a person in a situation of crisis or disaster, the objective is to promote the activity of the prefrontal cortex and decrease the action of the limbic system. To do this, four guidelines are proposed: 1) Cognitive Communication, 2) Control and Challenge, 3) Commitment and 4) Continuity. Likewise, a PFA protocol based on the above mentioned model is presented. An explanatory and cross-sectional study was carried out with the objective of analyzing the effectiveness and the decision times when providing a PFA in the initial phases of a disaster, depending on the style and decision process involved. An intentional non-probabilistic sample, composed of 165 rescue volunteers from 4 fire stations in the AMBA area (Metropolitan Area and Greater Buenos Aires) and a headquarters of the Red Cross of the party of Tigre (San Fernando), was randomly divided into 2 groups (trained and untrained in PFA). Each volunteer was evaluated through the Software of the First Aid Interactive Psychological System (SIPAPSI); this consisted of a simulation of different crisis situations during which the participants must decide between different options presented in audiovisual format. The user must select the video that most closely approximates to what he or she would do in the presented situation. Then, the rescuers were randomly divided with respect to the slogan about the decision-making process used in the evaluation (“decide based on what you think”, rational, or “decide based on what you feel”, affective). The software SIPAPSI recorded the participant’s response and the response time for each scene. Likewise, each volunteer was evaluated using the test Bases for Urgent Decisions under Extreme Circumstances Inventory (BUDECI). The BUDECI is composed of 8 elements that evaluate the decision-making style in unexpected and very important situations according to two dimensions: affective and rational. Rescuers were divided according to their urgent decision-making style: affective or rational. Therefore, the volunteers were classified according to whether or not they presented an adjustment between the decision- making style and the decision-making process induced by the slogan. This allowed us to study the influence of this adjustment on the effectiveness and decision time in disaster situations. The results showed that the least effective and, at the same time, slowest were those trained rescuers with an urgent affective decision style but induced under an emotional process. The PFA training has enabled the acquisition of simple action strategies in emergencies and disaster situations. It is concluded that the rational decision-making style or a rational decision induction favors a greater effectiveness of the PFA actions. These results allow us to build an optimal decisional profile for the rescuers performance in crisis intervention tasks.

Se realizó un estudio explicativo y transversal con el objetivo de analizar la efectividad y los tiempos en la toma de decisiones al momento de brindar una primera ayuda psicológica (PAP) en las fases iniciales de un desastre en función del estilo y el proceso decisorio implicados. Se tomó una muestra no probabilística intencional de 165 voluntarios rescatistas de cuatro cuarteles de la zona de AMBA, se los dividió aleatoriamente en dos grupos (capacitados y no capacitados en PAP) y, a su vez, dichos grupos fueron divididos aleatoriamente respecto de la consigna impartida en la evaluación sobre el proceso decisorio a utilizar (decidir en función de lo que se piensa o de que lo que se siente). Asimismo, cada rescatista fue clasificado como “racional” o “afectivo” según el estilo decisorio urgente medido por el instrumento Bases for Urgent Decisions under Extreme Circumstances Inventory (BUDECI). Los resultados mostraron que los menos efectivos y más lentos fueron aquellos rescatistas capacitados con un estilo urgente decisorio afectivo, bajo una consigna que apelaba también a lo emocional. Este último grupo no presentó diferencias respecto de su efectividad cuando se lo comparó con el grupo de los no capacitados. La mayor efectividad la obtuvieron aquellos grupos que tenían un estilo o una consigna de tipo racional. La capacitación en PAP ha posibilitado la adquisición de estrategias de acción sencillas. Se concluye que el estilo decisorio y/o una inducción decisoria racionales favorecen una mayor efectividad de las acciones de PAP en las fases iniciales de un desastre.