aims to “translate” the contemporary knowledge into practical and doable recommendations as it takes into account technical advances on one hand and the current nature of terror attack on the other. The idea was to create a guideline focusing on preparation towards and recommendations for what should (and should not) be done in the first hours, days, week and month after an exposure to traumatic event (and more specifically, terror attack).
Telegram-based chat bot for Ukrainians affected by War
Immediately on the second day of the war, a unique Telegram-chatbot based on the 1stA2T recommendations with self-help tools was activated. A chatbot is a convenient service that simulates a dialogue with a virtual specialist on a mobile phone https://t.me/friend_first_aid_bot.
It constantly engages the user’s attention, and contains various exercises, tasks, useful recommendations on how to cope with ongoing stress. The content of the chatbot is based on psychological first aid (WHO, 2013). For this PFA recommendations had to be adjusted to the ongoing stress of the war by experts from our working group (Prof. Arieh Shalev, Prof. Marit Sijbrandij, Dr Kate Porcheret).
Chat bot uses a specific script for those in unsafe environments, as well as those in safe places. Additionally, it includes recommendations on mindfulness and stress management for adults and minors. It was developed for the Ukrainian language, but is also available in English. After four weeks it has reached more than 40,000 users across and outside of Ukraine.
Donations are welcome, please donate using this link
How to Use 1stA2T Guideline?
Choose Guideline on menu.
Press Domain and choose one by one options from drop down menu: Domain, Intervention, Timeline, Population. The instructions will appear when all four domains will be selected.
The guideline contains easy to use and to apply recommendations for preferable responses following exposure to terror attack in different time points. Mobile application now available on App Store and Google Play.
Guideline Structure (When, What, Who) and Color Code.
- When? The guideline is divided to five time points:
• First 6 hours
• 6 to 12 hours
• 12 to 24 hours
• 24 hours to 1 week
• 1 to 4 weeks
For each time frame recommendation were made per:
– Stakeholders organizations (“Societal preparation” which include recommendations for task forces, rducation, communication, leadership, risk assessment and policy);
– Individuals (psychological and pharmacological, sleep regulation).
– A separate set of recommendations were made for media, social media, preparation and research.
The Guideline contains a set of recommendations per different population groups (adult, children, first responders).
- The recommendations in the Guideline were identified upon their scientific strength:
- Positive randomized controlled trial (RCT)/empirical evidence
- Knowledge/clinical knowledge
- Not recommended. Positive randomized controlled trial (RCT)/empirical evidence
- Research (pilot) data
The guideline takes into account that more than 80% of those who will be exposed to traumatic event will usually experience spontaneous recovery.
Thus, the guideline main agenda is to:
a) identify those who are at risk
b) focus on interventions which facilitate recovery (secondary prevention) and to avoid those which interfering with the natural powerful, effective spontaneous recovery process (in line with the clinical principle “Primum non nocere”).
The idea of the guideline is threefold:
a. How not to interfere with this naturalistic powerful process
b. How we can improve the outcome to those who are not experiencing spontaneous recovery
c. How we can identify, early on, those who are at risk and how to focus clinical and social support on those who are not recovering.
Throughout the process, the expert group recognized the timeline as a critical factor in which a recommendation or intervention is given, as a critical factor. Similar to the treatment of cardiovascular accident, in which intervention in the first 3.5 hours (giving Vasodilators) might be opposite to intervention after 3.5 hours (giving Vasoconstrictors), the idea is that same intervention might be helpful in one timeframe but harmful in another. Specifically to the guideline’s neuroscience based approach, interventions up to 6 hours following the terror attack (taking into account consolidation and reconsolidation processes ) are different than what one should do 1 week after the exposure (when the memory is already consolidated).
The Guideline includes global perspective on terrorism, regulation and policy management of the media\social media in traumatic events, recommendation for evidence based biological and psychological interventions at specific time frames, instructions to civilian, forcibly displaced people and military, first responders, sleep regulation and many more.
The structure of the guideline is unique as it anchors time points on one hand while implementing wide perspectives on the other hand (i.e., not only pharmacological and psychological interventions but also media and social media recommendations as well as research perspective).
Mental health profession teams (municipal, regional and national), along with Emergency Department stuff, media, first responders and policy makers.
In September 13-16 2018, a group of 24 experts (psychiatrists, neurobiologists, psychologists, neuroscientists, social workers, computer experts, public health, etc.) from 10 different countries met in Odesa (Ukraine) to conclude a year of collaboration.
Participants of the Advanced Research Workshop:
TOP left to right: Nic van der Wee, Isaac Galatzer-Levy, Emily Holmes, Ingrid Philippens, Erik de Soir, Stevan Hobfoll, Rachel Yehuda, Lior Carmi, Michel Duckers, Simon Wessely, Marit Sijbrandi, Robert Ursano; BOTTOM, from left to right: Rakesh Jetly, Arik Shalev, Eric Vermetten, Joseph Zohar, Giorgi Sikharulidze, Iryna Frankova, Kate Porcheret, Kerry Ressler (missing are Elana Newman, Grete Dyb, Oleg Chaban, Levent Küey, Dominique de Quervain).
This advanced research workshop (ARW) “Risk Management of Terrorism Induced Stress – Guidelines for the Golden Hours (Who, What and When)” was organized by Prof. E. Vermetten, Prof. J. Zohar, and Prof. O. Chaban, Dr. Iryna Frankova, Dr. Lior Carmi and supported by the NATO “Science for Peace and Security Program”.
As a result of experts’ collaboration, in 2020 a book was published:
Prof. Joseph Zohar, Sheba Medical Center (Israel)
Prof. Eric Vermetten, Leiden University, (The Netherlands)
Dr. Iryna Frankova, Bogomolets National Medical University (Ukraine)
Dr. Lior Carmi, Sheba Medical Center (Israel)
The development of the Website and Mobile Apps was supported by European College of Neuropsychopharmacology (ECNP).
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