In the worst moments, when the world seems to collapse for a moment, dozens of people are busy in the shadows. Help first: police, paramedics, firefighters, but also the first responders of the soul, these famous “crisis cells” whose work is essential.
During each large-scale disaster or each major tragedy, such as the one experienced in Laval in the last week, the first thing that is announced is the establishment of a “crisis cell” to offer support to people affected. What this means in concrete terms is that a real psychosocial intervention operation has been launched.
No matter where you are in Quebec, if misfortune strikes, the same initial scenario plays out again in three very specific acts. A procedure designed by Pierre-Paul Malenfant, now president of the Order of Social Workers and Marriage and Family Therapists of Quebec (OTSTCFQ).
From 2006 to 2018, he held the position of national advisor and trainer in the psychosocial component in the context of civil security and emergency measures for the Government of Quebec. With his team, he created the Quebec intervention model.
Sound the alert
Let’s step back for a moment to understand the mechanics behind triggering the psychosocial operation. When a tragedy occurs, the first witnesses will call 9-1-1. Police, firefighters and paramedics are then informed and dispatched to the scene.
As paramedics are actors in the health sector, the hospital near the event is informed and if the situation is deemed to be major, it will be put in code orange, explains Mr. Malenfant. This code orange means that several potential injured people could be brought in urgently.
By triggering this code orange, the psychosocial intervention team is alerted in turn. In each integrated health and social services center (CISSS and CIUSSS), a person provides care and mobilizes his colleagues.
The first 24 hours
As soon as the alert is given, dozens of psychologists, social workers, psychoeducators or other specialists will then drop everything to coordinate around the tragedy.
This is the first phase, that of immediate intervention, where uncertainty is managed and where managers will assess the situation to adapt their reaction according to the existing planning guide.
Some workers go to the scene, uncertain of what they are going to observe and of course without putting themselves in danger. As Pierre-Paul Malenfant describes it, you have to have a realistic perception of what is happening and of the state in which people are.
“We immediately begin to make interventions, mentions the one who is himself a social worker. We make sure people are safe. We make sure that the children are in contact with significant adults, with family. »
Quickly, we try to bring people together. In the case of the tragedy that occurred in Laval this week, we targeted a nearby school. On site, speakers welcome those who are nicknamed “primaries”.
“We identify people. We want names,” insists Mr. Malenfant. This step is crucial, because the closer the degree of exposure is to the event, “the more you have to monitor and support these people because they can develop adjustment problems,” he warns.
Other people are then identified among “the secondary ones”. We are talking about the rescue teams who came to the aid of the victims or neighbors who gave a hand. We then make sure to bring them to safety or call relatives if necessary.
In order to intercept the devastated relatives who will rush to the emergency room, workers are also sent to the hospital to welcome them. We then seek to ensure their safety, their comfort and to inform them of what is happening.
24 to 72 hours
A first post-mortem at the end of the immediate intervention makes it possible to specify the needs, then to assign tasks to the interveners who will continue the work. We designate who will be in charge of the children, parents, first responders, etc.
In this transitional stage, once a certain calm returns, targeted interventions are carried out with the people identified during the triage. We will then do individual or family work. Group activities can also be coordinated to provide psychosocial information to people.
We then distribute psychosocial information sheets adapted to each role, be it a victim, a bereaved person or a first responder. These six sheets were also designed by Pierre-Paul Malenfant and were used for the first time during the train derailment in Lac-Mégantic in July 2013.
The documents of a few pages aim to popularize what they experienced psychologically and physiologically. Food for thought, advice and help resources also appear on the sheets.
the after
When the dust settles and the cameras have left the scene, the victims and the bereaved stay put. Their pain is still sharp and time must now be taken to heal. We are talking about the recovery phase.
“It’s quite a challenge, recognizes the expert. And it can last a long time. »
Pierre-Paul Malenfant speaks knowingly. Following the fire that killed 32 people in a residence for the elderly in L’Isle-Verte in 2014, it was he who coordinated this intervention. Eight months ago.
We then offer accompaniment to people in the community in their grieving process. We also look for signs of post-traumatic reactions. It is also at this time that the people in care will integrate existing psychological assistance programs offered in their region.
The aim is to help people in their process of adapting to their new situation.
Dr. Mélissa Généreux, who was regional director of public health in Estrie at the time of the Lac-Mégantic tragedy, has developed world-renowned expertise in this specific stage.
Under his leadership, Quebec created a network called the “Eclaireurs” in all regions. Their job is to meet people in all sorts of circumstances, informally, to make sure the community as a whole is doing well.
One of Dr. Généreux’s concerns is that the magnitude of the shock wave is overlooked.
“The basic pool of people affected may be larger than we think,” she recalls. The extended family, the neighbours, the parents or the staff of neighboring daycare centers may have been shaken.
With the media coverage of the drama, many people were also able to suffer indirectly. If this is the case, as Prime Minister François Legault said, we must know how to accept the help that is offered to us.