How does Cumbria cope with the trauma of the shootings?
Shock and disbelief. Those two words have littered reports from west Cumbria, where the seemingly ordinary Derrick Bird went on the rampage shooting 12 people dead and injuring 11 others.
But what happens now? After the initial response, how does a community cope with such an event?
And what does the future hold for this relatively close-knit group of people - made up of the bereaved and all those associated with them, the survivors, the witnesses and those who are simply feeling the impact because they live in the area?
And of course health and emergency service workers are not immune from the effects of such a violent crime - all are provided with chances to be debriefed and receive counselling.
End Quote Liz Bolt Psychological advice clinic, West Cumberland Hospital
At the moment the best advice for people is to do what comes naturally when they are feeling stressed. For some people that's talking, for some that's taking themselves off quietly”
GP Dr Barrie Walker, who tried to help one of the victims, spoke emotionally to the BBC about how painful the day had been and how "impotent" he had felt in such an overwhelming situation.
"We're not equipped to deal with major trauma... we're not Northern Ireland, we're not Moss Side, we're not used to dealing with major trauma and yet we have to deal with a gunshot wound, a guy who's bleeding and losing his blood and there's no ambulance coming for two hours," he said.
In this immediate aftermath support is already being provided by local health services to those who need it, and Cumbria Police have a team of officers working with the families of the dead.
Many will still need that assistance in the weeks and months, even years, to come.'Very distressing'
Liz Bolt is in charge of the psychological advice clinic at the West Cumberland Hospital, where counselling sessions are being held.
She told BBC Radio 4's The World At One a small number of people had contacted them so far, which was "to be expected".
"At this stage most people will be talking to friends, family, doing what they would do in any stressful situation really.
"But we've had a small number who've needed something extra and they've made contact with us."
• PSYCHOLOGICAL ADVICE
• 24-hour help and advice line for people who are struggling or overwhelmed - 0800 171 2333
• Information leaflet published, suggesting some will need therapy to cope with their feelings
• Cumbria Partnership NHS Foundation Trust running sessions at the psychology department, West Cumberland Hospital, for those affected.
- Sessions available from 0800 to 2000 on 3 and 4 June.
She said there were various reasons why some people had sought immediate professional help.
"It may be that their own family and friends are so traumatised that they don't want to burden them further.
"For some it might be that at the moment they've got no-one to talk to.
"Obviously what people have experienced has been very traumatic, very distressing and people need support with that."
The daughter of one victim - 64-year-old Michael Pike - told the BBC that they wanted to deal with the tragedy by celebrating her father's life in a positive way, rather than concentrating on the questions of 'why' and 'how'.
Jude Talbot, who lives in Slough, travelled to Seascale to be with her mother and brother when the news of her father's death came through on Wednesday.
She told The World At One: "I'm not hugely interested in what actually happened. I'm more interested in celebrating the life my father had. That's the sort of person he was, he was a humanist, he thoroughly believed that we should celebrate life, not rake over coals.
"So that's what we are doing, we are focusing on my father and the happy times we've had with him. We are not really engaging with the other stuff."
It is well documented that the full effects of trauma can often take a while to emerge, after the initial shock of an event.
Ms Bolt added: "Most people will feel some impact immediately, and most of those people will talk and do what they normally do to cope with things and in a few weeks they will be getting on with their lives.
"But a minority of people will find it hard to get over, it will continue for weeks and months ahead, maybe give them nightmares, flashbacks - [they will be] feeling like they are being more short-tempered than normal.
"That small number of people in time will perhaps need more specialist input.
"But at the moment the best advice for people is to do what comes naturally when they are feeling stressed. For some people that's talking, for some people that's taking themselves off quietly and just thinking by themselves, it's a very personal thing."Children 'playing shooting'
She said it was "hard" for children affected by such a tragedy because they are used to the idea - especially in a normally quiet area - that "bad things like that don't happen here".
"Although obviously in recent months in the west of Cumbria we've had a lot of things, we've had the floods and then last week there was the bus crash so children locally must be feeling a bit like 'well yes, bad things do definitely happen here'.
"And what they need is just to be, similarly, allowed to do whatever comes naturally to them. Some may want to talk about it. Some may want to do anything at all except talk about it.
"You'll find some playing with toys about shootings in the next few weeks and that's OK, that's what children do naturally."
Mark Hoelterhoff, a psychology lecturer at the University of Cumbria - who is advising local police officers on how to deal with the effects of trauma - said he visited Whitehaven after the killings on Wednesday and his six-year-old daughter was "terrified that I was going there and could be shot".
"Both adults and children should take the opportunity to talk about it. Children need to know they are safe and that even though horrible things happen, they are still going to be OK."
He added that the wider "emotional results" of Derrick Bird's shooting rampage would start to emerge in the coming days.
He said: "It doesn't matter whether you are talking about police officers, people involved in the shootings or just witnesses.
"Anyone who has experienced a trauma can have nightmares and flashbacks."
Dr Hoelterhoff said that talking about what happened, however painful it might be, was vital.
He said: "It helps you to take a step away from it."
Meanwhile Cumbria Police said that helping and supporting the many families affected by the shootings was of "utmost importance" to the force, which has put more than 30 family liaison officers on the case.
And in the health service, a spokeswoman for the Cumbria Partnership NHS Foundation Trust said some local people coming to them would already be struggling to cope following the Keswick coach crash that killed two teenagers last week, only to find themselves in another "horrific situation".
She said: "Many people from west Cumbria will have been psychologically affected by the recent shootings.
"Some will feel saddened, frightened or horrified.
"Overall, people are resilient when traumatic events occur and most people will recover without long-term problems. However it is normal to have strong reactions," she said.