When faced with crisis, particularly threat to life or limb, a number of factors are important to consider, particularly for those individuals responding to those threats in a capacity as first responders. The downstream effects of appropriate mindset and mental preparedness cannot be overstated. Examination of numerous disaster events over the past years, whether they be natural or manmade in nature reveal both valuable lessons to be learned and consequences that were avoidable. Acknowledging the impact of stress on function, and adopting strategies to counter and replace previously learned maladaptive responses can make a difference when seconds count.

The physiologic impact of stress - Why we panic:

In January of 2005, 291 Hindu pilgrims attending the annual Kalubai Jatra pilgrimage at the Mandhardevi Kalubai temple in India’s Maharashta district died as a result of a panicked stampede that broke out. Witnesses later stated that the stampede began because of a fire caused by exploding gas canisters in nearby shops. Far more deaths were caused by the stampede than by the fire.

Romeo Vitelli notes that “while “fight or flight” is a natural human response when people think they are danger, this instinctive reaction may lead us to make very unwise decisions, especially if we are part of a large group of people trying to do the same thing” (Vitelli). The physiologic effects of panic triggers something atavistic, hardwired deep within our limbic system. At the group level it is extremely difficult to overcome, even in the presence of clearly marked exits or calm recorded voices telling us not to panic. At the individual level, we may experience distortion of time as we move through phases of denial, deliberation and finally action. We may experience tunnel vision, muffled hearing or other delays or impairment to our senses (Agency). Parasympathetic activation at the level of the central nervous system and systemic effects of catecholamines, such as epinephrine explain this in part. Another neurologic component lies in the paleomammalian cortex, or limbic system. It is here, in the amygdala and hippocampus where past memories are associated with strong emotions. These pairings can be triggered by new events, causing us to re-experience deep feelings of fear or dread, leading to inaction.

Disaster mindset: How we can overcome our hardwired circuits

Once we understand how these responses are formed, we can use this information to build new reactions. To prepare for combat, Marines utilize immediate action drills. These are sequences of actions with defined roles, both at the group and individual level in response from everything to an IED ambush with mass casualties to a chemical weapons attack. By rehearsing those responses over and over, they become automatic. Effectively, we are able to create new, stronger pairings in the amygdala, associating them with positive outcomes such as situational awareness and control, accountability of personnel, and ultimately survival. In their training materials, FEMA astutely recommends taking a pause to gather information using our special senses: sight, hearing, and smell. Is the scene here safe, or safer elsewhere? Can you detect the smell of smoke or see fire, or smell fuel or chemicals? Understandably, training your brain to respond calmly takes repetition and work to create hooks on which to anchor thoughts and actions, but it is feasible – even professionals work at it consistently. But when our best efforts to calm our mind fail, what then?
Navy Explosive Ordinance Device (EOD) technicians are people that diffuse bombs and improvised explosive devices or IEDs on a daily basis. They are extremely well-trained in numerous devices, and draw on that training to defuse and disable devices that they have never seen before. Eric Barker of Observer interviewed one of these extraordinary professionals to understand how they are able to stay “frosty” in life-and-death situations. They refer to the spiral that the panicked brain reverts to as “the rabbit hole.” What is X happens? What if I forgot about Y? Going down the rabbit hole is dangerous, so to avoid that, they do a threat assessment. What kind of problem is this? You consider a similar situation you’ve been in before that looked like this one. How did you resolve it? What worked? Generalize your knowledge from experiences that were similar. Maybe you didn’t perform that procedure, but you saw someone else do it. You have done this before, but only on a mannequin. This is called leveraging experience.
The second recommendation is to emphasize the positive, and focus on what you can control. An EOD tech recounts a situation in which he was trapped underwater in a net while trying to disable an underwater mine. “I’m still breathing, so that’s good. Now I can wiggle my fingers, so I got that going for me.” Take one small action to improve the situation, and then another. This combats spiraling negativity. Finally, remaining calm and focused on “the next step” is a key to staying in control of the situation. The next step may be to ask for help from a colleague. Instead of focusing on fear and panic, you remain mindfully engaged in the process and dismiss thoughts that aren’t helpful (Barker).

What you need to know

In summary, disaster mindset requires acknowledgement of our own physiology. It is natural to feel amped up, but we have to remain aware of our conditioned responses, and take steps to unlearn panic and replace those responses with immediate actions that are helpful and facilitate improvement of the situation. Drilling and practice can make new associations in the limbic cortex to empower instead of hinder when disaster strikes. Pause, and use all your senses to gather information and exercise situational awareness. Leverage your experience from previous situations. Stay focused on the problem you are solving and ask yourself what the next step is, don’t go down the rabbit hole. Emphasize positivity and incremental progress, and dismiss thoughts that aren’t helping you. Developing this mindset won’t happen overnight, but consistent application of few principles can make a difference when we are faced with high acuity situations and enable us to improve the situation and not become a casualty ourselves.

Bibliography

Agency, Federal Emergency Management. You are the help until help arrives. 25 August 2017. web. 25 August 2017. <https://community.fema.gov/until-help-arrives>.

Barker, Eric. “How to be calm under pressure: Three Secrets from a Bomb Disposal Expert.” 2 February 2017. Observer. web. 25 August 2017.

Vitelli, Romeo. “Why do we panic in Emergencies?” 5 October 2016. Psychology Today. 25 August 2017. <https://www.psychologytoday.com/blog/media-spotlight/201610/why-do-we-panic-in-emergencies>.

 

Gene Harper is a 4th year medical student at Mayo Clinic School of Medicine, and plans to pursue Internal Medicine. Prior to starting medical school he was a Marine Infantry Squad leader and deployed to Iraq twice in support of Operation Iraqi Freedom. Gene personally witnessed the devastation of the terror attacks in NYC on 9/11. His research interests include emergency preparedness, systems dynamics, and high consequence infectious disease preparedness.