Crisis Triage - Assess the Adversity

There was a time when I would've really lost it when the transmission on my car started to give out on my way home. I was already in a very emotional state, the thought of being without a car was terrifying, I felt humiliated that my car was the one holding up traffic while it crept along at the side of the road. Luckily, I had already begun treating crisis like a patient care scenario and was able to take a more objective look at what I was dealing with.

One of the first things I learned when I took the EMT Basic course was the Heimlich maneuver. Our class watched a dramatized video depicting a man eating and talking in a hospital cafeteria when he suddenly clutches his throat. A nearby nurse observes this and approaches the man to ask if he is choking. He nods frantically as his eyes bulge. The nurse steps behind him, plants a foot between his legs and circles his waist with closed fists placed just above the man’s navel. With quick upward thrusts, the man's diaphragm is forced to contract violently, pushing residual air into his trachea and allowing the piece of food that was stuck there to be dislodged.

Bear with me for a minute while we compare evaluating adversity to patient care. If the “A” adversity in Cognitive behavioral therapy is our moment of conflict then the "A" airway from our Patient evaluation ABCs is the severity. In this analogy, I also add in my own "A" action as every challenge requires us to take some immediate action.

A complete airway obstruction is any adversity that by necessity shuts down every other aspect of our life and requires our immediate attention. Major events might include a natural disaster, war, loss of a loved one, a severe personal injury, or an unexpected divorce; basically anything that triggers a complete and abrupt upheaval (physical or emotional) of your life. My brother's death was an obstruction like this. Essentials like food, water, or sleep are no longer important. It feels like you are moving through minutes and hours in a time warp: past, present, and future cycles run together like a gelatinous goo that dulls your senses. Words have meaning but no value and decisions are based on sheer emotional instinct rather than rational thought. The only action you can take when you are facing a complete obstruction is to give the adversity your full attention.

The only action you can take when you are facing a complete obstruction is to give the adversity your full attention.

Other events cause just a partial obstruction or perhaps are just minor irritations. These challenges usually have multiple actions that we can choose from, and yet oftentimes we treat all adversity with the same level of response. We may get into a fight with our partner over cleaning up after the dog, but our reaction is at same level as if they had informed us they were moving out and taking the dog with them.

"Airway is something we take for granted when we forget that we are breathing."

Airway is something we take for granted when we forget that we are breathing. The trachea, a narrow 10 cm long corrugated tube, is the only way oxygen enters our lungs where we need it in order to survive. By some cosmic design flaw it is located directly parallel to our esophagus where hastily chewed food slides down into our bellies to be processed for nutriment. It's interesting then to note that we can survive for 30 days without food, but after just 4 minutes without oxygen, our brain and bodies begin to rapidly die. This perspective alone should give us pause, and help us slow down when we eat and in this analogy, should give us reason to stop, take a breath, and consider the true severity of the adversity we are facing.

When we learn how to treat our adversity as a patient, we can step back for a moment and look at the situation with an objective eye. Back in my hobbled little car, I was able to realize that this was a relatively small adversity. I still had multiple actions to choose from and I proceeded with the one that made the most sense to me at the time: carefully drive my car as far as I possibly could with the aim of reaching my dad's house. And if it stopped for good? Well that was the next adversity and I'd just handle that when it came up.

I had identified the severity of my “A” adversity and decided on an “A” action. On to “B”.

Coming next: Crisis Triage - Assess your beliefs