On top of everything else that happened that day, my car stopped working. Not quite in the dead on the side of the road, call a tow truck sort of way. That at least would have come with a sense of finality. Instead, it jerked and shuttered as the engine overheated. It limped to my dad's house like an overworked horse while I, with alternate whispers of encouragement and colorful epithets, I had to let it rest on the side of the road every time it slowed to a stop. The thought track in my mind was decidedly negative. "Why me? Why now? On top of all the other shit I have to deal with, I really don't need this right now!”
We can't change our circumstances or our emotional responses, but by understanding our thought process and beliefs, we can positively impact the outcome or at the very least our reaction.
This thought track has occurred hundreds of times throughout my life and oftentimes, I let the negativity wash over me like a black tide, sucking me into the depths of despair and hopelessness. But I had recently discovered Albert Ellis's “ABC” model of Cognitive Behavioral Therapy (CBT) which correlates “A” Adversity to our “B” Beliefs. These two pieces construct the “C” Consequences that follow. The idea is that we can't change our circumstances or our emotional responses, but by understanding our thought process and beliefs, we can positively impact the outcome or at the very least our reaction.
Before we get into that, I want to take you back 12 years to when I worked as a paramedic. Treatment for traumatic and medical emergencies are about as complicated and different as the people that experience them, but it starts with 2 simple steps: Assess the scene, assess the patient.
The foremost priority of the paramedic is to ensure the scene is safe for themselves and then the patient. Rigorous training allows us to take in every possible danger - from downed wires, to riotous family members - at just a glance. Only then do we move in to give the patient care, looking for a few key things as we approach: Airway, Breathing, Circulation. That's right: “ABC”. You see where I am going with this.
So when my car stopped working, it hit me. I’ve got this. I have handled emergencies before. I could be the first responder in my own crisis. I just had to connect the “ABCs” of Cognitive Behavioral Therapy with the “ABCs” of paramedicine.
So how does this work in real life?
Assess the Scene
One thing was clear as I coaxed my car along that day, I was not in any immediate danger. I mean, I was a little worried about a careless driver failing to notice my crawling vehicle, but I took all of the necessary precautions. Of course, the Amygdala in my brain was still tripping over the perceived threat. It’s an evolutionary response we inherited from our ancestors.
The presence of danger to our physical or psychological safety triggers the fight, flight, or freeze response deep in our brains. This notifies our Hippocampus to release cortisol and adrenaline which effectively shut down our entire rational brains in order to shunt energy to our body so we can react immediately to escape, confront, or avoid danger. Our ancestors needed this response on a daily basis, we rarely do. That doesn’t stop our basic instincts from kicking in at even the perception of danger. The good news is, we can learn to identify this response for what it is and begin to tame our primal instincts in response to less than lethal setbacks.
Our ancestors needed the fight, flight, or freeze response on a daily basis, we rarely do. That doesn’t stop our basic instincts from kicking in at even the perception of danger.
Beyond threats to safety, basic human needs such as food, water, shelter, and connection must be met in order for us to feel safe. If any of these are in jeopardy, it puts our bodies on high alert and potentially triggers a low level state of constant fight, flight, or freeze.
Back in my hobbling car, I knew I was safe and I had all of my basic needs met. Having a working vehicle as convenient as it is, really doesn't put any basic human needs in immediate jeopardy, a fact that I was forced to admit to myself as I grumbled my way home. Once I established this, my rational brain began to take control again. It was time to assess the patient: myself.
Assess the patient
It takes mere seconds to gather enough data in an emergency situation to make an initial assessment of a patient’s condition. I am not saying it is easy, but from the moment we walk into our first class to the day we hang up the keys, the steps are drilled, repeated, tested, and evaluated at every call, live or practice. Is the person sitting up and talking? Great, we know that their trachea is open, they are breathing, and their heart is pumping blood through their body. When we are faced with a crisis, we can view ourselves as both the patient and the responder. With practice and training, we can learn to assess ourselves during a crisis and respond in a way that is beneficial to ourselves rather than simply reacting.
Coming next: Crisis Triage - Assess the Adversity
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