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Psychological First Aid - Part Two: Staying switched on in a crisis

Updated: Aug 26, 2023

When the plan turns sour there's no point crying over spilt milk. Or frantically rushing in and doing yourself a mischief. A measured approach means pausing to review what is going on, taking a breather and letting the executive brain switch on. It's designed to take charge, weigh up the options and prevent you losing your head. The last thing you want is to run off a cliff or from the frying pan into the fire when a more cool headed state of affairs can return a crisis back into an adventure!



I champion an Adventure Neuropsychology approach to inspire and motivate others in the face of adversity and the challenges of life. This draws on escapades I have experienced as well as observing those who prevail in adventurous predicaments to provide insight into the mindset necessary to thrive under stress. As well as a basis in cutting-edge neuroscientific research into how the brain operates in extreme environments to optimise performance.

“A key aspect of executive control is the ability to inhibit responses that might seem appropriate at the time (such as to escape from the place of danger) but which can actually make things worse (staying put with the prospect of a rescue on its way)... Another aspect involves being measured in emotional response rather than giving way to fear, anxiety, panic, terror. The executive brain exerts influence over the emotional centres that might otherwise trigger the fight or flight response, as well as default mode ruminations spiralling out of control. "

Pausing for thought


When last we spoke, I was on a mountain ridge trying to exert some control in a casualty evacuation situation. Things weren’t quite going to plan with the group I was leading. A helicopter was on the way.


(Not again! I might have found myself thinking, much like the bowl of petunias accompanying the sperm whale plummeting to earth in Hitchhiker’s Guide to the Galaxy - for the uninitiated.)


It might seem as if this sort of thing happens a lot to me.


Not a lot, as it happens, but sufficiently enough to be less unfamiliar. This helps in not being mesmerised by the novelty of a situation, and consequently overwhelmed with the stress of it all. It also presents opportunity to take executive control...


Running around like a headless chicken will not confer the best results high on a mountain as the weather deteriorates and shock sets in – and potential to create additional casualties. Poor judgement could see someone rush off and topple over an unseen cliff. Suddenly things get much much worse. An incident on Ben Nevis, Britain’s highest mountain, saw this happen despite mountain rescuers telling the located casualties to remain where they were. They summarily ignored instruction and proceeded to fall 200m, making the operation much trickier to manage.

A cool-head allows us to weigh up the situation, process what is going on in the surroundings, evaluate courses of action and make adaptations on the fly. There are different executive functions which serve different purposes to these ends.


For instance, in the Snowdonia scenario I described, let’s say we opt to get out of the location as quickly as possible, to more comforting ground. We pick up the casualty and skidaddle. The weather closes in, phone signal is lost as we get into more convoluted terrain. Someone slips on loose rocky ground, twists their ankle. Two casualties. No immediate means to summon help. Increased likelihood of shock.


A key aspect of executive control is the ability to inhibit responses that might seem appropriate at the time (such as to escape from the place of danger) but which can actually make things worse (staying put with the prospect of a rescue on its way).

Another aspect involves being measured in emotional response rather than giving way to fear, anxiety, panic, terror. The executive brain exerts influence over the emotional centres that might otherwise trigger the fight or flight response, as well as default mode ruminations spiralling out of control. Self doubt run rampant is not conducive to decisive judgement.


Other elements of executive control involve monitoring information moment-to-moment in order to update one’s mental model of what is going on, adapting behaviour on the fly as needs be and conditions dictate.


Springing into action with a strategy that seems to fit the bill is all well and good, but there is a risk of becoming too focused, and overly invested in that strategy. I’ve seen a collective of experienced mountaineers proactively disperse in small groups to pursue decisive courses of action when a comrade fell down a steep ravine. Sometimes when everyone is at a similar high level of experience, all taking charge at once might cause complications if communication is not clear. In this case I judged that my most useful contribution was to remain high up on the mountain to attempt to keep track as best I could of where the casualty was situated, should the helicopter need directing to the right part of the mountain. Leaders don't always need to lead for the sake of it - they can become effective seconds-in-command, or just another competent hand-on-deck.


As happens this meant coming down in the dark with some of the remaining members of the group. We arrived some time after all the rest had been transported back (by chopper) to ground level with the casualty (who was miraculously ok – that's another story entirely...). The day turned into a very long and protracted one and those who had not anticipated that didn't have enough food and water. Fortunately I always carry a surplus as even on days when the forecast is stable and the mission is supposedly cut and dried, you just never know...


There are many accounts of people persisting at a course of action that fails to account for changing circumstances. This is a phenomenon known as perseveration. Even skilled and experienced operators can fall foul of this. Practiced and well-worn skills and schemas are employed which initially may be suited to the task at hand, but as the situation changes, need to be abandoned or modified as new information arises as to what is required. Perhaps the wind has shifted direction, the ground become unstable requiring moving the casualty, or the safety of the rest of the group is now an urgent priority, not exclusively the immediate casualty. A particular brain structure in the prefrontal cortex, the DLPFC, is involved in control of attention and selection or inhibition of behaviour suitable to the task. Too much or too little activity in this region can contribute to persisting in the current behaviour when an alternative needs to be sought.


An associated phenomenon is inattentional blindness (if you’ve seen a gorilla playing basketball on youtube you might be familiar with this). We can be looking at a scene and completely miss significant elements that occur within it, because our attention is elsewhere, or we are so focused on one aspect that we just don’t notice what someone else sees as obvious.


Seminal studies involving pilots in flight simulators put this in more alarming context. An unexpected object sometimes appeared on the runway (such as a vehicle or small plane not meant to be there) timed to coincide with the final approach. Many of the professional pilots were oblivious to the hazard and forged ahead with the landing. Whilst it’s said that some of the participants quit their jobs mortified that this could happen (feeling incompetent and unsafe to continue), it nevertheless attests to the fallibility of the human perceptual system.


We perceive what we attend to. Or fail to perceive what's right in front of us when our attention is so narrowly focused or focused somewhere other than our point of gaze.

There are many facets to the executive control of attention. This includes a capacity to solve problems, and innovate – creative solutions, association of ideas that move us forward to new patterns of thinking and acting.


To be able to engage these under pressure is something we evolved, conferring advantage to our species in order to thrive in the wild. Given the popularity of wilderness and adventure-based activities that involve risk and challenge, we need to keep these skills up to date.


How can we do this more effectively?


The first step is to pause for a moment – slowing the breathing and stilling the chattering mind. To tune down the default setting and shift focus to the external world. Then to switch on to the surroundings, processing what information is relevant, and importantly up-to-date. We are taught in First Aid courses to stop on approaching a casualty and review the scene. Rushing in puts us in danger of, well, being in danger, but also missing the bigger picture and activating those more reflexive behaviour patterns. When it comes to making decisions under pressure, taking that pause and allowing the higher brain to switch into gear gives time and space to begin weighing up the scene and the options we have to address the predicament.


In a diving incident some years ago, by happenstance I was first on the scene, shortly followed by my buddy. I opted to pause and take stock before approaching the casualty who was face down in the water. A critical rule in attempting to rescue a stricken diver (or anybody else in distress in the water for that matter), is to give a wide berth and approach cautiously from (from the rear ideally). This gives a better chance of not being dragged down in ensuing panic. I was exhausted at the time due to a long surface swim as fast as I could go, laden down with multiple tanks. I simply had to slow and stop, get my breath, and evaluate what was before me and what I might have to do next. The outcome of that incident, despite the best efforts of all concerned, unfortunately was not a happy one.


Therefore, we must inhibit responses and urges that might seem to serve our immediate needs but can get us into deeper trouble if not careful. And as circumstance necessitates, to employ an ability to think creatively and find innovative solutions to the problems we are encountering. Outdoor First Aid courses I have attended bring this to life. Solutions are not necessarily prescribed - trying to find the casualty hidden upside in the bushes; assessing what the issue is surrounded by the sights and sounds and smells of nature, the cold, covered in mud. In this respect it's also a great exercise to play the role of the casualty as you embody symptoms, and confusion, which can help down the line when you recall how you 'felt' when trying to decipher what is wrong, improvising, adapting the appropriate response.


The CognitvExplorer approach promotes a framework which uses adventure related challenge and stress management to switch the brain networks into the gear that is optimised for the situation.


I firmly believe this is a vital skillset everyone can adopt prior to setting foot on the mountain, and to this effect I am working with the outdoor education and adventure pursuits communities to reinforce the message, and integrate such an approach. And this of course has application in everyday life when dealing with stress and adversity.


In the incident mentioned in part one, when the Mountain Rescue and SAR operatives arrived on the scene and did their primary care checks, they acknowledged that there actually wasn’t a lot for them to additionally do. Our party had done a good job of casualty care. Everyone acted as a coordinated team. Stress was managed and each was focused on particular tasks that subserved the situation. I’d like to think that some of the techniques and principles I had impressed on the group previously had some effect on this.


The programmes I am involved with have this idea of psychological first aid at the core. When things go pear-shaped and an emergency situation unfolds, it is crucial that the individuals involved do not become submissive victims but can take a semblance of charge over the predicament. This will help those who come to their aid in a two-sided fashion.


After all, its stressful and traumatic enough for the emergency services, so we are obliged to make their life easier and reduce the strain they are already under...


You may be wondering about some of the other incidents, helicopter rescues and snowmobile extractions I alluded to. These incidents provide extra flavour in my workshops and talks, alongside the insights and learnings on how to optimise performance and wellbeing with an Adventure Mindset!

Furthermore, in a team building context, this includes working on the so-called stress-circuits using adventure activity challenges to help come to terms with the stress response, using mindfulness and stress-reduction techniques that turn down the default setting. The flip side involves exercises that focus on executive functions and how to optimise thinking under pressure!



Please get in touch to find out how I promote these ideas through talks, workshops and facilitated adventure experiences in the wild.


References


DeHais, F., Roy, R. and Fairclough, S. (2020). A Neuroergonomics Approach to Mental Workload, Engagement and Human Performance. Frontiers in Neuroscience (14), Article 268


DeHais, F., Hodgetts, H.M., Causse, M., Behrend, J., Durantin, G. and Tremblay, S. (2019). Momentary lapse of control: A cognitive continuum approach to understanding and mitigating perseveration in human error. Neuroscience & Biobehavioral Reviews, (100), 252-262


Miyagi, T., Oishi, N., Kobayashi, K., Ueno T.,Yoshimura, S., Murai, T. & Fujiwara, H. (2020). Psychological resilience is correlated with dynamic changes in functional connectivity within the default mode network during a cognitive task. Scientific Reports. 10:17760


Zhang, Y., Daic, Z., Hud, J. Qine, S., Yuf, R. and Suna, Y. (2020). Stress-induced changes in modular organizations of human brain functional networks. Neurobiology of Stress 13 (2020) 100231





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