Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

Wilderness and Rescue Medicine 246

it is certainly not ideal when a situation calls for immediate action. As trained first responders know, the brain responds to any perceived threat by secreting chemicals that lead to an acute stress response. And although this response can be highly ben- eficial in certain emergencies, elevated levels of stress chemicals almost always negatively affect thought processes and performance. As stress levels rise, one’s ability to recall information falls, decision-making becomes bogged down, and multi-tasking becomes almost impossible. While untrained people are more likely to underperform in an emergency, even experienced professionals can be affected. Consider the tragic case of Eastern Airlines Flight 401 where the flight crew became hyper-focused on a burned-out landing gear indication light. Their ability to take in environmental cues, sometimes referred to as situational awareness, naturally declined under stress. Only seconds before the plane crashed into the Everglades did the pilots realize that the aircraft’s autopilot had been accidentally shut off and the plane had been in a long descent. More than 100 people died. How We Respond To some degree, how one performs in an emer- gency will be influenced by factors that cannot be modified through training. There is no doubt, for instance, that physiology and life experiences will affect how a person responds. Nonetheless, research consistently shows that, by minimizing surprises and by modifying training techniques, we can improve the chances that first responders will perform well when it counts. To start, let us consider how the brain responds in a crisis. When the pre-frontal cortex (where decision-making and critical thinking take place) is presented with a sudden emergency that requires an immediate decision, it kicks into action by conducting a lightning fast “search” of sorts, scanning its databanks for prior knowledge that might be helpful. Relevant memories, impact- ful experiences, and applicable trainings pop up as search “hits,” and each of these options are quickly

assessed for their potential as viable options. If no “hit” is found, that is; if a person has no prior experiences or relevant training, then no alterna- tives pop up, and like the spinning computer icon, the person remains frozen (bewildered) as the brain considers what to do. It is useful to know that bewildered people, although ineffective on their own, are often high- ly suggestable. When the crew of Asiana Flight 214 started giving instructions, people followed. Flight attendant Lee Yoon-Hye, downplayed the accolades and instead gave credit to her training. “I wasn’t really thinking,” she said, “but my body started carrying out the steps needed for an evac- uation.” In the year prior, she added, she and her colleagues had gone through timed trials, set up by her employer. She had been required to shout over pandemonium and engine noise, she had confronted and given direction to actors frozen in fear, and she had repeatedly opened jammed doors and windows. For her and her colleagues, the high-quality trainings and scenarios had cre- ated multiple “hits”, providing the brain with a foundation for action. Improving the Odds For more than 50 years, researchers have inter- viewed thousands of people who have faced extremely intense situations, looking for trends or commonalities. In the 1940s, for instance, S.L.A. Marshall examined the behaviors of American soldiers who fought in WWII. Curious to know how the average man performed under the pres- sures of battle, Marshall interviewed thousands of men. In his report, he suggests that 75 per- cent of frontline soldiers never fired their weap- ons. Instead, he said, those who were involved in intense gun battles often froze, hid, or ran. Although the military leadership initially condemned Marshall’s report and defended its training methods, the soldiers came to Marshall’s defense. Many pointed to fact that they had been trained to shoot at stationary bull’s-eye targets, not real people, as a problem. To highlight their points, many added, “German soldiers look noth- ing like those targets.”