Lessons Learned from a Decade of Conflict - Boekje Pienter

Identification of Stress SymptomsEmergency medical professionals canexperience various predictable EMS stressors,such as:• Self-induced stress to save a life• Time constraints• Colleagues’ presence• Dynamic and unstable environment(terrain, weather, crowds, etc.)• Patient’s psychological state (scared,irritated, angry or combative)• Third parties (family, friends or bystanders)• Poorly designed equipment• Failure to perform a skill correctly the firsttime• Threat to the operator from a third partyor environmental conditionsEach form of stress can be equally debilitatingto precision-based skills. A combination ofany two stressors can magnify the deteriorationof precision skills. Combinations of threeor more stressors can trigger an immediatecascade of all precision skills. Further, survivalstress trumps all combinations of stressors.To combat these stressors during emergencysituations, many medics employ“tactical breathing,” which, when done properly,turns off the SNS for short periods of time.Multiple Precision NeedsThe EMS professional’s operational requirementis precision, but not in one single area ofperformance. Rather, they require:• “Precision in Perception” —not a singlesensory experience, but all of the processessimultaneously.• “Precision (Analytical) Processing” —theoutcome of interpreting all of the perceptualsensory information into a singleworking hypothesis ofpatient symptoms andtreatment.• “Precision-Based Pretreatment”—anoutcomeof preparing yourmedical kit with productsthat are stresscompatible.A well-laidout and stocked kitreduces the time neededto treat a trauma patient.The kit should be alsodesigned and stockedaccording to levels ofThe Braintrauma/care, in a way that compensates for stress-inducedvisual distortions. In addition, products within the kit must bedesigned to be gripped easily and firmly.• “Precision in Treatment” —the hallmark of an emergencymedical professional. Virtually every skill an emergencymedical professional provides requires hand-eye coordinationwithin finite spaces.• “Precision in Demeanor” —the emergency medical professionalmust exude an aura of confidence, competenceand calmness. All of these attributes are absorbed by thepatient and directly affect the patient’s respiratory rates, bloodpressure and the level of hemorrhaging.Our Body’s ResponseThe prefrontal cortex is the centerfor precision perceptual processing,precision analytical skills and theformation (and execution) ofprecision motor skills. But as stressincreases, the efficiency of theprefrontal cortex breaks down,resulting in a loss of perception,analysis, evaluation, precision motorskills, processing of time and memoryof past experiences.Extreme stress and absolute precision create a conflict withinour body’s performance network, the autonomic nervous system(ANS). The ANS controls all of the voluntary and involuntaryfunctions of the body, and is divided into the parasympatheticnervous system (PNS) and the sympathetic nervous system (SNS).During waking hours and times of non-stress, the two brancheswork together to create a state of balance, or homeostasis, inwhich our high-level cerebral functions (perception, analysis, theexecution of precision motor skills) are performed optimally. TheSNS performs the opposite function of the PNS and is referred toas the “fight or flight response,” the “fear system,” the “predatordefense system” and the “survival system.”SNS activation stimulates the immediate release of stress hormonesin proportion to the threat. It also increases arterial pressureand blood flow to large muscle mass (resulting in enhancedgross motor skill and strength), stimulates vasoconstriction ofminor blood vessels at the end of the appendages, increases pupildilation and causes cessation of the digestive process.The SNS is always on a hair-trigger and is activated by perceivingconscious and unconscious threats. The result is asurvival system that makes us explosively strong throughincreased adrenaline levels, whereby reactions to threats areautomatic and without hesitation.But our system gains speed by bypassing the high analyticalcapabilities of the prefrontal cortex. Thus, we become fast, quickand strong—but dumb—because we don’t need precision ofperception, analysis and execution when running for thenearest tree.ILLUSTRATIONCOURTESYBRUCE SIDDLEElsevier Public Safety War on Trauma 29