How to stay calm in emergency situations

0:00You're listening to Life Kit from NPR. Hey, it's Marielle. Today we're going to talk about some of the most difficult things that can happen to a person. Scenarios that nobody wants to end up in. House fires, mass shootings, emergency medical procedures, mental health crises. And how to stay calm if these ever happen to you. When somebody calls 911, they're usually having their worst day. Probably the worst day they've ever had.

0:31Former fire captain Ryan Field-Spack says it's natural and human to panic when faced with an emergency. But with time and practice, he learned to find ease, calm, and even peace during these kinds of crisis moments, even when things were going really badly. And to help the people experiencing the crisis find that calm too. And if you can harness that inside yourself, it's the best feeling in the world. More than that, finding your composure can help you stay alive. But you don't have to be a first responder or an emergency room physician like Dr. Italo Brown to learn to manage your fight, flight, or freeze stress response.

1:08I think that it's something that can be taught. I think that there are elements of it that can be constantly reinforced. And sometimes, you know, people are faking it and they make it. It's something that we sometimes have to lean on in order to get past that initial fear. On this episode of Life Kit, how to stay calm in an emergency. And to be clear, this is not a definitive guide. It's a collection of personal approaches and advice from people who've devoted their lives to helping others on their very worst of days. Reporter Andy Tegel is going to talk to them about how they each approach the crisis work that they do and how we might apply their mindsets to our difficult moments.

2:18Takeaway one. you can set the tone of an emergency situation for yourself and others. Ryan Field-Spack has spent the last 25 years or so working in public safety in one form or another. He spent about a decade of that time as a paramedic, firefighter, and fire captain for the city of Aurora, Colorado. He's also served as a paramedic to professional athletes, and today his primary focus is his kids. But he also heads a communications platform specifically for first responders. Be it a fight at the family dinner table or a five-alarm fire, Ryan says your approach should be the same. A level head and an even disposition.

2:59The best leaders in the world are the calm, composed ones. Anxiety and fear can cause mistakes and be contagious to the people around you. That can be dangerous, especially in large-scale, high-stakes public safety emergencies. For example, Ryan was a responder in the Aurora, Colorado theater shooting in 2012. He remembers the streams of people coming out of the theater. All of them covered in blood. You have no idea what's happening. Everybody knows something absolutely horrible is happening. They need direction. If you allow for the anxiety to jump in, people will run into a situation that they shouldn't be running into.

3:38By having calm, composed guidance at the very outset, at the first drop of that tone, it gives everybody else around them that same level of calmness. It's a quality Ryan learned early on in his career. One of his first formative experiences was in high school as a volunteer firefighter. He was on a call for a structure fire and was trying to battle a blaze in a chimney area. Those can be really tough, he says, because they're tricky to access. And this fire is just taking us to town. It's getting worse. The smoke is filling. At that moment, Ryan felt himself start to panic. What am I going to do?

4:17Maybe I should just back out now, let this thing burn to the ground. But then the chief came to me in a calm voice, confident tone. He stood right next to me, put his arm on my shoulder, and he said, here's what we're going to do, Ryan. We're going to pull down this wall. You're going to access through here and you're going to fight the fire from the inside. We are not losing this house. Instantly, Ryan calmed down. My shoulders relaxed. I felt confident and we stopped the fire. And what I've spent the last 25 years of my life doing is trying to hone down the ability to be able to do that on the fly in the moment, no matter what's happening before the incident started.

4:54His approach to emergencies centers around learning to shift your internal gears into neutral, learning to pause rather than immediately acting on impulse or panic. A good amount of that work can and should be practiced before a crisis hits, starting with your mindset. For example, Ryan says daily mindfulness and meditation can help bolster you for any manner of high-stakes situation. If you listen to Life Kid Often, you're no stranger to this concept, but in case it's new to you a quick primer. You're exercising your mind to notice when it's being a monkey mind and it's thinking about other things.

5:34We all go through this all the time every day, right? We are watching a show and our mind just starts to wander. Oh gosh, what am I going to have for dinner tonight? And before you know it, an hour is up and you haven't paid attention to anything that's going on. The benefits of practicing that awareness, clearing your mind and focusing in on your breathing are well documented. It can reduce stress and anxiety, promote emotional regulation. Ryan says even a short, consistent daily practice, like five minutes a day, can give you a foundation to steady you for those everyday upsets and in the heat of a crisis.

6:12Then, when that metaphorical fire is in front of you, Ryan came up with this phrase that he uses. It's called a first, just breathe. And this takes five seconds. And this is a superpower. The F or first stands for fist, as in be conscious of them in moments of high stress. You haven't looked down and you've got marks on your palm from that unconscious clasping of the fist. This is stress. Simply shaking out your fist can release tension. Same thing with J or just, which is to remind you to unclench your jaw. And expanding out from there, maybe just take notice of where and how you're holding any tightness or anxiety in your body and try to release it.

6:58The last one, breathe, is just what it sounds like. One mindful deep breath. It's so simple, I know. And yet, so often forgotten or overlooked in moments of crisis. A few deep breaths are a powerful and critical tool in your emergency response tool belt. Studies have scientifically proven that that lowers your pulse, lowers your blood pressure, lowers your anxiety level, and allows you to focus more. A final action item to try and then keep in the front pocket of your go bag, a mental rehearsal. The logic is essentially the same as a fire drill. If you practice for a potential emergency beforehand, you'll be less scared and more prepared if and when it ever happens.

7:44So when Ryan was a firefighter, for example, he'd mentally rehearse different scenarios that might come up for his team that day and how he'd handle them. So if they got a call for, say, a cardiac arrest, he'd first think about how he'd assign different roles for handling equipment. And then from there, I'm going to run through my mind what I'm going to say on the radio, how I'm going to articulate what needs to happen, what medications I want to give. Now, this is something you can and definitely should do for more likely emergency scenarios. Like maybe if you live in a flood zone and want to make sure everyone in your household is familiar with the escape route.

8:19But Ryan says it's also a good idea to take the time to do a quick mental rehearsal in the moment of crisis. Because in those instances where you absolutely need to make a decision, like there's an active shooter in the vicinity or your kid is choking, yes, urgency is often of the essence. But also, oftentimes we immediately go to the freakout because this is the first time probably ever that we have actually faced a threat that is external that would actually cause us to fight or flight. And that's when mistakes can happen, Ryan says. So instead, just take a moment to pause and let that initial cloud of chaos and anxiety pass.

9:02Breathe and think for a second. What is the best way to handle this situation? What resources are available to me? What do I need? You're going to be able to think about others, think about getting your kids safe, those type of things. And if everybody does that, I think the world will continue to improve because we're all thinking just a little bit more before we act.

9:27All right, now that we all have our thinking caps on, let's keep working to... Slow down time. I try to think of it as time might be moving in one direction and very, very quickly, but my actions can be measured. Dr. Italo Brown is an emergency physician and assistant professor at Stanford University School of Medicine. He brings us takeaway two. Focus in to freeze the clock. As the son of a firefighter father and an educator mother, Italo's chosen career path was par for the course. It just breeds this, you know, desire to serve, but also highly valuing the learning process. It's never a dull moment.

10:10There's always something to learn. And some, you know, new thing that's occurring and trying to navigate your way through that is exhilarating to me. Exhilarating probably isn't the word a lot of people would use to describe an emergency medical situation. But Italo says he likes to think his way through things. And because he's passionate about his work, it's all worth it. But that's not to say his job doesn't come with its fair share of anxieties. I immediately snapped to Bone Crusher to say I ain't never scared. But that would be an absolute lie. I have a bunch of sphincter-clenching moments throughout this shift.

10:51there are occupational hazards of course like the potential harm to his personal safety but also the anxiety of performing under pressure the fear of not always knowing exactly how to help and the weight of making literal life or death decisions and italo just has to be ready and stay ready for any and all of this potential unnamed chaos for example he told me about a patient who came in one night who was struggling to breathe. And a heads up, we're going to talk about some bodily fluids in a second. I'm saying to myself, like, we need to get this airway in the next, like, five minutes. The patient's airways were swollen and her mouth was filled with blood and vomit.

11:33So Italo knew it was going to be really difficult to get a breathing tube in without surgery. He made a quick decision to try this tricky intubation method using a special tool and a computer monitor. But he'd only have one shot. The space is very small. It almost feels like comparing it to playing a video game where you have to direct something into a very narrow passageway with a bunch of obstructions at the same time. To set himself up for success, Italo says it was all about zeroing in on exactly the task at hand. He did that by first ensuring his working conditions were as favorable as possible.

12:09So, height of the bed is where I needed to be. I have the equipment that I like. Things like that to remove the thinking from those and let those things not be distractions. Translated outside of the ER, maybe for you, that might look like assigning everyone in your household direct, specific tasks for evacuation so no one gets lost or confused. Or making sure you update your first aid kit before you go on that big hike and knowing exactly where to find that gauze in case you need it. Then, in those few moments before the moment of the procedure, Italo says he tries to quiet everything around him.

12:48Just me and the patient. Not whoever else is around. Not hearing the sounds of the emergency department. And sometimes not even sensing my own degree of concern, like body aches, position. Like, I'm not thinking about any of that. That extreme focus helps Italo from locking up. Like anytime something scary happens, you're driving a car, you get in a car accident at the point of collision, you tense up. And so you have to breathe through those moments and trying to maneuver and not have jitters. Next, add in your favorite, most effective, positive self-talk. Steady hands, cold blood. But like, I'm often trying my hardest in that exact moment to just tell myself, like, you've done things that are harder in life and you can do this.

13:39That can also put a pause in the clock and the pressure of the moment. Because the moment demands accuracy, not being expedient. And so I try to focus on that nice and easy. Move on your speed. And then the muscle memory kicks in. And that's all there was to it, he says. Well, almost. I would be remiss not to, I mean, I am a praying person. I'm praying when the person first lands in the ambulance bay, and I'm praying as I'm, you know, preparing to do something like that. So there's definitely a spiritual component to it. But bringing all of these things together in a matter of seconds is kind of the secret sauce for me.

14:23In the end, he came through. Italo was able to place that breathing tube for his patient, and her oxygen levels rose. In those moments, you're always thinking like, all right, what if this doesn't work? And so when it goes right, there's such a sigh of relief, like a universal sigh of relief in the room.

14:46Now, not everybody is an emergency doctor, and hopefully very few of us will ever have to perform a complex emergency intubation. but you never know when you'll have to answer the call to action. Like when someone gets hurt or overdoses or has a severe allergic reaction, hyper-focus can always come in handy. And Italo says, don't forget, there are certain emergencies in life you can anticipate and get prepared for. He thinks everyone should be CPR trained, for example. You could be sitting there at Benihana's eating dinner and someone just collapses And if you know what to do, now you've helped change the arc of that person's life.

15:25You know, those types of skill sets are stuff you understand, learn, practice. And as for all the other types of emergencies, the ones we can't predict, Italo says his work has taught him to embrace joy as much as you accept hardship. Scary stuff happens every day, and people find ways to work through it every day. We have to normalize the fact that everybody's going through this at some degree. every single day. Somebody is reliving a trauma. Somebody is working through a trauma. Someone is overcoming a trauma. And if we're normalizing the fact that that's happening constantly, it makes it more approachable and it makes it feel like something you can try on.

16:10Our final comm curator knows just how commonplace dealing with crises can be and also is witness to how often the solution is simpler than you think. Takeaway three, don't discount the value of connection. You can be the one to make real change simply through honest communication. Because for some, the unforeseen storm will be an internal one. As in, maybe you're here because you or someone you love is struggling with mental, behavioral, or emotional health. Maybe you're dealing with intimate partner violence or suicidal ideation, or you don't know how to talk about substance abuse with your kids.

16:51LifeKit has more resources available for you for each of those topics, by the way, as does Wendy Martinez-Farmer, a licensed clinician who's worked in mental health for over 20 years. I enjoy helping people probably when they're having their very worst day. I think we've all had those very worst days, And I just know how incredibly important it is to have people who really deeply care when people are facing some of their toughest challenges. Today, she's a vice president at Vibrant Emotional Health, where she works on clinical standards and grant strategy for 988, the nationwide lifeline that offers free and confidential support 24 hours a day for anyone in crisis.

17:34She says one of the hardest parts about her job is all of the stigma around mental health emergencies. and the general misunderstanding about behavioral health. There's a kind of a myth out there that if you talk about suicide, you'll put it in someone's mind. And we just know that that's absolutely not true. People are already thinking of suicide. They are thinking of ending their lives. And being willing to talk about it with someone gives them permission to share their pain and gives an opening to help them find a way out of it. What Wendy really wants people to understand about these types of emergencies is that they're just like any other medical issue and should be treated that way.

18:15If you were a bystander with someone having a heart attack, you would not hesitate to call 911 on their behalf and to get them care. And that's the way that we treat it. You know, the brain is part of the body and this person is in severe danger and we're going to call and get them care. It's no different. But instead of trying to stop a bleed or clear an airway, when someone is experiencing suicidal ideation, Wendy says a crisis counselor is often trying to help with harmful cognitive distortions, like trying to pull that person out of all or nothing thinking. They're only seeing one way out of the situation.

18:54And by asking some questions, getting them to see that maybe there are some other options and maybe they have some other choices, they can start to see that that's not their only choice. And this process of connection, whether or not you ever find yourself on either end of a serious mental health emergency, can help us all better cope, expand our viewpoints, and empathize with our fellow humans in moments of high stress. Wendy broke down the approach in five steps that follow 988's Be The One To campaign. It's an evidence-based strategy for communicating with someone who may be suicidal. The first step is to address the elephant in the room head on.

19:36Don't beat around the bush. Sometimes when people are feeling the way they do, they think of suicide. Is that something you're thinking of? Just being very matter-of-fact and very direct. Wendy says when she was first starting out, she was really afraid of asking this question. Who wouldn't be? But over the years, I can't tell you how many times when I looked across the table at the other person, I could immediately see relief on their face when I brought it up, when I asked the suicide question directly. It's almost like they took a deep breath to say, oh my gosh, it's safe to talk to this person about this very scary thing.

20:14That can be a good reminder for a lot of scenarios in daily life. Like maybe it's okay to just talk about the hard thing straight out with a person that you trust. Next, it's about active engagement. Demonstrating to this person that you're there for them by not only listening, but reflecting back what you hear and expanding on what they have to say. So I understand, you know, that you're feeling a lot of stress. Tell me a little bit more about that. asking a lot of open-ended questions to try to get more information and get them to talk. It seems kind of simple, but really it just tells the individual that you're listening and that you care.

20:50This is also when a crisis counselor will try and get the particulars of someone's situation. Are they eating and sleeping enough? Interacting with other people? It's really important to get those basics to find out if someone's really having an interference in their functioning. Then confirm the person is safe. As in, have you already done something to harm yourself? Wendy says having just a bit of a game plan in those moments, knowing what resources you have at your disposal in the worst case scenario can help you feel more prepared and calm. For instance, if you're on the phone with someone and you know that they've got others in the house, that always makes me feel a little bit better, right?

21:29Thinking about that as I'm asking the question. And how can we use having other people around to keep them safe? The fourth step is helping them connect to what they need. Are there things that we can do to keep you safe today? Are there resources that you have? And then we can help build kind of a safety plan with them. You know, so if you start feeling like this, that there's some things that you can do. Wendy says most of the time, the phone call is really what the person needs. But in some cases, they might need to seek out more robust resources like a mobile crisis team or an appointment with a local counselor.

22:05The final step is follow-up. After that initial cloud of chaos has passed, 988 operators will offer to check back in. And most people do take us up on that. We get a lot of feedback from people who just say, thank you so much. You know, that's exactly what I needed. I just needed to know that I wasn't alone. And get this, the average length of a 988 call About 12 to 14 minutes. Yeah, that's it. There's something pretty amazing in the fact that a person could be lifted up out of one of their darkest moments in less time than it takes to get through your favorite sitcom. So Wendy is being literal when she says sometimes just knowing there's someone who's willing to really listen to you, validate you.

22:50It can be life-saving. So Wendy says while you may never have to go through this process for a severe mental or behavioral health issue, everyone can use a helping hand now and then or a listening ear and a reminder that not everything is black and white especially on those hardest of days so remember she says nobody is expected to have all the answers so if and when you can't find solutions to a crisis right away don't just go it alone and sweat it out seek support instead you might not be able to find all the answers you want or need, but sometimes just having good company in times of hardship can be a solution all its own.

23:29Because bright spots can be hard to find, especially when it comes to moments of crisis. Wendy's work has shown her that though there's a lot of heartache in the world, there's a lot of help out there, too. I think people would be surprised that we all take hope from it. It's a very tough job. It's a very challenging job, but I feel a tremendous amount of hope knowing that there are people out there who really care and who are willing to help their fellow man. And it happens every day.

24:07A reminder, if you or someone you know is in crisis, LifeKit has an episode on ways to help linked in the episode description. or you can call or text the Suicide and Crisis Lifeline at 988 at any time, day or night. Someone is there waiting for you who truly wants to help. Okay, let's recap. Takeaway one, you can set the tone of an emergency situation for yourself and others. Shift into a neutral mindset during a crisis by prepping your mind beforehand and consciously relaxing before acting. Takeaway two, focus in to freeze the clock. That could look like getting into the best possible headspace, removing distractions, positive self-talk, or prayer.

24:52Takeaway three, when life is at its most stressful, don't discount the value of honest communication. Real listening can really help. We're all in this together, friends.

25:11That was reporter Andy Tegel. For more Life Kit, check out our other episodes. We've got one on how to do CPR and another on how to help someone who's struggling with thoughts of suicide. You can find those at npr.org slash lifekit. And if you love Life Kit and want more, subscribe to our newsletter at npr.org slash lifekitnewsletter. Also, we love hearing from you. So if you have episode ideas or feedback you want to share, email us at lifekit at npr.org. This episode of Life Kit was produced by Margaret Serino. Our visuals editor is Beck Harlan, and our digital editor is Malika Grebe. Megan Cain is our supervising editor, and Beth Donovan is our executive producer.

25:51Our production team also includes Claire Marie Schneider, Sam Yellowhorse-Kessler, and Sylvie Douglas. Engineering support comes from Jimmy Keeley. I'm Mariel Segarra. Thanks for listening.