Why Stress Makes First Responders Suck (and what can be done about it) 

That pause to breathe and reset has saved some really sick patients of mine. I strongly recommend this technique to new providers when they find themselves drowning.

I grew up in a bad neighborhood and have been a victim of a drive-by and two armed muggings. I joined the military at 18 and deployed with confidence, no ptsd. Once I ETS'd, I joined a security company and I froze when someone ran towards me with a knife. I stuttered my words on the radio and couldn't make out a sentence. I was NOT afraid of guns but I never trained with knives and I didn't think I'd be scared of them. Learning experience.

When I was training CQB tactics, we did things on a tempo to keep us from rushing and skipping steps. The instructor had a metronome and we trained until the metronome was sped up to a real speed. It made every door, hallway, and room into a check list that we flowed through. If we needed more time for something we added a beat to that item, meaning a task that we felt rushed on in one beat was cut in two and made into two beats until we could do it well enough to finish in one beat.

Loved this. I'm a paramedic educator, and one of the first things I like to do in sim evolutions is put everyone in a high pressure timed scenario, and after they inevitably fail, get them to do it again but "at 50-75% speed", but don't miss anything. I secretly time them that round as well, and they're usually blown away when I show them they were actually FASTER, and didn't fuck anything up. If you have to take even 15 seconds to just pause, chill, breathe (or as one wise preceptor told me many years ago - relax your sphincter), it will feel like an eternity but you will more than make up the time by not tripping over your own two feet.

Back when I was volunteering for a fire department, I was an EMT but hadn't finished my protocol test and all that and we had a car accident literally 300 ft from the station, around the corner. And it was a significant wreck. That was the first time I dealt with having to snap into Go Time without a minute or two of driving to really get my head right. Immediately after I got on scene I stepped out of the engine and knew we were going to have to start cutting. I had all of the tools next to the car before the engineer had finished parking and my Lt had finished the 360. I don't remember the steps between seeing the accident and having the tools on the ground next to the car. It took me a couple weeks and a couple talks with my Lt to actually string together the order of events that I had snipits of. I'd been told to cut the roof off and "make it a convertible", get a trash line out for fire protection, I attempted to assist in medical care, and then get told to go treat the mom who is in the second car that I had not seen up until this point. I didn't freeze at any point, but there was no critical thinking going on. It was lights on but no one home.

It happens to all of us first responders. I always try to remind myself its not my emergency. Build a game plan on the way to the call that tends to relax me a little that and chewing gum. Communication with other responders also can help ease some of the stress (sometimes) in my personal experience.

Hi. I'm an EMS feldsher (paramedic, essentially) from Ukraine. The most gruesome case of acute stress I've had was before the war. It was my first childbirth on the job. Usually we go on call when it's just a first stage of labor, get the woman into the vehicle, check her and fetus vitals and go to the hospital, but this lady didn't call emergency services for far to long and we got there before, probably, 10 min., before this little girl got her head out into the world :D The patient had her third child, so everything went fast. We brought a healthy baby that night, so that's great. Now it's almost fun to remember, but at that moment I just froze there for about a minute or two. Fortunetly I wasn't working alone on that day and my doc did the delivery almost by herself. In a minute or two I unfroze and did my part (like vitals, IV and stuff), but this experience was almost horrifying for me. Just forgot everything and dosed off into a blank stare at the wall or something. This is why you need a reliable colleague in this line of work. Thank you very much for these tips and awareness about this. Gonna try to do my job better with them. Well, that's it, just wanted to share my little bit of expirience. Thanks for the video!

Thank you, I was an EMT before being an ER nurse in the Army forty-five years ago. We were never taught about “bad” days on the job. You cope or get out. I still carry guilt about what if I had done something different or better for a patient.

I am a Paramedic with 22yrs experience (half my time as a fire/medic) and this is a great video. An analogy I was taught about being calm is to “be the duck swimming across the pond”. On the surface calm and graceful but under the water, the ducks feet are swimming 100 miles an hour. Even if you are not calm, fake it and it will really help. Taking a deep breath right before an intense scene is also very helpful.

Progressive tones would go a long way in reducing stress. 5 seconds of soft to mild red lights, followed by a 5 second ramp up of gentle to full tones. Found a department with this and it is life changing.

My favorite quote and what I say when I train: "when shit hits the fan you will not rise to the occasion, but fall to your level of training". Great video and something I needed. Train on everyone and stay safe Recently I had response for the first time in a long time. I'm a civilian who's first response was a gsw about 15 years ago. I knew nothing and had nothing. He died at the scene, and why I learned first aid and carry an ifak. My last response was a few years ago at work. Collision repair shop. Coworker in welding sliced his arm open. Slipped and cut his arm on the fall down. Like 5in long gash about 2 in deep. He lived because I had a CAT. My recent response was not a wound care but found a guy in my car at 3am. The moment I stepped out I saw him and froze, with my pistol in hand. Took 2 seconds to breath and put my pistol behind my back. Confronted the guy and he didn't act in a way to warrant me having my gun. He didn't know I had it but he was apologizing and sat on the ground crying. He would not let me pay him down but emptied his pockets of my stuff and the items from 4 other cars in my complex. He reeked of alcohol and started talking about how shit his life was. Then he started walking away, I tried to get more info as he walked but then he started yelling how he's gonna kill himself. I stopped following as it wasn't worth getting into a fight over nothing. My items were returned and he was in the car because I forgot to lock my doors.

The old saying. At a cardiac arrest the first thing you do is take your own pulse. There is some wisdom in this as being able to assess the situation realistically is paramount. Applying that to yourself takes time & experience. Knowing when it's time to stand down & have a break or even take a different career path. That a whole other deal.❤️🙏

As a first responder I have been in a large number of very stressful situations. Frankly the only real way to become effective under stress is to gain real experience under stress. But just experiencing those situations isn’t enough, you also have to be employing mental preparation/rehearsal beforehand, stress management during, and self evaluation afterwards. I’ve seen some people who get calmer and more effective all the time, and some who just always seem paralyzed and ineffective. The difference seems to be mindset, the effective responder is preparing before and self evaluating after, the ineffective responder is just winging it every time and trying to move on as soon as it’s over.

I've found that having a good relationship with your Co worker can have a huge effect on lowering stress levels. Working off of each other and knowing what each other are thinking before even saying anything can really help not only speed up treatment and decision making but also instill a sense of calm in yourself as you know they are competent and that anything you might miss they will pick up on and vice versa.

Retired LEO . First, this is an extremely forthright and informative video. Fantastic and tiemly topic. Plus, I like the way you use yourself as an example, thus showing - Hey I did this, made it through it and am here to talk about it. Excellent approach. As far as law enforcement, training such as you are providing should definitely become a requirement across the board. Perhaps we could have less outrageous shootings, etc. The job is tough so lets make a tiny bit easier. I was an FTO over 30 years ago. I was trained and trained my people i the method you mentioned, "What if's". When I was on patrol, I was pretty good at dealing with emergent situations. After being in a suit and tie for years, the street self awareness diminished considerably. My responsibility totally, however hubris can rear its ugly head anywhere. "I have LOTS of experience and I can handle anything." Not so much, bud. Thanks for your work on this topic.

Great video, reminds me of incidents where I blanked out. While I applaud those that go out and train and advance in a short amount of time, there's a lot to be said about experience. Repetition is key in overcoming "locking up". Rehearsing on the way to the call is what I always train my students to do. We all know once we get to the scene, it's never how it was dispatched. But that's ok, because you rehearse it EVERY TIME you go out, you've already practiced that thought process before. Calmness, or the appearance of calm is hugely important in deescalating bad situations. Too many times I have intercepted a crew that is beside themselves with a bad patient. While the patient's situation has not changed, just being calm gets everyone back on track to make a positive outcome for the patient. Anecdotal story: My long time paramedic partner went to a simple unintentional narcotic overdose. While the situation was very straight forward, the husband of the patient was very amped up. The husband asked us if we know what to do. My partner, like diarrhea, blurted out, "I'm a paramedic, I know what to do." Got the patient loaded up, my partner pulls out the Narcan and just stares at the bottle. Seems like he was staring at it forever. I looked up since he wasn't moving, and asked him if he was having a stroke. I took the bottle from him. We all laughed at his TIA later. Both of us have more than 40 years of experience between us, so it can happen to anyone. Stay calm, train, and play out situations in your head, so when faced with real life, you have already worked out that process.

Thanks for this video. It's nice to know that I am not just clumbsy and useless because I freeze up in certain stress situations.

Excellent video and very good points! On Friday I experienced this first-hand when I drove up to a motorcycle crash that had just happened. I pulled over and grabbed my IFAK, but noticed that my heart rate was up as I got out of the car by the busy highway and ran to the scene where a few others were already gathering around him. The rider had gone over a 20’ embankment, was unconscious, and his arm was severely broken in several places. He hadn’t been wearing a helmet and had a contusion on the base of his skull. For what felt like an eternity, but was probably 20 seconds, I felt frozen and unsure of what to do or how to help. I’ve been through the Army’s TCCC training every year for 15 years and I’ve seen people take gunshot wounds in combat, but for a few seconds I stood there racking my brain trying to remember what to do for this type of trauma. It was eye opening. Fortunately, by the time I splinted his arm and we stabilized his neck, the ambulance arrived and he had regained consciousness. The impact of stress was very apparent though and I plan on changing the way I personally train and the way I train my soldiers. Thanks for this video!

I’ve had a stress problem in Firefightinh training. My previous instructor was the stereotypical hardass (for good reason) instructor. The class was working on putting up ladders on a 2 story building alone. I was the only one to volunteer and failed, volunteered alone again failed and almost dropped the ladder on someone’s head because I just couldn’t think. I knew I could hear and feel I just didn’t have the sensations; you don’t ‘feel’ anything until either the gut wrenching realization of failure or the relief of success.

Thank you SO MUCH for sharing this. I'm a volunteer firefighter and EMR. I've been on calls where I froze up and tunnel vision took over. I was allegedly a rock star in the classroom, but I went brain dead on scene a few times. On my first EMS ride along, I put the BP cuff on inside out (twice)...fortunately it wasn't a truly emergent call. I have had good days too, but still, my failures resonate far more loudly in my mind than my successes. I'm about to start my EMT-Basic with the goal to hire on with my local EMS full time and then get my AEMT. I definitely want to take this path, but knowing that I've performed poorly previously has put up a mental block. Seeing a professional at such a high level admit to his own issues on scene helps greatly. I know I have the capacity to be a great pre-hospital caregiver, but knowing and doing are two different things. I appreciate your take on the matter.

big lesson to take home that i was told very early in my career; You will not rise to the occasion, you will only fall to the level of your highest training. so make sure that level will be high enough

When I was right at the beginning of my medical training and practicing CPR with half-automatic defibrillators, I noticed auditory exclusion first-hand. The training situation was stressful enough for me to completely ignore the instructions the defibrillator gave me. It's eerie how tunnel-vision also affects hearing.

By far one the greatest topics you have covered, this was my issue on preceptorship, thank you!

This is my favorite video of yours. I think that every first responder needs to learn stress management, and this is a great place to start. It'll save both patients' and providers' lives.

Thank you! Similar personal experiences, but still early in my time as a first responder and needed to hear your perspective. Keep it up!

This was so helpful. I feel myself getting stuck and just being frustrated because of the tunnel vision I can’t get out of. I as a result my confidence tanks. Thank you for spending the time to talk about this topic this is really helped.

Great content. I feel like the phrase "fake it till you make it" definitely has some validity when it comes to making yourself feel calm and collected.

Just awesome that you can open up and share what some people would consider horrifying stories of failure, but you understand it is neurological function and you accept the reality of it. Your sharing will help alot more people open up to it.

I’m going to be 100% honest. At about 11:46 you say “I hope I don’t get a pede patient those scare me”. I can’t count how many times a shift I say that knowing that I don’t have a full grasp on their vitals and still do nothing about it. Thank you for calling me out on my bullshit. I know it wasn’t intended for me but wow, you really hit it on the nail.

This was helpful, thank you. I’m a volunteer firefighter and starting EMT school this week. This sort of general info is very valuable for someone like me who is new to this world.

A brilliant video talking about stress and how to take control, love it

The component of control is super true in other scenarios too! I’ve given birth twice, and during the first birth i was not at all an active participant in the decision making process. I wasn’t educated and i had no idea what to expect or what the procedures i was being coerced into were. That lack of control was extremely traumatizing. During my second pregnancy I worked very hard to educate myself and practiced hypnobirthing for several months. The birth of my second child was very complicated and eventually ended in a ruptured uterus and emergency caesarean, but i felt so much more in control and everyone was amazed at how calm and collected i was even while blacking out intermittently from the pain. If not for an episode of profound bradycardia and subsequent hypersensitivity reaction to atropine that landed me back in the hospital later that week I probably wouldn’t have developed PTSD at all. I still feel very much at peace with how my second birth experience went.

Such an interesting topic. I've thankfully never had to deal with real-world casualties (military) but of the training that we do receive I think more needs to be focused in on how we train medics/corpsman for that stress inoculation. We do a lot of "run here, carry heavy thing, do medicine" training that just gets you tired and angry (which is good training lol), but more of that as-close-to-real training is what needs to be pushed imo. We get some, at least on the navy side of things, but stuff like sim-rounds/arty sims/etc really need to be pushed more. I'm amazed at your knowledge on this stuff, far beyond what I've got!

Hey Sam, Combat Medic in the Army. Being a peace time army the combat experience isn't there but more on the training experience. The "training under pressure" portion of the video felt pretty on point. However in my training environment the stress came from the instructors harping on you along with sim grenades, blank fire, your fellow trainees yelling and freaking out, etc. A lot of the time I would zone in and know exactly what I needed to do and it was fine, for the most part it was a lot of fun. It was when we did the blood lab with the sophisticated simulation mannequins that would "die" on you that I experienced the freezing and tunnel vision. Not only was the pass or fail aspect down to whether or not your patient mannequin died, but it was under nods, with all the noise and cumbersome battle rattle. I remember trying to finish HABC and not being able to find the trauma shears because I hulk hoganed my aid bag. It took me 10 minutes to stop and breathe, and really think about what I was doing. As for the non-training patient experiences, early on it was always just trying to think of what I should focus on first and worrying about steps that were out of order. I find stopping to think about and process all the information for just a few seconds, really jumpstarts that flow state.

Great subject matter. With this sad state of a world we now live in, I have a feeling that sooner rather than later most people will be facing stressful situations themselves. It was a great video to reflect on and maybe start practicing or training. Thank you!

A sheep had attacked a farmer who had suffered head trauma. Two minutes into the job, the experienced EMT and on-site manager fucked off to see the area of the attack for himself. Me and the other guy were fairly inexperienced at that point and order completely broke down with the CRM gone and the woman coughing up red fluid (luckily not blood as it turned out a minute later). My colleague who was supposed to do structured examination just stopped. Meanwhile I was concentrating on the stopping the bleeding on the head and didn't realize what he was doing. Order only returned with the arrival of the emergency surgeon. It's so easy to talk to one another during training but then and there, we were both working in our own little universes without taking note of what was going on around us.

Great Video, some thing that needs to be addressed with ALL EMS systems for longevity, as a former 25 yr EMT with NYC EMS I've experienced situations from care under fire (bullets hitting the Ambulance, brick and mortar hitting me in the face giving care ) being ambushed along with being taken Hostage, One of the main ways to combat situational freeze as you are aware, is absolute !! mastery of your knowledge of your skills!!, Lights and Sirens should NOT effect you, they should almost be annoying or even forgetting there on, Competitions are very good way to induce stress inoculation you can control the environment and scenarios, In NY we had Multi agency training to ie: Building collapses, Train crashes, Plane crashes to terrorist attacks. Place obstacles in the way of performing care, train with Patrol, SWAT, and Fire, and ER staff, if not be the calmest person on the scene and rock on.

WOW . . . Thank you . . . you have given us much important food for thought and thank you for your transparency . . . much respect.

In an unexpected stress situation I experienced a non-traumatic loss of of blood pressure and was unable to function physically. My thought process was also impaired. This is another very relevant tutorial. Thanks.

11 month probie FF here. The training/knowledge beforehand is huge, having that confidence knowing you have trained on ladders, power tools, hand lines, medications, etc. Another thing is to just focus on your given task. Not saying don’t keep your head on a swivel, but if my officer tells me to ladder the Charlie side of a building, I will ladder the Charlie side of a building, then when my task is done, I will go back to said officer for reassignment. Just focus on your one task at hand. Just last night my crew and I had a two vehicle/four victim MVA with one DOA. In my opinion, having most of my focus on patient care, then transitioning into setting up extrication kept my mind from wandering and allowed me to just do my job.

This is beautifully put. It happens to all of us! We all learn and grow.

Great and very helpful video. I am not any kind of responder - just finding your videos are helping me learn skills that might be helpful if I encounter a situation where I might be helpful. On a personal level this video taught me that one traumatic personal encounter that I look back on wondering if I might have made a difference in the outcome that would have been quite important to me, made it clear that my frame of mind was such that I clearly could not have helped in what was looking back an already forgone conclusion.

“When the time comes, you will not rise to the occasion. You will default to your level of training.” Let them humble you in the way it should.

Been around for awhile, getting ready to teach a series of CEU classes for the next few months, for free because, well no one went out and got CEUS due to covid. Love the video, I have been a reserve 8404 and other NEC's corpsman/paramedic, and retired EMS Chief Fire/Paramedic and still supporting ESU teams (SWAT). I love your speech and you are definitely not off canter, this is the first time I have seen your page as I am doing class prep and I intend to use your presentation for the classes. I have told all my students the same and found that I am not practicing what I preach lately, I blame old age. Love the presentations, keep it up. Ken H

My recert instructor always says "It's not your emergency", as some have said here, but I remember probably the first actual I had with a large crowd, it was outside in 40C + weather, lot's of people having heat issues, and someone just came up to me while I was taking a break to get some food and said there was someone passing out and collapsing. I went with them to find the casualty, then because I didn't have any kit or a radio with me, I had to go find our base through the crowd. I jogged the whole way there, and when I arrived and informed an EMS team that happened to be there, I then lead them to the casualty. I remember thinking how ridiculous it was that I tried to go fast, and had to stop for the EMS techs to catch up because they were walking. It makes complete sense that hurrying causes that unneeded stress because that's exactly how I felt by the time we got back to the casualty. Thankfully the EMS techs did most of the work and there were other medics that turned up as well. It didn't help that I had no communication (not enough radios for all and cell phones were ineffective due to twenty thousand people using one tower) and had to leave a first aider with the casualty to go back to base.

As a paramedic for over 30 years, I can say this is so very true. PrepMedic is able can articulate this message extremely well! This message is very well done!

Super video Bro, it's so important to know about this kind of things when you're getting started in a new hobby or job!

Paramedic and Former Marine here, Great video, and for when I respond to emergent calls I breath and just check my pulse rate before we arrive on scene. I also do a quick rehearsal out loud with my partner of what takes priority and what I’m thinking and what i want done. Also I agree I don’t run to calls typically cause I try to remove myself and assess my surrounding. But i think the worst thing I’ve commonly come across the most is the anxious and excited inexperienced first responders , because when they get excited. I know I get a little excited. So now I don’t take anything to serious, until I assess the pt. But lastly as a Marine in Afghan , the couple of times we were engaged I felt you naturally revert to a level of training you subconsciously fall back to. It was a natural instinct to get down scan your sector and return fire.

Just got out of my clinical rotation, needed this. Thank you

Another huge item IMO is to be confident. Never second guess yourself. You will be tempted to try and correct what you believe was a blunder on your part, but in fact was perfectly okay. And in the process you will fall behind on other things. You can ask others to double check or whether they concur with your actions. But never, ever doubt yourself. The "do not run" rule is SO important. If you run wearing SCBA gear and manage to trip and fall over a hose or something (because you cannot see what is directly in front of your feet without craning your neck) then this serves no good purpose. At best you become the butt of all jokes for the rest of the shift (and the following 3 weeks), at worst you cause injury to yourself and damage your equipment and leave your crew one short.

Thanks for this video, really valuable conversation. I have experienced pretty much everything you have mentioned at some point, even though we are in different emergency response fields. I do think that experience has a big factor here, the stress inoculation you mentioned. When I was still new I had the tunnel vision and auditory exclusion at one particular incident. I was looking for my colleague to check he was ok. The guy was stood right next to me!

I really needed this video because I am a fairly green emt that works ift full time and I am about to score a full time 911 position and pick up a lot of shifts working in said position. I recently had a shift out in the 911 side and we got a call for partially amputated fingers and I got really stressed out because it would be the first time I see that. We get there and I basically run to the pt side and completely forget about my medic and when I got to the patient side I could barely speak. I didn’t take a second to breath, I just acted and it ultimately made me stress even more because I didn’t have my paramedic next to me when I was patient side. It is crazy that the little couple seconds to take a second and take a deep breath can change an entire outcome of a patient. We got the pt packed up and loaded and all was well but looking back at the call I could have slowed down so much and it would have led to a me being less stressed. Great video. Really needed it especially because I am still green and need some guidance still.

I have worked in security for years, biggest experience stresswise has veen bouncing in seedy small bad neighborhood bars, where you work alone and fights happen continuously. However according to finnish law, you as a licensed bouncer are supposed to show considerable constraint and are liable to litigation if people start breaking arms. I started when I was 20… Learning to control your breathing and ”acting” like your calm actually helps. And one other thing. YOU are not in a hurry. If people are screaming and whining well maybe they are in a hurry. Im not.

Excellent video brother. Spot on.

Hey, I am a paramedic in the uk, what you have said there is 100% true, I see so many first responders and paramedics running to calls and 9 times out of ten they come out even more stressed than when they went to the call. I guess with paediatric patients the heart rate is a little more increased with it being a child and those with children stress a lot more which is totally understandable but like you said about walking with a purpose and not running, I never really thought of it that way so thank you ! You are a great man !

Uncertainty and not been able to modify possible outcomes in many situations throughout my life had occasionally taken a toll. If I can get involved or participate no anxiety or any other negative feelings had ever shown.

Good points. It's called Psycho-Cybernetics, or visualization. It's very effective in all types of situations. Same with "square breathing." Inhale for 10 sec, hold 10, exhale 10, hold 10. It reduces brain fog and helps to get you settled in. Thanks for what you do, Sam.

I think everyone can relate to having tunnel vision or being brain dead for a few sec, the times it has happened to me was simply because I didn't have enough capacity stored up for that call. Taking a few seconds and taking a breath is a huge one for me, we also talk through different diagnosis on the way out to the patient and look up the different procedures if we are not 100% sure about a medication or treatment. One of the best tricks to reducing stress on a call that i found is methodically going through ABCDE, SAMPLER and OPQRST, that helps to reset and also makes sure you don't miss any important information in a high stress situation.

25 years as a firefighter/ EMT, thank you for this video. It is so accurate!

Stress I can say that stress on the job can reduced for sure…. First and foremost, Sam please keep up the good work. I think stress can be lessened with a looking at a few things. #1 Know your equipment and how to trouble shoot issues. Know your protocols! #2 This is the hard part, I think. Self-Care! Care takers need to recognize that they are not a superheroes and have to “vent” at times. Taking time to relax! Try not to take work home. Do not feel stigmatized in making use of bending the ear of a coworker or accessing Employee Assistance Programs. I have always thought that saying things “out loud” helps put somethings in perspective. #3 I am sure that a lot of stress is brought on by self-doubt. A lack of confidence will make things 10X worse. You must have confidence in your knowledge of the level of EMS you provide. Admitting that you do not know things is good. Go refresh your knowledge of medications. Go look and make sure that you know how to set up the less used equipment on your truck. It not shameful to ask for clarification on how something works. It takes confidence to see help with a piece equipment. That is a good thing! #4 Whether you are the lead medic/EMT call or the assistant…know what your roll on the call is. Every system is different. Experience will help manage calls from dealing with law enforcement, first responders, and the patient and family. #5 You can not always learn everything from a book. Be Flexible. Experiences are a wonderful teacher! #6 I think the most important Take those deep breaths. Clear the brain…..deal with what you see in front of you.

Loving your content over in the UK. Thanks

Thank you That was a great talk Very very important I understood every word you said I needed this ….you helped me

Block breathing helps alot. Recognizing stress coming then block breathing

This video is just great, and I'm definetly recommending this to people. I'm a pilot and I can confirm, that no matter how many times you practice engine out procedure, it's nowhere near the situation, when your engine actually fails or worse. Training and briefing for these situations can help, but you will only know how you will react in said situation is to get in one, since as you've mentioned and I can confirm that, you can't simulate situation, where your life is in actual danger. You can have some realistic simulators, but your mind just knows, that it's no actual threat to you.

I preach the take a breath and present a calm attitude. It can go a long way in preventing an avalanche. I had a pediatric drowning victim. She was not responding to any treatment that we gave her. As we got in to the back of the ambulance, EVERYONE (4 EMS and 4 FF) tried to pile in to help. I had to tell the FF that we were OK and didn't need any other help. The adrenaline was flowing full steam and everyone was amped up. I told everyone "Everyone stop and take a breath. This child is not going to be saved, but are going to treat her as though she can be. That way when we have another call like this one we can hopefully be calmer". It was amazing at how well everyone was able to relax and perform a better job.

Nice thoughts on this delicate topic.

Your a great help for medical advice. Thx for making the vids.

I enjoy reading an learning even if I am retired. As I read some of the comments, I was transported back to days of calls and training. I first read about the "take your own pulse" in a book called "The House of God" by Dr. Samuel Shem. The passage referred to was a series of "The Farman's Rules". The Fatman was the Chief Medical Resident, I believe, and Rule #1 was, "When responding to a code, the first thing you do is take your own pulse". This equates to your statement to take a few deep breaths and center. During my early years as an LPN and EMT, I would run like a cray person to get to a code, even hurdling a housekeeping mop cart and arriving to the code too winded to even speak, let alone perform CPR. As I moved to RN and Paramedic, the instances I ran became less and less and that stressor was diminished. Training and becoming competent in a skill(s) helps but after the adrenaline dump, skills and memory lapse. New nurses and medics today have not been exposed to enough direct patient care with real patients to become comfortable let alone become competent. I read a term reportedly used the SEALS; "Train until you get it right and then train until you cannot get it wrong" (Paraphrased). A seasoned medic taught me to mentally think of the worse scenario possible and mentally prep for that and the real situation might be a much less situation..

This was very helpful. Also love this style of video. Im about a month into medic school which is making me rethink everything I thought I already knew. Several weeks ago, I was the first unit (BLS) on an ALS level call and I froze. I went to the standard NREMT test question answer and placed a NRB @ 15lpm which the patient didn’t entirely need lol. While no life threats were ignored, my interventions weren’t totally logical because I was pretty much locked up mentally. Then it was time give handoff to the arriving ALS crew and I froze again. My newer EMT partner had to step in. Felt bad.

Reading On:Killing and On:Combat helped me understand the stress response and how to prepare. I have had some stressful situations and the tactical breathing really helped.

I once had an acute stress incident that caused me to have tunnel vision during a code. I was an ER RN that had just received a "train wreck" sepsis patient via EMS. Her pressure was 60/39 and she was a difficult vascular access patient. I saw a strong potential for the patient to code. As as result, I put all my time and energy into trying to cannulate her cephalic vein using ultrasound to administer ACLS drugs rather than assess how the patient was doing in that very moment. A respiratory therapist, that was in the room, was looking at the monitor and even asked me if we should call a code. The heart monitor was right in front of me, but my eyes were glued to the ultrasound screen. In my tunnel vision state, I ignored her and continued attempting access for 3-4 minutes. Later, it was the same respiratory therapist that had to alert the rest of the team that the pt was coding. Looking back, I should have assessed the patient and alerted the rest of the ER. Yes, vascular access is important during codes; however, chest compressions and calling a code are priority. The patient ended up getting an IO and central line (both being put in by in MD anyway). And luckily the patient did end up getting ROSC thanks to the team I was around that day.

great video on a great topic that just isn't covered enough. I'm in absolute agreement with the never run sentiment--nothing good comes from the pyschological and physiological changes that happen in stressful events when you are running

Great video!!! Oh, I just thought of something in regard to heartrate. Being physically fit definitely helps with stress management. I'm a cyclist, and my max sustained heartrate is between 140-160bpm. Being able to hold that heartrate for a prolonged period helps to not induce MORE stress when my heartrate gets to that point. HOWEVER, if I am hovering at 80bpm, and my heartrate rapidly accelerates to 140bpm, there is a rather uncomfortable acclimation period before I start to feel normalized in a sense. My blood vessels have to adjust to blood flow, the blood itself has to heat up, and a host of other things. Again, I am not doctor, but I know my body needs a 'warm up' period before I can sustain a 140-160bpm heartrate. So being fit definitely helps. Additionally, being fit will help so that stress doesn't continue to escalate. That worst thing that can happen is to allow your stress to drive you to be more stressed. One thing that I do to help mitigate stress is to focus on the input and output, and not the stress itself. Think of yourself as a computer: a computer can only do what it is told based on programming. Even when it comes to decision making, there must be a stimulus or input. This actually ties into the soldier with the objective example. A person with a clear objective is less likely to suffer for from adverse reactions to things experienced than one who might be unsure about what to expect in a certain scenario. And to clear things up a bit, my God, help us if a soldier is sent on a patrol without receiving some type of logical warning order or objective...lol. The more accessible tools in your bag that you have (figuratively speaking), the better you'll be able to mitigate stress. Tools can include training, mental preparation, physical preparation, focusing on the objective, and even something as silly as a belief structure that what you are doing is vitally crucial. One last example... I remember taking a speech communication class in college (not first responder related) and rehearsing for the speech. One of things I did is video record myself rehearsing the speech. Very interesting to watch my rehearsal. I was able to identify all sorts of issues with why I couldn't deliver my speech, even in rehearsal mode. Watch contextual videos of yourself and others during REAL stressful situations. Mentally insert yourself into the situation as you're watching. This, while not like the real deal, can help you to mentally engage with the scenario understand how your body is stimulated by what you are experiencing and figure out ways to help manage stress during those situations.

great presentation, and I think this can apply to any one who runs into some bad shit. Thanks for your love and concern.

I have found talking through what you are doing to or with your patient help me stay calm and remember what the protocol is for treatment. Even if the patient isn't listening, then talking to my partner helps them hear what's going through my mind and they can add something I'm missing or not seeing. It also helps for them to see hear what the treatment is going to be so they can help me without me actually telling or asking them

Hey Sam. Loved the video. I may have missed the point a bit, but I think a big part of stress with paramedics is (on average) less than ideal training. The gold standard should be what The Medic One Program out of Seattle does. For example, during school, most paramedic students are pushed to the side and do not get hands on or get a chance whatsoever to interact with critical patients in the hospital. Then, they are placed in the field and expected to deliver high-quality care when they may never have had a chance to get hands on with whatever disease process they are trying to treat. I believe if paramedic educations was fundamentally restructured around greater student involvement in the hospital setting along with pairing a paramedic student with a physician mentor, stress on calls would be greatly reduced. I have notice the general theme of low opportunity and reps of critical patient care for paramedic students at most placed in have researched and feel it is too bad. Anyway, thanks for what you do. Stay safe.

Reminds me a little bit of Colin Mortlock's zones of adventure model, where two people on a hike could be having very different experiences! For one it could be play, as simple as a stroll in the park, but for the other, it might be borderline 'misadventure'. Experience, repetition and training under extreme circumstances help to extend our stress proficiency levels. Something that training rarely seems to allow these days is an exercise and post-mortem, followed by a reset and do-over. It's great to figure out what could be done better, quite another to then lock that into the muscle memory

Very good video! In my experience (merchant seaman) when we are supposed to perform under heavy stress the operation takes on an almost farsical level of innefficeny. Drills tend towards (in practice) serving all other kinds of purpose than to actually prepare you for emergency. The master just wants to tick it off from his long to-do list, the ambitious young officer organising the drill wants to make it impressive and orchestrates a way to complex scenario for the skill level and time we have. The crew bumbles through the exercise and fuck up all kinds of stuff that would get them killed in reality. Afterwards they all agree on a heavily retouched version of actual events in the review. The master because he wants it done The officer because he wants to look like he organized a good drill And the crew wants to think of themselves as action-heroes rather than bumbeling amatueres. They all assume that an emergency will not happen to them, and when it does the result is a rarely seen disaster.

I had a guy when I first joined the marine corps teach us during a tccc class that once the person is off the x throw a dip in to calm down and really understand what is going on. Also the best stress training I have ever done is getting intentional hypothermia then having to do medical tasks like IV’s and stuff. Was fantastic and hard as hell.

Exactly, I keep the CAT instructions for the same reason I have the Red Cross app on my phone, purely as a reference. We all small talk on the job and should be running visualization exercises. This is a great time to break out those resources and just re-familiarize ourselves. Thats the primary way to commit something to long term memory.

Good content - I remember being completely at a loss when my body wouldn't respond at all from stress. I was so confused, all I had to do was literally blow a whistle. That's it. I was like WTF is going on, for all the training I did, was totally unprepared for the event.

calmness is contagious. slow is smooth, smooth is fast.

Very informative. Thanks

As someone who is going into the first responder field as an EMT this is very useful to know. Thanks so much.

You guys are awesome.

Yes, pretty to the point, great information. And I believe Jocko willink was another person I've heard speak on the topic of acting calm to stay calm

I work for a pissant local agency where we get NO training and I was involved about a month ago where we got ambushed and my partner got her throat slashed and then was stabbed in the brain. It was super scary but I somehow subdued the suspect and then gave her the worst wet-check ever. I didn't handcuff the suspect and when I checked my partner out I fixated on her lungs and torso when she said she couldn't breathe. I never checker her throat. If medics hadn't made it there in time she would have died.

in my region we arrive late to patients with insufficient staff and with outdated ambulances....in a serious case we work automatically and later we bear the consequences of stress such as hand tremors strange reflexes such as catching objects before they fall...morale matters a lot when you go on a mission...if you know that upon arrival you will encounter a hopeless case and you are outnumbered (we are talking about victims vs rescuers) you have two options either you relax or you panic...and the third option appears when you you can use panic and relaxation for the benefit of the victim....when you cancel yourself as a person and work like a robot and often put aside compassion and mercy to be efficient in the system, you bear the consequences of physical and mental stress

I'm not only listening and watching this for your perspective and knowledge: I'm a medic focused gamer and I want to provide my team the best medic I can give. Thanks and good luck to you. Edit: Thank you, extensively.

Awesome. Thank you. This is great advice for your average civilian too.

30 years as a registered nurse and my hands still shake during a code blue. I.V cannula? Not a hope in hell, l delegate it to an other member of the team and focus in on what l know l can do. I never run to a code, it gives me the time to mentally go over my assessments. Great info. training and confidence is probably the biggest treatment for stress.

The experiences I had where I realized I had auditory exclusion was the 9 boxing fights I had. The referees would be so mad because I kept fighting after the bell rang 😂 I do believe that I always fought better than I felt while training. We always sparred hard. I think that might have helped along with having the plan to use straight punches with them at the end of my reach by using footwork. That's how I almost always trained. I have a lot of other experiences of becoming completely useless in other circumstances where I was under massive stress. Thanks a lot for sharing your knowledge

Box Breathing is a technique that can help regulate a stress response, especially how it pertains to arousal and breathing. What's been especially helpful is EXERCISE. But not just going through my reps. I intentionally stay cognizant of my tempo and velocity, forcing myself to stay present when the burn comes in and stay consistent from rep to rep. Jeff Nichols (former SEAL and exercise physiologist) put it best when he explained that exercise is a form of stress "training" where you're in control of the external factors and being purposeful in your response (ie consistent reps) builds that resilience.

As a EMT and dispatcher I see that just taking a breath and controlling the call makes a huge outcome difference

Although I'm not doing EMS (yet,) repeating the same move or procedure 20+ times helps me a lot. I'll do the exact same move at least 40 times in a row, and I will not stop doing it until I feel it's becoming second nature. Further more, I do this action with some form of external stimuli such as blaring music, doing it in an uncomfortable position (such as on a rock/uneven surface, in the corner of a room, or with my non-dominant hand,) or even asking my friends to distract me. People think it's weird but it has truly been beneficial.

Excellent topic!

Literally at the end of a 25 hour shift with no sleep and this hits hard. Some stress is out of our control and it really sucks. Just makes me want out of the field. Definitely be smart about where you choose to work and try not to get pushed around constantly.

thank you very much!

Great vido! This is not talked about enough. Breathing is the key. As a Hospital Corps School instructor I would teach my students a combat breathing technique that SEALs use to calm down in stressful situations. I have used it myself many times especially when you get to that point with the shaky hand twitching due to adrenaline. Some instructors say "In an emergency the first pulse you should check is yours" or "remember it is the patient's emergency not yours". Both of these help students calm down a bit. Stress inoculation is also key with multiple procedure reps to build confidence. We often use Physical Training Exercises to induce stress in field medical or TCCC training. This really does help people perform at a higher level in actual stress situations. It is not a perfect solution but it does build your stress tolerance and generally helps you perform better under stress than if you did not have that training.

The best remedy for stress is building a tolerance. I started underneath a great mentor who had tons of great tips and tricks on handling awful situations. The most helpful was simply seeing how a "seasoned person" handles different situations.