At the class

So, I'm at this medical class based on the US Navy Corpsman program. It covers a number of field things: cleaning and disinfecting wounds, suturing, basic and minor surgical procedures, some simple dental work, treating GSW and other combat trauma wounds.

It starts tomorrow so I'll let you know how it is.

Last bit on this most interesting book - Unthinkable

So- more things to help us out here... from the book, continued-

She (author) talks about this thing called group-think - People often doing what others do, especially in a crisis event. Possibly it's a genetic herd-instinct thing coming out- maybe we "think" our best chances are of all of us sticking together, so we do. She defines group-think as "the adaptive strategy of prioritizing group harmony."

She talks about people clumping together, even in danger, if no one is moving! But the opposite can happen too- people can PANIC... as a form of group-think. Panic can be contagious...

She says- used to be that people thought that crowds were like water... they would easily flow out of an burning building or airplane. But instead what they find is fear and pain can influence the movement of people - people fall, they take short-cuts, they can pause to rest... but once a decision is made, people will statistically not change their minds; "Hey, let's go this way"... like they did on one of the twin towers- they went up, to the roof... but they found the doors had been locked.

Another thing is people do not always move together- some will take precious minutes to look for things to take with them, like briefcases, and pictures, etc. Or they will go looking for others, like friends or children, etc.

Also- the more noise there is, the more stressed people can get, and the more stressed people get, the less they are able to see clearly/think clearly, etc. And in some cases... thinking clearly is EXACTLY the thing people need to be able to do... and in many cases, we need to be able to do this relatively fast. "If you have to stop and think it through, then you will not have time to survive." This goes back to the idea of taking some time PRIOR to an event - like in an airport or restaurant, or whatever... and either physically walking through the things you need to do, or doing it in your mind... at least.

The Submissive Crowd

People have a tendency to congregate... to clump together, to seek human connection in a crisis. But also people have a tendency to panic or clump around and wait, or "they" take too long in deciding what to do. "If disasters breed groups, then groups need leaders."

and these group leaders she studied in crisis events all had something in common:

1- They did not bully their way into power - they got respect because they seems calm and credible

2- They were knowledgeable, aware of details, and decisive... but

3- They were also open to other opinions

Crisis Leadership Needed. People will need someone to keep them calm and walk (maybe literally) them through what they will need to do

People will be in psychological shock... and in many, their "brains" (that part of us that helps us make rational and intelligent decisions) may not work.

In a crisis, be: Strong (Folks - there is a fire here... ) Direct (...there are exits to your left rear and right rear) and Loud - people pay attention to LOUD! especially in a crisis!

She describes a community in the bayou of LA that all survived the Katrina event - they were close, strong community. They joined boats, and all moved out together. The children saw this as an extended "camping" experience... which is how they all seemed to keep a good head about them. It was serious, but they'd done this before - they'd practiced many times, and they all knew what needed to be done. They packed up and left a few days before the government put out mandatory evacuation orders because they'd seen this before... they knew.

She said places like this are "models of resilience" because they "proactively help each other survive. They value their community more than their possessions, and they also trust the groups collective decisions."

Healthier, higher functioning groups tend to do better in crises. and the opposite is true too. Your level of health and functionality is directly proportional to your collective handling of a crisis. So this gets us to church or small group dynamics, and even families. I've heard of families falling apart in crises- I mean, a crisis can either bring the family members together and make them closer or it can destroy it. So, a crisis can bring out what is already there.

Stronger communities seem to bring with them a higher chance of survival - for the group and the individuals involved.

How can we make our church/small group communities/families more resilient? Spend time together, get to know each other, learn to trust each other, learn to have faith in each other.

DECISIVE MOMENTS:

"We have passed through the denial and deliberation phases, and there is nothing left to do but act. What happens next will be, as we will see, very hard to undo. The decisive moments are the cumulative results of the delay and dread, of the influences of fear, resilience, and group-think."

"The last sage in the survival arc is over in a flash. It is the sudden distillation of everything that has come before, and it determines what, if anything, will come after. As in photography, what happens in this single moment depends on many things: timing, experience, sensibility - and perhaps most of all, luck,"

Panic- the basics here only...

The obvious- panic can, and usually does, KILL.

The less pbvious- people are more likely to do nothing at all than to panic.

What causes panic? Conditions for panic to set in:

1- "People must feel that they may be trapped. Knowing they are DEFINITELY trapped is not the same." But if they MIGHT be trapped... it's different.

2- "Panic requires a sensation of great helplessness- which often grows from interactions with others." if one person feels they are "lost"... and others begin to accept that, then they see their inner feelings reflected in others... and it can spread.

3- "The final prerequisite to panic is a sense of profound isolation." but if you're with others, how can you feel isolated? Well, when you feel powerless, and everyone else does too, then you feel "exquisitely alone".

And comes the mad rush to the doors... which causes the doorway to jam with people, and then NO ONE gets out. so... tell people - yell if you have to (to snap them out of this feeling of impending dread)- to SLOWLY but steadily move to the exits. This orderly exit assures MORE survivors.

How can you tell who is more disposed to panic? A research doctor studied this, and was able to surprisingly predict with pretty high certainty who of his test subjects would panic and who would not. There are two different types of anxiety:

"The first is 'state anxiety', which describes how a person reacts to stressful situations, like a big exam or a traffic jam. The other is 'trait anxiety', which refers to a person's general tendency to see things as stressful to begin with. Trait anxiety, in other words, is your resting level of anxiety on any given day."

People with higher trait anxiety are more likely to give way to panic than people with a lower level of trait anxiety.

But the more likely human action in a crisis is paralysis... it is far more common, and... we may actually be more hardwired for this. It seems to happen in mammals pretty often - birds especially. It seems the prey animal is often prey because it has drawn the attention of thee predator... by running. Once it stops moving, it often can cause the predator to lose interest. Thing is often, people who've gone through this personally have left feeling guilty - "Why didn't I do" this -or -that thing????? Little consolation, but your biology took over.

Paralysis often occurs in the presence of extreme fear. So the idea here is... lower the fear level and you lower the possibility of paralysis. So, how do you do that? Well, one way is to put yourself in similar situations over and over until you get - as you can in something like this - more used to it. Easier said than done... but this is why the military/police/firefighters put them selves in training environments that simulate the "real" thing so when the "real" thing happens - they can more easily say - "I know what to do here."

Preparation is the best antidote. The second best is leadership!

Preparation can be as simple as - "Make a plan"... even in your mind. You're at a movie... take a few seconds to locate the exits. What is this one is blocked? Where's another one. That's much better than nothing at all! And walking through an exercise is much better than just thinking it through in your head.

Well, there's a little more to the book- and it had very good example and studies, so I recommend it, but this is pretty much it.

Any comments - stories - ideas - thoughts?

I'd love to engage-

Let'sget to the good stuff in the book- So, who makes it?

So, who makes it? Here's the bare-bones stuff out of the book- but I still recommend the book, the stories not only reinforce the points, but you learn a lot from them too.

Section- The Profile of a Survivor

Basically how you are in your "normal" life, may NOT be how you are in a crisis. This is either nothing new to you (cuz you've seen it in yourself or in others) or maybe you hadn't considered this idea before. Nature and nurture is involved here (biology and life-experience) as you might assume.

"But before behavior even comes into play, our basic profile can dramatically alter our odds." For example- those things that hamper our lives under normal conditions WILL hamper us in an emergency. Any physical handicaps... they'll still be there - in spades. Weight issues make a difference - obviously the more you weigh, the slower you will move, the harder it will be to move, etc.

This may be controversial to you - but gender plays a part as well. Men seem to be better suited for some emergencies while women seem to be better suited for others. About 2 times as many men die in fires than women do. Party- men tend to do more dangerous jobs and take more risks than women. "Almost every survey ever done on risk perception finds that women worry more about almost everything." From pollution, to kids to guns, and traditionally are more responsible for caring for others she says. Don't know if I agree that this is so different than me - is she saying that men tend to think less for others (even others they are responsible for?) than they do for themselves? I don't buy so much since I know guys are often have their families in their minds all the time. "How do I protect them, what do I have to do to help them", etc.

Thing about worry is - if you worry more, it can motivate you to evacuate more quickly. She says it's easier to get women and children to evacuate than it is to get men out of a burning building, for example.

Also- women tend to be "fashionable"... if you're a lady, consider what you have on your feet. Could you run in those shoes if you had to? Evidently there were a whole slew of women's shoes in the stairwells of the twin towers.

"Resilience is a precious skill. People who have it tend to also have three underlying advantages: a belief that they can influence life events; a tendency to find meaningful purpose in life's turmoil; and a conviction that they can learn from both positive and negative experiences. These beliefs act as a sort of buffer, cushioning the blow of any given disaster." To these people- dangers seem more manageable and as a result they perform better. She quotes George Everly, from the John's Hopkins Center for Public Health Preparedness in Baltimore - I went to one of his workshops on Psychological First Aid back in 2009 - "Trauma, like beauty, is in the eye of the beholder." She says a healthy proactive worldview should logically lead to resilience. But, she says... if the worldview leads to resilience... then what leads to the worldview? What makes some people come through an experience mostly in tact, while others are really thrown for a loop on some pretty small scale event?

What's one thing resilient people have in common? Confidence! So- how do you get confidence? Are those people born that way, or do they get this confidence in another way? Well, one way to get confidence is through training! "Confidence comes from doing." Train, train, and train. So, when you get into something... you feel like you already know what to do... actually your brain will already know to lead you right, if you know what I mean.

"Special Forces Soldiers Are Not Normal" In this section she says SF soldiers consistently outperform other general infantry soldiers- they were more mentally clear, stress didn't make them stupid as fast. But SF soldiers were "chemically" different than the average soldier. Blood tests showed they had much more of a chemical called neuropeptide Y - a compound that helps you stay focused on a task while under stress. But people who are more resilient can be identified not only through blood tests, but through a standard questionnaire- SF candidates where given a set of questions, a psychological test to determine dissociative symptoms. The more questions they answered yes to, the less likely they were to successfully complete the very stressful Special Forces Assessment and Selection course.

Here are some of the questions:

At this time, in this room...

Do things seem to be moving in slow motion?

Do things seem to be unreal to you, as if you are in a dream?

Do you have some experience that separates you from what is happening; for instance, do you feel as if you are in a movie or a play, or as if you are a robot?

Do people seem motionless, dead, or mechanical?

Do you see things as if you were in a tunnel, or looking through a wide angle photographic lens?

Do things happen that you later cannot account for?

Do you space out, or in some other way lose track of what is going on?

Does it seem as if you are looking at the world through a fog, so that people and objects appear far away or unclear?

It seemed there was a correlation between the amount of times a soldier experienced dissociative symptoms... especially under normal conditions... and his performance under stress.

More to come...

So I've been thinking about WHY I am so insistent on getting things together. It does seem a bit odd for me. I can't tell you how many times I have procrastinated in the past, even for important things. But this time, it's different. Is it the social climate? Let's be real....a lot of people are unhappy in this country. So much so, that all the nuts are coming out for the presidential race, the government seems to be trying to take away all of our important rights, and Congress....well they want to be the ruling class!!!

Is it because too many important variables are coming together at the same time? Could be. Is it the dreams? Good chance with that one. It's kinda hard to discount something when you're getting messages "from the beyond" (whatever beyond is for you).

But I think it ties into what Chad has been talking about. Psychological Preparation. I've been going over scenarios in my mind, talking them over, and trying to understand what I would do in certain situations. I'd rather do it now rather than when it's actually happening. I need time to process things correctly. But in the process of doing this, I find that I need to also start DOING as well.

Maybe it's a matter of crossing things off of this long list in my head. Are your finances in order? Check. How about food & water. Check. Ok, next step,..... I feel better knowing that not only are questions being answered, but things are in place. I won't be the one standing in the middle of the street going "what the hell is going on!". Ok, I might still be there....but then I can go back into my house and say "we are prepared, don't worry". And that is a very important thing to be able to say to my family. "It's ok kids. We've got it under control".

More from this very interesting book

In the next sections Ripley talks about the second stage of the survival arc... Deliberation. and the first part of this section is entitled "Fear- the body and mind of a hostage". She recounts the story of the forty eight year old American Ambassador of the US to Colombia back in 1980. As per international protocol, he'd been invited to the Embassy of the Dominican Republic for some reception honoring something or other. But, this reception was soon to be raided by hostage takers from some reason. Some guests and security people and hostage takers were shot and killed as they battled it out with government troops for a while before the hostage takers finally gained control and got their demands met.

But the point she makes is about how the ambassador- who survived- was able to handle the events. When all the shooting started, he acted decisively - he dived behind a couch and window while many just seemed to stand there in stunned silence of disbelief (denial). Some of this came from fear.

She says- first rule of fear... it comes from a primitive place. without training we tend to react to loud sounds (90 decibels or more) with some degree of fright. In a stressful, fear inducing event our bodies go through a whole host of psychosomatic activities; blood chemistry changes so it can coagulate more quickly, blood vessels constrict so you bleed less if you get cut. Blood pressure and heart rates increase, hormones such as adrenalin and cortisol are shot through our bodies to give our gross motor muscles more umph if needed.

But... rule #2 of fear... when fear giveth one thing, it taketh away another. Evidently we have limited resources when under "attack", and our brains prioritize actions/activity based on availability. Sometimes we gain super human strength, but our reasoning skills are compromised. She gives example of one person in the embassy attack who just froze. They can see, but can't move... or... they can breath and reason, but can't see- have you ever heard of "hysterical blindness"? Happens to soldiers sometimes in combat - the stress is too great, and among other things, they just go blind (it's temporary). But in stressful environment, some people actually get BETTER vision - crystal clear. speaking of vision- statistically most people will develop tunnel vision, though. Some people are protected from the damage of loud noises, there are stories of police officers or soldiers in some shooting situations who's ears are protected from the damage of loud shooting. In fact some said they never even knew there were shots fired. She says -"stress hormones are like hallucinogenic drugs. Almost no one gets through an ordeal like this without experiencing some kind of altered reality."

She has a section entitled - "The Survival Zone". Basically, preparation can't be beat! "The body's first defense is hardwired. The amygdala triggers an ancient survival dance, and it is hard to change. But we have an outstanding second defense: we can learn from experience." Basically, practicing actions that can help us... actually help us work through an emergency. "The best way to negotiate stress is through repeated, realistic training." Granted, civilians may not have time and/or resources to train for as many events as police and military do, but even looking for the exits in a public place can make a world of difference.

The thing is... in events like what she writes about, a whole host of physical and psychological events take place... and one of them is an increase in heart rate. Evidently studies show that people perform best when their heart rates are between 115 and 145 beats/minute. "At this range, people tend to react quickly, see clearly, and manage complex motor skills." But at a pulse of 200b/m, things get a little hairier. "The trick is to stretch out your zone through training and experience."

There IS something ALL can do to slow the breath down and thus the heart rate... in order to stay "centered". There's this thing some have given the manly name of Tactical Breathing or Combat Breathing... also know by it's less testosterone-inducing name of... dare I say it... Lamaze Breathing. Okay, let's split the difference... Combat Lamaze. Slowing down the breath, for a number of reasons, helps focus... and focusing can save your life!

And here it is... slowly (to a count of four) breathe in. Then hold it for a count of four. Then slowly breathe out to a slow count of four. Ta-Dah!!! Lamaze... I mean, COMBAT breathing!

Also - the idea of just believing things like breathing this way can help... actually can help. "Laughter, like breathing reduces our emotional arousal as well. It also has the benefit of making us feel more in control of the situation." And THINKING you're in control... actually helps you to BE more in control. Who knew????

More later...

From the book "Unthinkable"

I'm reading a book called - "Unthinkable; Who Survives When Disaster Strikes- And Why". A very interesting book so far! Some points:

The author, Amanda Ripley, starts off with a story about the destruction of the French freighter, the Mont Blanc, as it was pulling out of the Halifax harbor, Nova Scotia in December of 1917. It was leaving the harbor loaded with explosives and ammunition - headed for the war in Europe. On its way out, it seemed to accidentally get rammed by a larger ship. It wasn't inconsequential, but it wasn't a huge deal either. Or so they thought.

Well, as it turned out, one thing led to another, and eventually it got to the point where the ship actually blew up. The explosion was the largest recorded up to that point. There was an Anglican priest there who helped the victims, he helped organize search and rescue efforts. And later, as one might imagine, this experience stayed with him for a long time.

In fact he seemed so curious about this experience- why people did what they did, and perhaps more interestingly, why they didn't do what they didn't do. He later moved to New York City to earn a PhD in Sociology. His dissertation - entitled "Catastrophe and Social Change", was influenced by the experience three years earlier, and seemed to be the first systematic analysis of human behavior in a disaster. And his work has been the basis of much work on crisis behavior since then.

She goes on to say how we all seem to assume how we might behave in a crisis like this, or even a personal crisis, like a car accident. I haven't been an EMT too long, and although I've been to some accidents that had flipped cars and people with internal injuries, I haven't seen carnage on the road. But of the ones I have seen, even a fender-bender can be pretty traumatizing for some people.

In the introduction there's a section Ripley calls "The Things Survivors Wish You Knew". She got in touch with the World Trade Center Survivors Network - those who made it out of the buildings on Sept 11th, 2001. She interviewed some of them and she learned a few things from this connection: Nothing beats physical preparation! You can be told about what to do... but although actually physically going through the motions may be inconvenient, and may interrupt our day, etc, etc... doing the things we'd need to do in an emergency is worth it's weight in gold! And she says here that writing a book on disasters seemed to reduce her anxiety, not increase it. "The truth, it turns out, is usually better than the nightmare."

She goes on to address our governments reaction to the events of that fateful day - they put some good policies into place - policies that seemed to help the policy-makers more than anyone. The average person may know there is a "code Orange" day... but the average person doesn't know how to act any different on a code orange day than a code green day. The average person- who will be the ones mostly affected by some terrorist act - doesn't know what to DO in an emergency... and DOING seems to be the key thing in an event like this.

She goes on to say that the odds of us being killed by a disaster are VERY slim... but the odds of us being affected by a disaster is pretty likely! So... more reason for us to know what we might go through psychologically and physiologically. "We need to get to know our oldest personality, the one that takes over in a crisis and even makes fleeting appearances in our daily lives." We can train ourselves in how to react and what to do so we are not incapacitated mentally in a time when our family and/or friends may need us.

The Survival Arc...

"In every kind of disaster, we start in about the same place and travel through three phases"... Denial... Deliberation... Decisive Moment... and people often end up going through these not so much in sequence, but more jumping back and forth, into and out of these three phases as the effects of the event unfold.

Denial This initial shock can take the form of delay- which can be fatal! Look at what is happening now in terms of sovereign debt- "nothing is going to happen!" Our economy can't collapse, etc. And yet in 2008 we were weeks if not days from an economic melt-down. Who knows how bad the effects would have been, but they would not have been "business as usual" for most of us I think.

In the following chapter she talks about a woman who survived the 1993 garage bombing of the World Trade Center, and the 2001 attacks. And in her interview with this woman, a few things came out - she was VERY slow to accept the attack on September 11th. She wanted her world to be back to normal! And not only that, but she wanted nothing more than to STAY where she was... sort of a "if I act like nothing is wrong, then nothing really is wrong!" idea. She seemed to just NOT pay attention to some of the events - like smoke on the floor.

Another example of denial is laughter... people can just start laughing- incredulous of the events unfolding! It's SO NOT REAL! Or people just go silent. "We have a tendency to believe that everything is OK because, well, it almost always has been before. Psychologists call this tendency 'normalcy bias'." We use information from the past to make sense of what might be happening now. And some instances, some people "dissociate", they reject one reality for another. It's like they forget it's not happening... it's more like it's not happening at all! This is the psychological form of sticking one's head in the sand. Reality is too unreal! so... I make my own.

Deliberation We know something is wrong, but we aren't sure what. "The first thing to understand is that nothing is normal. We think and perceive differently. We become superheroes with learning disabilities." Here's where the fear response comes in - she asks... why do some people get out of a burning building while others don't?

One thing people do often is mill around - some looking for someone to lead them, some just in a mental fog. Another common action is start to gather things - "Let's see, what will I take with me." In some cases, some of the objects around them take on extraordinary meaning... and thus become "important" and need to be taken. The lady from the above example, when she finally knew things were VERY wrong, when she finally GOT it... she went back to her desk to take the mystery novel she'd been reading. then she looked for more things to take. Not uncommon evidently.

Decisive Moment Here "we've accepted that there is danger; we've deliberated our options. Now we take action." Well, some people panic.. but some- in the same disaster- can freeze- and this can be deadly. But some go into "mission mode"... they move with deliberation and mission. She says later in the book she will show how we can do this - train ourselves not only to NOT panic or freeze, but to be as clear headed as possible to act with decisiveness.

Characteristics of crowds in a disaster - they can become extremely docile and quiet. What do we do... and how do we do it? And this seems to be one of the biggest problems with post Sept 11 policies... the policy makers may have good plans, but the average person does not know what to do, and more importantly, why they are supposed to do it!

I'm actually not that far into the book, but there's a lot of examples and anecdotes so it makes for a very interesting read! So.. there's more to come.

Stay tuned!

Here it is...

A place to share and grow. A place to help make some sense of things- as we are able.

And I want to remind us what the angels almost always say to people in the Bible - "Do not be afraid." Fear can paralyze us. But having something to do and/or think about can help us remember there's stuff we CAN do. Although a lot of life really is out of our control... it's not ALL out of our control. And to stay healthy psychologically, we must believe there's at least a little that's in our control still.

So- let this be one more tool to help us in our journey of preparing as we are able... sharing and growing and laughing and crying and praying... together in the faith that God is with us all! Use the force!

Can I Get An AMEN!?!?!