In Your Mind’s Eye Using Imagery as a Tool for Improving Effective EMS By: Jess Fulkerson EMT-P Mason County Fire District 2 Mason County Sheriff’s Office SWAT Mason County, WA
Mar 26, 2015
In Your Mind’s Eye
Using Imagery as a Tool for Improving
Effective EMS
By: Jess Fulkerson EMT-PMason County Fire District 2
Mason County Sheriff’s Office SWATMason County, WA
Before We Get Started
No! This is not some hippie-dippy Kum-By-Yah, incense burning, yoga stretching, Ravi Shankar listening, out-of-body, cosmic experience.
But if you want to….that’s cool too!
OBJECTIVES
Identify why/how Imagery works Identify why/how Imagery is
applicable to EMS providers List the two different “perspectives”
to Imagery Complete a Imagery sequence as an
example….if we have time.
Getting Started
Where these crazy ideas started for me:
S.W.A.T. and Sheriff’s Deputy Training Realization of the “mental
toughness” needed in law enforcement/military
Drawing parallels to Fire/EMS, after witnessing problematic behavior for years.
The Problem
Anxiety and Fear – Plain and Simple You’ve seen it, felt it.
It affects our abilities to provide effective care.
It affects how we deal with patients and other providers.
Often times we’re just “thrown in” to scenarios we aren’t prepared for.
How Visualization Works
Neurons in the brain take in visual/audible/olfactory/tactile stimulus from “the real world”.
The brain reacts to these stimuli with physical responses Sympathetic Nervous System responses Parasympathetic Nervous System
responses
How Visualization Works
Now consider a dream… Nightmares
Real Sympathetic physical response Sexual stimulus dreams
Real Parasympathetic physical responses
How Visualization Works
So…as far as your brain is concerned….
If the brain “sees it” it’s HAPPENING!
THAT’S A POWERFUL CONCEPT!!
How Imagery Works
Can we use Imagery CONSCIOUSLY? YES Easier for some, not so easy for others
But achievable for all…we’ll get to that. An Example: “The orange” exercise.
Mental Imagery At Work
Olympic Athletes Downhill skiers, ski-jumpers, high-
jump/pole vault Shooting
Shooting bulls-eyes Practical shooting stages
EMS Skill based Backboarding Traction Splint application
So…we know it works…but…
HOW/WHY DO WE USE IT? Not just building skills proficiency Anxiety Reduction
Stress Inoculation Cops/Military using video scenarios
Confidence Building Positive Self-Talk Calming Exercises
EMS Application
Everybody in “basic training” may benefit
Identify those in your ranks who are “having trouble.”
Imagery may help new providers swim where they might normally sink.
EMS Application
Ever been anxious/afraid? So anxious/afraid you have trouble
performing? Was it something you’d never “done”
before? What if you had seen it before…in your
mind? Would you have been less anxious/afraid? Maybe…because you’d have “done” it
before…
Two Perspectives
Associated Imaging = First Person
Helpful for building skill or achieving a specific goal.
Goal identification is key!
Two Perspectives
Dissociated Visualization = Third Person
Helpful if you want distance from an emotional response.
See a scene “go well” first
What if: “I CAN’T”
For some, visualization is not easy The key is repetition and relaxation
Open/close your eyes on something Combat breathing/Skip breathing Learn not to “try so hard” Arrival of emotions = start over, keep
going Have fun with it.
HOW TO:
Self-guided visualization Must be careful not to reinforce poor
qualities
vs. Guided visualization
Not “hypnosis” Can be done by anyone, but in some
cases it’s best left to experienced “professionals”
CAUTION!
We cannot use imagery to substitute for actual, practical, tactile reference markers.
This can build over-confidence and reinforce poor performance.
Use imagery only after a certain proficiency has been built through training/education.
This CANNOT BE OVER-STATED!!
Attitude Adjustment Ahead of Time
Cockpit management = ambulance mgmt Good rig check with purposeful focus
I always seek out my “worst case” equipment, touch it, and if necessary…check it.
Affirmations and Positive Self-Talk….what are “affirmations”?
Might go like: I am a skilled and compassionate EMS provider I am courageous I am committed to excellence I constantly seek self improvement
Attitude Adjustment Ahead of Time
Create a Pavlovian Cue for relaxation Who’s Pavlov? Use relaxation techniques to create a
sense of extreme calm/relaxation. Then say a choice word in that state….repeatedly….
This takes a little time/effort-but pays off !!
Attitude Adjustment in Real Time
On the way to a call (high-stress or not), go to the cue word. The association you’ve built with relaxation can/will help you relax.
Invoke positive self-talk/meaningful quotes of others
Combat breathing Inhale for a count of 4 Hold for a count of 4 Exhale for a count of 4 Hold for a count of 4 Inhale for a count of 4 Repeat
An analogy….
Horse and jockey Horse = emotion. Jockey = reason Keep the horse calm in the starting
gate. If the horse gets out of hand and panics….
Both the horse and jockey are mangled and there’s no race.
But the calm horse, guided by reason hears the bell, and is off to the finish line!
Attitude Adjustment in Real Time
Stopping negative thoughts AS SOON AS you find yourself in
doubt, or negative thought….. Say/Shout to yourself or outloud
“STOP!” Perhaps imagine a “stop sign” Then immediately give a positive cue
such as: “Focus”, or “check the ABC’s”, or
“smooth” or another cue you’ve prepared
Attitude Adjustment in Real Time
In stopping a negative thought…. Don’t think of not thinking of a negative
Try to NOT THINK OF something “Rebound effect” is possible
Focus on a “distraction” This can be completely off topic…or A relevant alternative
Healing hands on a patient More/stronger hands on that extrication tool
Remember…
Positive self talk and Negative thought stopping
Isn’t stuff done “by the seat of your pants” It Takes Practice AHEAD OF TIME !!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!! !!!!!!!. . . Get the point? ???????????
Let’s Try Some Imagery
Pediatric Emergency
Car Crash
What We’ve Learned
Imagery is a pro-active way to experience things without actually experiencing them
It can be used to enhance our performance ahead of time
We can use the positive-self-talk and negative-thought-stopping to aid us during EMS situations
References “Warrior Mindset” by Dr. Michael Asken, Lt. Col
Dave Grossman and Loren W. Christensen “On Combat” by Lt. Col Dave Grossman and
Loren W. Christensen “On Killing” by Lt. Col Dave Grossman “Image Streaming: The Ultimate Creative
Thinking Technique” www.creativethinking.com “Advanced Creative Visualization”
www.wilywalnut.com “Visualization Techniques”, “Sports Guided
Imagery Exercises” and “What’s the Miracle Question – Solution Focused Therapy” Dave Mason. Key-hypnosis.com
Questions?Comments?Concerns?
Issues?Applause?Cheers?
Standing Ovations?Want to throw money?