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Verbal First Aid and Motorcycles!

Biking Article
Montana Cross RiverUsing Your Head After A Crash.

It’s dusk in the desert and you’re relishing the open space and the glorious solitude. The sun hangs heavy as it bursts into shards of color across New Mexico skies. It’s been a perfect ride. You and your riding companion come around a tight turn as you head down into a canyon, thinking only of where you’re going to have dinner, when the lead rider hits a patch of sand and high sides into a wall of granite.

You manage to stop in time, but your friend’s bike tumbled over an embankment and while he is thankfully still on the road, he is not moving. His leg is bent at an angle not meant for human bone. He is conscious but in shock.

You’re alone. It’s nearing dark. What do you do?

If you’ve managed to reach 911 and they’re on the way, what do you say when every moment and every word counts?

This is an all-too familiar scenario for riders. It happens in the country, in the city and all parts in between. Some people, mostly those who have been specially trained to handle critical events, have the skills to approach a situation like the one above with great calm, self-assurance and compassion. Most of us, on the other hand, slip into emotional shock along with the one who is injured. There’s an old wisdom about target fixation: Never watch someone go down, because that’s where you’ll wind up. It is true on a number of levels.
But, even when there’s nothing you can do besides wait for the ambulance, there are things you can say—and ways to say them—that can help your friend survive. Words, when used strategically, can be a most powerful medicine, helping us to lower blood pressure, reduce inflammation, or stop bleeding.

Lt. Samuels (*name changed, story true) sat behind a large, conspicuously clean desk at a Westchester, N.Y.  police station. He was cool, composed, and seemed as uncluttered mentally as he was physically. The awards on his book cases and certificates on the wall attested to a long, successful career. “I paid my dues,” he smiled as he scanned the room and the work it represented. As he saw it, however, his career really started in Vietnam when he was only a teenager serving in the U.S. Army. It was there, assigned to an armored car division sent deep into the jungle, that he learned what it took to survive physically, mentally, and emotionally.

He was on a mission in the Delta, it was summer and the temperature outside had reached upwards of 115 degrees Fahrenheit before noon. Inside the tank it was at best unbearable under normal conditions. On one particular day he still remembers with stunning clarity, it was life-threatening.

“It must have been 130 or more inside. It was hot in a way I had never experienced before. I couldn’t stop sweating, couldn’t drink enough, couldn’t just get up and go to the bathroom. I was burning up. I don’t mean that metaphorically. I was literally burning up and I had to lower my body temperature somehow or I was going to die.  Funny how it didn’t scare me. It was just as clear to me as the coffee in front of me now. It was a fact. I had no air conditioning. I couldn’t get out of the tank. There was nowhere to go except a POW camp, if I was lucky enough to get caught and not killed right away. I remember thinking that I should have been panicking. Instead, I was utterly, crystal clear. It was in the space of such a small moment that I realized it was completely up to me. Whether I survived or not was between me and my own mind.” The lieutenant sat forward, his body compressed with the intensity of the experience, still vivid in him.

“For some reason, I thought about something I’d heard about some monks in the Himalayas, how they went outside in sub-zero temperatures and howling winds to meditate and never suffered any ill effects. They raised their own thermostats. And I figured if they could do it that way, I could lower it. To this day I don’t know exactly what I did or how I did it, but I imagined cool water inside me and around me, like I was dunking myself into a cooler filled with ice or skinny dipping in the lake back home. And hell if it didn’t work. I’m here. I never forgot that,” he sat back. “This,” he pointed to his head, “was my greatest weapon of all. And it has served me ever since, no matter what or where the battle.”

What he used without knowing it at the time is a simple protocol called Verbal First Aid. It is based on the simple notion that the images we hold in our minds are held in our bodies as well. What we think is what we are. What we feel determines how we heal.  Dr. Larry Dossey, one of the foremost proponents of mind/body medicine, has written, “Images create bodily changes—just as if the experience were really happening. For example, if you imagine yourself lying on a beach in the sun, you become relaxed, your peripheral blood vessels dilate, and your hands become warm, as in the real thing.”

If this is even partially true, it is an astonishing statement.

The case to definitively establish the link between mind and body was opened almost 1,500 years ago when Hippocrates wrote that a person might yet recover from his or her belief in the goodness of the physician. It was continued in 1912 when one doctor reported that tuberculosis patients who had previously been on the mend, when given bad news (e.g., that a relative had passed away) took sudden turns for the worse and died. And today the data supporting the connection between thoughts and health, indeed between mental images and survival, are mounting.

Brain scans have shown that when we imagine an event, our thoughts “light up” the areas of the brain that are triggered during the actual event. Sports psychologists conducted one study in which skiers were wired to EMG machines and monitored for electrical impulses sent to the muscles as they mentally rehearsed their downhill runs. The skiers’ brains sent the Bille instructions to their bodies whether they were doing a jump or just thinking about it.

What does this mean for a person out riding in the mountains who suddenly finds himself stuck in a downpour and unable to get out before dark when the temperature is expected to fall nearly 40 degrees? How does this help someone with an asthma attack in the middle of a lake or a rider with a broken leg one hour from the nearest town?

What some people claim is that it can mean the difference between life and death because the words we say (to ourselves and to one another) do matter, especially when we are afraid, in pain, or in shock. By saying the right words in the right way we are able to speak directly to the body, reduce an inflammatory response, help to slow down or stop bleeding, change the way an event is interpreted so that it is experienced differently IN the body.

What Can We Do, What Can We Say: Verbal First Aid in Real Life

According to medical experts, anxiety (or fear) and pain are inextricably woven together for the vast majority of people. A great deal of human discomfort comes from our anticipation of it and our perception of it. Unfortunately, there is nothing marketed as vigorously in this country as is fear. If we’re not scared to death by a headline, it’s a radio report, a movie, a video game, or a television show. We’re literally bombarded by images and ideas that promote fear. We are propelled by it and sold by it.

If the science is correct, the good news is that we can change it on every level—from the conscious to the autonomic. When we alter our thoughts, are soothed by a kind authority, or are assured that we are in good hands, we can begin to feel the changes in our bodies—the softening of muscle fiber, the opening of bronchial tubes, the quieting of pain, the start of healing. This is why so much of Verbal First Aid in the field is directed to the alleviation of anxiety through the development and utilization of rapport. In rapport, a person will feel, “She understands me.” “He is going to help me.” “I’m safe, now.” When we feel understood, our anxiety is reduced. And when anxiety is reduced, pain is relieved. Even if we are entirely alone, clinicians and scientists agree that what we say to ourselves matters and we can direct our thoughts so that our chances for survival are enhanced.

Whether you’re speaking to yourself or to someone else on the trail, how you approach someone mentally and emotionally is at least as important as the medical expertise you have, according to Winnie Maggiore, former Asst. Chief of Placitas Volunteer Fire Brigade, paramedic, former Asst. D.A., and now a malpractice defense attorney. “We saw the Bille things in the wilderness that we saw locally—snake bites, mountain bike wrecks, breaks, falls, cardiac conditions—but the injuries in the wilderness feel worse to the patient in that he’s away from familiar surroundings. Most of what we had to do in rescues was anxiety management. The first step is to let the person know you have the expertise to help. This conviction allowed us to say ‘do this’ in a way that motivated compliance.”

The other major ingredient in dealing with crises, according to Maggiore, is giving people some sort of control over what is happening to them. “When we were just learning emergency medicine, we were given a course in hypnosis so it could be used in pain control, because it could be all we’d have to work with out there. The worst part for patients was being out of control so put them back in control as much as we could, gave them something positive to focus on. Panic is a patient’s worst enemy.”

People normally want to reassure with blanket statements, e.g., “you’re fine.” When this is obviously untrue, it’s the sort of statement that breaks rapport. It’s better to say, according to the experts, that the worst is over and you’re there to help. Your caring presence is the cornerstone of the healing process. If you don’t know what to say, say nothing and listen as you wait for help or do standard first aid. Your care can do more than you might imagine.

The following are just two examples of ways we can talk to someone in distress so that they are calmed, their pain is reduced, and they are moved steadily towards healing.

Asthma Attack .

Bill and his son, Jake, went for a dirt bike ride up a trail that was almost never used. Bill was sure his son had his inhaler with him. Jake was sure dad had it with him.

It was a rugged trail that required more physical exertion than either had expected. When they finally made it up to the first crest, Jake was starting to panic from the tightness in his chest. When they realized they’d forgotten it, Bill was smart enough to take a deep breath himself so that when he turned to his son he was calm, focused, and sure-footed.

Bill:                 Jake, I can see you’re breathing but that it’s a little tight?

Jake:                (Nods, but can’t speak.)

Bill:                 Sit with me here and lean forward like this. Put your head forward like this so your bronchial tubes can open and smooth out. [At this point, Bill’s voice drops in pitch and slows down so that it’s soothing and controlled. He “paces” his son’s breath with his own, carefully so as not to hyperventilate, just enough so that there is a joint rhythm. As he speaks to his son, his breathing slows down just a little bit at a time, “leading” his son back to normal breathing.) And as you do, you can remember very clearly how your inhaler feels when you take a puff on it, a little cool, a little tingly and how it opens you up pretty quickly, you can remember how it feels when it’s working…a little more open now…a little more open, a little cooler, until you can get a really good deep, slow, even breath…


A High Side at Five

When we get a whiff of twisting and turning mountain roads, open vistas and the winds of freedom that fill us, it’s easy to take off on an impulse and forget basics: water, first aid kit, cell phone.

Manny and Janice took off on an early Sunday morning, the first of spring. It had been a long winter and while they remembered to charge their batteries, they forgot just about everything else. Manny and Janice pointed their bikes west, Janice leading, and kept going until a deer ran in front of Manny. Reflexively jamming on his front break, he went head over hind end until he wound up in an intimate embrace with a hundred year old oak.

When he was finally able to gather his wits, he saw Janice standing over him. Even though neither had a first aid kit, Janice knew Verbal First Aid.

Manny:            How’s my bike?

Janice:             It’s fine. It’s just taking a nap. That was some acrobatic act.

Manny:            Did you get it on video?

Janice:             Yeah, with the camera in the back of my head.  (She smiled.) I’m going to help you    now, Manny. I can see that you’re talking and thinking just fine.  Let me see  how the rest of you is.

When he stood up, though, they realized he had a deep laceration from a piece of metal

That had been left on the side of the road and blood was pouring down his leg.

Manny:            Damn it! It’s really bleeding.

Janice:             It is and that’s actually a really good thing so that it cleans out the wound. As soon as you’ve cleaned it through enough, you can stop [Janice emphasizes “stop”] the bleeding.

Manny:            Damn it. That was so stupid.

Janice:             It happens to everyone. I know you’ve gotten cut before and you’ve stopped the bleeding before just like you’re stopping it  right now. [She wraps her bandana around it and applies pressure.] You can hold it tight like this. Y’know even as we’re sitting here, it’s already starting to heal and the bleeding has slowed to a stop.

Manny:            Damned if it hasn’t!

Janice:              So… we can either wait for a car to pass or you can sit on the back of my bike…and we’ll ride into town.

Manny:            I’ll hitch.

Mental survival—regardless of where a person is, whether that’s in the extremes of battle or a cross-country ride—is often a matter of recalling or being made aware of the resources one already has. As Lt. Samuels learned the hard way, the mind is the greatest weapon of all.




Asthma and Verbal First Aid

A patient came in the other day having difficulty breathing, anxious. She had just taken a couple of puffs on her inhaler, but still felt uneasy. Having known her a while I was able to ask, “What happened?” It had become clear to both of us that her asthma was as much the result of feelings as it was of pollen.

Her daughter had been expelled from school and she was in danger of losing custody to her ex-husband. Her anxiety was bulging out from her sides. She was terrified.

Having both suffered from asthma (years ago) and worked with asthmatic patients for quite some time, it has been my clinical observation that it is a “poetic” pathology, often expressing a grief, a panic, or a worry that has not been expressed in other, more productive ways. Even in cases where there is a clear physical etiology (smoke inhalation, chemical burns, and the like), it may be ameliorated by understanding the way the human organism works and the power of both imagery and emotions.

The research has shown that Verbal First Aid. techniques are being used successfully with children who suffer from asthma.  In one pediatric study measuring the effects of guided imagery and hypnosis the results were dramatic: 80% of the children had improvement that was measurable, none of the children’s symptoms worsened, and, best of all, some patient’s symptoms resolved after one hypnosis session (Anbar, 2002). 

In an article entitled “Applying hypnosis in a preschool family asthma education program: uses of storytelling, imagery and relaxation,” author D.P. Kohen found that combining those modalities helped the children both physically (they needed fewer office visits) and emotionally (with greater self-confidence as marked by both the parents and the children).

Helping an asthma patient was the experience that changed one paramedic’s way of thinking after I taught Verbal First Aid to his team in NY. He used the techniques of pacing and leading, utilizing both imagery and the rhythm of his own breath to calm the patient. “By the time she was at the hospital,” he recalled later, “she was fine. It was amazing.”