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?