How to stay calm in emergency situations

There are some emergency scenarios we don't want to think about: medical accidents, mass shootings or suicidal crises. But when these situations happen, staying calm and having a response plan could be the difference between life and death. In this episode, a fire captain, emergency room doctor and mental health advocate share how they keep their cool in the most high-stakes emergencies. There are skills that everyone can learn. Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  This message comes from NPR sponsor Viori with the Halo Essential Wide-Like Pant. Receive 20% off your first purchase at viori.com/NPR on any US orders over $75 and free returns. Exclusions apply. Visit the website for full terms and conditions.

• 0:16Marielle Segarra?

  You're listening to Life Kit from NPR. Hey, it's Marielle. Today, we're going to talk about some of the most difficult things that can happen to a person, scenarios that nobody wants to end up in. House fires, mass shootings, emergency medical procedures, mental health crises. And how to stay calm if these ever happen to you.

• 0:38Speaker 02

  When somebody calls 911, they're usually having their worst day, probably the worst day they've ever had.

• 0:48Marielle Segarra?

  Former fire captain Ryan Fields-SPAC says it's natural and human to panic when faced with an emergency. But with time and practice, he learned to find ease, calm, and even peace during these kinds of crisis moments, even when things were going really badly, and to help the people experiencing the crisis find that calm, too.

• 1:07Speaker 02

  And if you can harness that inside yourself, it's the best feeling in the world.

• 1:12Marielle Segarra?

  More than that, finding your composure can help you stay alive. But you don't have to be a first responder or an emergency room physician like Dr. Italo Brown to learn to manage your fight, flight, or freeze stress response.

• 1:24Speaker 03

  I think that it's something that can be taught. I think that there are elements of it that can be constantly reinforced. And sometimes, you know, people are faking it, and they make it. It's something that we sometimes have to lean on in order to get past that initial fear.

• 1:44Marielle Segarra?

  On this episode of Life Kit, how to stay calm in an emergency. And to be clear, this is not a definitive guide. It's a collection of personal approaches and advice from people who've devoted their lives to helping others on their very worst of days. Reporter Andy Tagel is going to talk to them about how they each approach the crisis work that they do and how we might apply their mindsets to our difficult moments.

• 2:29Speaker 04

  Stay tuned for the following announcements and messages from our sponsors.

• 2:34Speaker 00

  This message comes from Schwab. At Schwab, you can get everything from self-directed investing to full-service wealth management, all in one place. No matter your investing goal, life stage, amount to invest, or know-how, you can invest your way with Schwab.

• 2:50Speaker 04

  This message comes from Angie. Angie has been helping homeowners find skilled pros to get their home projects done well for over 30 years. For everything from minor repairs to major remodels, find reviews, pricing, and booking at angie.com or on the Angie app. This message comes from Bowlin Branch. Change the way you sleep with soft, 100% organic cotton bedding from Bowlin Branch. Designed to help you fall asleep faster and never sleep hot, while wrapped in luxurious comfort, airy blankets, cloud-like duvets, and breathable sheets. Experience pure comfort and feel your bedding get softer with every wash.

• 3:30Speaker 04

  Discover the difference with 15% off your first order at bowlinbranch.com with code NPR. Exclusions apply. See site for details.

• 3:44Speaker 05

  Takeaway one. You can set the tone of an emergency situation for yourself and others. Ryan Fields-SPAC has spent the last 25 years or so working in public safety in one war or another. He spent about a decade of that time as a paramedic, firefighter, and fire captain for the city of Aurora, Colorado. He's also served as a paramedic to professional athletes. And today, his primary focus is his kids. But he also heads a communications platform specifically for first responders. Be it a fight at the family dinner table or a five-alarm fire, Ryan says your approach should be the same. A level head and an even disposition.

• 4:25Speaker 02

  The best leaders in the world are the calm, composed ones.

• 4:29Speaker 05

  Anxiety and fear can cause mistakes and be contagious to the people around you. That can be dangerous, especially in large-scale, high-stakes, public safety emergencies. For example, Ryan was a responder in the Aurora, Colorado theater shooting in 2012. He remembers the streams of people coming out of the theater.

• 4:47Speaker 02

  All of them covered in blood. You have no idea what's happening. Everybody knows something absolutely horrible is happening. They need direction. If you allow for the anxiety to jump in, people will run into a situation that they shouldn't be running into. By having calm, composed guidance at the very outset, at the first drop of that tone, it gives everybody else around them that same level of calmness.

• 5:17Speaker 05

  It's a quality Ryan learned early on in his career. One of his first formative experiences was in high school as a volunteer firefighter. He was on a call for a structure fire and was trying to battle a blaze in a chimney area. Those can be really tough, he says, because they're tricky to access.

• 5:34Speaker 02

  And this fire is just taking us to town. It's getting worse. The smoke is filling.

• 5:39Speaker 05

  At that moment, Ryan felt himself start to panic. What am I gonna do? Maybe I should just back out now, let this thing burn to the ground.

• 5:47Speaker 02

  But then the chief came to me in a calm voice, confident tone. He stood right next to me, put his arm on my shoulder, and he said, here's what we're gonna do, Ryan. We're gonna pull down this wall. You're going to access through here, and you're going to fight the fire from the inside. We are not losing this house.

• 6:04Speaker 05

  Instantly, Ryan calmed down.

• 6:07Speaker 02

  My shoulders relaxed, I felt confident, and we stopped the fire. And what I've spent the last 25 years of my life doing is trying to hone down the ability to be able to do that on the fly, in the moment, no matter what's happening before the incident started.

• 6:21Speaker 05

  His approach to emergencies centers around learning to shift your internal gears into neutral, learning to pause rather than immediately acting on impulse or panic. A good amount of that work can and should be practiced before a crisis hits. Starting with your mindset. For example, Ryan says daily mindfulness and meditation can help bolster you for any manner of high-stakes situation.

• 6:47Speaker 05

  If you listen to Life Get Often, you're no stranger to this concept. But in case it's new to you, a quick primer.

• 6:53Speaker 02

  You're exercising your mind to notice when it's being a monkey mind and it's thinking about other things. We all go through this all the time, every day, right? We are watching a show and our mind just starts to wander. "Oh, gosh, what am I going to have for dinner tonight?" And before you know it, an hour is up and you haven't paid attention to anything that's going on.

• 7:16Speaker 05

  The benefits of practicing that awareness, clearing your mind and focusing in on your breathing, are well documented. It can reduce stress and anxiety, promote emotional regulation. Ryan says even a short, consistent daily practice, like five minutes a day, can give you a foundation to steady you for those everyday upsets and in the heat of a crisis. Then, when that metaphorical fire is in front of you, Ryan came up with this phrase that he uses.

• 7:43Speaker 02

  Called a first just breathe. And this takes five seconds. And this is a superpower.

• 7:50Speaker 05

  The F, or first, stands for fist, as in be conscious of them in moments of high stress.

• 7:57Speaker 02

  You haven't looked down and you've got marks on your palm from that unconscious clasping of the fist. This is stress.

• 8:06Speaker 05

  Simply shaking out your fists can release tension. Same thing with J, or just, which is to remind you to unclench your jaw and expanding out from there, maybe just take notice of where and how you're holding any tightness or anxiety in your body and try to release it. The last one, breathe, is just what it sounds like.

• 8:28Speaker 02

  One mindful, deep breath.

• 8:31Speaker 05

  It's so simple, I know, and yet so often forgotten or overlooked in moments of crisis. A few deep breaths are a powerful and critical tool in your emergency response tool belt.

• 8:45Speaker 02

  Studies have scientifically proven that that lowers your pulse, lowers your blood pressure, lowers your anxiety level, and allows you to focus more.

• 8:53Speaker 05

  A final action item to try, and then keep in the front pocket of your go-bag, a mental rehearsal. The logic is essentially the same as a fire drill. If you practice for a potential emergency beforehand, you'll be less scared and more prepared if and when it ever happens. So when Ryan was a firefighter, for example, he'd mentally rehearse different scenarios that might come up for his team that day and how he'd handle them. So if they got a call for, say, a cardiac arrest, he'd first think about how he'd assign different roles for handling equipment.

• 9:25Speaker 02

  And then, from there, I'm going to run through my mind what I'm going to say on the radio, how I'm going to articulate what needs to happen, what medications I want to give.

• 9:33Speaker 05

  Now, this is something you can and definitely should do for more likely emergency scenarios. Like, maybe if you live in a flood zone and want to make sure everyone in your household is familiar with the escape route. But Ryan says it's also a good idea to take the time to do a quick mental rehearsal in the moment of crisis. Because in those instances where you absolutely need to make a decision, like there's an active shooter in the vicinity, or your kid is choking, yes, urgency is often of the essence. But also...

• 10:05Speaker 02

  Oftentimes, we immediately go to the freakout because this is the first time probably ever that we have actually faced a threat that is external that would actually cause us to fight or flight.

• 10:18Speaker 05

  And that's when mistakes can happen, Ryan says. So instead, just take a moment to pause and let that initial cloud of chaos and anxiety pass. Breathe and think for a second. What is the best way to handle this situation? What resources are available to me? What do I need?

• 10:37Speaker 02

  You're going to be able to think about others, think about getting your kids safe, those type of things. And if everybody does that, I think the world will continue to improve because we're all thinking just a little bit more before we act.

• 10:53Speaker 05

  All right, now that we all have our thinking caps on, let's keep working to-

• 10:57Speaker 03

  Slow down time. Like, I try to think of it as, like, time might be moving in one direction and very, very quickly, but my actions can be measured.

• 11:09Speaker 05

  Dr. Italo Brown is an emergency physician and assistant professor at Stanford University School of Medicine. He brings us takeaway two: focus in to freeze the clock. As the son of a firefighter father and an educator mother, Italo's chosen career path was par for the course.

• 11:26Speaker 03

  It just breeds this, you know, desire to serve, but also highly valuing the learning process. It's never a dull moment. There's always something to learn and some, you know, new thing that's occurring and trying to like navigate your way through that is exhilarating to me.

• 11:46Speaker 05

  Exhilarating probably isn't the word a lot of people would use to describe an emergency medical situation. But Italo says he likes to think his way through things. And because he's passionate about his work, it's all worth it. But that's not to say his job doesn't come with its fair share of anxieties.

• 12:05Speaker 03

  I immediately snapped to bone crusher to say I ain't never scared, but that would be an absolute lie. I have a bunch of sphincter clenching moments throughout this shift.

• 12:18Speaker 05

  There are occupational hazards, of course, like the potential harm to his personal safety, but also the anxiety of performing under pressure, the fear of not always knowing exactly how to help, and the weight of making literal life or death decisions. And Italo just has to be ready and stay ready for any and all of this potential unnamed chaos.

• 12:42Speaker 05

  For example, he told me about a patient who came in one night who was struggling to breathe. And a heads up, we're going to talk about some bodily fluids in a second.

• 12:50Speaker 03

  I'm saying to myself, like, we need to get this airway in the next, like, five minutes.

• 12:55Speaker 05

  The patient's airways were swollen and her mouth was filled with blood and vomit. So Italo knew it was going to be really difficult to get a breathing tube in without surgery.

• 13:05Speaker 05

  He made a quick decision to try this tricky intubation method using a special tool and a computer monitor, but he'd only have one shot.

• 13:12Speaker 03

  And the space is very small. It almost feels like comparing it to playing a video game where you have to direct something into a very narrow passageway with a bunch of obstructions at the same time.

• 13:25Speaker 05

  To set himself up for success, Italo says it was all about zeroing in on exactly the task at hand. He did that by first ensuring his working conditions were as favorable as possible.

• 13:36Speaker 03

  So height of the bed is where I need it to be. I have the, the equipment that I like, things like that to like, remove the thinking from those and let those things not be distractions.

• 13:47Speaker 05

  Translated outside of the ER, maybe for you, that might look like assigning everyone in your household, direct, specific tasks for evacuation, so no one gets lost or confused. Or making sure you update your first aid kit before you go on that big hike and knowing exactly where to find that gauze in case you need it. Then, in those few moments before the moment of the procedure, Italo says he tries to quiet everything around him.

• 14:14Speaker 03

  Just me and the patient, not whoever else is around, not hearing the sounds of the emergency department, and sometimes not even sensing my own degree of concern, like body aches, position, like I'm not thinking about any of that.

• 14:31Speaker 05

  That extreme focus helps Italo from locking up.

• 14:34Speaker 03

  Like anytime something scary happens, you're driving a car, you get in a car accident, at the point of collision, you tense up. And so you have to breathe through those moments and trying to maneuver and not have jitters.

• 14:48Speaker 05

  Next, add in your favorite, most effective, positive self-talk.

• 14:52Speaker 03

  Steady hands, cold blood, like I'm often trying my hardest in that exact moment to just tell myself, like, you've done things that are harder in life and you can do this.

• 15:06Speaker 05

  That can also put a pause on the clock and the pressure of the moment.

• 15:09Speaker 03

  Because the, the moment demands accuracy, not being expedient. And so I try to focus on that, nice and easy, move on your speed, and then the muscle memory kicks in.

• 15:23Speaker 05

  And that's all there was to it, he says. Well, almost.

• 15:27Speaker 03

  I would be remiss not to, I mean, I am a praying person. I'm praying when the person first lands in the ambulance bay and I'm praying as I'm, you know, preparing to do something like that. And so there's, there's definitely a spiritual component to it. But bringing all of these things together in a matter of seconds is kind of the secret sauce for me.

• 15:49Speaker 05

  In the end, he came through. Italo was able to place that breathing tube for his patient and her oxygen levels rose.

• 15:56Speaker 03

  In those moments, you're always thinking like, all right, what if this doesn't work? And so when it goes right, there's such a sigh of relief, like a universal sigh of relief in the room.

• 16:12Speaker 05

  Now, not everybody is an emergency doctor and hopefully very few of us will ever have to perform a complex emergency intubation. But you never know when you'll have to answer the call to action. Like when someone gets hurt or overdoses or has a severe allergic reaction, hyperfocus can always come in handy. And Italo says, don't forget, there are certain emergencies in life you can anticipate and get prepared for. He thinks everyone should be CPR trained, for example.

• 16:41Speaker 03

  You could be sitting there at Benihana's eating dinner and someone just collapses. And if you know what to do, now you've helped change the arc of that person's life. You know, those types of skill sets are stuff you understand, learn, practice.

• 16:57Speaker 05

  And as for all the other types of emergencies, the ones we can't predict, Italo says his work has taught him to embrace joy as much as you accept hardship. Scary stuff happens every day and people find ways to work through it every day.

• 17:11Speaker 03

  We have to normalize the fact that everybody's going through this at some degree. Every single day, somebody is reliving a trauma, somebody is working through a trauma, someone is overcoming a trauma. And if we're normalizing the fact that that's happening constantly, it makes it more approachable and it makes it feel like something you can try on.

• 17:37Speaker 05

  Our final com- curator knows just how commonplace dealing with crises can be. And also is witness to how often the solution is simpler than you think. Takeaway three: don't discount the value of connection. You can be the one to make real change simply through honest communication. Because for some, the unforeseen storm will be an internal one. As in, maybe you're here because you or someone you love is struggling with mental, behavioral, or emotional health. Maybe you're dealing with intimate partner violence, or suicidal ideation, or you don't know how to talk about substance abuse with your kids. Life Kit has more resources available for you for each of those topics, by the way,

• 18:21Speaker 05

  as does Wendy Martinez-Farmer, a licensed clinician who's worked in mental health for over 20 years.

• 18:27Speaker 06

  I enjoy helping people probably when they're having their very worst day. I think we've all had those very worst days. And I just know how incredibly important it is to have people who really deeply care when people are facing some of their toughest challenges.

• 18:45Speaker 05

  Today, she's a vice president at Vibrant Emotional Health, where she works on clinical standards and grant strategy for 988, the nationwide lifeline that offers free and confidential support 24 hours a day for anyone in crisis. She says one of the hardest parts about her job is all of the stigma around mental health emergencies and the general misunderstanding about behavioral health.

• 19:09Speaker 06

  There's a kind of a myth out there that if you talk about suicide, you'll put it in someone's mind. And we just know that that's absolutely not true. People are already thinking of suicide. They are thinking of ending their lives. And being willing to talk about it with someone gives them permission to share their pain and gives an opening to help them find a way out of it.

• 19:32Speaker 05

  What Wendy really wants people to understand about these types of emergencies is that they're just like any other medical issue and should be treated that way.

• 19:41Speaker 06

  If you were a bystander with someone having a heart attack, you would not hesitate to call 911 on their behalf and to get them care. And that's the way that we treat it. You know, the brain is part of the body. And this person is in severe danger, and we're going to call and get them care. It's no different.

• 20:01Speaker 05

  But instead of trying to stop a bleed or clear an airway, when someone is experiencing suicidal ideation, Wendy says a crisis counselor is often trying to help with harmful cognitive distortions, like trying to pull that person out of all or nothing thinking.

• 20:17Speaker 06

  They're only seeing one way out of the situation. And by asking some questions, getting them to see that maybe there are some other options and maybe they have some other choices, they can start to see that that's not their only choice.

• 20:32Speaker 05

  And this process of connection, whether or not you ever find yourself on either end of a serious mental health emergency, can help us all better cope, expand our viewpoints and empathize with our fellow humans in moments of high stress. Wendy broke down the approach in five steps that follow 988's Be the One To campaign. It's an evidence-based strategy for communicating with someone who may be suicidal. The first step is to address the elephant in the room head on. Don't beat around the bush.

• 21:03Speaker 06

  Sometimes when people are feeling the way they do, they think of suicide. Is that something you're thinking of? Just being very matter-of-fact and very direct.

• 21:12Speaker 05

  Wendy says when she was first starting out, she was really afraid of asking this question. Who wouldn't be?

• 21:17Speaker 06

  But over the years, I can't tell you how many times when I looked across the table at the other person, I could immediately see relief on their face when I brought it up, when I asked the suicide question directly. It's almost like they took a deep breath to say, oh, my gosh, it's safe to talk to this person about this very scary thing.

• 21:40Speaker 05

  That can be a good reminder for a lot of scenarios in daily life. Like, maybe it's okay to just talk about the hard things straight out with a person that you trust. Next, it's about active engagement, demonstrating to this person that you're there for them by not only listening, but reflecting back what you hear and expanding on what they have to say.

• 22:00Speaker 06

  So I understand, you know, that you're feeling a lot of stress. And tell me a little bit more about that. Asking a lot of open-ended questions to try to get more information and get them to talk. It seems kind of simple, but really it just tells the individual that you're listening and that you care.

• 22:16Speaker 05

  This is also when a crisis counselor will try and get the particulars of someone's situation. Are they eating and sleeping enough, interacting with other people?

• 22:25Speaker 06

  It's really important to get those basics to find out if someone's really having an interference in their functioning.

• 22:31Speaker 05

  Then confirm the person is safe, as in, have you already done something to harm yourself? Wendy says having just a bit of a game plan in those moments, knowing what resources you have at your disposal in the worst-case scenario can help you feel more prepared and calm.

• 22:46Speaker 06

  For instance, if you're on the phone with someone and you know that they've got others in the house, that always makes me feel a little bit better, right? And thinking about that as I'm asking the question. And how can we use having other people around to keep them safe?

• 23:02Speaker 05

  The fourth step is helping them connect to what they need.

• 23:05Speaker 06

  Are there things that we can do to keep you safe today? Are there resources that you have? And then we can help build kind of a safety plan with them, you know? So if you start feeling like this, is there some things that you can do?

• 23:20Speaker 05

  Wendy says most of the time-

• 23:21Speaker 06

  The phone call is really what the person needs.

• 23:24Speaker 05

  But in some cases, they might need to seek out more robust resources like a mobile crisis team or an appointment with a local counselor.

• 23:32Speaker 05

  The final step is follow-up. After that initial cloud of chaos has passed, 988 operators will offer to check back in.

• 23:39Speaker 06

  And most people do take us up on that. We get a lot of feedback from people who just say, "Thank you so much. You know, that's exactly what I needed. I just needed to know that I wasn't alone."

• 23:51Speaker 05

  And get this, the average length of a 988 call-

• 23:55Speaker 06

  About 12 to 14 minutes.

• 23:57Speaker 05

  Yeah, that's it. There's something pretty amazing in the fact that a person could be lifted up out of one of their darkest moments in less time than it takes to get through your favorite sitcom. So Wendy is being literal when she says sometimes just knowing there's someone who's willing to really listen to you, validate you-

• 24:16Speaker 06

  It can be life-saving.

• 24:18Speaker 05

  So Wendy says while you may never have to go through this process for a severe mental or behavioral health issue, everyone can use a helping hand now and then, or a listening ear, and a reminder that not everything is black and white, especially on those hardest of days. So remember, she says.

• 24:36Speaker 06

  Nobody is expected to have all the answers.

• 24:39Speaker 05

  So if and when you can't find solutions to a crisis right away, don't just go it alone and sweat it out. Seek support instead. You might not be able to find all the answers you want or need, but sometimes just having good company in times of hardship can be a solution all its own. Because bright spots can be hard to find, especially when it comes to moments of crisis. Wendy's work has shown her that though there's a lot of heartache in the world, there's a lot of help out there, too.

• 25:09Speaker 06

  I think people would be surprised that we all take hope from it. It's a very tough job. It's a very challenging job, but I feel a tremendous amount of hope knowing that there are people out there who really care and who are willing to help their fellow man. And it happens every day.

• 25:33Speaker 05

  A reminder: If you or someone you know is in crisis, Life Kit has an episode on ways to help linked in the episode description. Or you can call or text the Suicide and Crisis Lifeline at 988 at any time, day or night. Someone is there waiting for you who truly wants to help.

• 25:53Speaker 05

  Okay, let's recap. Takeaway one: You can set the tone of an emergency situation for yourself and others. Shift into a neutral mindset during a crisis by prepping your mind beforehand and consciously relaxing before acting. Takeaway two: Focus in to freeze the clock. That could look like getting into the best possible headspace, removing distractions, positive self-talk, or prayer. Takeaway three: When life is at its most stressful, don't discount the value of honest communication. Real listening can really help. We're all in this together, friends.

• 26:38Marielle Segarra?

  That was reporter Andy Tagle. For more Life Kit, check out our other episodes. We've got one on how to do CPR and another on how to help someone who's struggling with thoughts of suicide. You can find those at npr.org/lifekit. And if you love Life Kit and want more, subscribe to our newsletter at npr.org/lifekitnewsletter. Also, we love hearing from you, so if you have episode ideas or feedback you want to share, email us at [email protected].

• 27:06Marielle Segarra?

  This episode of Life Kit was produced by Margaret Serino. Our visuals editor is Beck Harlan and our digital editor is Malika Greb. Megan Kane is our supervising editor and Beth Donovan is our executive producer. Our production team also includes Claire Marie Schneider, Sam Yellowhorse Kessler, and Sylvie Douglas. Engineering support comes from Jimmy Keely. I'm Marielle Segarra. Thanks for listening.

• 27:39Speaker 00

  Stay tuned for the following announcements and messages from our sponsors.