MINUTES TO SURVIVE AFTER A DISASTER
Raquel Eidelman Cohen MD, MPH
The outcome of disasters can have varying impacts on individuals. It can make the difference between surviving, serious injury, or death. Is it a matter of fate or are there actions that people can take to possibly change the outcome?
The question is whether the human brain has a system to address our survival in this modern world? Do we have neurobiological mechanisms that can guide us in today’s technological contemporary environment and promote actions to rapidly save us? The answer is yes and no.
Observations and experiences of individuals who have survived disasters show similar patterns of behavior. Initial reactions are denial of the event with slow acceptance of the imminent danger. It is a defense that serves to automatically control the psychic disruption due to fear or anxiety. It's like a preparation to act rationally. A few seconds to collect data and decide on the degree of risk, and identify "what is this all about"? The brain is programmed to recognize the event and catalog it before acting. Finally, the individual realizes he is in danger and acts to save him.
These brain processes are the cumulative result of a group of variables that are being processed at any given time: the initial delay followed by arousal and fear, degree of cognitive ability, the influence of the environment and the leadership of the groups involved in the disaster to help decide if the event is dangerous or not. In addition to these processes we have another primitive system, which also handles signal action depending on the degree of hazard. These signs start the movements of flight before the central brain centers send messages of being aware of what is happening. The duration of a millisecond difference in reaction to begin an action may mean the difference between life and death.
Generally, the brain tends to try to understand its environment through known familiar and daily events. When something happens in the environment that is unfamiliar and novel, the brain tries to find an explanation to understand what is happening. It has to organize what it has seen, heard, experienced through neural networks. These networks guide the action body to accumulate enough data to stimulate the cognitive system and form an opinion. When we face incompressible situations we usually ask others what is happening in order to verify what happened. At the same time the brain seeks in it’s memory searching for similar events. The brain needs to find an explanation and put new data in that explanation.
The feeling of fear is a universal reaction that appears as more thoughts recognize a dangerous situation. It is a survival sign that indicates "the need" to act in order to survive.
Generally all traumatic experiences record difficult memories. The strength of these memories is expressed in brain neural centers (cognitive and affective) by fear. They imprint in our bio-psychological and body system “a type of scar” that discharges preventive action stimuli to protect us if we are in the same dangerous situation again.
To understand this behavior we can use results of research in the area of neuroscience exploring the brain processes.
Research on this topic has shown how systems react in the primitive components of the brain to the threat of danger. In a dangerous situation an important variable is the length of time between the traumatic impact and the instant and automatic reactions.
In a situation of toxic smoke, fire, a plane crash or earthquake, it can be a matter of seconds before the end of life. What is happening in the brain in those seconds? How long does the cognitive brain wait before it knows how to act?
Current research shows the following: It is likely that the brain has primitive predisposed systems of natural aversion to signs that indicate something can affect us dangerously. This bias needs to be activated by past stored memories of personal experience. This is how individuals accumulate knowledge and emotional reactions. The storage of these memories requires the passage of time and the accumulation of experiences.
Certain investigations are exploring the neural systems that transmit the emotions of fear that connect to the structure of the brain called the amygdala. These structures reflect a perception of danger in action in two ways:
The cerebral cortex is constantly stimulated with information through our senses. If there is a danger the connection from the cognitive centers sends a torrent of detailed information from the frontal lobes of the cerebral cortex to the amygdala which in turn selects and processes the dangerous signs and discards the other stimuli. Defensive actions are beginning to emerge to avoid the danger. A more rapid parallel system sends information from the senses through specialized neuronal connections direct to the sub cortical regions of the amygdala bypassing the cortex. The hippocampus is a learning and memory center and contains the signals involved reminding us of the danger signs.
. TRAINING TO MITIGATE FEAR
When the defense systems of the brain are stimulated by fear, there is a potential to streamline our reactions. Fear can be reduced through learning, training, and preparation for known and anticipated hazards. We can train to take action of known situations that could produce intense stress. Research has shown that stress reactions within our bio-psychological comfort zone allow us to perform better.
However, experiences of intense stress can overwhelm the survival system. In this case, the senses of sight, hearing and cognitive processes begin to decline. The capacity margin is individual but has the flexibility to expand to show effectiveness and competence.
The best way to strengthen the ability to endure stress is through repeated practice in a realistic setting it is necessary that the actions be performed within an environment that replicates the actual experience and can predict the risk. This has the effect of establishing new neural connections in the brain where responses are automatic and spontaneously developed. These mechanisms have the potential to increase capacity to cope and reduce the risk by modulating the fear. Although we still have no exact data and evidence, it is believed that this change is due to the plasticity of the brain to form new structures and, as a result, increases the possibility of survival.
What can we learn from this knowledge to implement preventive behaviors?
Are there procedures to shorten the time it takes to process survival actions?
How do we shorten the time required to measure the possibility of danger and risk?
We can answer using certain principles that can help us and they are as follows:
Everyone has to be aware about what their beliefs are about the consequences in certain dangerous situations, for example: the use of lighted candles, speeding, drunk driving, swimming in turbulent waters, crossing the street with heavy traffic
By measuring the levels of risks we can arrive at several conclusions: potential or high risk. Usually we measure the likelihood that something might happen and anticipate how the consequences may affect us. There are two reactions: intuitive, which is formed rapidly and emotionally, involving memory and experience. The other is analytical, logical, pragmatic and realistic.
To assist individuals in this situation, we can remind them that there is a balance between thoughtful and impulsive risk taking behavior. It is important to educate people with the hope that they use this information to make decision that would increase their possibility of survival. The content of the communication has to be reasonable and tangible, so that the individual could trust the advice and respect authority.
The advice has the following characteristics so as to overcome emotional beliefs: must be consistent, easy to understand, be specific, repetitive, accurate, and focused. Such communication can control emotional fears and/or false beliefs. This in turn increases the knowledge of how to act in a dangerous situation-using guides of conduct that one can control in order to decrease anxiety and fear.
* The more we believe we can control the impact of an event the less we will feel fear. Our ability to act improves and our ability to survive increases.
* At the beginning of a disaster, the more we recognize and know, (for example the sound of an earthquake), the less time it takes the brain to process confusion, denial and understanding in order to decide on an action. Knowledge acquired in investigations has shown that the individuals usually do not take quick action to escape or seek shelter.
The American Army has a useful exercise that can be used to prepare for situations of potential danger.
These are the steps:
* Set a goal of how to escape from danger, such as knowing and practicing how to go down the stairs of an apartment or hotel in the case of an earthquake or fire.-a cognitive process to identify the steps is controlled by the central components of the brain that are connected with the amygdala and the hippocampus
· Rehearse mentally-Use your imagination to rehearse and perform all actions necessary to reach their goals
· Talk to yourself-- in your thoughts use positive words with a affirmative attitude of "yes I can"
* Emotional control-- breathe slowly, use the knowledge of relaxation (this is very individual), take a deep breath to send more oxygen to the brain
* If applicable, use spiritual / religious practices -- if you have them.
The contents of this document are based on multiple observations, documents, research, experiences of survivors including the author and other mental health workers who have worked with traumatized survivors after a disaster.
For more information browse Web pages using the contents presented.