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.