Points from Verbal First Aid workshop I attended

[AnthonyM83]

Last month I went to a Verbal First Aid lecture, intended for health practitioners, EMS, and civilians.

I was worried about it being a total hippie/white light community crowd, but there was a doctor, a few nurses, a civilian employee from a PD who was setting up training for the cops, and some ex-military. A large number of psychologists/therapists, MA and PhDs/PsyDs.

The speaker was Judith Prager who has given her lecture at many different departments at different hospitals.

The main thing is how your words can direct healing if you gain rapport with a patient.

Here's some of the points:

-People look to others (usually authority figures) in emergencies and become very open to suggestion on things like:

-emotional state, severity, physical direction, and even body's response

-Mind has ability to influence body. Every thought has a physiological/chemical reaction

-Embarrassment-->Blushing

-Nightmare-->Fight/Flight response persists after waking

-The power of well-documented placebo effect

Pharmaceuticals must compete with the 1/3 placebo success rate, including angina, bronchitis, and (I think the 3rd was pain)

Dr. M Erik Wright's Experiment (with control group)

-Paramedics were told to: 1) Minimize extraneous input 2) Read them a simple paragraph 3) Eliminate unrelated conversation

The paragraph included, "The worst is over. We are taking you to the hospital...Let your body concentrate on repairing itself and feeling secure. Let your heart, your blood vessels, everything, bring themselves into a state of preserving your life...You are now in a safe position...The worst is over."

-This group had a higher survival rate and it's said the only problem with the experiment was it was hard for the paramedics saying the paragraph to keep it from the control group. Dr. Wright apparently died before the study was completed.

Words can affect these functions:

-Pain, HR, Contractions, BP, Bleeding, Inflammatory Response, Respiration, Smooth Muscle Tension, Allergic Response, more

When talking to patients, always keep in mind the healing trajectory you're implanting. Positive or Negative.

Steps to helping:

1) Center yourself (imagine a role model, be present in your breathing)

2) Gain Rapport

-Show you understand. Repeat back what patient just said. Especially when anxious (freaking out) people forget what they just said. You can repeat it right back and they'll feel like you're really "there" with them

-Mimic Body language (hair twirling, stance, speech pattern)..helps build familiarity

-Don't disturb someone's reality, instead work within it. She gave the example "Patient: No! Don't give me O2! I've watched ER and they always die when they get O2! Medic: Oh, it's okay. They don't use real O2 on the show"

-Let people know their responses are normal for their situation

-Pace their anxiety level and lead them out of it (works great with those hyperventilating)

-Use of reassuring touches, just on the shoulder is great.

3) Give suggestions

-Avoid words "pain" and "hurt"

-I see your arm needs medical attention. Scan the rest of your body to make sure it's alright. How about here...here...here... (distractionary)

-When giving a treatment say: "Notice how ______" insert what treatment is supposed to do...they'll concentrate on noticing the effect of treatment instead of

severity of injury

-As I ________(treatment or just any movement), you can _______ (some effect they'll feel)

-Involve them in their treatment, even if it's just having them hold a bandage.

She gave some examples of how to help children as well, like having finding a role model for them...a cartoon character, superhero, etc and having them pretend to be brave like them (this one works well...if you pick the wrong one, kids will say "no!" and tell you the appropriate hero)

I guess I just wanted to give a little overview. I don't want to post all the good details or phrases, because I'd feel like it'd be stealing her lecture that she gets paid to do by hospitals, fire departments, and police departments... I thought it was worth the drive to Los Angeles and apparently a lot of EMS is using it to different levels.

[Acosell]

Great post Anthony, Thank you.

[Michael]

Very nice! Thanks, Anthony. All of it sounds great to me, except

Mimic Body language (hair twirling, stance, speech pattern)..helps build familiarity

When I see someone doing this, it makes me sick. It is so obviously a technique designed to manipulate compliance, used by salesmen and others who acquired it from training. Seeing it in a healthcare provider it would generate the "halo-effect" of causing me to suspect insincerity in everything else they say and do, and thus provoke the very opposite of a therapeutic effect. How to elicit noncompliance? Monkey do. But maybe that's just me (though I know it's not). As Emerson said of raising children, "I suffer whenever I see that common sight of a parent or senior imposing his opinion and way of thinking and being on a young soul to which he is totally unfit. Cannot we let people be themselves and enjoy life in their own way? You are trying to make another you. One's enough." There. My first rant. Please don't anyone imitate it! :wink:

[AnthonyM83]

Understandable.

It is actually a sales technique. It's one I've been uncomfortable using either to make friends or in therapeutic settings, simply because I've always noticed how I subconsciously sometimes start imitating the stances or mannerisms of people I admire. I always try to correct myself, so they don't think I'm a nerd for trying to act like them (this was mainly in high school where I had more hero worship for certain older role models).

But in this case, it's to make them feel more at ease. It's not about me, it's about them. BUT that's true. If it makes you uncomfortable, they'll pick up on it, and reflect it back.

[Ridryder 911]

Sounds like someone is pushing the old "mind imagery" theory and maybe now following up with a book ?.. Same old psycho babble.. it has been out for several years and was popular for a while in mid 80's, until most medics found it was a waste of time. However, it did some good .. most patients started laughing when used...

R/r 911

[RegularEMT]

The only real importance to me is body language and voice tone.

[hammerpcp]

Very nice! Thanks, Anthony. All of it sounds great to me, except

When I see someone doing this, it makes me sick. It is so obviously a technique designed to manipulate compliance, used by salesmen and others who acquired it from training. Seeing it in a healthcare provider it would generate the "halo-effect" of causing me to suspect insincerity in everything else they say and do, and thus provoke the very opposite of a therapeutic effect. How to elicit noncompliance? Monkey do. But maybe that's just me (though I know it's not). As Emerson said of raising children, "I suffer whenever I see that common sight of a parent or senior imposing his opinion and way of thinking and being on a young soul to which he is totally unfit. Cannot we let people be themselves and enjoy life in their own way? You are trying to make another you. One's enough." There. My first rant. Please don't anyone imitate it! :wink:

I agree to a certain point. This technique is taught in sales to manipulate the buyer into feeling a kind of camaraderie and commonality with the sales person. However, the only reason this work is because it is also a naturally occurring behaviour in humans. As Anthony mentioned, we often inadvertently or subconsciously mimic the body language of those we are interested in or feel close to. So yes, in certain circumstances this body language can be used to manipulate, but in others it can be used to communicate more effectively, and put the person you are interacting with at ease. Use your knowledge for good rather than evil. :wink:

-Don't disturb someone's reality, instead work within it. She gave the example "Patient: No! Don't give me O2! I've watched ER and they always die when they get O2! Medic: Oh, it's okay. They don't use real O2 on the show"

I'm not sure I completely agree with the above statement. Not as a blanket statement in any case. It can often be quite detrimental if you agree or play along with a pt's delusions. It also raises the ethical question whether you are enabling educated, informed choices to be made by the pt. Decision making capacity is a spectrum rather then an all or nothing state of being.

For the most part though, these are great points and deserve to be emphasized more in the medical field. Mind and body are not separate and this is truly an archaic way of looking at things. Take stress for example. It may be the precursor for more diseases and illnesses than we are even currently aware of. Certainly there is more and more research coming out supporting this theory.

I can’t over emphasize the importance of not asking leading questions to the pt. Not only in the interest of attaining accurate history and symptomatology, but as was mentioned, in contributing too or retracting from the pt’s final outcome.

And yes we can label this “psycho babble” but the fact remains that more and more scientific evidence is arising that supports this type of thing. I would love to hear this woman’s lecture.

[Scaramedic]

Sounds like someone is pushing the old "mind imagery" theory and maybe now following up with a book ?.. Same old psycho babble.. it has been out for several years and was popular for a while in mid 80's, until most medics found it was a waste of time. However, it did some good .. most patients started laughing when used...

R/r 911

The book is already out Rid.

http://www.amazon.com/gp/product/158872023...098436?n=283155

Peace,

Marty

:thumbleft:

[Ridryder 911]

That is what I figured.... this is not ground breaking psychological news... actually these theories hit its peak in the mid-80's as was found not to be clinically significant. Now they are trying to cash in on the private sectors for training and sales... it and CISD came out about the same time. Both now being considerd "bunk"....

Science and research has shown that patent's retract to Maslow's Hierarchy and basically cannot handle such type of questioning or even making decisions. That is why they called you not so much on what you can do, as much as they do not know what to do. Over whelming circumstances overloads the sensory. Many psychologist is recommending a more softer, but direct approach, instead vagueness and open ended questioning. Since we have been through many disastrous events recently these type of studies are always an on-going process.....

R/r 911

[Dustdevil]

The whole process is condescending and patronising. It assumes your patient is a mindless idiot. Many of your patients are smart enough to know when they are being manipulated and sold a bill of psychobabble goods. If you use these techniques, you had better not underestimate your patient or you're going to alienate him and lose his trust. Then you have nothing.