The reasons why some performers excel under intense stress—and others shut down—is an evolving area of study in academic and research institutions, with pervasive implications. EMS training and simulation are frequently aimed at recreating chaotic and high-stakes scenarios to “inoculate” responders to stress and to reinforce skills acquisition. But do they work? How does the panic state affect the human mind and are there successful, research-backed strategies to predict task performance under horrific circumstances?
EMS World spoke with leading panic researchers Torin Hill, director of training for TORIS, a New York City-based provider of panic research and testing, and David D. Timony, PhD, chair of education at Delaware Valley University, Doylestown, Pa., to learn more about the panic state and why conventional “high-stress training” often fails.
EMS World: How did you first become interested in the topic of panic and how it affects human performance?
Hill: For the past 25 years, I’ve been working in combatives for law enforcement and civilians. Over this time, you could sum up students’ concerns as: “I’m afraid I won’t be able to perform this in the field.” Whether it’s our sense of adequacy, or the stakes, or the dangers we expect to encounter, panic and fear are in the back of our minds when we perform. The old saw “train like your life depends on it” raises the question: What does it take to execute because your life depends on it? Dr. Timony and I partnered in 2016 to quantify learning, memory, and performance factors in that suboptimal condition.
Timony:Torin and I were introduced by a mutual friend in law enforcement who knew that we both had an interest in schema theory and its benefits in predicting and explaining performance. The idea of adding layers of convolution to performance scenarios is very interesting to me. I am developing some theoretical foundations of deep learning that takes place in contextual extremes. I believe we are just scratching the surface of high-level performance in horrific scenarios.
Can you briefly describe your areas of research related to panic and how it could affect first responders?
Timony:My research focus is expertise and high-level skill acquisition. Essentially, I study how the superlative performers in a given context achieve that level of skill. Together, we are exploring the variables that predict and influence performance in panicked scenarios as well as the effects of panic on skill recall and short-term memory performance. Early indicators suggest a set of psychometric factors that may predict task persistence and skill resilience in panicked situations. It may be that there are traits that make some first responders more likely to be successful when panicked.
Hill:Panic induction. We create a panic testing ground to observe its transformational effects on high-level individuals during critical moments. The induction is a proprietary application of neuroscience, clinical, and educational psychology. It elicits the same affective, cognitive, and physical experiences you’d expect from a predatory threat or terrifying crisis. We induce the panic state and then test clients on their skills: their weapons handling or retention, arrest procedures, rendering of aid, partner-team communication, scene security, triage, etc. During the session and culminating exercises we collect biometric and psychometric data. The data and experience provide the client (and us) a detailed view into how they manage these worst-case scenarios.
How can panic affect the performance of an EMS provider on the scene of a chaotic or challenging call?
Timony:It’s important to note the chasm between high-stress and panic. Most folks, especially the archetypal first responder who thrives under pressure, have never experienced authentic panic. Real panic, when it takes hold, can shut down a provider and render them incapable of operating. Panic disrupts access to memory and clouds the principles that guide skilled execution.
Hill:The impact of panic on skills—even well-trained skills—can be massive and disastrous. EMS providers can expect the common indications of panic: profuse sweating, elevated heart rate, poor perfusion, shallow breathing, dry mouth, dissociation, and derealization. Couple that with rapid deterioration of physical abilities, evaporating cognitive bandwidth, impaired recall, elevated (or suppressed) emotional responses, and distorted memory encoding. During a high-risk or high-threat call, this degradation can cost lives.
Are there successful training and/or management strategies that you recommend to improve performance and decision-making under duress?
Timony: You have to train in realistic scenarios; otherwise you’re simply getting better at simulation. Your brain knows better and it isn’t fooled by what Hill calls the “crisis pantomime.” As for discrete skills in the field, it’s critical that these skills are practiced to the point of automaticity under the supervision of a coach or mentor. A mentor who can maintain a level of challenge that triggers growth is invaluable and can be the difference-maker in high-stress (non-panic) contexts. Unfortunately, you don’t know what your worst fears are but there’s a fear-shaped hole in your mind. You’ll know it when you see it and it will be too late.
Hill:Most training for “high stress” fails on two fronts. First, everyone tries to recreate a dangerous scenario by modeling the scene from a 3rd person perspective—the script, role players, the moulage. It’s the difference between accident reconstruction and surviving a car crash. Sure, it goes down as diagrammed but none of those details get seared into your mind.
Preparing for a critical incident has to feel like a critical incident. You must cross a “threat threshold” to improve memory consolidation and create affect-situated learning. That threshold creates an accurate mental model (or schema) of how a soil-your-pants call will be, which gets to the second failure. “Stress inoculation” doesn’t generate panic-driven errors, and it creates false expectations of ability and emotional competence.
It’s important that we know ourselves, and how far our baseline can fall, before we expect others to rely on us. That said, we can add to the arsenal to improve your performance. The best one is experience. Prior exposure to your worst-case scenarios can temper negative impact and improve your self-efficacy.
Cardiorespiratory fitness is another valuable tool. A low heart rate is a good marker for stress reduction, panic resiliency, and decreased burnout. Rapid heart rates result from neurophysiology and threat perception; they are not the root cause of panic and poor performance (an oft-repeated fallacy in some tactical circles). We can train stress management methods in a panic state and then use them during that state in the field. Otherwise, they might be more bullet points you can’t remember when it matters.
What are your future plans for research in this area, and where can readers turn for more information?
Timony: We are continuing to investigate our predictive model of success in panicked scenarios. That’s a really exciting outcome of our work right now, so we are eager to dive back into our next round of data collection. Last month we presented some of our work at Ulster University in Derry, North Ireland, and we’re working on a book based on our research titled PANIC: Why Everything You Know Will Fail When You Need It Most.
Hill: Alongside PANIC, we are also looking at the dispositional makeup of our top performers. Beyond the success factors, there are traits these panic-resilient individuals share, which readers might find inspiring. Admission into our panic induction program has become nomination-only. Along with this change, we are identifying where our process can scale, and simultaneously, how we can reduce costs and pricing. The long-term goal is to provide first responders with tools and training to reduce the negative panic outcomes, at no cost to the individual or administration.