by Charly Miller, EMT-P

This page was originally published in's October, 1998 issue.

People do not "normally" experience emergencies. No matter how often they watch TV emergency dramas, normal people do not normally experience emergencies! Thus the sudden, unexpected and unfamiliar occurrence of an emergency situation (whether traumatic or medical) spontaneously produces a profound psychological alteration in each person's sense perception - an alteration each person is totally unaware of!

An emergency crisis produces an altered state of awareness that can be likened to a spontaneously entered state of hypnosis.

Hypnosis is defined as "an artificially induced state, resembling sleep, characterized by heightened susceptibility to suggestion." People contract with a hypnotherapist to be placed into a suggestive state of mind and given suggestions to improve their lifestyle: to quit smoking, to lose weight, to stop biting their nails, to stop drinking alcohol, or to alter other difficult-to-change habits. Hypnotic suggestion frequently results in people succeeding where they had previously failed.

Emergency patient communication is not about hypnotizing patients! It is about recognizing that emergency crisis spontaneously produces an altered state of awareness that is very similar to a state of hypnosis.

Emergency patients experiencing the sudden, unexpected and totally unfamiliar occurrences of emergency spontaneously enter a state of awareness that is entirely different from their normal state of awareness. All their senses become more acute, and they become hypersuggestible to everything they sense. This altered state is not something they can feel or recognize. It's not something they have any control over. It's not something someone else "does" to them. It's a basic, human response to the sudden and unexpected onset of a traumatic or medical emergency.

First, the emergency patient develops a heightened state of sense perception. They suddenly can see, hear, smell, feel, taste or otherwise perceive all environmental stimuli much better than they could before. The emergency patient is entirely unaware that this heightened sense perception has occurred.

In addition to heightened sense perception, emergency patients automatically consider everything they see, hear, smell, feel, taste or otherwise perceive to be "about" them!

Their environment is communicating to them. Thus, they are developing beliefs about themselves and their prognosis (the seriousness of injury or illness) based solely upon this personally filtered and interpreted environmental communication. Even if what they perceive is not really "about" them, it doesn't matter! If they perceive it, the patient automatically considers the stimulus to be about them. And their personal processing of these perceptions contributes to them developing impressions and beliefs about their injury or illness - beliefs they're profoundly physiologically affected by.

For example, a woman slipped and fell in a grocery store. The rotation and shortening of her affected leg obviously indicated a fractured hip. I sent my partner to retrieve our scoop stretcher so that I could "splint" the patient and transport her as comfortably as possible.

When he returned with the scoop, my partner needed to know how I intended to use it. Did I want to "break" the scoop, splitting it into two halves so that I could "scoop" the patient up? Or did I want to roll the patient to her uninjured side, place the scoop below her, and then roll her back onto the unbroken scoop?

Innocently enough, my partner asked me, "Do you want me to break it?"

Instantly, the patient screamed, "NO!" in an incredibly loud and acutely anxious manner!

She was processing her environment's communication stimuli in her own way. Everything she saw, heard, smelled, felt, tasted, or otherwise perceived was "about" her, and was processed through her own personal belief system.

Clearly, the patient heard my partner's question and immediately believed that we were considering the need to break her leg!

This perception increased her pain and suffering, seriously frightening her. Obviously, such was not our intention. But equally obviously, this was the patient's emergency - not ours - and we neglected to control the environmental communication stimuli so that it would only affect her in a positive manner.

Imagine a patient's response to hearing, "Bring in the Hurst!" Obviously, if a rescuer called this out, he would be referring to the Jaws of Life extrication tool. But it's entirely likely that the patient would hear, "Bring in the Hearse!" Because of this personal perception, the patient can quickly develop a lethal belief that his death is eminent.

If any patient develops the belief that he is going to die, it is entirely likely that he will - even without a pathophysiological cause for death!(1) "Taboo Death Rituals" are still successful in killing people - even in the good ol' US of A in 1998. The postmortem examination of these victims usually reveals no pathophysiologic cause of death! Sometimes, the only abnormality found in the autopsy is an increased level of parasympathetic nervous system hormones. These hormones are not present due to some sort of external poisoning. They are a direct, physiologic result of the victim's belief that death is going to occur!

This seemingly esoteric phenomenon is a reality, because - in addition to heightening senses of perception - EMERGENCY CRISIS produces an ALTERED STATE OF AWARENESS that causes patients to be HYPERSUGGESTIBLE TO ALL PERCEIVED STIMULI.

Why do placebos have physiological effects? Because the receiving person has no knowledge of the fact that he could be getting the real drug or a placebo. Each study subject believes he's taking a drug that will have a positive physiological effect.

Likewise, especially in an emergency, a patient will physiologically respond to what he believes is going to happen - based solely upon his personal interpretation of what his environment suggests is going to happen.

Every emergency patient is hypersuggestible. Everything they see, hear, smell, feel, taste or otherwise perceive "suggests" something to them. And the patient is the person who ultimately determines what each sense stimulus means.

Emergency medical providers may impact any patient positively or negatively by simple virtue of how we communicate with the patient.

The difference between positive and negative patient communication lies solely in our recognition of the patient's altered state of hypersuggestibility. If we recognize this condition, and work to control the environmental, physical and spoken communication stimulus so only positive perceptions are processed, our patient's condition will significantly improve. If we disregard this hypersuggestible state, our patients are likely to be negatively effected by the negative communication stimulus they process.

Emergency care providers can improve a patient's condition - can even improve a patient's response to treatment - by actively providing positive suggestions to their hypersuggestible patients.

"Suggestion does not consist in making an individual believe what is not true. Suggestion consists in making something come true by making a person believe in it's possibility." This is a quote from Dr. Jacobs text,(1) attributed to someone named J.D. Hadfield. It means that giving patients "suggestions" does not involve lying to them. Lying does not work! Patients have an impressive ability to perceive when they are being lied to. (That's why placebo trial drug administrators cannot know whether they are giving the real drug or the placebo.) Instead, care providers must learn how to utilize real and true suggestions to achieve positive interpretations of all stimuli a patient perceives.

(1) Patient Communication For First Responders and EMS Personnel - The First Hour Of Trauma: by Dr. Donald Trent Jacobs, published by Brady, Upper Saddle River, New Jersey, 1991.
(2) Webster's Encyclopedic Unabridged Dictionary of the English Language.

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