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Staying resourced and regulated in life and EMS

Understanding our autonomic nervous system can help us stay calm, cool and collected through stress

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Last fall, my colleague, Rev. Gwen Powell, and I offered some education sessions for the fire department at the Minneapolis/St. Paul International airport. We titled our presentation, “Staying resourced and regulated in life and public safety.”

Together, we explored what it means to understand the ways in which our autonomic nervous system responds to stress so that we can do our best to stay regulated and calm during the various situations we encounter in our personal and professional lives.

One of the concepts we explored was seeing one of our primary life tasks as being a “regulated and regulating nervous system,” an idea I first heard from clinician Deb Dana, LCSW, of Polyvagal Guided Living | Rhythm of Regulation.

What if as a chaplain, a first responder, a parent, a partner, a human, we made it a priority to be a regulated and a regulating nervous system? What does that mean? What does it look like?

|More: Creating calm within chaos. Kris Kaull relates his most memorable call, and how practice, and a mindset to control what you can allows EMS providers to provide help and calm during the chaos

Dysregulation

Put simply, to be regulated means we are doing what we can to not have too much or too little activation in our bodies. Too much activation is symptomatic of sympathetic nervous system engagement, which triggers the fight/flight response. We all know this feeling of being kicked into high gear, with our adrenaline and cortisol pumping, heart racing and breathing accelerated as we move into a mobilized stance of being prepped to defend against a threat. This state can entail increased restlessness, irritability, anxiety, fear, anger, rage and a whole host of other things. It can also simply look like being on alert, ready for action and indeed moving through the necessary steps of being a first responder in a high intensity situation.

Too little activation, on the contrary, is characteristic of a dorsal vagal, shutdown/collapse response. This hypo-aroused state is our last defense against life-threat, when our body unconsciously and instinctively feigns death as a survival resource. This immobilized response can look like varying degrees of dissociation, disconnection, lethargy, depression, hopelessness, defeat, complacency, apathy, numbness and again, a whole host of other things. On scene, this could look like emotionally or mentally shutting down, an inability to think or make choices, or physically collapsing.

On either end of this continuum, we lose access to our pre-frontal cortex and as such, our higher thinking and reasoning powers. The latter is not a conscious choice and it is true for all of us, no matter who we are or what we do for a living. For better or for worse, this is one reality of being human.

Maintaining regulation

Staying regulated then, means maintaining the sweet spot of “optimal arousal” or being grounded in the ventral vagal state of our parasympathetic nervous system. Of course, it is not possible for any of us to stay in a ventral vagal state of calm and regulation 100% of the time. We all get triggered by stress responses. We all have the capacity to lose our ability to remain calm, cool and collected at times. However, the more we know and the more we practice, the more we grow our ability to stay in a regulated state more often than not.

So, how do we stay regulated? Arguably, first we need to consciously pay attention to our activation levels. For example, we need to notice when we are starting to get edgy, irritable, fidgety or anxious, all signs that we are trending towards hyper-arousal.

Then, we need to actively do something to decrease that excess energy. We might try running, dancing, shaking, boxing, throwing or pushing, all in safe ways, all while our pre-frontal cortex is still fully functioning.

We could try decreasing external stimuli by perhaps dimming the lights, playing calmer music, taking a hot shower or drinking something soothing.

We might cry, scream, or talk the activation out, whatever helps our minds and bodies to feel calmer and quieter. The key here is taking action before we are fully dysregulated.

Video: Box breathing

In contrast, if we start to notice ourselves slipping into a numbing, shutdown, dissociative or depressed response, we need to bring more activation into our nervous system. In such cases, we might similarly increase movement to counter the urge towards immobilization. This could be more subtle, such as going for a walk or doing some stretching.

We could also try increasing external stimuli, such as watching a funny video, listening to upbeat music, diffusing peppermint oil or splashing cold water on our face.

Ultimately, each of us needs to find our own tools and tricks with the underlining goal of decreasing activation when we have too much and increasing activation when we have too little. All together this is a skill commonly referred to as staying within our “window of tolerance,” a coin first termed by Dr. Dan Siegal. In the end, the more we practice staying regulated overall, the easier it will be to remain in a regulated state when we are triggered by stressful, threatening or overwhelming stimuli.

Helping others through co-regulation

And then finally, when we are regulated, we can focus on regulating for others. Our nervous systems respond to other nervous systems. One of the greatest gifts we can offer those in our sphere is co-regulation: by remaining calm, reasonable, mindful, etc., we help others to do the same.

If we communicate through our words and actions that the situation at hand is safe and in control, we help others to feel the same way, which in turn reduces dysregulation on all fronts. This is especially useful in a shared space such as a communication center or at an emergency scene.

Again, whether as a chaplain, an EMT, a dispatcher, a parent, a spouse, a friend, we can provide a regulating response to others during otherwise activating or stressful situations. We can offer co-regulation.

Imagine the impact if we all focused on learning and practicing how to be regulated and regulating increasingly more of the time ... the impact on EMS, our families, our communities, our world.

Nikki Holm has been engaged in the meaningful work of EMS chaplaincy through Allina Health since the Spring of 2020. Prior to making the transition to EMS, Nikki provided spiritual care and health education in an outpatient mental health setting for several years. Nikki was board certified with the Board of Chaplaincy Certification Inc. in 2017, graduated with a Master’s degree in Spirituality from St. John’s School of Theology in 2007 and with a Bachelor’s degree in Theology from The College of St. Benedict in 2005. Nikki lives in an earth home with her husband, their three beloved children, and three furry companions. Outside of soaking up life with her littles, Nikki enjoys rock climbing, writing, reading, yoga, gardening and otherwise spending time with her tribe. Contact Nikki at Nicole.Holm@allina.com.