It’s 9:15 in the morning. You are at your station, finishing truck check and chores, when a man drives up. Then man gets out of his car, he appears agitated and is demanding information. He begins to demand the name of staff members present. The man is asked to leave and struggle ensues. Within moments you realize you have been stabbed in the head and you are bleeding profusely. What do you do now? How would you respond? Now what is next? Do you strike him? Do you push away? Do you yell? If so, what words do you yell?
It really happened: Firefighter Attacked
Taking a moment to put yourself in the shoes of the providers attacked, like the reports in the Assault On Staff Log, is mental role playing, it is a scene safety tactic to practice that must not be overlooked. Mental preparation for escaping a violent encounter is as important as any physical skill you may possess.
You can also view the Mental Preparation and Survival Mindset video at EMS1.com
Police officers are trained, at the academy level, to use mental role playing daily. They play the “what-if” games in their head to speed up reaction time and not “freeze” if attacked by surprise. An example would be, an officer is on patrol, he imagines stopping a violator. The officer may imagine the violator jumping from the driver’s seat and charging toward the patrol car pointing a 
gun. The officer mentally rehearses, step by step , every possible event he can. The officer even plans for what to do “if” he is shot, how to get out of his seatbelt, does he put the patrol car in reverse? Does he pull forward? All of the “what if” possibilities.
I was first exposed to mental role playing for survival when I went through the police academy. Being a martial artist I immediately understood the significance of mental training.
Since teaching the first DT4EMS course in 1997, I have tried to share the importance of these mental rehearsal tactics to people I have trained in EMS/ Fire, healthcare, martial arts and women’s self-defense.
This mental “practice” concept is not unique to self-defense or law enforcement. Many competition power lifters envision lifting a heavy weight successfully before ever attempting to move the bar.
You were actually taught mental preparation in EMT and/or medic school. You do this in the form of “pre-arrival preparation”. Usually en route to a scene you begin to play the “what-if” games in your head in preparation for the medical treatments you plan to perform. You formulate a plan based on dispatch information and the nature of the call. You have to mentally prepare for the call with regards to what equipment to bring with you, location, other resources needed etc.
So, if you are already using this mental preparation to save someone else, why then is it such a foreign idea to have a mental plan to save yourself?
Mental preparation using role playing help you physically: It will help you MOVE!
In the medical field, we are all very familiar with the condition of Fight or Flight or more accurately the Sympathetic Nervous System. There is another “F” in the mix which does not get as much attention but is just as important, known as “Freeze”.
This primal response to “insult or injury” can happen to a person due to a real or perceived threat. In other words, a person might claim they are going to punch you, or actually punch you without saying a word. The body’s initial reaction to the insult or may include an increase heart rate, dilation of the pupils, increased rate and depth of respiration, decrease in peristalsis and increase in sweat production (1).
But as we will see later, a freeze response may occur. (There are other physiological effects, not noted for the purpose of this article.)
When teaching an EVE course, I usually use my caveman story to help participants prepare for the stress they will experience if attacked. Here is a non-animated version. It doesn’t have the same flair, but it gets the point across.
Imagine a caveman who wakes from slumber, and finds that he is very hungry. He looks at his female mate and grunts “Food!” She responds by tossing the last piece of a rabbit’s foot at him. The caveman realizes that he must go out and hunt for his food. He picks up his club and drags it behind him as he leaves his cave.
As the caveman walks through the tall grass, he observes a wild rabbit a few feet in front of him. He raises his club over his head in preparation for the kill. The rabbit freezes in fear; its heart rate increases and its heart pounds. The rabbit’s respiratory rate increases and his little legs tremble. Just prior to delivering the fatal blow, the caveman hears something in the tall grass behind him. He turns to see a large saber tooth tiger crouching in the tall grass preparing to pounce on him. Now the caveman experiences the same physiological and psychological response as did the rabbit.
Numerous studies have been conducted on the physiological and psychological changes that take place when the human body is exposed to stress. Many of these studies have come to similar conclusions regarding the response to stress. Stress can be defined as a situation or an event that taxes and causes an imbalance to a person’s psychological and physiological state. Here are some of the perceptions a person may have that would increase their stress in a violent encounter:
• An encounter where the defender believed they could be killed.
• The aggressor is too close to the defender being attacked.
• The defender is not confident in their self-defense skills.
• The defender has never experienced that type of aggression.
You may respond as the caveman did in a stressful situation like one of the news reports above. There is an adrenaline dump (Sympathetic Response), which causes an increased heart rate, increased respiratory rate and depth, and dilation of the pupils as well as shunting of the blood from the extremities to the internal vital organs as the body prepares to “Fight or Flight” or even the momentary freeze.
Knowing these physiological changes will occur, the provider can recognize the changes as normal. Having mentally role played, the amount of time the freeze occurs can be greatly reduced.
It is important to note that with these physiological changes there are also changes in the ability to perform certain activities. A person will experience a loss of fine motor skills. (Try to write your name after you have been scared). Some people may experience tunnel vision. It is the natural response to visually lock-on to the perceived threat. This will affect your ability to see things around you. You may have auditory exclusion (not hear certain things) because you are so focused on the threat. It may distort you recollection of the events.
We have all heard of the deer in the headlights-frozen by fear. The idea of getting concrete feet or growing roots is the same concept; freezing for a moment due to stress, real or perceived.
In 2005, WebMD posted an article derived from an article in Psychophysiology that conducted a study showing Researchers also found an increase in muscle stiffness after the participants viewed the unpleasant images.
They say this pattern resembles the ‘freezing’ seen in many animal species when confronted with threatening stimuli, which is controlled by nerve responses designed to promote defensive survival.(2)
In observing human behavior, training literally hundreds and hundreds of people in self-defense , I have made some interesting, non-scientific observations.
When a physical skill is new, the defender usually has very jerky, almost robotic, appearing movements. Once their brain begins to understand the skill, the more smooth their movements become. As an observer, you can literally see their brain attempting to process the information. We call this processing of information R.A.C.E for Recognize, Analyze, Calculate and Execute. In EVE, we train to win a RACE. More on R.A.C.E. can be read here : RACE2REACT Having an understanding of RACE motivates a provider to train in both mental and physical skills. 
I would also make observations when I would have the students practice a particular skill, say defense against a knife, send them out a doorway and have a scenario where they were faced with an attacker armed with a gun. I was simply trying to teach them never to lock themselves into a particular way of thinking. To always expect the unexpected.
Mental role playing is exactly why we use a F.I.S.T. suit. Many in EMS have never thought of being the victim of an assault, some have never been in a “fight” since grade school. Having a role player in a padded suit allows for more realistic training. The provider is attacked and when the scenario is over, the provider always talks about it. Usually over and over. This mental replay if you will, is a form of mental training. The provider goes over and over the scenario in their head. They process what they did right and what they could have done better.
The ultimate goal in mental role playing as taught in EVE is to train the body to MOVE. Movement will create opportunity to escape with less damage. For instance, instead of freezing upon first sight of attack like a push, punch or grab, through mental role playing (having seen a winning outcome) the defender will MOVE. Mental role playing will also help the provider recognize the difference between a patient and an attacker. 
So, let’s go back to the stressors and the Caveman story and how mental role playing can help the provider MOVE.
An encounter where the defender believed they could be killed. Through mental role playing where the provider “imagines” various types of assaults where he/she has potentially life threatening attack and SURVIVES, this will help the provider not freeze!
The aggressor is too close to the defender being attacked. Practice mental role playing of the attacker being close and grabbing, punching, choking and the provider escaping. Because after all, many times where patients turn into attackers, providers are in close proximity because of initial patient care.
The defender is not confident in their self-defense skills. Practicing both mental role playing and physical skills to boost confidence. In order to build confidence in one’s self, there must be some form of physical practice put in place as well. It would be like reading a book on how to play pool and then going to a local pool hall and expecting to win you first game. You have a mental understanding of how things are supposed to go, but not the physical attributes to make the balls drop into a pocket……….yet.
The defender has never experienced that type of aggression. While impossible to imagine every possible type of an attack, the provider can imagine the more “probable” attacks based on the types of attacks documented to occur. Look here for reference Assault on Staff Log
Take the time to look for yourself, the types of attacks that are most common. Go to the forums on the DT4EMS website and look at the Assault on Staff Log. Then do your own mental role play “what would I do if” one of those attacks happened on your scene, to you or your partner. Imagine, truly imagine your surprise if you are punched in the face, threatened with a weapon, or grabbed violently. What would you do?
Simply taking a few minutes every day to “Imagine” scene safety can make all the difference in the world “if” you have to face a violent encounter.
Sources:
1) Sympathetic Nervous System- http://en.wikipedia.org/wiki/Sympathetic_nervous_system accessed 02-05-2012
2) Like Deer in Headlights, Feat Freezes People http://www.webmd.com/balance/news/20050610/like-deer-in-headlights-fear-freezes-people accessed 02-05-2012