• Jonathan

Your Amygdala and You In High Stress Environments (how not to pee your pants under pressure)

Let us talk about your amygdala for a second. This almond sized portion of your brain is responsible for triggering your fight or flight response. It’s the part of our brain that when we perceive a serious threat (such as a gun pointed at us) that sensory information goes to our thalamus and is distributed to various parts of our brain such as the motor cortex (running may be a good option in this scenario), your visual cortex (it’s hard to avoid a threat you can’t see) and the rational part of your brain feeds all of this information to your amygdala so you yell and scream as we are doing this to hopefully distract and deter the threat (the person holding the gun).

This is how it’s supposed to work……. However, there is also the amygdala hijack. In the amygdala hijack once a scary thing is recognised instead of signals going to the rational part of the brain, they go straight to the amygdala which gives us that sense of panic that doesn’t allow us to think and process the scenario in an effective way.

In emergency




medicine we will frequently be confronted by a myriad of intense scenarios and we must learn how to recognise our own amygdala triggers in order to manage them in an effective way. It is hard to manage our patients effectively when our heart rate is 170 due to psychological concerns and fear yet we must learn to do this if we are to going to be able to function in this environment.

We all need a certain amount of adrenalin and arousal to perform because that is challenge and challenge is good. The problem arises when challenge crosses that line and becomes threat because it will lead to a decrease in performance.




To combat the amygdala hijack, we must learn to be able to identify triggers and move the red line to the left to avoid us from becoming dysfunctional.


Fear related heartrate has a massive influence on our performance. The following figure comes from Dave Grossman’s book “On Combat” and illustrates that fear induced heart rates around 115 result in a reduction in fine motor control. Many of our procedures such as thoracic decompression, IV insertion and advanced airway management (to mention but a few) require fine motor control. At heart rates above 145 our gross motor capabilities decrease significantly, and it only gets worse from there.



At EMTG we know that “practise makes perfect” but recognise that not all practise is equal. It is possible for a learner to practise multiple times with no observable improvement. This could be attributed to several factors, but we at EMTG we also assess the learner’s internal environment (by non-invasive means such as ECG or pulse oximetry to obtain HR) to identify if this could be a possible factor and provide him/her with strategies to control it to achieve best performance. We then allow plenty of opportunity for that skill once mastered to be repeated multiple times prior to introducing the external factors that further induce stress. We place the learner in specially selected scenarios that mimic possible work environments in the immersion suite introducing ambient noise, heat or cold, wind, bright sunlight or low light conditions and even smell as further stressors to challenge you the learner.


Our instructors have the skills to induce stress as an element of emotional context while balancing the need for experiential learning to be safe and for appropriate support and coaching to be available always. We are however not afraid to stress our learners. The right amount of stress and cognitive load can enhance experiential learning and keep you engaged. Couple this with a short, formalised debriefing immediately after each exercise in a low pressure, friendly atmosphere we will increase your clinical capabilities. From the 30-year veteran to brand new learner, we have something for everyone in EMS at EMTG. We hope to see you soon on one of our courses. Prepare to be challenged!


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