About Trauma
Lemonade With Lisa
Empowering
First Responders rise strong, heal from trauma, prevent burnout and provide Trauma Informed Care.
Lisa VanFleet, RN, CTP
Certified Trauma Professional
Trauma Informed Care Consultant
About Me
Hi. I'm Lisa. I'm a former ER nurse turned Employee Health nurse with a passion for empowering First Responders (and others):
1. Heal from trauma.
2. Help each other heal trauma.
3. Avoid burnout.
4. View each other and our patients through the eyes of trauma informed care.
My experiences as a nurse led me to search for help for myself and my teammates. I started taking classes about trauma and how the every day experiences of first responders affect us and how we can heal and help each other. I am a Certified Trauma Professional and I want you to know that First Responders truly can heal and enjoy every day life again!!!
Lisa VanFleet, RN, CTP
Contact me if you would like me to come to your business and help educate you and your staff on Trauma Informed Care.
Lisa VanFleet, RN, CTP
Certified Trauma Professional
Trauma Informed Care Consultant
As soon as I left the ER, I started taking classes, reading books and trying to heal myself so I could stop hearing crying mothers every time I closed my eyes and I was learning the most amazing things!!! My first class was in EMS Resiliency Training. It included First Responders from all over our state. I was blown away at the education and the aids they gave. I had to learn more.
As a nurse, I was able to take classes from PESI in trauma taught by the top trauma experts in the world. I was getting more and more amazed at what I was learning and noticed I WAS healing as I was practicing what I was being taught.
The voices of the crying mothers stopped…. and I knew, even more, that EVERYONE should know what I was learning and that we should be taught this as children!!
I finished my CTP classes through the NICBAM (National Institute for the Clinical Application of Behavioral Medicine), took classes in Trauma Informed Care and Trauma Debriefing and now am excited about finishing the Trauma Response and Crisis Intervention program through Rutgers University.
All of those classes have led to a lot of information that I want to share. This notebook breaks that information down into bite-sized, easy to learn nuggets to learn quickly, so we can help ourselves and each other heal. I have included links to some of the books in case you want to learn more.
The information I’m giving you is the basics of what’s in the top trauma books and classes. It’s what they also say we all should know. It is not to take the place of a therapist if you need one.
Manifesto of the Brave and Brokenhearted
There is no greater threat to the critics
and cynics and fearmongers
than those of us who are willing to fall
because we have learned how to rise.
With skinned knees and bruised hearts;
we choose owning our stories of struggle,
over hiding, over hustling, over pretending.
When we deny our stories, they define us.
When we run from struggle, we are never free.
So we turn toward truth and look it in the eye.
We will not be characters in our stories.
Not villains, not victims, not even heroes.
We are the authors of our lives.
We write our own daring endings.
We craft love from heartbreak,
compassion from shame,
grace from disappointment,
courage from failure.
Showing up is our power.
Story is our way home. Truth is our song.
We are the brave and brokenhearted.
We are rising strong.
Brene’ Brown
This quote is from the excellent writer, speaker and researcher, Brene' Brown's book, "Rising Strong:
How the Ability to Reset Transforms the Way We Live, Love, Parent, and Lead."
Look for the little lemons through my website. It will show you links to some excellent "lemon -ades” I've used and some are even written by the teachers I've had. All of them are from the top trauma researchers, writers and teachers. There’s a ton of amazing resources out there!! But, I want to stear you in the ones I found that helped me the most. So, just click on the lemon to go right to Amazon to learn more.
(As an Amazon Associate, I earn a minimal amount from qualifying purchases.)
Trauma Basics
Trauma IS your body's response to an event that overwhelms your nervous system's ability to cope.
When that trauma response kicks in, your brain gets hijacked. You can't organize your feelings or your thinking. You can't learn or see other people's point of view. Your brain can only focus on safety.. regardless if the danger is real or percieved.
When this happens, as First Responders taking care of patients, we must understand that patient care, when your brain has been hijacked can be unsafe for the patient.. and you.
This is where trauma informed leadership is crucial. Leadership that understands that IT'S NOT YOUR FAULT and makes sure you.. and the patient... are taken care of without judgement or criticism.
Lack of this understanding can lead to burnout.
-Trauma IS our reaction to an experience that causes us to act and react in certain ways, especially in situations that remind us of the original trauma.
-Trauma IS the cause of many chronic illnesses.
-Trauma IS a cause of disconnect with ourself, others,
our patients and God.
-Trauma IS NOT simply a behavioral health issue.
Trauma IS NOT the actual event. It's the way your body reacts to the event. What traumatizes me, may not traumatize you. Dr. Van der Kolk explains it perfectly in his book "The Body Keeps The Score" and in this video.
You become a specialist in dealing with danger, but no longer a specialist in dealing with spring in western Massachusets..
and it passes you by.
-Bessel Van der Kolk
If you were going to by one book to learn about trauma and help you heal, I would suggest "The Body Keeps the Score" by Dr. Bessel Van der Kolk. Click on the lemon to learn more about it.
Ace Study
Adverse childhood experiences (ACEs) are potentially traumatic events that occur during childhood. The Centers for Disease Control and Prevention (CDC) and Kaiser Permanente conducted the first ACE study from 1995 to 1997 and asked more than 17,000 adults about childhood experiences including emotional, physical and sexual abuse; neglect; and household challenges of parental separation, substance abuse, incarceration, violence and mental illness. Nearly two-thirds of participants noted at least one ACE and more than 1 in 5 noted three or more. Researchers identified a link between ACE exposure and a higher likelihood of negative health and behavioral outcomes later in life, such as heart disease, diabetes and premature death.
ACE Scores and Health
According to the CDC
Remember:
Your ACE Score is NOT your fault
and does NOT define who you are or limit what you can become.
Trauma IS NOT only related to childhood experiences, but
they do impact us in serious ways and this can last through
our whole lives, unless we learn how to heal.
Trauma robs us of 2 basic human needs:
When these needs aren't met, we can't climb Maslow's Hierarchy. We're stuck.
Safety
&
Connection
If you don't have a connection at work, guess what feels in jeopardy? The very first step. So, Trauma and the lack of connection it can bring, can lead to life-long struggles in every area.
We heal by reteaching the brain it's safe and through reconnection with ourself and others.
Safety
&
Connection
It sounds hard and like it has to be done in a therapist's office. But, even Dr. Van der Kolk says that until every person that walks into his office learns how to self-regulate, he can't help them. He even goes to say that:
"these basic steps CAN'T be done in a therapist's office. They MUST be done one-on-one, peer to peer in the moment."
This is where we have to learn to help ourselves and each other when the going gets tough.
Our Connection with each other
can help create that presence of safety even in the middle of the worst medical traumas we come across in the field, on the truck, in the ER, on the floor, etc.
"Safety is not the absence of threat. It is the presence of
Connection."
Ourself
Others
--Bessel van der Kolk
(your spiritual belief)
God
Patients
Connection
How do we make lemons into lemonade and help our brains feel safe?
By widening our Safety/Connection Zone and staying in it whenever possible. When we can do that, we can help others do it too.
The word resilience is getting a bad rap. So, I steer clear of it.
The Amygdala: Your Internal Smoke Alarm
Think of the Amygdala as your smoke detector. It goes off when it senses that you aren't safe. When our brains go into a trauma response, our frontal lobe goes "offline" and we "flip our lid". Your brain can't reason, can't learn. It's impossible for you to think clearly no matter how hard you try. Your brain only cares about safety.
Click on the books if
you’d like to learn more.
Out of the Safety/Connection Zone: You've "flipped your lid" or "gone offline".
Healing our Brains
We can reteach our brain by creating new pathways. It's called Neuroplasticity. Pretty amazing stuff. (Check out these videos.)
Types of Trauma Responses
Of course there are times when we need to listen to our smoke alarm and get out of harm's way. Our amygdala has an important job and we do need to listen to it when there is a legitimate safety issue. We each have a main trauma response that our brain goes to most of the time.
Which one is yours?
How do we Keep Our Brains "In The Zone"?
By self regulating (using simple practices that bring your brain back into the safety of the moment).
"Things that make you go AHHHH."
These are only an example of exercises that can help. Do them until you feel your breathing slow down, your shoulders lower and you feel the safety around you. AHHHH!!!
They Really do work!
Dr. Peter Levine has done extensive work in somatics and healing from trauma. In my certification class “Healing From the Bottom Up: How To Help Clients Access Resource States” he taught us about regulation techniques, our nervous system and how to release trauma from our body. Most importantly, he teaches how the body truly can heal from trauma.
Click on the books if
you’d like to learn more.
Mood Board
Some people create a mood board that helps them visualize things that calm them or make them happy. You can take a picture of it in your brain and pull it out when you need it.
Connecting with Others
Now that we're trauma informed, we can think about how trauma may have affected our connection with others. Sometimes, those we love the most take the brunt of our frustrations and fears. Instead of connecting with others, we can tear them down and further traumatize them... and ourselves by the loss of connection.
"Connection is the energy that is created between people when they feel seen, heard and valued-when they can give and receive without judgement."
-Brene' Brown
One kind word can make all the difference.
How can we help each other?
"I've been there
before. I know how it feels."
“Can I help you?”
Sometimes 5 minutes of your time can make
all the difference.
"Breathe in the flowers and blow out the birthday candles".
Must be judgement free and sympathy free.
Guide them through the
self -regulation techniques.
"What do you need to hear"?
(More on the next page.)
"What do you need to hear?"
In a NC state-wide resiliency class for First Responders, this was one of the activities that we used to help others regulate. We were all amazed at the effect it had on us and each other.
We were paired up with another person. One of us was supposed to be the helper and the other to be the one that needed some encouragement. I immediately felt myself going out of my connection zone. I immediately started worrying about having to be the one to have to talk about trauma. Just the thought of the mothers crying made me start to cry. My brain shut off. I couldn't think, couldn't even understand what the instructor was saying at that point. I honestly almost left the class. I was apologizing over and over to everyone.I felt useless and embarrassed.
The instructor turned it around and asked me to be the one to ask the question. Through my tears, I started the exercise and asked my partner what he needed to hear. He responded and we completed the exercise. His breathing slowed, his shoulders lowered and I knew I had helped him...with both of us shedding tears.
The instructor used me to make a point. A point I'll never forget and one that I want you to know. What I was embarrassed about.. my tears... made me a better helper.
Guess what happened next? The instructor told everyone that I should become one of their instructors. My tears and hurt didn't matter. What did matter was that I treated him without judgment and with empathy.
You don't need to be healed to help others heal. You simply need to be there in the moment with sincere empathy and without judement.
Our experiences as First Responders make us the perfect people to help each other because NOBODY ELSE can truly understand.
"What do you need to hear?"
When you see someone is stressed or just generally upset, it's amazing how this "aid" can help.
- Ask the person what they need to hear. It can be a word, a sentence, etc. Maybe a nurse just needs to be told that they're a good nurse.
- Using the exact wording they used, tell them what they need to hear. Be sincere and there fully in the moment with them.
- Wait 10 seconds and tell them again. Look at them, let them know you mean it.
- Wait 10 seconds and tell them again. Watch for their breathing to slow, their shoulders lower. Look for the AHHHH.
- If you don't see the AHHH kick in, tell them again.
Notice that the person struggling doesn't have to tell you anything about their trauma. They don't have to go into any details about themself at all, but you can help them feel safe in the moment and give them a boost in just telling them something important to them.
A couple of the cases in the First Responder class were:
- I need to hear that I'm a good daughter.
- I need to hear that I'm capable to be a good father to the foster children coming to my home.
Burnout
....because the struggle is real
Nobody can truly understand the struggle/trauma of a First Responder except another First Responder. We're the only ones that can keep this from happening.
Caregivers have to take care of caregivers.
“If you are not in the arena getting your ass kicked on occasion, I am not interested in, or open to, your feedback. There are a million cheap seats in the world today filled with people who will never be brave with their own lives, but will spend every ounce of energy they have hurling advice and judgement at those of us trying to dare greatly. Their only contributions are criticism, cynicism, and fear-mongering. If you're criticizing from a place where you're not also putting yourself on the line, I'm not interested in your feedback.” Brene Brown
How can we stop that statistic from happening?
By understanding how it happens and by caring for each other.
I had the opportunity to be part of an all day live webinar with Dr. Gabor Mate' himself. To have him sitting there live with us, teaching us and actually answering our questions, was amazing.
I had been researching burnout at the time and had come across my own theory. There are a lot of people talking about burnout and calling it "compassion fatigue or empathy fatigue". But, we NEED compassion and empathy to do what we do and in my opinion, we can't really have too much of either.
My theory was.. and is... that it's a lack of boundaries that creates burnout.
We became caregivers because we're compassionate and empathizing people. It's why we do what we do. But, we can care so much and empathize so much that we take on other people’s pain and trauma. It’s like we hug them and forget where they end and we begin.
We also want to help so much and are so short staffed that we work way too much, keeping us in that constant stressful caregiver role.
You become a specialist in dealing with danger, but no longer a specialist in dealing with spring in western Massachusets..
and it passes you by.
-Dr. Bessel Van der Kolk
As you can tell, I love this quote. I don't want to let another season pass me by.
We don't take time for ourselves.
We don't want to say, "No".
We don't let ourselves live in the moment.
Our ability to enjoy life becomes impaired
.... and it passes us by.
Boundaries are the key!!!!!
In that webinar with Gabor Mate, someone directly asked him what his thoughts are on compassion fatigue/empathy fatigue. His answer: "It doesn't exist".
I near started jumping out of my chair!! My theory was right!!!! Dr. Gabor Mate' agreed!!!!!
What causes burnout?
Compassion Fatigue? NO
Empathy Fatigue? NO
"Empathy without boundaries is the leading cause of burnout!!"
Lisa
Click on the books if you’d like to learn more.
Not long after I learned about boundaries, something tragic happened where I needed to draw upon everything I've learned about trauma, empathy and boundaries.
I was getting ready for work one morning and heard a crash. I looked outside to see a school bus and a car that had been in an accident right in front of my house. I ran to the bus first thinking there may be little children on there. I got on the bus and realized they were teenagers and all seemed to be doing well. I triaged quickly and one of them called 911. I made sure everyone was ok and nobody was missed and headed for the car on the other side of the road.
When I reached the car, I realized it was a young girl. I couldn't tell who it was because of the way she was lying, but I knew she was a neighbor because we live in a small community. I tried with everything I had to get the doors open. To get to her somehow. I grabbed a phone and insisted the dispatcher get someone there fast because there was an entrapment. All I could do was reach through the partly open window, hold her hand and tell her I loved her. That we all loved her. Her whole community loved her.
She was unresponsive, but breathing. I knew how serious this was. I don't think I've ever felt so helpless, especially as a nurse.
In a matter of minutes, that felt like hours, my whole street was full of people helping. Fire Rescue, EMS, friends and family. They finally got the passenger side door open and one of the young men from our community with the fire department got his head in and saw who the driver was. He stood up and I saw the look on his face. Tears started to roll down his cheeks and he stepped backwards. I yelled, "Who is it?"
Just then, I saw my friend running down the street toward us frantically screaming her daughter's name. The name of a young lady I had known since her childhood and taught in Sunday School. She had just turned 16 and got a new car for her birthday two weeks before. I didn't recognize the car as her new car.
All I could do was run, grab my friend before she reached the car and hold her back. I hugged her, told her we needed to let them work to get her out of the car. All I could do was stand there, reassure her that her daughter was alive, pray and let her scream and cry.
A mother's screams, the screams of my nightmares, were all I could hear.
I started putting myself in her shoes and imagining her pain. Thoughts of my daughter flying through my head. But, I made myself think about what I was learning so I could be there for myself, for my friends and for my community. I created boundaries.
I literally kept telling myself that this was my friend's trauma.... not mine!! This was her daughter... not mine!!!! Heartless and cold? I used to think so. Now, I realize that it actually kept me from getting completely overwhelmed by the situation. I controlled my response rather than it controlling me. It meant I was healing. I still had empathy and compassion, but I didn't let myself forget where she ended and I began.
I was going to end the story there, but I didn't want to leave you wondering. They were able to get her out of the car, onto an ambulance and intubated while we waited for a rescue helicopter. As the helicopter took off, I remember seeing my community all around me. Exhausted, traumatized, watching the helicopter until it was out of site. Not a word spoken. Then..... tears and hugs. A whole community broken, exhausted and crying together.
We rallied in praying for our young friend and neighbor. Praying for a miracle. We knew what the damage was and knew the chances were slim. But, we prayed for a miracle.
The miracle came in a different way than we had wanted. About a week later, our young friend saved 8 other lives.
Are you wondering if the screams came back when I closed my eyes?
They didn't!!
Connecting with Our Patients
Through Trauma Informed Care
Now that we’re trauma informed, we can start seeing our patients through the eyes of trauma informed care.
"Anything that is "wrong with you (or someone else), began as a survival mechanism in childhood".
-Gabor Mate'
Universal Precautions
Trauma Informed Care (T.I.C) assumes that people are more likely than not to have a history of trauma. It recognizes trauma symptoms and acknowledges the role trauma may play in that person’s life.
The CDC’s 6 Guiding Principals
Let's see things through the eyes of our patients in this video.
Sometimes just explaining the "why' behind what we're doing and letting our patients be a part of their care, can help them feel understood and keep them from being re-traumatized.
I hope I've helped you not only understand trauma, but also helped you heal through safety and connection and see our patients through the eyes of trauma informed care.
Manifesto of the Brave and Brokenhearted
There is no greater threat to the critics
and cynics and fearmongers
than those of us who are willing to fall
because we have learned how to rise.
With skinned knees and bruised hearts;
we choose owning our stories of struggle,
over hiding, over hustling, over pretending.
When we deny our stories, they define us.
When we run from struggle, we are never free.
So we turn toward truth and look it in the eye.
We will not be characters in our stories.
Not villains, not victims, not even heroes.
We are the authors of our lives.
We write our own daring endings.
We craft love from heartbreak,
compassion from shame,
grace from disappointment,
courage from failure.
Showing up is our power.
Story is our way home. Truth is our song.
We are the brave and brokenhearted.
We are rising strong.
Brene’ Brown
I hope this information helps you rise strong and squeeze the lemons into lemonade. Don’t miss another season in North Carolina, or wherever you are from. Don’t let life pass you by. -Lisa
You can reach me at:
Additional Resources
Digital Notebook Cover. Can be used
in Good Notes, etc.
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in Good Notes, etc.
Digital Notebook Cover. Can be used
in Good Notes, etc.
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in Good Notes, etc.
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LWL
Digital Notebook Cover. Can be used
in Good Notes, etc.
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Digital Notebook Cover. Can be used
in Good Notes, etc.
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Digital Notebook Cover. Can be used
in Good Notes, etc.
$1.50