Verbal First Aid: A New Tool For Risk Management In The Workplace
A New Tool for Risk Management in the Workplace:
Verbal First Aid™
c. 2009, Judith Acosta, LISW, CHT
Within the last several years, particularly since 9/11 and the inception of a broad-
reaching emphasis on national security, the American workplace has changed. Where at
one time there was free and open intercourse, there are now multiple gateways prior to
access—technological, social, and physical. Getting into a secured building requires the
emptying of pockets and purses, the removal of shoes, and a sometimes more personal
inspection. With that security—which is by its nature is based in the experience of fear—
comes an increase in general anxiety. People are generally more hypervigilant--readier to
perceive danger, more high strung, and more sensitive.
After 9/11, National Employee Assistance Programs, such as Longview
Associates in White Plains, New York, had been virtually inundated with calls for
debriefings, information sessions on trauma, and support services for employees. In the
ten years since then the situation has not radically altered.
“It’s more acceptable now to have emotions in the workplace,” says Kristen
Nagle of Longview. “Corporations have been more sensitive to the psychological and
emotional needs of employees virtually across the board. They know the importance of
their support, particularly since 9/11. It’s not only about productivity anymore. It’s been
about doing the right thing.”
Corporate support has taken many forms—conferences, counseling services,
trainings—on issues ranging from post-traumatic stress to Internet security. Businesses
have begun not only to react, but to respond proactively—giving their employees the
tools they need to handle emotional and physical crises.
The Place For Verbal First Aid in the Post-9/11 World
It has been repeatedly documented that the earlier the intervention, the more
likely a positive outcome. When a person at work experiences a traumatic event—
whether that is a fall, a broken business deal, a heart attack in a fellow employee, or a
mass layoff—the quicker we address the fallout from that experience, the better that
person will respond. What that means in business terms is a quicker return to work, less
rancor, better productivity, and less litigation. The research literature on PTSD indicates
that the way in which we handle traumatic incidents (whether they are personal injuries
or the employee is witnessing an incident) at the moment they occur has an impact both
on how the employee heals and then deals with traumas in the future.
This is the core principle of Verbal First Aid: What we say at the scene of a
medical emergency or emotional crisis is as important as what we do.
Unfortunately, most crises are handled without much consideration of the impact
of words. If a person is bleeding, we bandage the wound, but we don’t address the fear. If
a person’s feelings are “hurt,” we tell them to “get over it” and get back to work. There is
another way, a better way—both ethically and practically—to handle any critical
The Right Words to the Rescue
According to the book, The Worst Is Over, (Acosta/Prager, 2002) there are words
we can say and ways to say them that can not only calm an employee who is overly
stressed, but help stop bleeding and scarring from burning, reduce the panic in a person
with heart symptoms, give comfort and pain relief when an employee is angered, and
perhaps save a life in more dire circumstances.
The protocol for Verbal First Aid was first developed for paramedics to use in
emergency situations. It works because when someone is in a crisis or emotional state, he
or she is in an altered state of consciousness in which the autonomic nervous system—the
part of our brain that regulates everything from heartbeat and bleeding to body
temperature and perception of pain—is open to suggestions. A first responder can say,
“stop your bleeding and save your blood,” and the victim will respond by literally
stopping the bleeding and saving his blood. The paramedic could say, “imagine your arm
packed in cool, comfortable snow,” and the burn victim can instantly feel better as he
begins the healing process without scarring.
This occurred to me personally some years ago when I was preparing to give a
talk to a group of firefighters in Sleepy Hollow. I had held onto a burning pot for too long
and before I could let it go realized that two of my fingers on my right hand were
blistering white. The pain was intense and instantaneous. I couldn’t believe how foolish
I’d been – and I had a talk the next day on Verbal First Aid!! How was I going to go in
there with a bandage around my hand because of burns?
I immediately put my hand in tepid water and gradually lowered the temperature
until it was mildly cool (not icy) and repeated the words to myself, “cool and
comfortable, deep, deep down.” I saw the coolness as a gentle, blue stream moving
through my skin, down into the muscle, all the way to the bone. I repeated this to myself
all night until I fell asleep. The pain subsided fairly quickly, which pleased me greatly,
although I was still concerned about having the need for bandages.
In the morning when I awoke, I took off the bandage—and even after many years
of doing this sort of work what I saw surprised me. The burn was completely gone. I do
not exaggerate. Where before it had been a clear secondary burn, there was absolutely
I am still surprised by what Verbal First Aid can help us do—not only for
ourselves but for one another.
Work, Words, and Stress
Who would argue that the workplace in America is stressful? There are layoffs,
downsizings, crunches, and closings. People are doing jobs they never imagined doing
before. They are forced by circumstance to seek new professions at a time in life when
perhaps they had imagined they would be preparing for retirement. To some, stress is too
polite a term.
Stress is a perception. According to Hans Selye (the Founder of Stress Medicine)
it is a byproduct of all we do—waking, sleeping, running, breathing, working, not
working. It is a part of life and in proper doses it can animate and inspire us. In too heavy
a dose, it becomes toxic.
He distinguishes stress from strain. Stress is the event or the incoming force.
Strain is our response. It is the way a person reacts to a situation. It is our receptivity and
perception. One person might find something frightening (and therefore stressful) that
another person would find challenging (and therefore even exhilarating). It is still quite
real, of course. Stress—and the way we “strain” against it or through it—has been
implicated in most of what leads people to call their doctors and linked as a major
component in back pain, heart disease, cancer, and chronic ailments such as fibro-
Stress in the workplace is costly. It costs employers in terms of down-time,
medical reimbursements, workmen’s compensation, poor production, and bad publicity in
Trauma in the Workplace and Risk Management
These dissociative states are not limited to car accidents, plane crashes or military
events and natural disasters. Smaller scale crises—pink slips, mistakes on important jobs,
personnel issues—can take their toll on the job as well. Understanding this simple fact of
human nature and, most importantly, knowing both what to expect and how to handle it
can make the difference between a return to a normal work environment and a
deterioration into risk management.
When I give this talk to emergency medical corporations and medical personnel, I
sometimes begin with a simple question: Do you know what the number one factor is for
litigation and malpractice lawsuits?
Every now and again, a few people raise their hands and answer correctly: It is
not skill, technique, cleverness, strategy, or even whether the patient lives or dies. It is
whether the clinical practitioner or emergency worker is perceived as having cared about
the patient and the patient’s family.
It is common knowledge in law circles that a person who believes that his doctor
or provider cares about him is far, far less likely to seek compensation or damages for an
injury that occurs on the job. This perceived caring is a manifestation of what is called
“Rapport,” the sense that the person who is handling things cares, understands, and is
doing everything possible to help. Rapport utilizes authority (benevolent rather than
commandeering), believability, and confident compassion to pave the way for words to
be used for healing. With rapport, our words will be utilized and understood in the best
way possible. Without rapport, Murphy’s Law rules.
The same is true in the workplace. Diffusing a potentially critical situation is
easier, more ethical, and more compassionate before it becomes critical. Knowing Verbal
First Aid helps us to see the signs before they become symptoms. And when we do see
symptoms, it helps us to gently address them so that the person is led to healing and
When people are scared, we look for a benevolent authority to tell us what to do,
how to find safety. It is instinctive to all social animals. What we do and say in those
moments is particularly important. Do we use those sensitive moments thoughtlessly,
fanning the flames of anxiety or do we serve as a guiding light to lead someone to
emotional and physical safety. With Verbal First Aid, the choice and the task are easy.
Verbal First Aid helps you know what to say when you need it most, when every
moment and every word counts. Although it was initially created to help emergency
medical and rescue personnel to do precisely the sort of thing I did with that frightened,
young girl, anyone can use it anywhere. Wherever there is a human emotion or a
vulnerable moment, Verbal First Aid can help.
The Importance of Rapport in Reducing Stress at the Workplace
With Verbal First Aid (starting with a solid rapport) you can use words to diffuse
a situation and therefore relieve the stress and forestall future trauma. For example,
someone at the next desk stands up too quickly, hits her head on the sharp corner of the
metal filing cabinet and falls to the floor. She is angry, embarrassed and bleeding. The
manager sees it and goes right to her. If she seems seriously injured, he makes the call to
911 or to the nurse on call if there is one. Once the manager has assessed the urgency of
the situation and responded accordingly, what does he say?
The first thing he does if he knows Verbal First Aid is let his employee know that
he is there FOR her. Unless there is a unique bond between them and a long-standing,
non-work related relationship, humor is inappropriate. His approach should be direct,
compassionate and take-charge, particularly if she is badly hurt.
“Susan, I saw that and I’m right here. I’ve called the nurse. He’s on his way. The
worst is over.”
“Damn it,” Susan mutters and sees that there’s blood dripping down onto her
shirt. “Damn it!” She starts to appear pale.
“I can imagine how you feel…I banged my toe on a door and wanted to take it off
its hinges with my other foot.” (This called “pacing”, a technique in which a manager
would match her behavioral and emotional state by being present with her in her
discomfort, her anger and her fear, without rushing to try and cheer her up or dismiss her
This rapport can’t be manufactured. Intention always manifests. So, if you’re
doing it to manipulate, it will be transparent. Rapport is born of real concern and real
Delivering Suggestion for Healing
One way to deliver suggestion is to use story telling. Once rapport is established,
you can simply tell her a story of someone you know who had a cut like this and stopped
bleeding within minutes. Often, just the suggestion works, because in a stressful situation
the person is in an altered state and you are the authority figure.
If there is pain, a technique that is terribly useful is distraction. If the injured party
complains of discomfort, you can direct her attention elsewhere—specifically to places in
her body that are uninjured.
For example, you can say: “I can see that your head needs attention. Would you
take your mind down through your body and see if there’s anyplace else that needs
attention?” You might point to an uninjured part and say, “How about over here? How
does it feel over here?” Not only does the change of focus provide pain relief (because
the mind is only capable of processing one thing at a time), but now she takes note of the
fact that there are parts of her that are still all right. And in your presence she feels a little
better, so she trusts you to give her other helpful suggestions.
Imagery is a technique that can not only deliver suggestion but can give great
comfort. “Now that help is on the way, you can relax with me and take one or two nice
easy breaths. I’ll bet you’d rather be out on a hike right now. I know you love it outdoors.
It would be fine if you wanted to take a little vacation right now...”
The way this works is simple: Every thought that we have generates a
physiological, chemical reaction in our bodies. Fearful thoughts create adrenaline and
other chemicals that can cause harm. Imagining a peaceful place literally changes the
chemistry within and facilitates healing.
Our physical and emotional wellbeing at work—our sense of being safe,
understood, and cared for—is essential to our overall health. We spend most of our lives
at work. When you know Verbal First Aid, you can help make the workplace a place
where, when you and your co-workers need it, healing can also begin.
Judith K. Acosta, LCSW, CHT is a published author and well-respected
psychotherapist, hypnotherapist, classical homeopath, and crisis counselor with a
private practice in New Mexico.
She is the co-author of The Worst is Over (2002) and Verbal First Aid (2010 Penguin
Books). She has authored numerous articles on verbal first aid techniques, stress
management, trauma, animal-assisted therapy, and viral fear. She specializes in the
treatment of trauma and anxiety—particularly with military, paramilitary and