3 Steps for Trauma Triage
When trauma occurs, how can you respond effectively in those critical moments? Tragedy is an inevitable part of life, and having immediate tools to respond can help mitigate compounding trauma.
Join Dr. Dan Allender and Rachael Clinton Chen as they offer a practical framework for engaging with traumatic experiences. They present a 3-step process to help you respond: sitting down, grounding yourself with both feet on the floor, and focusing on your breath.
This is not about resolving trauma, but rather how to tend to your body in those crucial moments. While these strategies are not a substitute for professional help or a comprehensive trauma-healing journey, the aim is to provide practical tools to regulate and care for yourself or others during those initial minutes or hours after a traumatic experience.
Please note, we understand that discussing traumatic experiences can be triggering, and we encourage you to be compassionate with yourselves as you listen.
Join Dr. Dan Allender and Rachael Clinton Chen as they equip you with essential insights and practical tools for trauma triage, empowering you to respond compassionately and effectively to trauma when it occurs.
Rachael: Well, today we’re going to engage, as usual, a pretty intense topic here on the Allender Center podcast. I’m laughing. I don’t know if we ever have non-intense topics, but what would you say, Dan? We’re just…
Dan: Oh, I’m just laughing. It’s not, yes, it is true. I do think we should do a kind of comedic entry into the life of what a therapist…
Rachael: Oh yeah. We could do that someday.
Dan: But you’re right. Yeah, not today.
Rachael: I mean, we’re funny people. That’s very true. We’re both very comedic people and sometimes we don’t always get to showcase that. No, but in all seriousness, today we want to talk about trauma triage. Any time we’re entering a topic like this, we’re doing it because I mean, our tagline, no one can escape tragedy. And so we want to be able to offer some helpful framework that’s both, in your imagination, but also some practical tools for how to engage within the first hour when there is a traumatic experience. So our hope and our heart behind it is that people need these tools and they need this framework. But before we enter into that, just to hold the reality that for both Dan and I, and we’re certain, almost everyone listening, some of these realities that we’re going to talk about are so near right now and are very palpable experiences of loss of tragedy. And so just a pastoral note to tend well to your body as we listen in today. We want you to have these tools. We want you to have this framework because in some ways it can help mitigate compounding trauma in a traumatic moment. And we’re going to be talking about realities that are just part of living and being human that I don’t think any of us have escaped. And again, I was just saying to Dan before we started, even for you, Dan, so recent, the loss of a dear friend and finding out some tragedy that closer friends and more friends are dealing with. And so not closer friends, more of your close friends are dealing with. And so just, we wanted to have a tender entrance into this topic to acknowledge that we do not take it lightly. And even though we’re going to try to have a real, not intellectual, but tangible conversation about it, that we just hold these realities with a lot of compassion.
Dan: Well, and we’ve had seven friends, past students, good people die in the last three months. And yeah, I said to a friend, and I may already said this, I just can’t remember, but I said, it feels like we’re in this season of death. And he said, how old are you? And I said, 71, I’m not, Becky just turned 71. So I practiced five months before my birthday to use that. So I get about 17 months to be a particular age. And he said, you’re not in the season of death. You’re in the eon of death, the age of death. And that feels really true. I did and had the privilege, but heartbreaking honor of doing my friend Len’s funeral and realizing that probably probably will not be doing a lot more weddings. I have that privilege with a number of dear friends, but it’s going to be more the reality of being able to say goodbye. And in that we’re dealing with trauma, and it’s important to hear that there are different levels. And so for example, another dear friend, just they were on this long awaited Italian vacation and within days of being there, the husband was hospitalized and still to this moment not clear what’s happening to his body. And so illness, injury, accidents, and let’s just put it this way, anything that is sudden, unexpected, out of the blue, dangerous in the sense that it has the threat, a mortality or at least a very uncertain outcome. And it’s disruptive. All those events that hold that are trauma events, but so important to know it’s not just accidents, injury, illness. I mean, what else do you consider Rachael to be in that category of traumatic events?
Rachael: Yeah, I mean life upheaval. When something happens with your job or a core relationship in your marriage with your children, with your finances, that again is in that realm of threat, danger, unexpected out of the blue, any of those realities and any of those core categories of living will have that element of a trauma. And whether it’s a big T catastrophic trauma or I would say not even a little t, there’s not a medium T, but if you had something between a capital T and a little t trauma, it would be in that realm because these are core attachments and core of survival and sustenance and provision. So that would be another category where I would say it necessitates a kind of trauma triage.
Dan: Well, and I would put those, those kind of life upheavals and the category of what prompts a lot of anxiety and stress. You may not have lost your job, but there’s a deep disruption with regard to your work or a friendship that’s teetering on ending. And so it’s not realized trauma like an accident, but it’s that sense that it’s not far ahead that things could go disastrously. So it’s trauma anticipated and therefore the experience that’s going to be often primary will be a kind of a ramped up uncertainty. But I do want that to be heard as the need for trauma care, the need for some kind of triage. And the obvious, of course, is where grief is involved. And that would be any loss, death, suicide, divorce, the loss of a job, any of those experiences where you know that some ending has happened that you do not desire and may not have been sudden like an accident, but still bears that threat now realized with impending or overwhelming sorrow and grief. So just the experience that brings us to that is traumatic, but also if we can underscore being, and people have used this word drowning. Drowning in grief is in and of itself, not just the results of trauma, but another kind of trauma that is going to need care and triage. Anything else that you want to put in that?
Rachael: I mean, I think certainly experiences of abuse or injustice need trauma, care and triage. What can be tricky is they’re often more chronic and complex and can be ongoing. So I think what we would be offering would maybe be more in the realm of after a significant experience of abuse and or injustice that you know, need some trauma care around.
Dan: Yeah. Friends had their home broken into, and that sense of their space that even if most people don’t use this word with regard to their space, it’s holy, it’s set aside. You only let in those who in some sense are companions whom you trust. But when someone breaks into a car, not just the theft or even destruction, but the sense that there has been something unholy breaking into your space, it is in and of itself that experience of injustice abuse. So something has been so violating that you oftentimes don’t have language, don’t have the capacity to work it through. So we’ve done this before, but I want to at least come back to say with any of these experiences, some that are going to be intense and sudden some, a little long term, some that are, as you put it, brilliantly complex. There’s still the reality of what’s the effect for us as a result of any form of trauma.
Rachael: Well, I mean, we’ve talked about this, what’s your phrase you always use? Ad nauseum. Infinitum ad nauseum. And again, we have to keep coming back to it is just this reality of fragmentation and dysregulation. You are going to experience a fragmentation of thought, a fragmentation of breathing, a fragmentation of sleep, a fragmentation of in some ways making sense of reality in the moment. And Dan, I will let you put much more words to that, but it is that, as we’ve talked about, that an activation of the limbic system, which moves you out of your reasoning center of the brain into survival mode. So as we talk about what are some of the impacts of that, it has to be tended to, and unfortunately, a lot of the ways we think we need to tend to people in these moments is more words, more language, kind of rationalizing things to help them see it’s going to be okay. And that’s typically not what they need in this kind of immediate aftermath.
Dan: No. Well, Becky and I were in a situation not long ago where I was highly activated and in my high activation, I was very verbal, very intense, and I was making no sense whatsoever. And I remember it wasn’t a horrible situation, but I remember Becky looking at me and smiling, and I’m not happy that she’s smiling because I could tell that she wasn’t mocking me by any stretch of the word, but there was a certain degree of she’s inviting me in the smile to join a reflection of what I was actually like in that moment. And I’m like, why are you smiling? And she was like, just sometimes when you’re this irrational, when you are this incoherent, I just want to video it for you, but I know you would be very unhappy with me. And I’m like, damn, right I wouldn’t be happy with you. On the other hand, I’m kind of intrigued to see what I’m actually like. So that fragmentation is just so important to know that thank the living God, that our amygdala is pumping out all sorts of stress, biochemicals, adrenaline, cortisol, et cetera. And Becky at that point just said, she said, why don’t we thank God right now for your amygdala? That may be a little bit overactive, but let’s just ask that the Spirit might activate your hippocampus. And I’m like, ah, shoot. Yeah, yeah. I’m not, I mean, don’t think I often thank God for my amygdala or pray for the hippocampus. But the point being that in the middle of any trauma, you’re left frontal lobe that is, shall we say, the house of your executive functioning, your ability to reason, to deduct, to synthesize the thalamus, the portion that in one sense is just sort of a bridge between your limbic system and your cortical process doesn’t synthesize. So time goes off, your ability to synthesize goes off, your ability to think and reason goes off in the middle of trauma. And I’m so glad you brought up. Our bodies stop in the middle of trauma, being hungry, wanting any kind of sexual engagement, and our breathing activates our fight flight response. So all that, and then add that what we know about the pathway from the brain to the stomach, that huge highway essentially gets us numb. So we’ve got a whole series of biological processes happening when we’re in trauma. And it’s absolutely imperative that we know we’re not going to make good decisions, at least in the immediacy in the first five minutes, 20 minutes of any kind of tragedy. And in that period of time, we’re probably more prone to wanting to make decisions that will change the outcome or resolve the problem. And yet because it will feel impulsive, and to some degree as she was naming a kind of irrationality, a kind of fragmentation, even in my syntax, you can just feel that sense of danger we’re in externally and now what’s happening inside feels like we’re in danger internally. And the heightened degree of self-protection.
Rachael: Yeah, that’s so important to name, right, because that’s going to look different for everyone. Some people are going to freeze and move towards being catatonic. Some people like myself are going to try to fight everyone because that feels safer to have some volition. Maybe someone is trying to micromanage everything, but it’s like, I feel this sometimes I think being a mom is traumatic, so that’s again, more chronic. But that sense of overwhelm where, I mean this is happening to me a lot in this season. So I think it’s just a good example on a small scale, feeling a little bit of a trauma response, a cortisol flooding, feeling overwhelmed, but my need to move towards control so that I’m trying to micromanage how to get out of feeling this way, but I’m so fragmented that the micro I can, I’m like that and get the thing out of the thing and the thing and whatever that’s called, it’s like I can’t even think of the name of the cabinet that I’m trying to point at to get the thing. And then everyone’s walking on eggshells and feeling really stressed because they want to help me and they can see I’m distressed, but I’m not willing to just, I need help actually to sit down to breathe for a second, so, I you know. Whether it’s screaming or blaming or moving towards, some people become incredibly productive, task oriented in this as a way of cleaning, maybe moving in the sudden loss of someone. Okay, I’m going to move right towards finding the documents that it’s like, again, this can look very different, but if know matter how it looks, someone is in profound fragmentation, we can talk more about what do you do to help? But that sense of ways, the structures of self-protection being amplified is just really important.
Dan: So one of the things that I would, so hope you all would hear is that when you are with someone in trauma, you’re going to feel traumatized. And in that sense, even if it’s not the best of terms here, it’s still adequate. And that is you’re going to experience in an accident or in a death or in more complex trauma, you’re going to feel what the other person feels. The event itself, the death of a good friend. Remember the moment that, not to speak the names, but that our dear friend Len’s wife called, and as I’m hearing the data, I literally fell to the floor. I mean, my body could not sustain itself in the midst of that, but as I’m hearing, and I’m not literally flopping to the floor with dramatic sound, but I have to engage. I want to engage. I’m now in my own trauma hearing the trauma of my dear friend. And so there has to be an ownership of how have we cared for, honored, and engaged our own traumas. You will not do well on behalf of others if you have spent a good portion of your life trying to muscle your way through your own traumas. So it’s just one of those places where can we invite you to know something of your own history of how trauma has been addressed in your own life, both ineffectively but also warmly and well, what has worked, what has honored, what has given you breath or space to begin that process of dealing with what’s going on in the numbing and the fragmentation and some degree, the isolation that all trauma brings. So when we begin to give you some very direct things to do, it’s going to be much more your heart in your engagement than the particularity of the structure. But this is one of those places where actually what you do can be described in some fairly honorable steps. Like step one, invite the person to literally sit down or if they’re moving or if they’re on the ground or again, whatever they may, there is something about just getting physically in a position where you are comfortable, you are sitting down. And that begins a process. And let me underscore, by inviting a person to sit down, asking a person if you’re on the phone or unable to actually see, just to ask that question, are you sitting down? No, I’m not. Can I ask you to do so for our conversation? Can you sit down? Now, there are two things happening. Number one, you’re actually inviting them to the beginning of good care, but you’re also letting the other person know you are comfortable, even if you’re not, even if you are highly traumatized, you are presenting a level of calm, not control, but kind of, I have some authority here because of our friendship, because of our care for one another, I’m going to invite you to do things. And that again, I hope I’m not being misheard, it isn’t control over them, but it’s providing them a cast for a broken arm. You’re providing them some structure to begin the process of moving. Have you found that helpful?
Rachael: Thinking it through. Yeah, I mean I definitely think, again, what it feels like we’re talking about is just containment, right? I mean, it’s what the language you’re putting cast as a container is just a sense of I have enough, I have enough to give you right now for you to be whatever you need to be. I have enough grounding, I have enough sanity, I have enough clarity. Even if you don’t, you’re, I’m kind of right here with you. And it can be really mutual. You can be offering something to someone else that you’re offering to yourself at the same time. So it’s, again, it’s a capacity to just, you’re not ask, because I think what I want to clarify is inviting someone to sit down in the midst of immediate trauma is not asking them to not feel deep grief, not asking them to not feel out of their mind. It’s literally making sure they can start to catch their breath a little bit so that there’s not more harm that comes. So it’s just slowing things down enough to maybe help someone restore their breathing so that you can make even a small simple plan for what the next minutes, hour, half-day are going to hold if there are things, if it’s an accident or an injury, you know, have to get medical care, you know, have to get somewhere if it’s, there’s usually things that need to be done and they need someone who can step in and not take over for them so that then they’re powerless. And that’s kind of can be a different harm unless they’re really at that place, but so that they can begin to participate in the next steps with really good care.
Dan: So once I have somebody literally sitting down, I will then ask them, are your feet on the floor. We cross our legs, we tuck a leg under, I want both feet on the floor. And often what I’ll say to the person is, I’m going to ask you to do a few things because I know you’re in some degree of fragmentation, which you in one sense should be given the nature of the trauma that you’re encountering. So can I just ask that your feet would be on the floor? And then can I ask, can you feel your feet? And then even the particularity of can you feel your toes? Can you feel your heel? If you press a little bit harder, can you feel your instep? So what I’m inviting a person to is presence. Are you here instead of being flooded, simply being aware of one’s body. And I think one’s feet versus face, hands, shoulders, neck, stomach, legs. Your feet literally are what ground you to some degree to reality. And so once I have sitting, feet on the floor, and feeling. What I’m going to say is, I’m suspecting, if I can see them, obviously I have the data, but if I don’t, I’m going to say, my guess is that your breathing is rather rapid and shallow. Can we breathe just for a few minutes together before we have any other conversation? So sitting feet on the floor, can we breathe? And generally, if I’m physically with a person, I will say, I want you to watch my breath, watch me take air in through my nose. And then for a count of two to three, depending on age of the person and the level of stress, count of one, two, three and then to hold it for account of two or three, and then to let the air out through your mouth on account of one, two, and three. And that process, I’m telling you, it’s part of God’s brilliant design of the body. No matter what level of grief you’re in, no matter what level of fear you’re in, over a process of a minute or two, a breathing in that way, your body will begin to calm. Now, it may take longer for certain people and certain situations, but I’m telling you that the way God has written us, you will come back to yourself. And what you’ll begin to find is that the left hemisphere, the particularly broca’s area that manages language and the ability to comprehend language begins to come back online. So all the triage at this point is about returning a person’s being to themselves by being able to lower some of the stress biochemicals. And it’s crucial that you have something of that framework, having a person sit, having a person’s feet on the floor and being felt and then choosing to be a model for them to actually breathe with you. And most of the time, I don’t find most people going, that’s crazy. I we’ve got to deal with this problem. Even if somebody were to say that, it’d be like, we’re not going to take long here, but I need for you to come back online and trauma takes us offline and we need to be able to think this through well and clearly as humanly possible. What has your experience been in that process, Rachael?
Rachael: It’s like, it’s hard to… I’m thinking of times when people have been with me, but also thinking of times when I’ve had the profound honor and privilege of being with others. And I think what feels true is that another way God wired us is that we can come back online and we can face really hard, scary things if we’re not alone. And there’s something of this, that enlisting of community to come around someone so that no matter what they face, they might have a tangible experience that the care meant for them not will be bigger than the trauma. I don’t think life works like that, but will be, can be just the same amount of volume. And so these have been moments where that feel really holy. They’re really scary because when someone is in trauma, there’s legitimate reasons they’re in trauma. And like you said, sometimes you’re also experiencing it with them in your own way or vicariously. But that sense of seeing someone be able to catch their breath, come back into their body also means they’re able to receive care that’s available to them. They’re able to receive help. And again, sometimes that’s not possible for people. It’s not like someone’s going to breathe and come back into their body and be like, okay, thank you. Now I feel so right. It’s not what we’re talking about. We’re literally talking about keeping someone from falling off the edge. That place of someone is about to go over the edge. We cannot sidestep the impact of trauma or the process of grief or the process of terror and horror. In some ways these are things that have to be walked through. But if you can help someone find enough regulation that they don’t fall off the edge, the capacity to navigate that immediate aftermath just becomes a little kinder.
Dan: So well said. Yes. We’re not talking about resolve by any stretch. We’re just talking about that first hour, that first five minutes. So being able to regulate even just a little gives you not just as you put it earlier, containment, but we’re talking about how deeply we need someone to be attuned, knowing, look fragmentation’s inevitable, that’s attunement, being able to name it on their behalf is attunement. And then beginning to offer a way to create a different kind of regulation. And again, it almost sounds too easy, but on the other hand, there’s a lot of folks who would go, I just don’t know what to do. I mean, I wouldn’t know what to do in that moment. And so I would just say, oh, I’m so sorry. I’m so sorry. I’ll pray for you. Which again, grief on behalf of another is not meaningless. And hearing that you’ll pray, I’m all for it. I just need a little bit more at that moment than your own grief.
Rachael: Yeah. Well, and I think something that comes to mind for me, like an experience I had on a plane, actually, I have weird, crazy experiences on planes that’s reading all these news that people have a meltdown. So I’m like, please, I do not want to be on a plane or someone is having a psychotic break and trying to open the door, just I’m not ready. But I had an experience with a woman who was physically accosted by a man sitting behind her. And thankfully the plane handled it very well. It was a stranger, he was kicking her seat. There were racialized dynamics at play, and there was a flight, what are they federal air marshals on? And there was a pilot who was flying home who was a bigger bodied man that basically they sent the pilot to sit back by the man who, because they needed to get the plane safely to the ground, they had the air marshal sit next to me. And the pilot that they moved to the back was sitting next to me in the window. I was in the middle seat. So they moved this young woman up next to me. And thankfully at that time, I had enough trauma training to know she is so traumatized right now and she is trapped on this airplane and has to get to safety. So all I did was say, I can’t imagine how scared you are right now and how you’re trying to make sense of what just happened. I also know it’s going to be really hard to make it to that gate and get off this plane. So if I can be of support to you, I’d love to help you right now. Would you like some help? I work in trauma. I think what we could do is just work on breathing and you getting to have enough safety in your body for us to make it down. Now, she was going to need some of her capacity to dissociate. So there was not a pressure to get her talking to me, get her recalling the incident, get her happy. It just was to offer some mercy to her body. And that’s all we did is put your feet on the ground. We did some tapping, got her breathing, and then it was just like, it might be really kind to put on a movie. And even if you can’t pay attention to it, you’re safe. We’re here. We’re going to get you down. But I think again, in that moment, if I hadn’t had any sense of what to do, I would’ve just felt so bad for her. And I probably would’ve tried to talk with her a lot thinking that will help in this moment. Let me just talk to you. Even though her brain is not in a space where talking to a stranger about anything feels good. And so sometimes these tools come into help in places where we encounter strangers who just need someone who can be with them for a minute to help find regulation until more help comes.
Dan: And I want to go back to the reality that if you cannot bring this process to yourself, you will have no degree of confidence to be able to bring it to someone else. So there’ve been a number of events just in the last 10 days that have had an element of trauma, small T trauma, and I’ve had to go through my own form of triage, of stop being activated, come sit down and having to almost again, speak to myself the way the Psalmist does. Why are you in despair, my soul? And being able to say, all right, put your feet on the ground, et cetera. And then regulating my breathing for a few moments and beginning to feel enough calm to now be able to say, yeah, this really does work. Now that I’m a little calmer, I still have a whole lot to deal with. And so that regulation opens the door to some degree of dysregulation and then returning. So what we’re inviting you to is don’t offer it to someone unless you’ve seen it work on your own behalf. But if you do see that it works, then why wouldn’t you offer it to a son, a daughter, a friend, or a stranger on a plane? As you did? And I’ve been in settings as well where a person’s clearly in trauma and fairly close to what could be called a psychotic episode where because I know this works, I’ve had the privilege of being able to, in one sense, do what triage is, which is not to resolve, but to help a person solidify to then come to a point where far bigger treatment can be engaged in order for health and flourishing to occur. But I think one of the things you did on her behalf was to outline a little bit of a plan. Once you begin to get a little degree of regulation, being able to, in one sense, help her get a plan. Just watching a movie, even if you can’t, literally that was a gracious gift. And being able to say, we’ll help you get off this plane to your gate, et cetera. But provides kind of that next step of, is there in the next five minutes a plan? One of the things I said to my dear friend who had just lost her husband, I said, you’re going to need to look at your clock and every hour, at least for the next six to 12 hours, you’re going to have to stop and then make something of an intent. Not for the day, not for what’s happening tomorrow, but for one hour. What is it you need to do? And I said, it shouldn’t be a full hour. You should have something clear in your mind, I need to make breakfast. I’m not hungry. That’s fine. Make a very small breakfast, but do something every hour for at least the first half day when some significant loss has occurred. Now you’re not trying to resolve you. You’re trying to give again, containment, attunement. And even though it will not sound like repair of rupture, you, you’re giving something of a plan to help the person begin to move. But I want to say it again loud. Don’t give a plan until you’ve tended to the body tended to the process of some of restoration of that fragmentation. Now the question becomes, how are you going to think about this process? And part of it is being able to think about what you would’ve liked to have offered to a friend or to a family member. And again, it does sound a little critical, but what did you do? I mean, it’s not like anyone can escape trauma or tragedy. So you’ve been in those places and to ask the question, how did you handle that? First five minutes, first 30 minutes, first hour, and what would you change? And for those of you who have done this work somewhat naturally, good on you, for those of us who didn’t, may there be no movement to sort of soliciting blame and judgment, but being able to go, wow, I was expecting this person to think a whole lot more clearly than they had the capacity. Or I was trying to get them to put words too quickly, therefore accessing language, which means that their left frontal lobe is working well, no. So as you begin to in one sense sort through, it’s a little bit, you can help me here because I’m not sure I have it correctly. If you’re on fire, you’re supposed to stop…
Rachael: Stop, drop and roll.
Dan: Stop, drop and roll. Alright. I mean, what a horrible thought. If you’re on fire, at least have those three words. This is sort of like what we’re wanting for you to be able to say, you got get people to stop. You got to get people coming back into their body and offering some level of containment and kindness, and then through physical awareness, through breathing, to open the door to that five minute, 30 minute, hour long plan for what’s ahead. That’s our version of the stop, drop and roll. Any last thoughts, Rachael?
Rachael: I think we are, we’ve offered a very linear step-by-step plan, which is effective. And again, the goal is to get someone back in their body. And so trust the Spirit to help give you what you need. And may there just be mercy for all of us in a season that I think holds a lot of trauma just in general right now with all that’s going on in the world. May there be mercy and grace to our bodies, to our hearts, to our minds, and to our capacity to have imagination for how to care in moments when I think it’s really stressful for everyone involved. So grateful to be doing this work with you, Dan.
Dan: Oh, amen. And thank you, Rachael.