Use Tactical Breathing and the Supernurse pose in an emergency.  

A medical emergency. An escalating violent patient. Breaking bad news. Managing your own internal stress meltdown.

When an unexpected critical event strikes you may not have the time to go off and mentally prepare or calm yourself down.

What you don’t want to do is react.
What you do want to do is RESPOND.

The sudden stresses placed upon you by such events can trigger a sympathetic squirt that leads to tachycardia, problems with fine motor skills, and concentration.
All things that are going to negatively effect your performance and interfere with your response.
But here is a routine to help you get your heart rate down, your focus up and your confidence on.
Think of it as your emergency response plan in 4 breaths.
It is also known as Autogenic or Tactical breathing.

  1. Breath in through your nose filling up your belly for 4 seconds. Don’t breathe up in your chest. Put it down into your belly.  
  2. Hold for 4 seconds
  3. Exhale through your mouth for 4 seconds
  4. Hold for 4 seconds

Repeat x 4

First 2 breaths:

  • Re-inhabit the whole of your body. That is, concentrate on the experience of your inside environment.
  • Force a strong body posture.

A strong body posture will have a big positive impact on your mental state.

Adopt the super-nurse stance.

  • stand tall
  • feet shoulder width apart.
  • chest out ( look to feel a warmth or light in the centre of your chest)
  • If you can…. put your hands on your hips with elbows out. Think Wonder Woman or Superman stance.

Sounds silly?
Well take a look as psychologist Amy Cuddy talks about how “power posing” or standing in a posture of confidence can affect testosterone and cortisol levels in the brain.

Second two breaths:

  • Turn up your situational awareness. Re-inhabit (feel) the outside environment.
  • Switch to your wide-angle lens.
  • Force a smile.

Then. Respond….

  1. What is happening now?
  2. What is the NEXT thing you need to do
  3. Focus on this but maintain situational awareness (look through that wide angle lens)
  4. Go back to 1.

Sometimes you don’t even have time to take 4 breaths before you need to get amongst it. At least you can try to do the breathing exercises as you respond.

If you are interested more in learning about tactical breathing and how it rates to emergent clinical experiences you can listen to this very interesting podcast that explores this topic in more detail:




Podcast 118 – EMCrit Book Club – On Combat by Dave Grossman. (n.d.). Available from

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