It is important to understand what the psyche undergoes during a survival situation, for the purpose of understanding a lost person’s behavior and preventing rescuers from succumbing to the same situation. The most important factor determining success or failure in a survival situation is the individual’s psychological state and ability to cope, rather than technical expertise, or equipment.¹ Oftentimes, survival elicits a stress response, be it from injury, thirst, hunger, environmental extremes (cold, heat, or altitude, for example), fatigue, or fear. Understanding the stress response can assist a rescuer in locating and rendering first aid to a lost person.

Many are familiar with the “fight or flight” response, which also includes an additional “freeze” response,² as a stressed individual simply gives up, and is unable to complete any task whatsoever. Macias and Williams discuss the physiologic responses induced from a stress response.³ An initial increase in pulse and respiratory rate occurs from a surge of endogenous epinephrine, accompanied by an increase in glucocorticoid hormones. This sympathetic response shunts blood from the gut to large muscle groups, allowing for increased work. Peripheral vasodilatation causes skin flushing and perspiration, allowing the body to stave off any deleterious heat accumulation. The limbic system of the brain, located in the center of the cerebrum and above the brainstem, contains several important structures crucial to survival. A specific region responsible for the fear, or pleasure response, is the amygdala, which modulates the emotional response to stress.^3,4 It is occasionally referred to as the “reptilian brain,” because of its immediate, but not well thought out, response to a stress situation, be it escaping, fighting, or freezing into a state of panic. These survival responses could also be counterproductive: the reaction bypasses the neocortex of the cerebrum (responsible for making well-thought-out decisions), literally “hijacking” the rational brain.⁵

The amygdala triggers the hypothalamic-pituitary-adrenal axis, resulting in the catecholamine surge already described. Unfortunately, the amygdala can also trigger cognitive disruption and inattention, as well as promoting a decompensated emotional state,^3,6 unless the highly cognitive, decision-making, and vigilant neocortex is trained to overcome the panic from the amygdala. Furthermore, elevated glucocorticoid levels augment excitatory synaptic amino acids and cause short-term memory loss. Ultimately, such elevated levels can atrophy the brain’s memory center, the hippocampus.^3,4 The reader may be familiar with this lack of recall and difficulty with decision-making when overwhelmed by a medical or trauma code. For example, routinely learned tasks, such as airway management, become difficult in stressful situations, whereupon a provider might forget how to perform a task, or where to find equipment. In many ways, a survival situation is similar to running a life-or-death code, with the exception that the survivor is in an unknown environment and may be inexperienced.

Quality survival training is therefore important; adding progressively graded and realistic stress situations will add helpful “stress inoculation.”⁷ Repetitive practice eventually produces an appropriate and faster automatic response, termed limbic learning,⁸ where “muscle memory” and intuition can be developed.
Although preconditioned emotional control may not be present in a lost person, wilderness medical providers trained with this type of learning benefit greatly with regard to decision-making and teamwork, making a rescue more efficient.^3,9 Additionally, being in good physical condition clearly confers an advantage on a lost person, as well as a rescuer.¹⁰ However, some elite performers might struggle to find emotional control: highly trained individuals and those from special operational backgrounds have succumbed to simple survival challenges from overconfidence, or the belief that rescue is somehow dishonorable.¹¹

One part of survival is ensuring, if lost, that behaviors point toward safety and being found. This section analyzes typical behaviors and behaviors that are more functional for those goals. A more complete discussion of search and rescue (SAR) methodology and philosophy for the rescuer can be found in Chapter 30.

In a search, the level of training and perceived mental resiliency of the lost person is helpful. However, these characteristics may not be evident. Gonzales, in examining why people live or die in survival situations, wonders how a 17-year-old girl in a skirt could survive solo from a plane crash and walk out of a Peruvian jungle¹¹; and one author of this chapter has inquired about the characteristics allowing one member of the 1999 American Shishapangma Himalayan expedition team to survive a massive avalanche, where two equally trained mountaineers died.¹² In the latter case, chance may have played a part; in the former, a certain humility and determination were key roles. Others survive when they stick to a good plan (such as not drinking sea water), or stay around a large object that can be easily seen (such as a vehicle). Others do well when they have a higher purpose, have loved ones to return to, or hold on to certain spiritual practices1; even anger can save a person.¹⁰ In short, a compelling will to live, added with the right conditions, will result in a rescue, rather than a recovery.

Syrotuck and Perkins’ analysis of lost person behavior is well known,^13,14 categorizing the lost according to age, and activity. Children 6 years old or less might understand being lost, and usually do not understand the need for a return route. They are likely to find a spot to hide under to keep warm, or hidden from perceived dangers; in the latter case, they might not respond to whistles or calls. Survivability is good, because of the tendency to find shelter. Children from 7 to 12 years of age frequently become lost during play, or while attempting a short cut to some destination. At this age, they are beginning to construct mental maps of their surroundings, which may be inaccurate. This group, as well as older children, might attempt to travel a trail, or up a hill to orient themselves when lost; the older ages, including adults, tend to panic and act irrationally, but may respond better to being lost if with a friend or sibling. We postulate that children know how to play, and are less accustomed to comforts that adults desire, since many children play in the mud, and tend to play imaginary games in the outdoors readily. Special situations with regard to hikers, climbers, hunters, and skiers are covered elsewhere in this book.

Mental models or roadmaps, discussed in the context of survival, are based on the interplay of previous experiences, analysis, and emotions; in a crisis, survivors rapidly interpret their new reality.¹⁵ In other words, they are flexible, do not adhere to rules, and can adapt. A survivor is a learner and a keen observer, open to do anything, able to calm their emotions doing simple tasks, conserve energy, and tolerate uncertainty and discomfort. Being optimistic, even laughing or playing can also optimize survival.15,16 Perseverating on a fixed mental map, or in the case of rescuers, falling into a trap of “rescue fever,” could worsen a situation. If lost, decisions must be pared down, and panic controlled. A helpful acronym is STOP.¹⁶

S means to stop what you are doing. Blind action can be dangerous. Take the moment to utilize tactical breathing. Accept that what happened cannot be undone. Conserve energy from here on out. Stop blaming yourself, or others for the predicament.

T is for thinking. Think about what happened, and think through a future action’s consequence, even if to take a step. Take efforts to utilize rationality. Turn on the ability to focus. Rid yourself of extraneous information, or delegate; this cognitive off-loading improves working memory.⁸

O is for observe and organize. Situational awareness of your new environment, of the possibilities, and the dangers, is a must. Take stock in organizing what you have for equipment and options. Survivors quickly organize, set up routines, and institute discipline.¹¹

Lastly, P is for planning, and carrying out that plan. Prioritize the immediate needs and resources as outlined below, and develop a plan to systematically put the plan into action. Follow the plan, but be willing to reassess and adjust, based on new circumstances.

Our experience has shown that many who are lost instinctively try to find food. Yet, depending on the environment, physiologic timetables prioritizing more urgent needs is crucial. Within the first 3 seconds, one can step off a cliff if in a panic. The remedy would be to calm the mind and STOP, as outlined above. Regardless of whether one is specifically near cliffs or not, the underlying principle is clear: Massively inappropriate conditions can be made anywhere, and most wilderness environments have some modality where such decisions could be immediately lethal. Within 3 minutes, most die without oxygen, which is important in water rescue (Chapters 16, 17, 26, and 27) and cave rescue (Chapter 29)—the priority is air. Most humans die of hypothermia within 3 hours; thus, for a terrestrial survival crisis, heat (fire) and shelter/clothing become the immediate priorities, much before food! Incidentally, fire is a great morale booster as well.²⁰ (See Chapter 13 for a more complete discussion of cold injury treatment and prevention.) Within 3 days for most, dehydration kills. Thus, water is a priority. Minimizing sweating, heavy breathing, and other water losses are important until water can be found. One can survive without food for about 3 weeks; thus, conserving energy, and recognizing that hunger is unpleasant, but not life threatening, is crucial. Simple traps, snares, or eating edible plants and insects may provide some sustenance. Lastly, 3 months without social contact can result in depression, or be the limit of illness or injury incurred in the event. Chapter 23 discusses behavioral medicine in the context of wilderness operations in more detail. Having a form of signaling, with a radio, cell phone, whistle, signal mirror, flares, or even a fire, can help a lost person to be found. Hopefully, the successful survivor, and rescuer, can address all these issues in short order. As discussed in the Introduction, rescuers themselves are in a threatening environment as well, and must be prepared to convert their mentality into one of a survivor if their own operation becomes compromised and they themselves require assistance. More importantly, their mentality should always be geared towards preventing the need to move into a survival priorities mode.

The rule of threes could also be extended to having three backups, or modes of initiation, for the above contingencies. Gathering at least three times the amount of survival material in the wild, and planning on expending at least three times the amount of time and energy needed for an endeavor is insurance against chaos, and can add a mental edge to stave off frustration and panic. Review and reassess frequently, and remember that pain and discomfort are temporary. We recommend survival practice, adding incremental stress as you practice, until you have mastered necessary survival and rescue skills.