Resiliency before "Survival"

From the time the alarm sounds, stresses begin to deteriorate our abilities to function as we do normally. The alarm itself kicks off an acute physiological response which immediately reduces cognitive and physical abilities. We pile on gear which restricts our movement, retains heat, and weighs down our body. The trip to the alarm in the rig is exciting; sirens, the smoke column, and radio traffic continue to ramp up emotion. Now we arrive to find the ball is set in motion; firefighters are engaged, glass is breaking, puffing smoke intensifies and lights off from a window on the side of the house.

The gloves go on (sense of touch lost), the mask goes on (sense of taste and smell gone), and the hood and helmet finish off the PPE (reduced hearing) as we grab our tool with our dominant hand (loss of sensitivity) and head to the front door.

At the door the scene is surreal. Though wide-open, it separates two worlds. You look back over your shoulder in the bright light of the afternoon sun, squinting to see your partner ascending the porch steps to join you. You turn back around to that portal to the other world and see the line disappear into the darkness and smoke of the first floor that you can only hope exists beyond your sight.

You know that hoseline is heading to the basement because somewhere in all that has occurred in the last 6 minutes you heard the radio traffic. You know that your job is to get upstairs and search because the three words you heard in your captain’s voice as you walked away from the cab to grab a hook were, “second floor search.” You know that three feet ahead of where you are right now you will lose your sense of sight and be reduced to the capacity of your training and experience.

If you look at how firefighter survival is currently being defined in the American fire service you can see that much of it focuses primarily in the technical realm of firefighter rescue. A cottage industry and the innate desire to “do something” have focused firefighter survival on skills or equipment, bailouts, buddy breathing, and mayday procedures. Firefighter survival is scenarios—the Denver, Pittsburgh, or Nance Drills. There is a perpetual overlap and therefore the confusion of incorporating rapid intervention techniques to firefighter survival. I would be willing to bet you may even want to explain that firefighter survival is all these things combined.

If you look beyond our fire service walls and begin to research survival the focus becomes resiliency, adaptation to change, and response to adverse conditions. In fact, the word survivor is almost completely absent of context in that a civilian approach to survival could swing from surviving in the wilderness, surviving a cancer diagnosis, or surviving tough financial times.

Two weeks ago a unique fire conference was held in Philadelphia. The reason why this conference was so unique to our profession was the focus—firefighter mindsets, not firefighter skillsets. Leadership Under Fire brought together some of the foremost experts in the fire service, law enforcement, and the military to bring a message of developing firefighter resiliency to a bigger audience.

“…the orphan child of survival training is mental preparedness.” Charles Remsberg

Resiliency is defined in many ways: ability to bounce back, overcome, adapt. These are all just various explanations of performing in spite of a challenge. So if we seek to become more resilient firefighters and improve our chances at survival, we need to clearly identify all the challenges we face beyond fire and collapse.

One of the first steps toward developing resiliency is to make it clear that the fireground is in its entirety a survival situation, not just in the microcosm of a mayday. If we are not being clear with all the threats of the modern fireground we will only feed the complacency monster and weaken the strength of the knights of vigilance. The lives of those we serve and stand beside stand a better chance if the fire service embraces this concept which continues to improve our nation’s officers and soldiers.

In Warrior Mindset: Mental Toughness Skills for a Nation’s Peacekeepers, Dr. Michael Asken presents the characteristics of a high-stress situation:

• Sudden and unexpected demands that disrupt normal procedures.
• Consequences of poor performance are immediate and severe.
• Task environment is complex and unpredictable.
• Personnel must perform multiple tasks under adverse conditions.

I believe this defines the narrative description above from the station to the fireground, and we aren’t even in the front door yet. All of this is to lay the foundation that we must back ourselves out of tactics for a minute and look at how we can best prepare to manage all that is working against us, and in doing so find ways to build resilience. In order to build resilience we must constantly reevaluate our preparation for the environment and the situations within it to determine the most correct course of action.

In the December 2010 issue of Fire Engineering Mark vonAppen wrote an article titled Trapped by Flashover about Sacramento City Fire Captain Jeff Helvin. Captain Helvin was critically burned when he became trapped on the floor above the fire in a single family dwelling fire on October 7th, 2008. Captain Helvin was a 22 year veteran at the time of the fire and still the powerful effects of stress quickly took over.

“Helvin knew what he was supposed to do: call a mayday, turn on his personal alert safety system (PASS) device and flashlight, seek safe egress, or seek safe refuge and await rescue. He was intelligent and was well trained. He had received training on Mayday procedures. Why had the training not provided the correct response immediately?”

“We should understand that we will respond emotionally, powerfully so when our lives are threatened. Emotions will drive us toward action, sometimes seemingly irrational action.”

In the April 2012 issue of Scientific American, three neuroscientists use an article entitled “This is your brain on meltdown” to explain how the effects of stress on humans reaches much further than previously thought:

For decades scientist thought they understood what happens to the brain during testing or a battlefront fight. In recent years a different line of research has put the physiology of stress in an entirely new perspective.

Now research reveals an unexpected role for the prefrontal cortex, the area immediately behind the forehead that serves as the control center that mediates our highest cognitive abilities – among them concentration, planning, decision making, insight, judgment and the ability to retrieve memories. The prefrontal cortex is the part of the brain that evolved most recently, and it can be exquisitely sensitive to even temporary everyday anxieties and worries. 

Arnsten, along with the late Patricia Goldman-Rakic of Yale University, were among the first to illustrate how neurochemical changes during stress can rapidly switch off the prefrontal function. The work showed that the neurons in the prefrontal cortex disconnect and stop firing after being exposed to a flood of neurotransmitters or stress hormones.

We have all been taught about how the body responds to threats as either fight or flight, but as many have noted there is a third F being left out of the discussion that is the most detrimental. The third F stands for FREEZE. These scientists are now showing proof that stress hormones can cause neurons in our cognitive brain to “disconnect” and “stop firing.” The key point here is that there is a major obstacle in our blood and between our ears that must be overcome before we will have any opportunity to put our body to work in the structure. But stress alone is too broad of a term. We need to reduce or control what stresses specifically do to our firefighters.

Psychological Stress

“The environment we must operate, and survive, is a high-energy environment that is unyielding to our plight. When you add to the equation emotion, which has priority over rational thought, it is almost impossible to sort through it all.” Mark vonAppen

The root of psychological stress is anxiety. Some of the things which cause anxiety are surprise, the unknown, and lack of confidence or understanding; I think any of us could make a list of those things which cause anxiety in us personally. In that list you will find the route to building your psychological resilience, but it takes a hard look and some serious commitment. One of the clearest approaches to this process can be found in Al Siebert’s book, The Survivor Personality. He describes the Roots of Resiliency as your inner “selfs”: self-esteem, self-confidence, and self-concept.

The first one I listed, however, can be changed quickly to begin to turn the tide on the complacent. If we “expect fire, expect victims, and expect problems” (Carey or Hofland or Materi or Le Blanc?), we will begin to harness what so many times is the first domino in the line of emotionally-driven decisions—surprise.  One quote I can properly credit is from Andy Fredericks, “The garbage man isn’t surprised when he turns the corner and sees the trash.”

Physical Stress

In chapter 2 of the Warrior Mindset, Dr. Asken does an exceptional job of explaining that while the mind controls our actions, our physical abilities are directly tied to it: “Because the brain (and the mind) exists in the environment of the body, the quality of that environment is an essential factor in the quality of psychological function.” The most basic example is if there is doubt in our physical ability to perform, we have immediately increased our anxiety about our performance and therefor increased our psychological stress. Dr. Asken completes the thought with this: “True fitness for duty is a combination of physical and mental excellence.”

The mistake we commonly make is assuming that physical stresses can be reduced simply by getting in shape. Even the fittest among us are challenged when 70 to 120 additional pounds, depending on the alarm assignment, are added to our body prior to starting a work period. Deeper than the gear is the physical stress on your body from the loss or reduction of our senses. All five of our body’s senses will be compromised, if not completely taken out of play, on the fireground; this can be debilitating to some if they have never been conditioned to it.

We may think we are invincible and that our can-do attitude will carry us through in the time of need, but a shark lingers in our pools of energy and we may not be aware of its power or presence. In Deep Survival, author Laurence Gonzales describes his research into the effects of fatigue. “Fatigue almost always comes as a surprise. It is as much a psychological condition as a physical one, and scientists have struggled without success to understand it.” He further posits, “There is nothing in the muscles or nerves or even the biochemistry of the body that would seem to predict or explain fatigue. Once fatigue sets in, though, it is almost impossible to recover from it under survival conditions. It’s not just a matter of being tired. It’s more like a spiritual collapse.” There is enough stacked against us in the battle we wage. The last thing we need is for a “spiritual collapse” to shut us down when we are needed most.

Environmental Stress

As a fully encapsulated firefighter, all the heat generated from our activity is retained in our gear, which can compound the effects of those activities. Add breathing dry compressed air and working inside a structure preheated by a working fire and our playing field is a desert in the summer.

Consider this excerpt from The Human Heart is Like a Fire Pump written by Dan Senn.He explains how our turnout gear compounds the effects of heat stress by eliminating our body’s natural coping mechanisms.

“There are additional concerns to consider about our cardiovascular health when training or working in full turnout gear. The added weight and resistance to movement our turnout gear provides consume a portion of our total work capacity. In other words for any given task, that task will require a higher heart rate with higher metabolic demand when performed in turnout gear compared with performing without turnout gear. Therefore, additional workload is placed on the heart when performing on-scene tasks. Additionally, our turnout gear restricts body heat dissipation. As our core temperature increases, two cooling response mechanisms increase in activity; sweat response in an attempt to enhance evaporation and triage of blood flow to the skin in an attempt to exchange heat through convection. As mentioned earlier, dehydration reduces preload. The triage blood flow creates competition between working muscle and the skin, subsequently reducing the residual pressure and volume of returning blood flow and causing the heart rate to increase further to maintain blood pressure and perfusion”

In an EFO paper written by Michael Boyle of Orange County Fire Authority, he cites two firefighter line-of-duty deaths where the firefighters were transported in cardiac arrest where their core temperatures at the hospital were recorded at over 107 degrees. Extensive research has been done on firefighter rehabilitation and even fluid replacement. Once again we are latching on to the technical aspects of the problem. According to most medical texts, heat stroke, or the point at which the central nervous system is being compromised, is when the body’s temperature reaches 104 degrees; and severe heat exhaustion (cramps, nausea, and weakness) can be precipitated at 102 degrees.

These temperatures can be ramped up in less than 20 minutes from the time you are awoken from a sleep with a resting heart rate of 60 beats per minute and a core temperature of a perfect 98.6 degrees. This is just one example of how vulnerable we are to extreme temperatures in our routine duties. We become even more vulnerable when our routine duties are conducted in extreme temperatures. Acclimation and conditioning are critical components to developing environmental resiliency.

Resiliency

The American Fire Service by and large has a can-do, will-not-be-defeated attitude. Some of our most revered figures are those who have pushed themselves to their physical limits to save others. I know that this deep respect for the physically tough among us will never go away as it is so engrained in our western culture and the service’s tradition. What we now must create is a respect for mental toughness as the playing field of our service continues to move towards increased threats, reduced staff, and dwindling experience. The paradigm shift calls for more pregame work, deeper introspection, and a new level of commitment to developing resilience. Know yourself and know your challenges, physically, mentally, and operationally. Finally, know that the odds of others’ chances of survival under fire, increase with your ability to thrive under stress.

Please consult some of the resources below for further discussion on developing resiliency.

Arnsten, A. M. (2012, April). This is your brain on meltdown. Scientific American, pp. 50-53.

Asken, M., Grossman, D., & Christensen, L. (2010). Warrior Mindset. Milstadt, Illinois: Warrior Science Publications.

Gonzales, L. (2003). Deep Survival. New York: Norton.

Senn, D. (2010, December Vol. 163 No. 12). The human heart is like a fire pump. Fire Engineering, pp. 73-77.

Siebert, A. (2010). The Survivor Personality. New york: Peguin Group.

vonAppen, M. (2012, December Vol. 163 No. 12). Trapped by flashover. Fire Engineering, pp. 41-49.

www.leadershipunderfire.com