Live @ FRI: Adrenaline-Based Stress in Firefighting

We all know that fireground operations are adrenaline-charged events. But what many don’t know is the impact that adrenaline-based stress can have on our bodies, both physically and mentally. In his Wednesday FRI session, “The Effects of Adrenaline-Based Stress on Firefighter Performance,” Captain Brian Giles with the Lincoln (Neb.) Fire Department offers tips about how to prepare your body for stressful events, how to recognize the triggers that activate your body’s fight or flight response, and how to react when you find yourself in an adrenaline-fueled environment so as to remain safe and survive. I had the opportunity to speak with Giles prior to his class.

FireRescue (FR): Why did you want to discuss this issue at FRI?
Brian Giles (BG): I’ve been in the fire service for 12 years. Prior to that, I was a police officer for 11 years. When I transitioned to the fire service–not that firefighters are doing anything wrong–but I saw a whole different side of the coin. The fire service hasn’t really researched or understood this topic until about the last three or four years, just now starting to understand that adrenaline can have horribly negative effects on our performance, especially if it’s a life or death situation on the fireground.

The law enforcement side has been studying this probably back to the 70s; they have studied those who have survived officer-involved shootings. And they started getting an insight into the minds of these survivors and what they remembered going through and the effects they felt on their body, and that has really guided the way law enforcement has trained since probably the mid- to late-70s.

So that’s what drove me to start putting my stuff together and try to spread the word. When you look at a lot of the NIOSH LODD reports, you start seeing firefighters who were lost or disoriented in an IDLH environment; when they were discovered unresponsive or unfortunately deceased, a lot of them had taken their masks off from their SCBA. Many of them still had 1,000 lbs. of air or more, so they could have stayed on air, but for an unexplained reason, they took it off. Now it may be purely conjecture on my part–the only one who knows why that mask came off is the one who took it off and they’re not here to tell us why–but when you start to look at what adrenaline does to the body and the sensory organs, my opinion is that they had this overwhelming sense that they couldn’t see and that’s because of what adrenaline does to your vision, the perceptual narrowing, and they thought that if they took their mask off, they’d be able to see and get out.

FR: How is adrenaline-based stress different from regular stress?
BG: Regular stress is your everyday normal events in your life–tension, mental or emotional strain. Some of the signs are worry, poor judgment, depression and sleep problems. It can have an effect on your heart rate but not to the point where it’s going to have a negative effect on your performance.

Typically adrenaline-based stress is going to occur in some type of combat situation, so in the fire service, that’s typically when we’re fighting a fire. Unfortunately, there are times when it could actually be combat on the medical side, dealing with a patient who may be unstable mentally or under the influence of alcohol or drugs and trying to assault us. It’s a much higher level of stress, and it can have life or death consequences.

We need to ask ourselves, what is the stimulus that we’re being flooded with that’s causing this huge spike in adrenaline (the release of the hormone epinephrine)? It’s when you have this adrenaline-dump that you have this adrenaline-based stress reaction.

FR: When it comes to the physiological changes, how does adrenaline-based stress impact the body’s motor skills, vision, hearing and decision-making?
BG: When you have the adrenaline release, it’s going to drive your blood pressure up, your heart rate is going to skyrocket, your pupils will dilate, and your digestive system will slow down. The reason the digestive system slows is because, during normal times, we’re in the “rest and digest” state. When we have the adrenaline dump, all of the blood is going to pool toward the major body organs because of the hormonal response, and it’s going to drive us into the fight or flight mode, which is an ingrained response that goes back to the caveman days. Your vision is impacted, and your heart rate, which is probably normally around 60 to 80 bpm, could go to upwards of 200 bpm in a matter of seconds.

FR: Can you address how the physiological changes impact decision-making and your cognitive functions?
BG: Your body is trying to process all of the stimulation that it’s being flooded with so it’s going to focus on the sensory organ that provides the most information; the majority of the time, that’s going to be your eyes. Specifically, in most cases, your eyes/vision will be the sensory organ that “drives the bus”; however, this doesn’t mean it isn’t negatively affected by the adrenaline. Adrenaline causes distortions in the eyes, specifically the shape of the cone of the eye, which distorts near vision and estimating distances.

The higher your heart rate rises, other organs in your sensory system are going to shut off, so you’re not going to be able to hear (auditory exclusion). That’s why we find that some firefighters couldn’t hear the radio; they may not hear people shouting at them. They aren’t trying to ignore you. Their heart rate is racing so high that it has shut off their ears and it’s funneling all of the attention to their vision.

The other thing that happens is that it affects your memory. So as you’re processing this information through your five senses, you first access your short-term memory, and it’s going to receive the information from your senses that’s processing the threat and it’s going to store it there in your short-term memory. It’s going to analyze the threat and it’s going to formulate a plan based on prior experience–your training or actual similar experiences on the fireground.

You’ve heard people talk about putting slides in your slide tray or slide carousel so you have those experiences to draw from; this is basically the same thing. You want to create a situation so that when your long-term memory tries to access that information, it’s in your short-term memory and you can formulate a plan to get out of this bad place. But when these physiological changes are happening, you’re not able to get into your long-term memory. So what that means is your reaction time is going to increase. A decision that would normally take you one or two seconds to make now may take you several seconds or you may not be able to make a decision at all–and that’s called Survival Reaction Time (SRT). This is based solely off of your short-term and long-term memory access. There are four steps in the SRT and they have to be completed in order. We have no ability to influence that; it’s just the way our brains work. Each step depends on the amount of information that’s received from the previous step.

Medical research has shown that if your heart rate is about 145 bpm, then your processing of those four steps in SRT is going to deteriorate, and if your heart rate exceeds 175 bpm, then your physical performance is going to become absolutely horrible.

If I’m trying to formulate a plan or response to a bad situation, and I know that I need to call a mayday, what are the steps to activate my PASS device and get on the radio? If I haven’t trained and trained and trained on those things, then the overwhelming, sudden surge of panic and the increased heart rate will prevent me from remembering what I’m supposed to do in that situation and I may just turtle-up and lay there and not do anything.

So what does it mean to a firefighter or EMS worker? If we have an adrenaline dump, our ability to concentrate is going to be disrupted, we’re not going to be able to stay focused, our SRT can take up to four times as long, and we’ll have an inability to access our memory, which is from where we pull those training evolutions to develop the survival response plan. The more the person panics, they can become irrational and the more they can go into a state that’s called hyper-vigilance, which means they are going to repeat irrational behavior. The panic is going to drive them and they aren’t going to have control over anything they do.

FR: So when you’re in the moment and you realize you’re in trouble, is it even possible to access the memories of all that training?
BG: The goal that I’m trying to convey is that before you get to that skyrocket heart rate, as you start to recognize that you’re in trouble, that’s when you have to start to take the steps to prevent your heart rate from skyrocketing. We’re a type-A-driven industry. It’s an adrenaline-based business; that’s what everyone says they love about it. But because of that, no one wants to be the person who appears to be the weak link in the chain. So when firefighters are in a building and they have an idea that “I could be lost” or “where did my crew go?” rather than immediately calling a mayday, a lot of times we’ll find that they hesitate and continue to try to find their own way out. They don’t want to call the mayday and then find out that they were five feet from a door and the RIT had to come in and pull them out and they’re never going to hear the end of it in the firehouse for the next 10 years. Their body pretty much knows that something bad is going on but they refuse to admit it. And then by the time they do realize that they’re in quicksand, they are so far behind the 8 ball that they begin to panic and that’s when the heart rate skyrockets and then they can’t access their memory.

So I’m trying to put information out there on the front end so people can recognize when their heart rate is starting to race and things aren’t like they should be. They can control their breathing, calm themselves down and think “OK, I’ve trained, I have a plan, I know how to address this, here’s what I’m going to do,” and then go through the steps that they’ve been trained to do.

What we’re trying to do in the fire service with all of these stress-inoculation drills–the mayday drills, the ladder bailout drills, SCBA-confidence entanglement drill–is create the muscle memory. If you give your body the repetition of being in those instances, then when you actually get in one, you have this confidence of “I’ve been here before; I know how to handle this.” Obviously, you’re going to be excited, but you’re going to be able to somewhat manage it.

We don’t want the heart rate to get above 175 bpm because that’s when your performance really goes down the drain. The fire service is developing all of those drills and it’s why we preach training. Training builds that muscle memory and it builds that slide carousel in your mind so if you can recognize that this thing is starting to happen, you can have that confidence of “I’ve done some very good training in this very thing and I know what I have to do to get out of this,” and it keeps your heart rate from racing.

FR: What are other simple tips to help prevent you from going into that panic mode?
BG: Certain performance variables have an impact. The first one is your mindset. They’ve found from interviews with survivors of life and death situations that they got really, really angry and refused to give up or be beaten on that given day in that given situation, and that’s what drove them to survive.

The other one is motor skills selection, and that’s realizing that your heart rate governs what motor skills work and which ones don’t. When you get above 115 bpm, you start losing fine motor skills–the ability to use your fingers to manipulate things like turn your radio knob or activate your PASS device. When you get above 145 bpm, you start losing your complex motor skills. They’ve found that of the three types of motor skills (fine, complex and gross), the only one that improves with the higher heart rate is your gross motor skills, which is the very large muscle groups, simple movements. When I teach a spontaneous knife defense class, I teach big muscle movements that are easy to remember.

The other things that can affect whether you go into that panic mode are your nutrition and hydration. Did you have a good breakfast that day when you can to the station? Have you been drinking plenty of water? That has a direct impact on how fast your body becomes fatigued. And the faster your body becomes fatigued, the faster you become overwhelmed with fear, and the faster you are overwhelmed with fear, the faster you’re going to experience the adrenaline dump, starting you on the road to bad things.

The minute you have that feeling that things don’t seem right, you have to recognize that and admit it and start addressing it immediately through all of the things you’ve trained to do: Get on the radio, call the mayday, activate your PASS. And if people want to make fun of you later because you were five feet inside a doorway, well, at least you’re there for them to make fun of.

Some other ways to reduce the effects of the adrenaline-based stress is what we call tactical breathing; this will help to lower your heart rate. Breathe in for a count of three or four, hold your breath for about three or four, and then breathe out for a count of about three or four. That forces you to focus.

Every day around the station, you can do visualization drills, which tunes your nervous system to enhance your reaction time and your memory. It’s just a way of preparing yourself mentally and physically. It helps keeps anxiety down and keeps performance up.