The Connection Between Awareness & Mental Health

The Connection Between Awareness & Mental Health


Total wellness comprises mental, physical and spiritual wellbeing. Like spokes on a wheel, one is intricately tied to the other, and when one deteriorates, the others are affected. Healthy habits cultivate these “spokes,” and whether it is eating healthy, exercising or even driving defensively, implementing healthy habits requires a certain mental commitment and level of awareness.

Sometimes, physical awareness comes at the expense of an injury; those who have had back or knee surgery move with care and deliberate action, trying to prevent another injury. Other forms of awareness stem from our education about the dangers we face. On the fireground, for example, seasoned firefighters train young firefighters to look for sagging trusses, melting shingles, pipes that appear to be growing and “mushy” roofs. When we’re interior, we are cognizant of certain sounds, the color and volume of smoke, the heat, and any structural compromises that may be happening. In other words, we train our senses to become heightened to include those variables that could possibly hurt or kill us. It is the wiser person who personalizes this conviction without having to first reap the consequences of these variables.

Put simply, developing the right mindset is key to maintaining good mental health and physical safety.

New Dangers
Along with the growing dangers associated with firefighting, we face a new threat that I dare say the fire industry did not anticipate years ago. Acts of violence have finally reached us, and we must be equipped with the proper mindset to acknowledge them and prepare for them. Assaults on responding firefighters are at times the byproduct of something else going on, while other times we are the intended targets. Arsonists pose increased risks to firefighters due to the possibility of accelerants and hidden dangers, such as propane bottles intentionally placed within the fire. In addition, there have been occurrences of shots fired at firefighters and booby traps found in burning structures.

In short, the types of calls to which we respond are more varied than ever before, and firefighters must have a heightened sense of awareness when responding to and mitigating these emergencies.

4 Levels of Awareness
The late Colonel Jeff Cooper, combat veteran, author and founder of the Gunsite Academy, a world-renowned firearms training center, developed a color-coded awareness chart that includes four basic levels of human awareness. The following is a brief description of the color codes:

  • Condition white is a mental and physical state of unawareness and unpreparedness. Your guard is down. Things are happening all around you, but you don’t notice them or react to them.
  • Condition yellow is a relaxed alert level. There is no specific threat, but you recognize that the possibility is there. You’re aware of things that seem out of place or out of the ordinary, and you’re cognizant of people around you and their actions.
  • Condition orange is where you observe a specific threat. You make mental preparations to avoid, retreat or, if needed, engage the threat.
  • Condition red indicates that the threat has come to fruition. You are actively engaged with this threat.

The majority of the time, our awareness should be at condition yellow. It’s physically and mentally exhausting to constantly be at condition orange, because the mind is operating at a heightened and more active level. In condition orange, everything in the vicinity is being recognized, evaluated and processed as to whether it is a danger. Options are then formulated and processed to mitigate this danger. Heart rate and blood pressure become elevated, along with mental concentration. Anything that does not directly pertain to the immediate concern is disregarded. This can be perceived as impersonal and callous to bystanders, but necessary for the person operating in condition orange.

If this person is unable to “turn off” or transition to condition yellow, their mind never rests, and their body suffers from that lack of rest. This process can be triggered multiple times a day with no ill effects, but to remain in this state takes its toll. Relationships may become strained because of this mental outlook.

Conversely, we would be too lackadaisical and vulnerable to stay at condition white (although we observe people operating all day long in this condition.) People who operate in condition white are oblivious to what’s happening around them. They wouldn’t be able mitigate potential dangers because they don’t even realize they exist.

Whether we realize it or not, firefighters have conditioned themselves to have certain levels of “mental readiness” based on call types. For example, a dispatch of “check fire out” would most likely find the responding firefighters in a condition yellow, while a dispatch of a “working fire” would elevate their awareness and readiness to condition orange, then red. An “assault” or “overdose” in a high-risk or dangerous area of town might prompt a condition orange.

Condition Red: Violent Incidents
One of the most significant situations that demonstrates a crucial need for proper awareness: responding to violent incidents. It’s imperative for firefighters to maintain a heightened sense of awareness when responding to and mitigating these emergencies.

A couple of years ago, one of our engines responded to a call involving a young man who had allegedly attempted to commit suicide by overdosing on pills. Upon arrival to the small apartment, firefighters began interviewing the patient. He denied trying to hurt himself, but agreed to go to the hospital anyway. The patient then requested to use the restroom and the firefighters obliged, but asked that he keep the door open so they could keep an eye on him. As the patient walked out of the restroom, he walked into an adjacent bedroom. Two firefighters followed him in and stood just feet away. The patient knelt down as if to don his shoes, and in the blink of an eye, he shot himself with a semi-automatic handgun. The bullet entered the patient’s temple, exited on the other side, and hit the wall, approximately two feet from where a firefighter stood.

An experienced captain and crew responded to this call. No one expected this man to take his own life in the way that he did, in the presence of his own mother and five firefighters. But this man was obviously intent on fulfilling his mission, yet cordial and friendly toward firefighters. Had he been angry or agitated at the firefighters, the call could have had an entirely different, and perhaps equally tragic, ending.

This incident was a lesson in many ways. First, it reveals that the potential for injury or violence can be present on any call. Second, it reminds us that those who want to hurt themselves can be extremely unpredictable. It also produced an array of emotions in the responding crew and spurred the need for a variety of support mechanisms for that crew. Lastly, it teaches us that, although we should not be hateful or assume that everyone is out to get us, knowing that some people may have violent intentions can work in our favor and help keep us safe.

The Mind/Body Connection
To maintain physical safety, we must employ certain tactics that engage and improve our awareness level, such as:
Educate and train members. Exercises, such as presenting and acting out different scenarios, can be extremely memorable and helpful.

  • Brief members on areas or people of concern.
  • Teach basic self-defense ideas, such as where to stand, where not to stand, where to place the patient, etc.
  • Scan the immediate area of treatment and understand how to treat agitated patients.
  • Note the type of structure into which you’re responding, whether it’s an apartment, bar or homeless shelter. Doing a brief scan of the room layout is beneficial if a sudden retreat is necessary.
  • Transport in numbers. The back of ambulances can be an extremely dangerous environment, especially when transporting a patient who is despondent, agitated or under the influence.
  • Develop good working relationships with the police officers in your area, and share information with them when responding to violent incidents.

Ensuring your physical safety is important, but how do you ensure you’re maintaining the proper frame of mind and thus promoting optimal mental health? As mentioned earlier, mental, physical and spiritual wellness are the spokes on the “total wellness wheel.” Controlling the things that you can control will help you with the things that you can’t control. For example:

  • Getting plenty of sleep off-duty will help you when you’re up all night on shift.
  • Exercising and eating healthy will help ease the physical stress of the job and deter certain maladies.
  • Having support mechanisms in place, like family, church and friends, will help you to “decompress” from the tensions and difficulties of the job.
  • Doing all of the above will help you stay mentally focused and alert for those calls that take a turn for the worse.  

Our call volume and diverse communities continue to grow, and quite often, we are the first line of medical assistance for people who can’t afford a doctor or hospital visit. Other times, we may find ourselves dealing with a violent patient who has run out of medication. Because the awareness and preparedness required to mitigate these calls are ultimately our responsibility, the commitment to stay healthy, fit and safe is a mindset that, although not failsafe, sets us up for success.

As firefighters, we not only face extreme physical challenges, we face mental ones too, which calls us to be mentally “fit.” One key to maintaining optimal mental health is developing the right level of awareness. Whether we are aggressively fighting fire or cautiously treating a patient, this mental awareness helps us do our jobs better, safer and longer.