Surviving means reacting, not thinking
By Jesse Birkey
Florida nights never seem to have enough strength to break the grip of humidity. My crew stumbled into its arms as the blast of emergency tones signaled a structure fire in our area.
An acting officer, still months away from official promotion, I had a gut feeling that this 3 a.m. response was going to be the real thing and my first opportunity to take command of a working structure fire. The glare of my mobile data terminal blurred the map as directives flipped through my mind, shoving out sleepy cobwebs.
We raced toward the scene but slowly, like a spider stalking prey, fear crept through my stomach, clawing toward my mind. Voices exploded, demanding audience: You’re not ready. You have no idea what you’re doing. You can’t do this. You don’t belong here. You should run away now! Every sneering accusation held me, paralyzed me.
The happy ending to this story is that I was able to gain control of myself and everything went well. But it doesn’t always end up that way. A quick Google search will produce articles and stories detailing incidents in which tragedy occurred because those on scene weren’t able to make reasonable decisions. Perhaps the most common term is tunnel vision. But that’s only part of the story.
You may have noticed the co-worker standing as close to the exit as possible during a critical EMS call unable to perform simple tasks. The paramedic student vapor-locked at the head of a cardiac arrest, wide-eyed and mouth partly open, offering no direction. Your partner bailing wildly out of an immediately dangerous to life or health atmosphere for no apparent reason. The inability of the incident commander to understand alternate tactics. You may have been that person yourself.
In this article, we’ll discuss the Fight or Flight (FOF) response, a natural and very beneficial (when activated as intended) program wired into all of us. I’m going to explain what it is, its purpose, and what happens to us when it fires.
We’ll also discuss its effect on critical thinking, a crucial element to decision making in high-stress incidents without which we find ourselves doing things we can’t easily explain.
Finally, we’ll discuss some practical steps we can take to prevent the FOF program from taking over our system inappropriately.
Fight or Flight
Imagine standing next to a mountain hearing a rumble above. You jerk toward the noise to find a boulder on a collision course with your head. Instantly, without thought, you jump back, feeling the wind as the massive rock misses your head by inches.
Something a little more relevant? A primary search takes you into a room hot enough to burn through your gear. You fall back and bail through a window moments before the room flashes. Or a patient suddenly sits up and aims a pistol at your head. You duck or perhaps try to grab the gun from his hand.
Though the FOF response may be the enemy of critical thinking (as we’ll soon learn), it’s not evil. In fact, it may have saved your life, which is exactly what it’s designed to do. FOF is a physiological reaction occurring in response to a perceived (remember that word) harmful event, attack, or threat to survival.
Time to geek out a bit.
In the brain, it takes 0.85 milliseconds for the amygdala to ask for a flood of chemicals. The sympathetic nervous system then releases the hormones cortisol and adrenaline. Heart rate, blood pressure, and breathing shoot up while digestion crawls. Blood shunts to the major muscle groups, vision narrows (tunnel vision), sweat forms, and muscles tense. There is a palpable burst of energy and strength. The body is prepared for immediate action.
Meanwhile, in the brain, physiologic neurotransmitters activate glucocorticoid receptors, which degrade working memory and executive function. The accumulating cortisol shuts down the prefrontal cortex–in other words, critical thinking gets hijacked, resulting in thoughts that tend to be irrational and illogical.
This is by design. Surviving means reacting, not thinking.
Two Paths
When triggered, we can go one of two ways: fight or flight.
Fight will typically be viewed as the better option because it looks like engagement. And it is. But the binding parameters of the physiological reaction still apply. What may not be seen is that the engagement lacks rational thought. That fact can certainly be evidenced by illogical actions noticed and discussed during a post incident analysis.
Fight manifests as focus on a single goal (tunnel vision), rushing in, rash decisions, and the inability to understand alternative perspectives/strategies/tactics.
Flight puts all its focus into escape. This can look like physically fleeing, mentally withdrawing, or refusing to interact with the team at all. This would be the classic deer-in-the-headlights analogy.
Two paths, both destructive, both preventing what we’ll discuss next—critical thinking.
Critical Thinking
Critical thinking is defined as the objective analysis and evaluation of an issue to form a judgment or make an informed decision. I would venture to guess that most of us agree this needs to be a core skill for those responding to emergency incidents of all types and sizes.
Although incidents discussed in the classroom may seem to follow a predictable pattern, anyone who has responded to emergency situations understands there’s no such thing as a textbook call. Emergency incidents are dynamic, ever changing, and morphing in unpredictable ways. Critical thinking is our weapon, the edge we need to constantly adapt to frustrating conditions.
There seems to be an emphasis nationally on the importance of being situationally aware, which is vitally important, but if we can’t think critically, we won’t be situationally aware.
The physiological effects of FOF rob us of the ability to think critically, and here’s the kicker: It can take up to 20 minutes for the body to reset! That means once triggered, we might be able to follow directions and complete tasks, but situational awareness and the ability to make reasonable decisions will be very difficult, if not impossible, during the most important time periods of incidents.
Therefore, it is very important for us to find a way to block the FOF response when responding to incidents. Victims and patients are not expected to remain calm and manage emergencies; we are. Let’s discuss a major obstacle.
The Fear of Failure
Let me remind you of something I emphasized earlier, that FOF is triggered by a perceived threat. It is very important to understand that the body is unable to discern the difference between an actual physical threat and a perceived threat, which is more psychological in nature.
For example, fleeing a structure about to flash is a physical threat and flight is needed. Standing up in front of a crowd and delivering a presentation can trigger a fear that would be more psychological. There is no physical threat, but our body responds as if there is, producing a dry mouth, inability to recall information, and more. Flight is not needed, but it becomes our only perceived option.
There are many of these psychological fears, but for this article I will focus on one I believe to be especially debilitating—the fear of failure.
The fear of failure tells us that we won’t be able to perform or manage what is in front of us. It convinces us that we are not the right ones for the job. Then, once we believe we’ll fail, there is nothing left for us to do but fulfill what we already believe.
The most important battleground is the time from dispatch to arrival on scene. That is when we’ll get the most information from dispatch about the emergency we are responding to—entrapments, fully involved, high-rise, cardiac arrest, pediatric calls, overturned vehicles, and the list goes on.
The fear of failure thrives on partial information, which is all we’ll get until we arrive on scene. But if we can manage the fear response and arrive on scene with critical thinking intact, we’ll be able to process the scene while formulating initial strategies and tactics to mitigate the incident.
Let’s talk about some ways we can do that.
Manage the FOF
Gold Bar
We are going to fail. There’s power in accepting that fact. WD40 failed 39 times. Perfection isn’t a goal, it’s a myth … a tantalizing vapor to be seen but never captured.
And that’s okay.
There is incredible freedom in giving ourselves permission to get it wrong. That doesn’t mean we shouldn’t aim to improve. In fact, feeling free to fail gives us the security we need to jump into messy situations and learn.
But the thought of failing scares us, so much so that it triggers our FOF reaction. That’s because we tend to believe failure has the right to own us, to brand us. Instead of failing, we become failures. But that’s not where the story ends.
Consider a gold bar. Its value is set, a constant (as long as the market does not fluctuate). Use it as a paperweight, drop it in the trash can, let it sink into an outhouse. The value doesn’t change. We are gold bars. Houses burn down, victims aren’t found, return of spontaneous circulation isn’t achieved, and through it all our value never changes. How freeing it is when we report to work and celebrate success, grieve failure, and never allow either to define who we are.
The deeper that sinks in, the less likely we are to trigger the FOF for psychological fear.
Prepare
“Give me six hours to chop down a tree and I will spend the first four sharpening the axe.”
–Abraham Lincoln
The more prepared we are, the less likely we are to be triggered by stressful events. That shouldn’t be difficult to understand. The more training we participate in, the greater the level of confidence we will feel when called to respond.
As emergency professionals, we have enough unpredictable stressors to encounter at emergency scenes; we shouldn’t have to add stress caused by being unfamiliar with skills we can practice every shift–things like stretching lines, throwing ladders, tying knots, etc. Take the opportunities to work with what’s available so when ordered to ladder the structure we can do so confidently, peacefully, and efficiently.
Experience
Experience can be the best teacher. The more often we are exposed to stressful incidents, the more comfortable we become with them. Recognition primed decision making is a powerful tool.
When I praised a celebrated firefighter at his retirement, he responded by telling me the only difference between him and me was about 30 years of experience. A humble response (not entirely accurate, in my opinion, as the man is a legend), but it certainly holds a measure of truth.
The only way to grow in experience is by actually responding to a variety of emergencies. So, let those at the end of their careers have the vacation stations and start running calls.
Exercises
Finally, I’ll share a couple of practical exercises designed to prevent the FOF trigger.
These practical exercises are designed to task the brain with something other than imagining scenarios that might trigger the FOF. If we can briefly and intermittently distract the brain during response, we can delay or prevent the FOF.
The goal is not to completely disregard the emergency until arrival on scene; rather, it is to intermittently relieve stress so we can stay focused throughout.
Counting backward from 100 by 7s is a simple yet effective way to briefly task our brain with something other than imagining the worst.
Inhaling through the nose while pushing the stomach out and exhaling forcibly through the mouth is another great way to task the brain. This is my preferred method because it actually takes some concentration to accomplish. By the time I figure it out and take a few breaths, any anxiety has settled.
Then, finally, take a deep breath and speak these words out loud: It’s going to be okay. We all need to hear this from time to time, and I’m always amazed at the flood of peace when I hear it from someone else or myself.
We need to be able to think critically and maintain that ability to ensure the best chance of successful emergency mitigation. My hope is that the information presented here will help us manage the FOF response in a way that allows us to make clear and rational decisions in difficult circumstances.
Jesse Birkey is a lieutenant with the Sarasota County (FL) Fire Department. He is an experienced instructor and field training officer.
