BY CHRISTOPHER BRENNAN
Human beings have a natural apprehension when it comes to fire. This natural impulse to flee from an unrestrained fire is perfectly normal; it is an essential survival skill. Fire is one of the most essential tools that we human beings possess, and it also has the potential to be one of the most destructive. Respecting this creature is the cornerstone that enables us to use fire safely in many ways.
As parents, we recognize the need to teach our children to avoid situations that may cause them harm. This training begins with essential survival skills ranging from “Don’t put anything in your mouth that isn’t food,” to “Stay away from the stove; it’s hot.” In dealing with children younger than seven years old, when the child’s level of cognitive ability is still developing, most of this training takes the form of a conditioned response. If the child starts to approach the stove or campfire, he hears a sharp, loud yell from the parent and, in many cases, gets a slap on the hand. The idea is straightforward—scare them and stop them in their tracks, or show them that going near the dangerous thing has painful consequences. There is no other way to teach young children to avoid these dangers. However, this early and often stern method of imprinting a behavioral pattern also develops in individuals an apprehension of fire.
As we mature, we are taught how to safely use fire to cook, to heat our homes, and to create structures that were unimaginable to our ancestors. Our early fear of fire is transformed into an understandable respect for fire and its power, but beneath that respect is the unchangeable imprint left on our three-year-old psyche by Mom or Dad slapping our hand when we reached for the stove.
Firefighters must behave in an abnormal way when they choose to enter a building that is on fire. Disregarding the normal psychological response to fire by entering a burning structure causes an understandable stress reaction even in an experienced firefighter. To operate safely and effectively on the fireground, you must understand the psychological and physiological reactions that affect your performance and how to manage your stress responses. It may seem a bit complicated, but understanding how your body reacts and why you respond in certain ways will help you to develop the skills to control your response.
Physiology
Firefighting requires that an individual willingly enter an environment that poses a threat to his health and welfare and, while in that environment, engage in strenuous physical activity encumbered by the very personal protective equipment (PPE) that is necessary to keep him from being burned and disregard the undercurrent of fear that tells him he needs to flee. He must physically perform at the level of a U.S. Navy SEAL1 and at the same time maintain situational awareness, anticipate the next steps needed to complete his assigned task, and provide progress reports to his supervisor. Firefighting takes a toll on the firefighter both physically and psychologically.
Since the late 1990s, significant research has been conducted on the physiological effects of firefighting. Dr. Denise Smith and Dr. Steve Petruzzello of the Illinois Fire Service Institute have conducted some of the most comprehensive research. Their ongoing work is adding to our understanding of just how the human body reacts to the effects of firefighting. This research is challenging because of the multiple variables to consider: Firefighters range in age from 18 to 70 years old, not every firefighter starts with the same level of physical fitness, and differences in heredity and upbringing all play a role in how your body responds to the stresses placed on it.
Certain conclusions are consistently repeated across several studies. During firefighting operations, firefighters reach their maximal or near-maximal heart rate. Maximum heart rate is measured by subtracting an individual’s age from 220 [e.g., the maximum heart rate for a 31-year-old: 220 – 31 = 189 beats per minute (bpm)]. Studies evaluating the heart rate of firefighters performing fireground operations during interior structural firefighting show that heart rates between 164 and 183 bpm are common.2 In other words, a 31-year-old firefighter will be functioning at between 86.8 and 97 percent of his maximum heart rate while operating inside a structure fire. This level of physical exertion has multiple effects on the individual firefighter.
First, the firefighter is increasing the level of thermal stress on the body because of the metabolic action required to perform the required actions. This metabolic stress can best be measured by the metabolic equivalent level (MET). One MET is the amount of energy/oxygen your body uses while sitting quietly. Based on studies by Barbara Ainsworth of the University of South Carolina, firefighters can expend 12 METS of energy while conducting firefighting operations. This is the same level of energy expenditure seen in U.S. Navy SEALs and in professional boxers. As a comparison, your body is working at roughly 13 METs if you are running 7.5 miles per hour (an eight-minute mile) at a one-percent incline.
Second, the firefighter must contend with an increase in thermal stress on the body from the elevated temperatures found inside a structure. Ambient air temperatures can rise above 449°F inside a burning building.3 At this level of ambient temperature, the firefighter would not survive without his protective ensemble of turnout gear and SCBA.
Third, the firefighter must contend with the limitations on his body by the very PPE that he needs to survive in the building. National Fire Protection Association 1500, Standard on Fire Department Occupational Safety and Health Program, specifies that all firefighters shall use coat, pants, boots, gloves, helmet, and protective hood in conjunction with their SCBA. Using fire-resistant materials and layered structures, these PPE components reduce the risk of the firefighter’s suffering burns. However, while wearing these garments, the firefighter is less able to relieve heat stress through perspiration, since the insulating properties that prevent heat from outside from burning him also trap his radiated body heat.
All of these aspects have been quantified through study into the physiology of firefighting. The normal human body temperature is 98.6°F. One study shows that, on average, the tympanic temperature (the body temperature measured by an ear thermometer) of firefighters completing 16 minutes of firefighting activity was elevated to 104.1°F after operating in an atmosphere varying between 170.1°F and 199.9°F.4 This physiological effect has been shown to reduce the heart’s stroke volume (i.e., the amount of blood the heart can pump in one contraction) and increase the dilation of blood vessels closest to the skin. These two factors can lead to a dangerous drop in blood pressure. This has potentially significant consequences, and it can be assumed that a number of the firefighter line-of-duty deaths (LODDs) listed under the “Stress/Exertion” category result from this cardiac compromise.
If we assume that a firefighter, equipped with the common “30-minute” SCBA cylinder containing 45 cubic feet of air at 4,500 psi, can perform 16 minutes of work prior to exiting the fire building, we can expect that he will exit the building with a body core temperature of around 104°F and a pulse rate of approximately 175 bpm. Interestingly, research has shown that despite this level of physical exertion, firefighters do not show a corresponding psychophysical effect.
The studies of Smith and Petruzzello have incorporated an evaluation of Rate of Perceived Exertion (RPE) based on the Borg Scale. These studies examine the RPE based on physiological and psychophysical factors, but they do not consider the purely psychological aspects. Based on their research, we can see that firefighters will rate their exertion as being “hard,” a rate of perceived exertion that we would expect to see for a person with a heart rate of 150 bpm, yet the recorded heart rates should have elicited a response of “very hard” to “extremely hard.”
There is no clear clinical explanation for this variation. The subjectivity of measuring effort based on the Borg Scale is a consideration; it is all in the mind of the individual what “hard” means to that person. Additionally, we must consider that the thermal stress, dehydration, and cardiac compromise may affect the individual responder’s ability to assess the level of exertion accurately.
These physiological and psychophysical effects can affect cognitive function as well. In Smith and Petruzzello’s 1998 study, subjects were assessed for their cognitive function after each of their three trials. Subjects were evaluated based on their response time and degree of accuracy using a Continuous Performance Test. Response time decreased across all three trials. The authors concluded that this could be attributed to the ability for neural signals to be transmitted more quickly across the warmed nervous system. The Continuous Performance Test used required the subjects to determine if a displayed number was a 0 or 9, or a number between 1 and 8. Although this does provide some understanding of the nervous system’s basic response time, it does not accurately predict the individual’s ability to analyze and respond to multiple sensory inputs while functioning in the fire environment. Even the United States Fire Administration acknowledges this: “The physical and mental demands associated with firefighting and other emergency operations exceed those of virtually any other occupation.”5
Psychology
People assume that firefighters aren’t afraid of running into burning buildings. My experience has been to the contrary. When new candidates start in the fire service, they have an understandable apprehension of what they will be called on to do. We know that we were raised to have a fear of fire, but we must control that fear if we expect our firefighters to perform. To be able to control your psychological responses, you must understand how fear and anxiety affect you.
Firefighters’ psychological responses to the environment they face and activities they engage in are an aspect of firefighting on which researchers have not greatly focused. We can use the research of Lieutenant Colonel Dave Grossman, Bruce Siddle, and Loren Christensen into the psychology of men in combat to understand some of the effects of psychological stress with which firefighters are expected to cope.
To understand the psychological reactions we confront, we must first understand our nervous system. The nervous system is comprised of the somatic nervous system, which is responsible for voluntary muscular actions, and the autonomic nervous system, which is responsible for all our body’s automatic functions. Primarily, we are concerned with the role of the autonomic nervous system.
The autonomic nervous system functions through the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). These two systems send signals that direct the actions of your organs, muscles, and brain. They work in opposite directions. The SNS is responsible for increasing your heart rate and respiratory rate, diverts blood flow away from your skin by constricting blood vessels, and other actions that would be considered a part of the body’s “fight” response. The SNS is the part of your nervous system that engages when you are threatened.
The PNS has the opposite effect: It slows your heart rate when the need to move large quantities of oxygen has been reduced and moderates your digestion along with your bowel and bladder control. The PNS is your body at “rest.”
During high-stress situations like combat, your body switches its resources from the PNS to the SNS. Your pupils dilate to enhance your vision, your heart rate increases to move a greater quantity of oxygen to the large muscles needed to fight or flee, and your peripheral circulatory system contracts, so that if you are cut you will bleed less. The downside to this sudden switch is that things such as bowel and bladder control can be quickly lost. You can urinate or defecate right on the spot. This is something that isn’t often understood, and it isn’t something talked about often, but it does happen. In The American Soldier, a study of the actions of soldiers in World War II, one quarter of all soldiers reported the loss of bowel or bladder control in combat. Responders who survived the September 11, 2001, attacks on the World Trade Center reported numerous cases of uncontrolled loss of bowel and bladder control.6
I am bringing this up because it is something that we need to understand. It is decidedly not “macho” to tell someone that you wet yourself while fighting a fire. Let’s say you have a young firefighter who on his very first structure fire is ascending a flight of stairs with the nozzle. He turns to begin attacking the fire and is met by a wall of flame and heat. His SNS kicks in because he finds himself in a threatening situation. A switch is thrown in his nervous system, and everything goes from normal to panic mode. If he urinates, or even defecates, it is actually a perfectly normal reaction. He isn’t going to feel that way, though, if he hasn’t been taught that it is a possibility. He is going to react with shame and discomfort. He may even decide that he doesn’t really want to be a firefighter because “he can’t hack it,” or he may become timid and less likely to develop an appropriate level of aggressiveness. I don’t believe in coddling people who don’t have the requisite courage, stamina, or strength to be firefighters. This job isn’t for everyone. We do not want to label a coward someone who simply hasn’t been prepared for what his body is going to do when it feels threatened.
For firefighters, the single most important side effect of the SNS taking primacy is the increase in heart rate. Emergencies are not scheduled events. When the alarm bell rings, your heart rate begins to increase. Controlling that initial adrenaline dump is critical. Grossman and Siddle have documented the effects of an increasing heart rate because of anxiety. There are five levels of anxiety we can experience at any given time (Figure 1). The White Zone in Figure 1 is the level of anxiety and ability you experience during your typical resting mode. You progress from White to Yellow as your heart rate begins to climb toward 115 bpm. As your heart rate nears 120 bpm, you enter the Red Zone, where you start to lose fine motor control.
Figure 1. Physiological Responses to Anxiety-Induced Elevated Heart Rates |
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Source: Adapted from On Combat: The Psychology and Physiology of Deadly Conflict in War and in Peace by Dave Grossman and Loren W. Christensen, PPCT Research Publications, 2004. |
Entering the Gray Zone, you are moving into a panic mode in which all cognitive ability, vision, and auditory senses are quickly degrading. If the heart rate exceeds 175 bpm, the psyche and the body essentially give up and either flee or are unable to react. A firefighter in an anxious mental state because of his fears can expect his heart rate to climb. As the heart rate climbs, the untrained firefighter will begin to feel as though his body is malfunctioning, further adding to the anxiety reaction.
Remember that these effects are only for stress-induced heart rate increases; they do not apply to heart rate increases resulting from physical activity. You will see that the effect of an elevated heart rate from exertion can have an effect on your ability to control the onset of anxiety reactions. Also, do not take the heart rates as concrete numbers but as guidelines for understanding your body’s reactions. As always, when dealing with people, there is individual variation.
The firefighter works in an environment where he may face an increase in his heart rate from exertion and anxiety. No conclusive study has analyzed the effects of combining the effects of heart rate increase from exertion and a sudden increase in heart rate because of SNS stimulation. It is reasonable to expect that an experienced firefighter who is conducting interior operations and working on his first or second air bottle will have a heart rate somewhere around the 160- to 180-bpm range. He will not likely experience any significant psychological challenges or a loss of cognitive function that impairs his ability to maintain his situation awareness. However, if conditions suddenly and unexpectedly deteriorate, he may rapidly go from being calm and collected in the Yellow Zone to the Black Zone without any warning.
Available research provides an insight into what happens when firefighters become disoriented. The U.S. Firefighter Disorientation Study examines the role that that plays in firefighter fatalities.7 In 100 percent of the cases studied, conditions changed suddenly from manageable for aggressive interior operations to prolonged periods of zero-visibility conditions. You can expect that those rapid changes would bring about an understandable anxiety reaction. A flood of adrenaline and a quick shift from feeling in control of the situation to being overwhelmed by the conditions would lead to the sudden surge of the SNS reaction. Couple that SNS surge with a near-maximal heart rate, and the firefighter is going to move into the Black Zone and have a nearly overwhelming flight response.
The dilemma is that when the flight response kicks in, the cognitive function shuts down. You recognize that you are scared and that your ability to think is compromised. So what happens? Your heart rate increases more because your nervous system realizes that you aren’t responding to the situation, and you can become caught in an escalating cycle of anxiety. Rather than calmly thinking, “I need to get my company together and follow this hoseline out,” the survival brain centers kick in and you will do only what you have practiced before. If you haven’t trained on maintaining company integrity and situational awareness under rapidly deteriorating conditions, panic will take over; you will become disoriented, and those combined forces will result in your likely becoming a fatality.
The goal must be to develop a training program and a philosophy that will help you to stay in the Yellow Zone, even under those circumstances where the “normal” firefighter would be expected to suddenly jump into the Gray or Black Zone. It requires a personal commitment to understanding yourself, your mind and body, and training yourself and your fellow firefighters to have the will to survive. It means becoming a Fire Service Warrior.
Conquering the Fight-or-flight Response
Developing survival skills has received quite a bit of attention from personnel in the military and law enforcement communities. Like us, they can find themselves in a life-threatening situation with little or no “warmup time.” We have already compared the physical workload of firefighting with that of a U.S. Navy SEAL; let’s see if we can learn some lessons from the SEAL model of survival skill training as well.
A SEAL who is patrolling along the streets of Iraq or the mountains of Afghanistan is aware of the possibility of coming under attack. He is operating in condition Yellow, alert and ready to respond. If he begins to take small arms fire from one or two enemy fighters, he has time to recognize and respond to the threat. He should be able to maintain himself in the Yellow Zone. However, if his patrol is suddenly hit by an improvised explosive device (IED) or ambushed by a numerically superior force, the chances are that he could rapidly shift into condition Gray or Black.
SEALs prepare for those sudden unexpected life-threatening encounters through immediate action drills (IADs). In the IAD, the entire platoon responds immediately, using one of several tactics that have been practiced hundreds of times until the response becomes automatic. There is no need for the cognitive function to operate at 100 percent; the response is conditioned.
One classic example is the Leap-Frog IAD. In the Leap-Frog response to an ambush, the SEALs must break contact with the enemy. To keep themselves from being overrun, the SEALs must maintain a constant volume of firepower. When enemy contact is initiated, the SEALs know to immediately turn to face the direction of the threat and engage it while seeking a position of cover. Then the platoon officer will command the SEALs to execute a Leap-Frog maneuver. The order goes out, “Ones up!” At this point, one squad of SEALs (generally eight operators) rises and moves away from the direction of the enemy contact to a position of cover while their mates keep firing. Once they reach a point of cover, the leader calls out, “Ones down!” The squad that had been maneuvering then assumes a firing position and engages the enemy. With this, on the order “Twos up,” the second group rises and begins to retreat. This movement occurs while the Ones are firing live ammunition in the direction of the enemy and the Twos are in between. The Twos continue until they have leap-frogged past the Ones, have assumed a new position, and have begun firing past the Ones.
Obviously, with all these people moving and shooting, and with friendly forces between the shooters and the enemy, there is the potential for disaster. The initial ambush will push the SEAL operator into a state of anxiety to which anyone who has ever been shot at can attest. A normal person’s heart rate would jump right into the Black. The IAD gives the SEAL operator the tools to respond instantly, with his psyche in the Red or Gray range, until he gets his cognitive reasoning back into the mix. The SEALs master these skills through constant repetition in a crawl, then walk, then run fashion. The skills become instinctual.
By conducting challenging scenario training, you can develop the ability to respond to unexpected situations that would cause anxiety reactions. During your training, design props to simulate a firefighter’s suddenly falling through a floor, a ceiling collapse, or a similar anxiety-inducing fireground event. The United States Fire Administration’s course Calling the Mayday: Hands-On Training for Firefighters program is a great resource for safely teaching your firefighters how to deal with potentially disorientating situations.8
Firefighters can develop the ability to control the fight-or-flight response. We have talked about how the sympathetic nervous system controls the fight-or-flight response; now you must develop the skills to control that response. You must train yourself to recognize and identify that your body has started to go into panic mode and develop a conditioned response that will kick in to enable you to regain control of your heart rate before you enter the Black Zone. Conquering the fight-or-flight response requires conscious effort. You must take the time to train yourself before you go out on a call. I have experienced the “freezing” associated with being in the Black Zone before. When I was going through my recruit academy as a hyper-eager 20-year-old, I felt pretty confident in my skills. I had spent time hanging out in firehouses and knew how to use an SCBA. We were nearing the end of our program and had finally gotten to tower drills in smoke conditions—really minor stuff, a burn barrel with some wet straw in it. I was the lead firefighter for my group of five students. We turned into a stairwell to head to an upper floor, and I was enveloped in blackness. I had never been anywhere that was so dark that I had absolutely no visibility. I put my hand on my face piece and could see my hand. My reptilian brain kicked in; I got panicky. I froze. I was on my hands and knees, supposedly leading this group of people, and I just didn’t move at all. I finally told myself to take a few deep breaths, that I was in a tower, that the instructor was just a step or two away, and that everything was okay. I got the group moving and completed the evolution, but it was an experience that stuck with me. I wondered if I would freeze up on a real call, and I knew if I did that it could get me killed. I have used that experience to help guide me as I practice developing a Warrior mindset as a firefighter, and I keep it in the back of my head when I’m teaching.
Douglas Adams’ Hitchhiker’s Guide to the Galaxy summed up the single most important element of conditioning yourself to control your fight-or-flight response: “DON’T PANIC!” It may seem like a simple thing, but being conscious of your response to the conditions around you will enable you to control your SNS responses. If you are not conscious of how you are responding, then it is inevitable that your heart rate will begin increasing before you are even aware of it. You will begin to move from condition Yellow to Red to Gray without even realizing it. Making the effort to maintain awareness of how your body is responding sets the stage for controlling your SNS responses.
How do you develop this kind of skill? We each come to the kitchen table in the morning with different levels of self-awareness. We see it in ourselves and our fellow firefighters. Some people are aware of everything they say before they say it; others are constantly putting their foot in their mouth. We all know that firefighter whose response to the company officer’s question “What were you thinking?” was “Nothing.” That person wasn’t lying; he acted without consciously deciding what he was about to do or say.
Developing awareness of your responses starts with looking at yourself and asking, “What kind of person am I?” Are you a cool, steady operator on the fireground or are you prone to getting nervous? Do you know your job well enough to do what is asked of you safely, efficiently, and effectively, or do you need to work on your fundamentals? Do you know building construction, fire behavior, and your SCBA well enough to keep yourself alive? Developing that understanding takes self-reflection and honesty. You need to start there. Once you can honestly understand yourself, then you can begin working on how to control those primal survival responses that spring from the reptilian brain that triggers your SNS responses.
I find the best place to begin is with mental rehearsal. Think about the situations in which you may find yourself. Think about the aspects of the job in which you are strong and those in which you are weak. Every one of us has weaknesses. I hate heights. I am not the kind of firefighter who finds rappelling from the top of a water tower fun. So I work on it. I climb ladders every chance I get. I hop up and run around on roofs. I practice self-survival techniques like window bailouts just so I can conquer that fear. You need to do the same thing with the situations in which you may find yourself. Rehearse what you would do if something goes wrong.
Picture yourself crawling down a hallway with your partner to conduct a primary search of a room immediately adjacent to the fire room. The engine crew has a line stretched to the top of the stairway and is holding the fire in check, leaving you with enough room to get ahead and conduct your search. You are in the lead. Are you doing a left- or right-hand search? What tools do you and your partner have with you? You get to the bedroom door and just before you turn to enter the room, the second bedroom flashes over. What do you do? If you haven’t gotten blown across the hall, which hand should you put on the wall to guide your retreat? Where is your partner at now? Who is leading the way out? If smoke conditions have suddenly gotten worse, or you got blown away from the wall, how can you orient yourself to find the way out?
These mental rehearsals are important. First, they get you to think about the fact that things can go wrong. None of us wants to think that we can get hurt or killed. We try to protect ourselves psychologically by thinking about how things seem to always work out. Unless you have witnessed a firefighter fatality or have been injured on the fireground, it is perfectly normal not to think about the fact that you could be in a situation that could cost you your life. You need to confront the reality that even if you do everything right, the possibly of everything’s going to hell exists in every fire building you enter.
The second benefit of the mental rehearsal is it gives you the opportunity to “war game” your options. Think about the various situations in which you may find yourself. Review every action on the fireground that you might have to perform—operating the nozzle, acting as the backup guy, forcing the front door, operating the pump panel, operating the turntable of the aerial, or venting the roof. Think about the problems that can arise. What if the engine pressure isn’t climbing as you throttle up? How do you fix it? What if four people are hanging out the front of a building calling for help? Whom do you rescue first?
The firefighter you consider to be an “awesome firefighter” already does this. He may not call it mental rehearsal or even be aware he is doing it, but he likely is doing it.
The second skill set to develop is to control your breathing. Remember when you were a kid and got so excited about something that you could hardly speak? What did your mom or dad say? “Take a deep breath, and then tell me what happened.” How rapidly you breathe has a direct effect on how rapidly your heart beats. Biofeedback is the art—or science, according to some—of consciously altering your autonomic nervous system responses by maintaining conscious awareness of how your body is responding. Breathing control is one aspect of biofeedback that works for me. By consciously slowing your breathing, by concentrating on breathing in a slow, rhythmic manner, you can slow your heart rate.
I use a tactical breathing exercise to control my breathing when I recognize that my heart rate is beginning to elevate because of anxiety. I got this exercise from Grossman’s book On Combat. (6) This will work on the fireground, in a promotional interview, or when giving a toast at a wedding. When you recognize that you are entering a stressful situation and anxiety is beginning to kick in, take that deep breath that Mom talked about to a new level.
- 1. Inhale through your nose for a count of four.
- 2. Hold your breath for a count of four.
- 3. Exhale through your mouth for a count of four.
- 4. Pause for a count of four.
Repeat that series three times. You will feel your heart rate slow. You will feel the anxiety begin to ebb. You will be able to regain control of your SNS functions and give your cognitive ability the time to kick in. I’ve used this exercise dozens of times in the past several years when things got stressful. The key is to use the tactical breathing exercise regularly. You need to practice it and to put it together with self-awareness and mental rehearsals so that when you are crawling down that hallway and conditions suddenly change, you don’t freak out, curl up in a ball, and get ready to die. You will have the skills in place and the mental attitude to fight and survive.
There is no question that as a firefighter you are going to have to confront physical and psychological challenges. You will be scared. That’s okay. What matters is how you deal with that fear. As Mark Twain said, “Courage is resistance to fear, mastery of fear—not absence of fear.” If you do not take time to understand how your body will react under stress, you are setting yourself up for failure. By conducting honest self-study and then using the techniques of mental rehearsal, challenging training, and tactical breathing, you can better prepare yourself to deal with the stressful situations that cause others to panic.
Endnotes
1. Ainsworth, BE. “The Compendium of Physical Activities Tracking Guide.” Prevention Research Center, Norman J. Arnold School of Public Health, University of South Carolina, January 2002. http://prevention.sph.sc.edu/tools/docs/documents_compendium.pdf. Retrieved 28 May 2008.
2. Smith, Denise L and Steven J Petruzzello, “Selected physiological and psychological responses to live-fire drills in different configurations of firefighting gear,” Ergonomics, 1998; 41(8), 1141-1154.
3. Davis, Paul O and Charles O Dotson. “Physiological Aspect of Fire Fighting.” Fire Technology, November 1987; 23(3), 280-291.
4. Smith, Denise L, Steven J Petruzzello, Jeffery M Kramer, and James E Misner. “Physiological, Psychophysical, and Psychological Responses of Firefighters to Firefighing Training Drills,” Aviation, Space, and Environmental Medicine, November 1996; 67(11), 1063-1068.
5. Emergency Incident Rehabilitation. United States Fire Administration. February 2008, 4. http://www.usfa.dhs.gov/downloads/pdf/publications/fa_314.pdf.
6. Grossman, Dave, and Loren W Christensen. On Combat: The Psychology and Physiology of Deadly Conflict in War and in Peace. PPCT Research Publications, 2004.
7. Mora, William R. U.S. Firefighter Disorientation Study 1979-2001. San Antonio (TX) Fire Department, 2003. http://www.sanantonio.gov/safd/PDFs/FirefighterDisorientationStudy.pdf. Retrieved 30 May 2008.
8. United States Fire Administration, Calling the Mayday: Hands-On Training for Firefighters course (H134). www.usfa.com.
CHRISTOPHER BRENNAN is a 12-year veteran of the fire service. He is a firefighter with the Harvey (IL) Fire Department and an instructor with the Illinois Fire Service Institute.
