How to Avoid Training Scars

BY CHRISTOPHER BRENNAN

I met a young firefighter some months ago who was in a difficult place-early 20s, sincere in desire and drive to succeed in the fire service, but feeling burned out far too early. What had led to this burnout? Was it a string of difficult calls that opened up emotions that were overwhelming? Maybe the reality of the job didn’t fully match up with this firefighter’s perception. Perhaps there was just a bad attitude at the root of this discontent! No, the answer was “D. None of the above,” but it didn’t take more than a five-minute conversation to diagnose the root cause: training scars.

I’ve heard it said that “experience is what you get when you don’t get what you want,” and there is a certain degree of accuracy in that for my life. What I’ve observed and experienced, though, is that “experience” in the context of a fire department training session often leaves a scar. Training scars are the leftover performance and physiological damage that can occur when our instructors or peers fail to help us come back from a drill as a winner. Now, before I raise everyone’s hackles here, I am not talking about the fire service variation of youth soccer, in which everyone is a winner just for showing up. However, we need to recognize that the firefighter we are training is going to leave us at the end of the drill or shift, and our objective should always be to help that member improve, not leave him broken.

PERFORMANCE SCARS

Performance scars happen when we allow improper actions to become habit. It takes roughly 200 repetitions of a given skill for automaticity (the ability to perform a task without thinking specifically about the steps) to kick in. That is the reason we see great strides in people’s skill in donning a self-contained breathing apparatus (SCBA), or back squatting, in their first 50 hours. Most of the learning is neurological. The trouble is, if we allow improper or inefficient patterns to be implanted then, that’s what our firefighter will walk away with. This can also be the case if we try and insert new procedures into an existing routine. I’m not sure if there is any citable source for this, but it’s accepted that one of the reasons that personal alert safety systems (PASS) have become integrated into SCBAs is that firefighters were not turning them on. Why weren’t they? Quite simply because during their 200 repetitions of donning, they didn’t have a PASS device to turn on. Depending on the study you read, it takes 3,000 to 5,000 repetitions of practice to replace a habit that has become automatic.

This is the reason it is critical that our instructors be dedicated to maximizing the effectiveness of their instruction. We must ensure that the mantra “Amateurs train until they get it right; professionals train until they can’t get it wrong” is implemented in our training academies and in our station and company drills. Whether career or on-call, the stakes for accepting error (what is known in the engineering community as “normalization of deviance”) are far too great.

Basic skill acquisition must be followed by a progressively more challenging set of drills to develop highly effective fireground application. This should begin with a solid foundation in the fire academy and continue as our firefighters are integrated with the line companies with which they will respond. Among the critical components you must integrate into this applied skills training is stress-inoculation training.

STRESS-INOCULATION TRAINING

Stress-inoculation training (SIT) is a collection of methods instructors use to train students to reduce anxiety and increase performance. Among the early developers of the methodology was Donald Meichenbaum, who initially “focused on cognitive-emotional theory of anxiety and learning approaches for the development of cognitive and relaxation coping skills for anxiety reduction.”1 Survival skills instructors have used variations on SIT from the days of ancient warrior cultures without having a specific label for it.

From the brutal rites of passage that are part of initiation into elite military organizations through the burn tower evolutions with recruit academy candidates to law enforcement defensive tactics courses, those who are expected to place their bodies in harm’s way have attempted from time immemorial to develop a mental toughness in their students. This is a noble effort. However, ineffective or poorly designed/executed attempts to use SIT can do more harm than good.

PSYCHOLOGICAL SCARS

The second type of performance scar I see in firefighters is psychological. It is likely that psychological training scars lead to a young firefighter burning out so early in his career. The difficulty with SIT is that it cannot be implemented haphazardly or you run the real risk of damaging people psychologically, which can happen without the instructor or student being aware that it has happened. However, these scars can become ticking time bombs that increase an individual’s stress level and increase risk of injury or illness and, depending on how deeply you care to examine the issue, perhaps even lead to an increased chance of heart disease and cancer (which have been linked to stress).

The first critical element in effective SIT is to prepare the students for what they are going to experience and what their expected action should be. This has to be done step by step. When teaching new recruits SCBA emergency procedures, the culmination is having a recruit reestablish his air supply while in a live fire environment. I have heard military instructors refer to the fine line between “hard and dumb” when it comes to challenging routines. A surefire way to leave a training scar (i.e., the dumb approach) would be to take your candidates with their newly minted SCBA donning skills into a burning building and shut off their air. You watch them thrash around for a few seconds, turn their SCBA back on, drag them outside, and then berate them in front of the other students and instructors for “trying to get themselves killed!” They actually have behaved exactly how we expect the human animal to behave when threatened and feel as if they can’t breathe-sheer panic.

The smart-but-hard routine is systematic. For the sake of illustration, I will briefly go over how I train new candidates on SCBA donning and emergency procedures. It begins with a classroom presentation about the SCBA, moving on to a hands-on review. With an instructor leading, we show them and have them find for themselves every part on their SCBA. From here, we guide them through donning their SCBA, one step at a time, as they are instructed to. This method allows us to prevent performance scars right away. Through dozens of repetitions in the classroom and a solid hundred more for homework, we lay the foundation for effective donning. After six or seven hours, we will begin to add an initial layer of stress-time. Timed donning drills have a consequence, usually five or 10 push-ups. The initial time standards are very generous, 90 seconds or so, to train the student to handle the stress. We could, of course, make the initial time standard 60 seconds (which is the minimum passing time), but then there would be a lot of push-ups done and a great increase in anxiety. Once we warm the group up with a few 90-second drills (which generally everyone passes), we can then slowly work our way toward the 60-second mark. As the time standard gets closer to the neurological skill capacity of the students, their anxiety will increase (they don’t want to do push-ups). We coach them to control their breathing and focus on their procedures. By the time this initial SIT phase is complete, most of our students will have done some push-ups, and a few will have become quite stressed out. We go back to a slow, mentored approach, without the time standard and reinforce quality mechanics in donning, leaving the students aware of their difficulties but with the knowledge that they did in fact meet the time standard several times when it was manageable and that their skills are improving.

I liken this process to training someone who is learning how to lift weights. When someone begins learning how to squat or dead lift, he is initially weak relative to his potential. The reason is that he has neither the technical proficiency or the neurological pattern to move the load efficiently nor the contractile muscle force. As he begins training, he will initially see a large increase in the load he can move as he becomes neurologically adapted to moving the weight. However, he will then plateau unless he increases the load he is moving and forces the body to adapt.

Adaptation is adaptation-it doesn’t happen overnight. Whether learning how to powerlift or practice SIT, we need a slow, steady increase in the stress load that disrupts homeostasis but does not overload the system to cause damage.

THE ISLAND OF MISFIT TOYS

Instructors who will use SIT in their programs (and we should) must have more than a basic understanding of the human animal and the effects of stress on the body. I have examined this in some detail in The Combat Position: Achieving Firefighter Readiness (Fire Engineering, 2011) and highly encourage instructors to look deeply at works like On Combat by Lieutenant Colonel Dave Grossman and Loren Christensen; Warrior Mindset by Mike Asken (with Dave and Loren); Bruce Siddle’s Sharpening the Warrior’s Edge; and articles by Donald Meichenbaum, Jerry Deffenbacher, and their colleagues who are looking into effective methods for implementing SIT.

What we must avoid in our training is turning firefighters into a living, breathing version of the Island of Misfit Toys from the Rudolph the Red-Nosed Reindeer TV special-bighearted but damaged. It is relatively easy to create a stress-inducing drill; the challenge is doing it in a manner that will allow the firefighter to grow, learn, and emerge stronger. That should be our ultimate goal.

PRIMUM NON NOCERE

“First, do no harm” is the translation of the Latin phrase above. It’s found in many ethical codes, including those of first responders. The Hippocratic Oath of the physician in part states, “I will do no harm ….”2 It’s a reasonable way to live your life: Try hard not to hurt people.

As instructors, this must be among our primary concerns, and yet we still hear of reckless instructors who injure or kill students during poorly planned evolutions. It’s often easy for us to look at training burns where fatalities occur and spot the errors. This is not always the case in a poorly designed SIT scenario. However, you can look around a firehouse fairly quickly and spot the damaged firefighter. He is the one who doesn’t participate, is unwilling to engage in the discussion, or issues the “Training is stupid-I know my job” statement. Although there will always be lazy people in any profession, I have seen that in an environment where firefighters are encouraged to participate, to learn, and to make reasonable mistakes, far fewer withdraw from training.

BREATHING CONTROL AND VISUALIZATION

A full treatment on techniques for mastery of stress control is beyond the scope of this article; however, I can introduce two topics that have tremendously positive effects. Breathing is the only function of our autonomic nervous system that we can control voluntarily. Training your students to control their breathing during SIT drills is the first key step in helping them manage their stress. I use two drills.

The first breathing control drill I teach is drawn from On Combat and used with the permission of Dave Grossman. Have your students close their eyes. Instruct them to inhale through the nose for a count of four, pause for a count of four, exhale through the mouth for a count of four, and pause for a count of four. This four-count breathing exercise has been shown to help reduce anxiety and anxiety-induced heart rate increases. This drill is excellent when the student is beginning to experience anxiety-for example, before an evaluation or when a call is dispatched.

The second breathing control drill I teach is for emergencies that occur in an immediately dangerous to life or health (IDLH) environment. I teach them to inhale deeply through the nose and try to fill their belly with air. This is a form of diaphragmatic breathing that encourages filling the lungs fully; when the lungs are completely full, exhale by humming your breath or through your lips. This method is based on the Reilly Emergency Breathing Technique.3 It is effective in scenarios where you have to focus on getting tasks accomplished and cannot afford to devote working memory to counting.

Warriors have used visualization drills since antiquity, and high-performing athletes use them to produce results. A way to learn this skill is to have your students mentally rehearse donning their SCBA. It is a skill in which participants must perform specific steps in a particular sequence. Once they have a sense of proper donning, have them close their eyes and visualize donning the SCBA. Once they have understood the basics, they can use these same techniques to practice emergency procedures and Mayday drills.

Coupling breathing control and visualization is a key in managing stress responses.

HELPING THEM HEAL

If you spend much time teaching firefighters, you will find yourself with a student who is already damaged. As an instructor, what do you do? You help him heal. I have corresponded on occasion with the firefighter I told you about earlier. Although there are still struggles, things to learn, and healing to happen, I don’t see the same sense of frustration and fear. Why not? We started to get on the right side of the problem. First and foremost, I acknowledged for this firefighter that not every hard routine is the right one and that while we need to have an intense level of mental and physical toughness, it must be mentored. Second, I used a process commonly used in SIT circles: Lay a cognitive foundation to help the student understand how and why stress reactions occur; then instruct in skills for managing the anxiety; finally, place him in an environment where he has to practice.

The single most important factor as an instructor is to remove your ego from the process. Focus on positive learning outcomes and understand that every word you use and every move you make will have an effect. Carelessness in word or action can leave a training scar. As instructors, we are preparing our firefighters to make the fireground a place where they can thrive. It is incumbent on us to instruct and not injure.

I have found over the course of a decade that the simplest means of accomplishing this is with SCBA donning and emergency procedure drills, like those I described earlier. Why? Human beings hate having their faces covered, hate being in an enclosed space (even if they don’t have a phobic reaction), and hate the thought of consequences for poor performance. On a bright sunny day, I can “create” stress just by holding a stopwatch. They know from the classroom that the stress is manufactured inside them, not by an outside antagonist. With this knowledge, I can train my students to manage the stress they have created: Perfect practice, breathing control, and visualization are all tools.

ENDNOTES

1. Meichenbaum, Donald H. and Jerry L. Deffenbacher. “Stress Inoculation Training.” The Counseling Psychologist, Vol 16, No 1, January 1988, 69-90.

2. North, Michael (trans.) “Hippocratic Oath,” National Library of Medicine, National Institutes of Health, www.nlm.nih.gov/hmd/greek/greek_oath.html, 2002.

3. Gagliano, Mike, et al. Air Management for the Fire Service. Fire Engineering, (2008) 527-528.

CHRISTOPHER BRENNAN is a 14-year fire service veteran, a firefighter in the suburbs of Chicago, and the president of Spartan Concepts, Inc. He is a field instructor with the Illinois Fire Service Institute and has contributed articles to Fire Engineering. He maintains the Web site www.fireservicewarrior.com and is the author of The Combat Position: Achieving Firefighter Readiness (Fire Engineering, 2011).

Christopher Brennan will present “Fire Service Warrior Fitness” on Wednesday, April 24, 2013, 10:30 a.m.-12:15 p.m., at FDIC 2013 in Indianapolis.

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