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HEROES AT RISK: An Overview of How Emotional Intelligence Can Reduce Death and Injury for Firefighters

Authors:

Abstract

Contrary to popular belief, the leading cause of death for firefighters is heart attack, not physical injury. Even more startling is the fact that most deaths do not happen during an active call. Over 47% of firefighter deaths are due to cardiac arrest (USFA-FEMA, 2013). Although various prevention methods have been defined and put into place, deaths have not decreased over the years, fire ground injury rates have held steady, and stress levels are increasing (Carlisle, 1999). This lack of improvement confirms the need for new strategies that promote wellness, awareness, and effective personal reactions to incident-related stress (Brennan, 2002; Duncan, et al., 2013). While the number of fatal heart attacks has held steady, the attempts to reduce these statistics have centered on increasing physical exercise, better diet, reducing smoking and alcohol, more training in standard operating procedures, weight loss, and getting enough sleep (FEMA, 2002). The efforts that address fatality issues suggest improving physical health, but few define psychological or emotional programs to deal with the hidden effects of stress, and reduce the related results of injury and death. Exercise does help with overall health, but such programs have not reduced the deaths caused by cardiac arrest. Thus, other prevention factors must be considered. This retrospective study and exploratory paper investigates statistical facts regarding firefighter death and injury, describes current methods that try to deal with these, and defines an entirely new approach to help rescue our rescuers through increasing their emotional intelligence skills.
HEROES AT RISK: An Overview of How Emotional Intelligence
Can Reduce Death and Injury for Firefighters
Presented at the Second International Conference on
Emerging Research Paradigms in Business and Social Sciences (ERPBSS)
November 2013, Dubai UAE
by
Greta E. Couper, PsyD, MBA, BA, TESOL, CERT
Adjunct Faculty
The Fashion Institute of Design and Merchandising, Los Angeles, CA
E-mail: gcouper24@gmail.com
Word Length: 5164
KEY WORDS
Emotional Intelligence
Firefighters
Stress
Job Burnout
Emergency Personnel
Fire Service Fatalities and Injuries
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ABSTRACT
Contrary to popular belief, the leading cause of death for firefighters is heart attack,
not physical injury. Even more startling is the fact that most deaths do not happen during an
active call. Over 47% of firefighter deaths are due to cardiac arrest (USFA-FEMA, 2013).
Although various prevention methods have been defined and put into place, deaths have not
decreased over the years, fire ground injury rates have held steady, and stress levels are
increasing (Carlisle, 1999). This lack of improvement confirms the need for new strategies
that promote wellness, awareness, and effective personal reactions to incident-related stress
(Brennan, 2002; Duncan, et al., 2013). While the number of fatal heart attacks has held
steady, the attempts to reduce these statistics have centred on increasing physical exercise,
better diet, reducing smoking and alcohol, more training in standard operating procedures,
weight loss, and getting enough sleep (FEMA, 2002). The efforts that address fatality issues
suggest improving physical health, but few define psychological or emotional programs to
deal with the hidden effects of stress, and reduce the related results of injury and death.
Exercise does help with overall health, but such programs have not reduced the deaths caused
by cardiac arrest. Thus, other prevention factors must be considered. This retrospective study
and exploratory paper investigates statistical facts regarding firefighter death and injury,
describes current methods that try to deal with these, and defines an entirely new approach to
help rescue our rescuers through increasing their emotional intelligence skills.
Page 3
1. Introduction
Firefighting is a high risk, stressful profession. Firefighters and paramedics suffer
from job stress, burn-out, and retention issues due to the very nature of their work (Brennan,
2002; Fishkin, 1989; Kennedy, 2007). They are required to respond immediately at all hours
to emergencies, risk their lives in dangerous situations, deal with the loss of people they
could not help, be exposed to death and destruction, and handle interactions between
stressed/ill/angry people, among other incidents. Although they are carefully trained in
standard operating procedures, they are often not prepared emotionally to deal with all the
aspects of unknown situations, or the lingering after-effects of stress (Carlisle, 1999; Shantz,
2002). This can disrupt their careers, health, decisions during an event, and even personal
relationships, sometimes resulting in unexpected heart attacks (Firefighter Nation, 2013; Los
Angeles Fire Department, 2013). This paper is designed to highlight the literature review on the
efforts to improve safety for firefighters through an emphasis on learning emotional in addition to
operational knowledge.
Society has an investment in the ability of firefighting personnel to maintain their
responsibilities effectively. With the increasing threats of natural disasters, terrorist attacks, active
shooters; residential, commercial, and wild-land fires; homeless medical needs, urban rescue,
daily hassle (e.g. pet rescue), and other intrusions, people depend on firefighting personnel for a
safe and secure environment (Milen, 2009). It is a fundamental aspect of community service. But
fire department personnel work long hours with much stress, both anticipated and actual, and thus
they need to recognize and implement effective coping strategies.
There is an on-going crisis in the firefighter and paramedic fields, and the related
emergency service occupations that deal with very stressful situations (Brennan, 2002; Fishkin,
1989; Karimi et al., 2013; Lloyd, 2004; Maslach, Schaufeli, and Leiter, 2001; Shantz, 2002).
In addition to dealing with dangerous incidents, there are major concerns within the
profession including worker shortages, budget constraints, lack of specialized equipment and
training, complexity of incidents, high levels of stress and burnout, increased terrorist and
active shooter events, communication and relationship issues, health concerns, and an aging
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population that requires more emergency services (Carlisle, 1999; Cline, 2013; Firefighter
Support Foundation, 2013).
Over 47% of firefighter deaths are due to cardiac arrest; 32% of all fatalities are not
incident-related and occur off-duty; and 16% of deaths happen after responding to an event
(USFA-FEMA, 2013). Heart attacks for firefighters are also significantly higher than for
police and construction workers (FEMA, 2002, p. 26). They are 44% firefighters, 25% for
guards, 22 % for police, 15% of other occupational fatalities, 10% for construction trades,
and only 10% for construction labourers.
These facts highlight that firefighter rescuers need more protection from hidden
emotional stress before, during, and after an event. Emotional Intelligence (EI) has been
shown to reduce stress, improve decision-making skills, promote effective communication,
reduce burn-out, and increase job satisfaction and retention among emergency service
workers (Barishansky , 2013; Brennan, 2002; Ghalandar and Jogh, 2012; Karimi et al., 2013;
Smith, 2007; Solverson, 2007). Thus, increasing EI skills among firefighters and paramedics
becomes a crucial task in protecting our rescuers.
2. Programs to reduce stress
Firefighters have one of the most stressful jobs in the world (Brennan, 2002; Finley,
2002; Fishkin, 1989, Frolik, 2012). Stress can cause an inflammatory response, which then
leads to illnesses such as heart disease, diabetes, anxiety, depression, and post-traumatic
stress disorder (PTSD) (National Volunteer Fire Council, 2013). Throughout their careers,
they are expected by the department, civic groups, city government, and the public to perform
like heroes. But they are not superhuman They are just ordinary people asked to be
extraordinary in emergency situations (Ottlinger, 1997). Like others, emergency service
personnel have their limits. Unmanaged stress is a serious problem. It is critical for fire
suppression and emergency medical service (EMS) programs to define and implement
methods to determine when stress is high by recognizing the symptoms, and providing
training to help diffuse the emotional reactions to traumatic incidents. When stress is too
great, symptoms such as ‘blanking out', not thinking clearly, and not knowing what to do next
can occur (Gohm and Baumann, 2001). Fullerton et al. (1992) added other negative reactions
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such as identification with the victims, feeling helpless and guilty, and having physical
reactions.
In addition to general job stress from emergency incidents, burnout for firefighters
and EMS personnel may be caused by public abuse of services, lack of sleep, high levels of
responsibility, lack of autonomy, providing basic medical care instead of using required
advanced medical expertise, and feeling unappreciated (Lloyd, 2004). Hildebrand (1984; as
cited in Brennan, 2002, p. 11) outlined five stressors as: Level of uncertainty, physical
response to an alarm, interpersonal tension, exposure to human tragedy, and fear. Wellness in
the fire service includes the control, diffusion, and management of firefighter stress reactions.
Research has shown that when firefighters learned to manage their stress they showed better
physical and psychological wellness, higher morale, and less absenteeism (Shantz, 2002).
Although the number of fatal heart attacks among firefighters and paramedics has
held steady, and is a critical problem in the profession, the attempts to reduce these statistics
have centred around increased physical exercise, better diet, reduced smoking and alcohol,
more SOP training, weight loss, and getting enough sleep (Federal Emergency Management
Agency, 2002). The American Heart Association website contains educational materials on
prevention strategies and heart attack (http://www. americanheart.org). Firehouse Magazine
(http://www.firehouse.com/fitness/) has information on fitness and well-being. This includes
workouts for firefighters on cardiovascular conditioning, strength and flexibility training, and
information on health trends (FEMA, 2002, p. 44). Physical fitness programs will inherently
help with stress, but such programs have not reduced the deaths by heart attack. Thus, other
causes and prevention programs must be considered.
In regard to emotions, there is a belief that a firefighter (FF) might be seen as weak if
he shows emotion or seeks psychological counselling (Dill, 2011). The expectation to
perform flawlessly in every emergency situation can be emotionally draining. The conflict
between reason and emotion might have started with the stoics of ancient Greece who
regarded feelings as being too self-centred to be reliable. Unfortunately, because fire service
culture is built largely on bravery and pride, firefighters often refrain from asking for help.
Another significant problem is that counsellors provided through health insurance programs
often do not understand the fire service industry (Pindelski, 2013).
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But, there is a growing recognition in business that highly successful people aren’t
just technically competent; they possess special people skills, or emotional intelligence
(Becker, 2013; Kastros, 2013; Messenger, 2012). During long periods of stress some
firefighters have suffered depression, addictions, suicide, sickness, anxiety, anger, PTSD, and
even homicide (Dill, 2011; Pindelski, 2013). McNamee (2001) pointed out that on average
firefighters die 10 years younger than the general population, and suggested stress and heart
conditions were a primary cause. Firefighter suicides contradict the very basis of fire service
because the profession is established to help save lives, so it is the antithesis of the code of
conduct when one takes his own life.
The symptoms of PTSD caused by stress falls into the following categories: Intrusive
memories, emotional numbness, avoidance, anxiety, and increased emotional arousal.
(Pindelski, 2013) Intrusive memory symptoms are defined by Pindelski (2013, para. 9) as “. .
. continuously reliving a traumatic event through flashbacks or nightmares, which strengthens
their negative impact, undermining health.” Avoidance or emotional numbing is exhibited
when a firefighter deliberately avoids talking about an event, quits enjoying hobbies, forgets
things, and has trouble concentrating and maintaining relationships. Anxiety and increased
emotional arousal can cause a firefighter to be highly irritable, show anger, or suffer from
insomnia. Other symptoms of stress include greater chance of cancer, viral infections,
weaker immune system, depression, myocardial infarction, ulcers, diabetes, and asthma”
(Goleman, 1995, p. 172). By contrast, learned optimism applied through the use of Emotional
Intelligence has a subtle healing power, resulting in faster recovery or a reduction in
symptoms.
A review of literature shows just how critical psychological wellness is for fighting
occupational stress. Incidents of global and local terrorism such as the World Trade Centre
bombing, the Columbine High School incident, and the Atlanta Olympic Park bombing, and
the rise of active shooters, require fire service personnel to endure terrible physical and
psychological battering as they perform their duties (Carlisle, 1999; Cline, 2013). Sometimes
it is the fame that occurs after a high-profile rescue that causes emotional trauma. A sad
example involved firefighter Robert O’Donnell (Katz, 1995). He was hailed as a national
hero after he rescued a baby from a well in Midland, Texas. He then suffered severe Post
Traumatic Stress Disorder (PTSD) from both the stress of fame and then the ensuing loss of
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public interest. He gradually became an emotionally troubled firefighter, lost his job and
family, and eventually committed suicide. He was a victim of psychological trauma related to
his profession (Katz, 1995; Munk, 1998).
What can be done to protect emergency responders? One answer is that through EI
workshops firefighters (FFs) and supervisors can become educated on the prevention and
awareness of emotional and behavioural health issues within the fire service. Not all FFs
respond the same to traumatic events. The difference, and why such occupational stress is
critical to acknowledge within the fire service, has to do with the "unfortunate regularity"
such workers face in horrible, dangerous, and stressful situations. But eeven as reliance on
Standard Operating Procedures (SOPs) and Standard Operating Guidelines (SOGs) has
increased over the years, fire ground injury rates have held steady, and stress is increasing
(Carlisle, 1999). This lack of improvement shows a need for other prevention strategies in
promoting FF awareness and reactions to stress (Brennan, 2002; Duncan, 2013). Duncan et
al. (2013) studied international fire departments from Australia, Canada, Japan, the United
Kingdom (U.K.) and the U.S., and there was much variability in SOPs.
Those in leadership roles, such as Fire Chiefs, have always been responsible for their
firefighters' health and safety, but that responsibility now includes recognizing emotional and
behavioural issues that can be just as debilitating as a line-of-duty injury (Dill, 2011). In
addition to traumas experienced on the job, officers must be aware of outside influences, such
as financial loss, a major lifestyle change, or family illness. Lorber (2013) and Divver (2013)
outlined the specific use of emotional intelligence within a Fire Chief’s leadership using
Goleman’s (1998) five EI components of self-awareness, self-regulation, motivation, empathy,
and social skills. Job competencies are of two types; hard skills and soft skills. Hard skills are
the mechanics of the job, like rescue procedures, EMS protocols and SOPs. Soft skills, or
emotional intelligence, are less tangible but even more important. Organizational
development research shows that more than 65% of skills essential for effective job
performance are soft skills (Dill, 2011; Pessemier, 2003). Officers not only need the ability to
read how fires react and behave, but also to read and respond to the reactions and behaviors
of Firefighter/Paramedics. The International Association of Fire Chiefs strongly recommends
that departments include relevant health and safety training to ensure the safety of fire/EMS
professionals (International Association of Fire Chiefs, 2013). Firefighters inherently focus
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on the mission at hand, but officers must reinforce the importance of and methods for
FF/PMs to save their own lives as well as the lives of other emergency responders.
3. Applying emotional intelligence to firefighter tasks
Fire fighting is unique. While the actual day-to-day tasks are similar and repetitive,
they are never in the same setting or situation! The in-station tasks of equipment maintenance
and SOP study are balanced by the emergency calls. Waiting for a call is a primary task in a
firefighter’s life, but when the alarm sounds they must immediately react and jump into
action (Barnes, 2000). This causes physiological and psychological stress (Solverson, 2007).
A firefighter’s training might be assumed to offer protection from the stresses of their work.
This is a false assumption. As acknowledged by the scholars in the field no SOP training can
help prepare firefighters and paramedics for the trauma of “dismembered bodies, the screams
of injured children, knowing that people may be trapped in a burning building, or having to
deal with distressed people who suspect family members may be trapped” (Barnes, 2000. P.
60). They carry this stress with them even when off-duty, affecting their mental and physical
states, health, and personal relationships.
Psychological stress a complex phenomenon. Actual research on the effects of
firefighter stress is scarce, and thus meta-analysis is not practical due to the variety of
measurement techniques, and reporting incidents within the fire service (Burgess, et al.,
2013). Information on job related stress in related emergency service fields was also
reviewed (Ashkanasy and Humphrey, 2011; Ghalandari, and Jogh 2012; Karimi et al., 2013).
Solverson (2007, p. 2) stated “the importance emotional intelligence plays in job
performance, advancement, and survival redefines what it means to be a smart firefighter.”
To persevere under pressure is a vital emotional competency.
Emotional labour describes how individuals manage their emotions in job situations
(Ghalandari and Jogh, 2012). It exists widely within the human service industry. Employees
can manage emotions through two different processes: (1) surface acting and (2) deep acting.
In surface acting, employees react in a style requested by an employer, even when they may
feel differently, perhaps using a counterfeit a smile to deal with problem clients. Deep acting
requires more control of internal thoughts (Brotheridge, 2006).
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Emotional intelligence (EI) is “the ability to perceive emotions, to access and generate
emotions so as to assist thought, to understand emotions and emotional knowledge, and to
reflectively regulate emotions so as to promote emotional and intellectual growth” (Mayer,
Salovey, and Caruso, 2004, p. 197). EI is as necessary as Intellectual Intelligence (IQ) for
success in life. Intellectual Intelligence works to acquire learned facts to understand and
resolve an issue, but EI helps manage the stress and emotions to implement these solutions in
an optimal way. The components of EI include: self-awareness, self-regulation, motivation,
empathy, and social skills (Goleman, 1998, p. 94; Salovey and Mayer, 1990). These are
relevant to firefighters and paramedics because they are all important in the interaction with
clients, staff, and colleagues; the lack of such skills can result in ‘burnout’ and high turnover
(Ashkanasy and Humphrey, 2011). To prevent this, firefighters, paramedics, and other
emergency care workers must learn to adopt new strategies to protect both their health and
that of the people they treat and work with (McQueen, 2004) Studies have found that
stronger emotional intelligence skills reduce self-reported traumatic stress, depression, and
anxiety for firefighters (Solverson, 2007; Wagner and Martin, 2012). By educating and
creating awareness about stress, and by implementing emotional intelligence skills and
changes in lifestyle, the overall health of firefighters can be improved (National Volunteer
Fire Council, 2013).
Seyle (1974) wrote about three stages of firefighter stress reactions during an incident:
1) the alarm or emergency reaction, 2) the resistance, and 3) the exhaustion stage (p. 26). In
the alarm stage a physiological rush of adrenalin occurs while the resistance to stress
diminishes. This is the fight or flight stage. During the resistance stage the body adjusts and
resistance rises, but in the third state exhaustion sets in, the body can no longer sustain the
resistance, and the symptoms from the first stage return, sometimes causing death. Brigati
(1995) suggested that education is the key to managing stress. By understanding how and
why stress occurs each person can develop practical solutions to stress and the ensuing
physiological reactions. Stress is cumulative. This is very important because while
occupational stress does occur during emergency incidents, the connection between
momentary stress and lifelong stress is not always emphasized or understood (Finley, 2002).
Casey (2013) stated that research supports a direct correlation between EI and
successful leadership. He stated that “Fire officers obviously cannot solve every problem, but
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they can surely recognize that every problem has an effect on human feelings that is unique to
every person, time, and circumstance. The presence of emotion should never be overlooked,
particularly during times of heightened sensitivity (p. 25).
The Fire Service’s primary role is to protect lives and property. In emergencies the
management style is ‘command and control, but since fire related incidents account for only
3% of emergency responses, the ‘command and control’ approach to general day-to-day
management or medical EMS responses might not be the most effective (Casey, 2013; Smith,
2007). For the other 97% of incidents, a more effective approach would use the principles of
positive leadership and Emotional Intelligence (EI). Whereas Goleman (1998 as cited in
Bradberry and Greaves, 2005, p. 31) used a four prong approach to EI that consisted of
emotional awareness, self-management, social awareness, and relationship management,
others have divided these skills into five categories, as shown below. Lorber (2013) and
Divver (2013) defined five key elements of EI and how they might be used within fire
leadership:
1. Self-awareness. Is aware of feelings and emotions, personal strengths and
weaknesses. Takes daily notes and slows down when frustrated to examine why.
Understands own weaknesses and shares them with the crew.
2. Self-regulation. Does not attack others, rush emotional decisions, stereotype people,
or compromise values. Maintains flexibility, commitment, and personal
accountability. Knows and follows the fire department “code of ethics.” Holds self
accountable. Control impulses and channels that energy for good results.
3. Motivation. Works toward goals, show optimism, and respects the value and quality
of colleague’s work. Remembers the attraction of the job, and finds something
positive in each situation. Sets an example and shows a passion for purpose and
achievement to become a change agent for the fire service.
4. Empathy. Puts themselves in someone else’s position. Responds to body language
and feelings, shows appreciation to subordinates. Takes into account the feelings of
others.
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5. Social skills. Good communicator, open to both positive and negative news.
Manages change diplomatically, sets an example, and praises others. Builds rapport
with staff. (Lorber, 2013, para. 4; Divver, 2013, para. 8)
Lorber (2013) concluded by stating that the three most critical EI skills in a fire supervisory
role are conflict resolution, good communication, and praise of others; while Divver (2013)
stated that applying excellent policies, practices, and recognition will result in a dynamic
team of well-grounded, motivated, and competent firefighters.
4. Significance and innovation
Fire department personnel around the globe have both specific and universal traits
related to handling incidents and stress. Each country has its own codes related to priorities
for national health procedures for emergency professionals. By studying firefighter protocol
in diverse cultures a comprehensive EI foundation can be established that is generic to
firefighter tasks, which can be then used to promote and customize related EI training
programs. Some have even suggested that EI assessment be part of the hiring process
(Carlisle, 1999). But unlike the intelligent quotient (IQ) which is fixed early in life,
emotional intelligence (EI) can be learned through life experience and training courses
(McLaughlin, 2013; Messenger, 2012; Sells, 2013; Smith, 2007; Solverson, 2007).
5. Summary
The purpose of this paper was to provide an overview of how stress can affect the
health and well-being of fire fighters and paramedics, highlight the statistical facts
surrounding death and injury in the industry both on and off duty, and to formulate a plan for
positive stress reduction programs that utilize the principles of Emotional Intelligence.
Solverson (2007) listed an “Emotional Competence Framework” for applying EI in stressful
situations for firefighters. He stated that emotions are required in order to make rational
decisions; they temper automatic logic and result in more appropriate and effective
behaviour. However, this requires self-awareness of emotions which mediates any rampant
reactions, and results in a less stressful but more effective experience and better health.
Research in psychobiology has provided a greater insight into the scientific aspect of
emotions and physical changes that occur during emergency incidents. When firefighters do
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not have the chance understand and recover from earlier traumatic responses the symptoms of
stress may aggregate. Training in stress reduction techniques must be made available to
professional firefighters, paramedics, and other emergency responders to learn how to deal
more effectively with such emotionally charged duties.
How one thinks and makes decisions on a physical, emotional, and social level
delineates the consequences and reinforces the role that emotional intelligence (EI) plays in
job performance, wellness, and survival. The direct and indirect benefits and effects defined
through using EI to reduce firefighter/paramedic stress provides a promising solution to the
risk of potential hidden health issues and early death that plagues the fire service industry.
Page 13
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