Sirenicide: The Impact of Stress on Vehicle Crashes

I'm doing great today. Thank you for having me. How are you doing?

Well, as you mentioned in my bio, my background was in safety — occupational safety — and as I moved on, I wanted to do research that tied my professional career in with my educational career — educational background in safety. So, I started just doing a quick examination, which anybody who has had Firefighter 1 knows that leading causes of firefighter deaths are going to be cardiac stress related.

I started looking at the traumatic and safety side and acute traumatic deaths in the fire service, and continually for decades now, vehicle crashes — emergency vehicle crashes — have been one of the leading causes, if not the leading cause of traumatic death. And in fact, firefighters are more likely to die on their way to a fire than they are inside of an actual fire, and that hasn't really changed over the years.

So, that piqued my interest. It was a well-known problem. But what really, I think, scared me the most is the fact that we're most likely to kill civilians than we are firefighters inside of the vehicle. So, a fact that really piqued my interest was that we kill, on average, about 10 civilians for every 1 firefighter that we lose in a vehicle crash, which is terrible.

And of course, the liability side — the legal side — that the cost to departments. So, it's a big issue and really has not gotten much better in recent years. So, that made me want to really focus on that and see what I could do to help solve that problem.

Exactly. You've got that ripple effect of now they can't provide the service that they were originally set out to, to provide. So, yeah, it's not just the crash that has the impact, it's the ripple effect that goes on.

You mentioned at the start about some of the recent research on the conspicuousness of vehicles. So, you know, we look at reflectivity; we look at lighting. That's a big one, and really interesting studies on that. And the U.S. Fire Administration even has focused on tanker or tenders depending on what part of the country you're from.

Trucks, because they're so dangerous. In fact, the leading cause — root cause of most crashes is the human factor. It's the person setting behind the driver's seat, and that ultimately is who has control over that vehicle, so that it kind of makes sense that that would be a root cause. So, I just sort of kept asking why, so we know that it's human factors, and well, why is that?

And the common denominator is a sense of urgency for the driver, that "get there-itis" is a term I've heard used before. So, we have a sense of urgency to get to the scene at all costs, no matter what. Which leads to aggressive and risky driving behaviors. And changing your risk perception a little bit whenever you have that sense of urgency pushing you in the back of your mind.

So, that's where I really, really focused. And an anecdotal example was in, I think, 1979 in Catlett, Virginia, just south of D.C., there was an engine that was responding to a car fire that missed the driveway, went about a mile too far, had to turn around and come back. In the meantime, the chief had beat him on scene.

There was a whole series of events that really led them to a sense of urgency to get there. And, as they were turning up the driveway, the 5 firefighters on board pulled in front of an Amtrak train going 75 miles per hour, which, as you can imagine, didn't end well, led to a couple fatalities as the 2 front firefighters derailed a dozen or so train cars.

And what was just a simple, you know, single company response snowballed into multiple agencies from multiple counties responding and after a pretty in-depth investigation into that, they determined that it was that sense of urgency. The witnesses said that the engine driver didn't even look both ways before he crossed the tracks.

He was focused on fire. So, you know, great example of what led to my research questions.

Right. So, there's a lot of things. The way that you are dispatched is what really piqued my interest. I was able to attend — in 2011, I think — to hear a presentation at the IAFF's Redmond Symposium on research that was done in Detroit, where they studied firefighters’ physiological response, mainly to fires, but what they found during that was that at the time of dispatch, a firefighter's heart rate will jump up.

And of course, you have a startle response, but what was interesting was it was dependent on the type of dispatch that they were responding to. So, fires in 1 study, I don't believe it was that one, but fires whenever they heard the word “fire” led to a more physiological arousal state.

So, more excited state of mind than did maybe a medical call. And what was noticed was that anytime the word entrapment was involved, that their heart rate went to red line. I mean, it was almost as high as the actual doing the work itself once they got on scene. So, that was a pretty good indicator that, you know, maybe we don't perceive all calls the same way.

And if it was affecting us — certain calls, certain dispatches led to more urgency — then maybe that leads to more risk. So, I wanted to correlate those 2 things. So, what I decided to ask was that right there. Does the type of response, the type of incident that we are responding to correlate with an increased risk of crash?

And how I was able to test that was using the U.S. Fire Administration's databases that already exist. I was just able to code those a little bit differently than what had been done in the past. So, the first thing that I did was looked at the firefighter fatality database, and I had to read through the narratives.

Each one of those has a narrative, which I would encourage anybody in the fire service to take the time to read some of those because it's really sobering. Because of so many of those actions are things that many of us do every day. So, I read through probably 2,000 fatalities, pulled out all the ones that were involved in a crash, and then of those, I pulled out the ones that were involved in a response or returning from a call.

So, my first question was, is there increased risk during responses compared to returning? Because those should be about the same trip. The distance from the station to a fire is about the same distance, or they're the exact same distance, than the return trip. So, that was my first question. So, I was able to determine that from that database. And then the next question was, what were they responding to whenever the crash occurred? So, of course, I excluded just driving to a training session or driving between stations, anything like that.

It was — just had to be during a response. So, that was the first set of data that I was able to code all that from, and I coded it very similar to the NFIRS coding system, because that was where I had to pull some other data from. So, what I found was 144 fatalities occurred while responding to an emergency of some sort.

Actually, that was 144 cases, not necessarily fatalities. So, some of those crashes occurred or led to multiple fatalities, but we considered that 1 case, 1 crash case. So, 144 occurred while responding. Only 12 cases occurred while returning, so 12 times more crashes happened while responding than returning from crashes.

So, that confirmed what we presume to be true, is that there's a lot more risk involved in emergency response than there is just normal driving, and that reinforced a lot of previous research that happened leading up to this.

So, as I looked at the types of incidents they were responding to, I noticed a trend very quickly that fires in general made up the majority of those.

And in fact, just fires in general, all types of fires, made up about 56% of the fatal cases that led to a firefighter — 1 or more fatalities of a firefighter. Now, 56% might not seem like that big of a deal. And that led to my next question, which I had to pull from the database to control for how many fires do we respond to?

You know, if it's 56% of the fatal crashes, and we have about 50% of our calls be fires, then that's not really significant at all. So, then I pulled from the NFIRS database to see what our average nationwide fire department responses is. And as many of your listeners I'm sure are aware, most of the responses aren't fires in the U.S. fire service today.

Most are medical in nature and actually a small percentage are fires. That also wasn't the whole thing. I also had to account for how many vehicles — how many apparatuses or vehicles responded on average to each type of fire. And of course, a house fire would have more engines and ladders and vehicles responding to it than would a routine medical call, or maybe even a minor vehicle crash.

So, I had to account for those 2 things to really give a solid statistic. Combining those, what we call it is an exposure. So, fires made up a little bit less than 12% of the exposures. That's accounting for number of fires and response vehicles going to each one but accounted for almost 56% of the crashes.

So, that was strongly disproportionate. Among those, the worst offender was structure fires. So, structure fires only make up for a little less than 7% of the exposure responses but made up 35% of the total fatal crash cases. So, very disproportionate there when it comes to structure fire.

So, that was the highest risk response that was assessed here. Moving down to the EMS type of calls, EMS calls as a whole make up a little over half — 53% of the response’s nationwide vehicle responses, but only made up about 37% of the crashes. But, within those, when you start looking at rescues where you have potentially somebody entrapped, which makes up a little less than 12% of the total exposure responses, that accounted for almost 27% of the total fate of crashes.

So, again, very disproportionate numbers there. So, whenever you crunch those numbers and look at the actual risk, what's called a risk ratio relative to everything else when firefighters are responding to a fire compared to all other types of incidents, they encounter about a 9.5 times higher risk of a fatal crash occurring than they do any other type of response.

And the worst of those is a structure fire. When looking at structure fires compared to EMS calls — so EMS are the most common type of call and structure fires are what we would imagine the pinnacle of our training to be. It's almost 20 times higher risk between those 2 types of responses. So, it was a very significant finding.

It was sobering for sure to see the numbers as they played out, and I knew it was going to be bad as I started counting, but I didn't realize it was going to be that bad. So, yeah.

Well, that was sort of where I stopped, and then officially for my schooling project.

But, of course, I had that question in my mind and wanted to look at, okay, how do we calm down? So, an interesting thing that I noticed back in that Detroit study was that more senior firefighters — more experienced veteran firefighters — didn't have nearly as much of an excited response to the call.

That's not much surprise. You know, they've been there done that, and they know what to expect is really what it is. So, the good news is that you can train for that, and we've got technology now that is great for this, but you can, you know, simulate the responses before they even happen. So, if we can desensitize ourselves to fires — structure fires — and make it more routine in our minds, that’s going to lead to a decreased sense of excitement.

I think that probably maybe the biggest thing is a bit of a culture change. I like to say that the response time between your station and that emergency incident is out of your control. And we have to accept that. The distance between the fire and your fire station is set.

So, if it’s 2 miles today, it’s going to be 2 miles forever. If it’s snowing, then it’s going to be a slower response. Even though the emergency hasn't occurred yet, the amount of time it takes you to get there is out of your control. And we have to accept that there are some things that are out of our control.

The things that are in control — in our control, of course, that's what we need to really focus on, you know, being very efficient in the station and being very efficient once we get on scene. But, if we accept that, then we're going to have a little bit less sense of urgency.

The other thing is, the military, especially Special Forces, has some breathing techniques, such as box breathing. You can Google that if you're interested. And also what's called a physiological sigh. Both of those are really good tools that can help you calm down and not only become a better driver, be more aware, but also a better decision-maker once you get on scene.

So, it's a great tool for officers, too, that might have to make those spur of the moment high-stress, high-urgency decisions once they get on scene. So, that's going to help increase your situational awareness for everyone. If we can just learn to reel it in a little bit and stay within our — stay in our minds.

You see a lot of progressive agencies now are using that research, and there's been a lot of research recently on exactly the topic you are talking about to reinforce the fact that not everything is a true emergency, and based on that dispatch information, you have to determine whether that increased risk of running lights and sirens to a call is worth it. And many progressive departments are reeling that in a lot and determining, okay, here's a set list of types of calls that we will consider a true emergency, but everything else that couple minutes isn't going to make a big difference for the amount of risk that we're putting our members and also the general public in to — to get there.

And you're right, it spans across fire and EMS and law enforcement too. Of course, each one of those has their own dispatches that are going to increase their level of excitement.

One of the things I thought was interesting was that law enforcement officers have an increased arousal response whenever they have to back up another partner. Also, anything that involves weapons was the 2 higher level of stressful types of dispatches, which wasn't much surprise. I mean, there's a lot of camaraderie in law enforcement and anytime that you hear somebody is in need, you want to hurry up and get there.

And in EMS, it was children, any calls that involved children. Again, no surprise, but those dispatches lead to higher heart rates, higher respirations, higher stress hormones. So, there's another research project if anybody wants to duplicate this in the EMS realm, for sure.

And who's going to make the most difference in those calls is going to be the first-arriving apparatus. And many of these crashes were for mutual aid responses. So, even going a county away or the second-, third- or fourth-due apparatus.

Which, maybe there's a causal link there that when you already feel like you're behind the ball or behind the game a little bit, you have even more sense of urgency since you're not the first one there.

That's the analogy that I like to make is, you have soldiers, anyone in the military, they finish up their basic training and they're perfectly okay going to war.

I mean, many occupations, because that's what they are trained for. They've received all this training, you know, top-notch training, and they want to use it.

And when you feel that confident in your skills, you want to use your skills. So, I understand that. Everybody wants a key to the city, you know, everybody wants to save the day.

But we have to realize that we're saving the day just by showing up and doing the job.

Yeah, and I've got to clarify too that I'm not advocating for a completely risk-averse fire service. This is a risky occupation at times, but there are very, very few instances in my 20-some years that I have felt that an urgent need to take extreme risk was actually justified, and that assumption of risk isn't until we get on scene and make sure that that risk needs to be taken. So, we really have to sort of stand back and determine what we're weighing. But yeah, there certainly is times for it, but it's, it's very few, very far between.

Most — and you sort of alluded to it a little bit ago — most of the crashes were about — actually two-thirds of them were amongst volunteer firefighters, which — be a solid warning to the listeners who are in volunteer fire service that you are at increased risk for a fatal crash to occur.

Now that might seem proportionate, but if you look at most of the U.S. population is protected by career departments, then that's going to be who's running most of the calls. So, that was a little bit disproportionate. I didn't go any further than that. That was just a sort of side finding that I was like, that's sort of interesting.

That was everything, every type of vehicle. So that was all vehicles combined, which also led to what type of vehicle they were in. And a good proportion — let me get you an actual number here — was in personal vehicles, as opposed to other types of vehicles, as opposed to tankers or tenders or engines or ladders.

So, many of those were personal vehicles.

Yeah, you’re absolutely right, we have to just reel it in and stay in our mind and realize where that risk is.

And yeah, all those things with vehicles, they all matter, but ultimately, it is the driver which is the hardest thing to control. You know, it's easy to paint vehicles different colors, add more stickers, add more lights here and there. The hardest thing to control is the behaviors of the person behind the wheel.

So, when you're climbing into that front left seat, assuming you're in the U.S., then you have a lot of responsibility on your shoulders. And just the end of the day, I was responding to a call, and I was thinking to myself, what’s something that would hit home to me, that would make me maybe want to change my behaviors, and I imagine my wife and a baby boy standing along the road somewhere between here and that call.

How would I drive? If I imagine I know they're somewhere along the road, and that hit home to me. So, I would take no risks at that point, which is how we should see everybody's families who are out along our highway.

Yeah, it's easy to get complacent with that, and what's even scarier is that whenever you are excited to a certain level, you don't realize you are inhibited by that.

It's just like being drunk. You know, after a few beers, many people think they're perfectly fine to drive. They don't realize that they're inhibited. They don't know that their responses are delayed. And acute stress is the same way. When you are under acute stress, you get tunnel vision. That's where you'll notice that you get in the truck to respond to a call and you can't hear what the dispatcher or anybody else is saying, so you crank the radio up and then you get back in the vehicle to go back home. And it's like, ah, why is that so loud? But nobody touched the volume.

So, yeah, that's — that's what's happening is your stress level is different. Whenever you get back in to just calmly drive back, then whenever you respond. So, if you're having that happen, that should be a red flag to you that yeah, work on some ways to reel it in and calm down a little bit.

They could just shoot me an email. Dusty, D-U-S-T-Y, Lambert, L-A-M-B-E-R-T, at gmail.com.