Statistical data from 1970 showed that a firefighter's life expectancy was 10 years less than the average male working in either hazardous or non-hazardous occupations. Many fire service leaders believed that the major cause of this decreased life expectancy was exposure to the hostile and toxic environments encountered during fire suppression. By the late 1980s, many of those had implemented SCBA policies mandating that all personnel wear both face masks and SCBA anytime smoke was encountered on the fireground.

Recent research has solidified the need for firefighters to wear a complete SCBA unit to avoid exposure to the dangerous products of combustion such as hydrogen cyanide and the free radicals contained in smoke. Both fire service leaders and firefighters are aware of these dangers because they are reinforced constantly and consistently during both basic and enhanced training.

To protect firefighters from all the effects of toxic smoke and fire gases, some fire departments now mandate that firefighters wear SCBA while suppressing wildland and vehicle fires. In fact, some policies now include donning the face mask while en route to the scene of a fire incident. In most new fire apparatus, SCBA even are incorporated into firefighter seats. When they arrive at the emergency scene, firefighters now are considered to be in the ready mode.

Extended emergency response times, however, will find firefighters wearing their properly secured face masks for extended periods without breathing air from their SCBA. What are the long- and short-term implications of such a policy? Will firefighters who wear their SCBA face masks for extended periods of time without breathing from an air supply suffer physiological anxiety? Will this practice cause any or all of the physiological impairments associated with breathing carbon dioxide? If the answer is yes, will end-tidal carbon dioxide, or EtCO₂, affect a firefighter's cognitive abilities and/or emotional state of mind on the fireground? Are some of the poor decisions firefighters and leaders make on the fireground a direct result of the affects of breathing carbon dioxide?

Newer department policies and enhanced safety mandates have created a potential problem for firefighters wearing protective clothing ensembles that include SCBA. When a firefighter dons a properly secured face mask and then does not breathe from a SCBA air cylinder, he will be breathing carbon dioxide. High concentrations of carbon dioxide appear to affect cognitive function. This is detrimental to fireground leadership roles. Naval research using SCUBA instead of SCBA supports the seriousness of this problem.

Research assumes that exhaling into a vessel, such as a properly secured SCBA face mask, prevents exhaled carbon dioxide from escaping into the natural environment. The wearer of the mask is forced to re-breathe exhaled carbon dioxide. This practice can result in several types of physiological impairments. Some of the milder impairments associated with carbon dioxide inhalation include nausea, vomiting, dizziness, headache, rapid breathing, increased heart rate and flushing of the skin. Significant or severe carbon dioxide toxicity produces muscle twitches, hand flaps, reduced neural activity or diminished consciousness, rising blood pressure, anxiety and a loss of cognitive function. The body reacts to increased levels of carbon dioxide by significantly reducing the ability of an exposed person to solve problems, concentrate and conduct abstract thinking. There also is a reduction in spatial memory function.

Some researchers believe that a discrete change in end-tidal carbon dioxide levels will cause only a slight decrease in cognitive abilities. Other researchers argue that even modest changes in EtCO₂ affects cognitive function. Normally, the body will tightly regulate the partial pressure of carbon dioxide, or PaCO₂, in the arterial blood, but these levels will vary among healthy people who are either at rest or undergoing routine non-stressful real-life situations. At rest, a healthy person will exhibit a normal PaCO₂ range of 32-44 mmHg.

Excess carbon dioxide has an especially negative effect on some. Breathing carbon dioxide triggers a higher rate of panic attacks in patients already diagnosed with panic disorders than with other groups. Once a panic attack is triggered, however, even people with no history or diagnosis of a panic disorder will experience increased respiratory rates after breathing excessive amounts of carbon dioxide. Increased respiratory rates also can trigger panic attacks.

For firefighters, excessive inhalation of carbon dioxide leads to a number of serious physiological impairments, again including a higher level of anxiety than what normally is associated with fireground suppression activities. Firefighters wearing 50 or more pounds of protective gear will exhibit respiratory rate increases, even if standing still. Firefighters are trained to remain in control at the scene of an emergency. They learn to control emotions by focusing on using the cognitive and psychomotor skills necessary to both stabilize and mitigate the emergency. Even with all of their training, firefighters still are subjected to stress. Exposing them to carbon dioxide from secured face masks adds to the stress level and affects cognitive abilities by decreasing the ability to concentrate, conduct abstract thinking, use spatial memory and solve problems.

But despite all of these potential problems, firefighters are reluctant to change long-standing behaviors. Successfully dealing with the many layers of resistance firefighters will exhibit when faced with change requires a multi-faceted leadership process. Leaders will need to assess accurately existing firefighter behaviors and attitudes regarding the practice of donning the face mask not connected to a SCBA for extended time frames. Until the reasons for the specific changes are spelled out, firefighters won't understand why changes are needed. Leaders also must assess the readiness of the organization to participate in change by understanding the assumptions, values, beliefs, norms and behaviors that have gradually developed and are now rooted in the culture of the organization. Firefighters will need to be shown all of the facts pertaining to this issue. Only then will the facts begin to influence their thinking. Leaders will need to:

1. Increase the urgency.

2. Encourage responsibility throughout the organization.

3. Focus on the problem of implementation and influencing shared values and norms of the culture through the right vision.

4. Emphasize the importance of continuously improving communications and obtaining buy-in.

5. Create short-term wins that challenge the existing shared values of the organization.

6. Persist regarding the importance of not donning the SCBA for extended periods of time without breathing from air.

Two-way communication will need to be nurtured to ensure that complacency does not take root. A sense of urgency needs to be displayed during the planning stage for the change to be effective. To enhance the understanding of the value behind not donning the SCBA face mask while en route to an emergency scene requires a change in the existing core of the old culture. Many times, the old culture is not compatible with the new vision. Other times, only some of the specific cultural norms will be incompatible with the new vision. When this occurs, the leaders challenge is to graft the new practices onto the old root while killing off the inconsistent pieces.

The plan within a plan will consist of simple and direct communications on the physiological impairment associated with end tidal carbon dioxide changes resulting from donning a face mask and not breathing from an air tank. In fact, all communication for this change effort will be widespread and simple, without any jargon. Leaders will talk about the negative effects associated with donning the SCBA face mask and not breathing from an air supply and will write about the effects and be passionate about the physiological impairments associated with this practice.

The plan within a plan will instill a clear vision for the needed change. Eliminating the past practice can be accomplished by developing a mentoring program designed to nurture relationships and care for, coach and maximize the potential of the firefighters. Many different forums can be used to communicate the vision of the hazards associated with EtCO₂ effectively. Large group meetings, memorandums and informal one-on-one talks can create and maintain the sense of urgency for this change process. A specific forum could teach leaders how to exhibit greater individual considerations and promote intellectual stimulation for their followers.

One important issue must always be remembered when instilling any plan with-in a plan into any organization. The most compelling vision rarely sinks deeply into the consciousness of the organization; that must be accomplished using repeated and more repeated communications. This will help the followers understand the meaning of the vision. Therefore, some leaders believe that the key to getting results simply is to cast the vision again and again and again. Accomplishing a vision requires much more than a pep talk, however; it requires nurturing a relationship.

Another vital part of the plan is leadership by example. This practice is the most powerful way to communicate a new direction. Leaders must remember that telling firefighters one thing and then acting differently is one of the fastest ways to undermine the communication of change. Leaders who don't lead by example eventually lose credibility. Nonetheless, every transformation requires explanations of all the perceived inconsistencies. As followers, firefighters are understandably sensitive to any indication that leaders might not be doing their share.

Leaders may need to take an entirely different approach to leading by example. Instead of giving a vision talk, the leader can ask a more experienced firefighter to teach the team a basic SCBA skill that all of the firefighters already know. Each team member, including the leader, goes through the process of donning a SCBA without donning the face mask. Only after the SCBA is donned and just before entry is made into a mock hazardous atmosphere will the face mask be donned. This routine training will serve as a valuable leadership lesson. Firefighters need more than just a vision; they need a planned step-by-step explanation and demonstration that everyone takes part in, including the leader.

Effective fireground leadership requires that both fire officers and firefighters be responsible for protecting lives and property. To accomplish these tasks, firefighters and fire officers must use a combination of cognitive and psychomotor skills. Flawless cognitive skills give firefighters the ability to concentrate, conduct abstract thinking and solve critical problems. Flawless psychomotor skills give firefighters and fire officers the fine motor coordination and spatial memory necessary to maneuver through debris and hostile environments.

When a firefighter breathes through a secured SCBA face mask and does not immediately connect to an air tank, his or her body consumes oxygen and releases carbon dioxide by exhaling directly into the face mask. Because the carbon dioxide is not released into the environment, it is retained inside the air mask for firefighters to re-breathe. Carbon dioxide retention will increase a firefighter's end tidal carbon dioxide EtCO₂. Firefighters wearing their face masks while not connected to air show an increase in respirations. Their increased urge to breathe is caused by a build-up of carbon dioxide. Naval research conducted on divers using open-circuit SCUBA supports this observable fact.

Although research indicates even discrete changes in EtCO₂ levels will cause anxiety and physiological impairments, existing fire service cultural norms will have firefighters resisting the practice of not donning the SCBA face mask long before making entry into a hazardous environment. Firefighters tend to behave in ways that teach their existing beliefs and practices to new members. They will reward those firefighters who fit in and sanction those who don't. Therefore, the communication of physiological impairments as a result of EtCO₂ becomes difficult and will require a give and take of both the leader and the firefighters.

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Donald Adams has 33 years in the fire service and is currently the fire chief of Lehigh Acres (Fla.) Fire Control and Rescue District. Previously, Adams served the Orlando (Fla.) Fire Department for 25 years, and retired at the rank of district chief/paramedic. Adams also served as the fire chief of Osceola County (Fla.) Fire Rescue Department and deputy chief of administration with North Port Fire Rescue District. He holds a bachelor of science in business management and is a graduate of National-Louis University's master's of education program. Adams currently is working on his doctorate in leadership organization. He also is a graduate of the National Fire Academy's Executive Fire Officer Program, where he won two outstanding research awards for “Distress Alert Signals from Personal Alert Safety Systems Devices Do Not Trigger Physiological Responses (2001)” and “Protective Clothing Ensembles Challenge the Balance of Firefighters (2000).” Adams is a member of the International Association of Fire Chiefs, Florida Fire Chiefs Association, Lee County Fire Chiefs Association and National Fire Protection Association. In addition, Adams is a contributor to the 1997 book Emergency Medical response to Hazardous Materials Incidents and the 1994 video for PULSE/American Heat, Seeing is Believing.

For More Info

Phyiological changes during carbon dioxide inhalation in patients with panic disorder, major depression, and premenstrual dysphoric disorder by J. Gorman, J. Kent, J. Martinez, S. Browne, J. Coplan and L. Papp, http://archpsyc.ama-assn.org/cgi/content/abstract/58/2/125

Effect of acute tryptophan depletion on CO₂-induced anxiety in patients with panic disorder and normal volunteers by H Miller, J. Deakin and I.M. Anderson, The British Journal of Psychiatry, http://bjp.rcpsych.org/cgi/content/abstract/176/2/182

Acute changes in carbon dioxide levels alter the electroencephalogram without affecting cognitive function by E. Bloch-Salisbury, R. Lansing and S. Shea Psychophysiology

Managing Transitions: Making the Most of Change by W. Bridges

The Heart of Change by J.P. Kotter

Leadership: Theory and Practice by P. Northouse

Courageous Leadership by B. Hybels

Lead Like Jesus: Lessons from the Greatest Leadership Role Model of All Time by K. Blanchard and P. Hodges

Leadership Without Easy Answers by R.A. Heifetz