Duty-related firefighter fatalities stand at an average of 100 per year in the United States. Since the beginning of this decade (more specifically since Sept. 11, 2001), a great deal of effort has gone in to minimize or eliminate these incidents. Most of these efforts have concentrated on increasing such things as the awareness of the dangers of firefighting through training and education, levels of protective equipment, accountability, firefighter health and wellness, and tactical considerations at emergency operations. Yet one contributing cause to some line-of-duty deaths may be getting overlooked. It involves the psychological properties that perpetuate a cultural belief that firefighters have a duty to die.

Some of the extraordinary efforts designed to minimize firefighter line-of-duty deaths have not been as successful as hoped. So what else is there to do? Firefighters already know that their chances of surviving a motor vehicle crash are increased substantially by using seatbelts. Yet some still refuse to wear them. Firefighters already know, as Acting U.S. Fire Administrator Charlie Dickinson recently said, that the only reason a firefighter should die in the line-of-duty is if he or she is trying to save a life. Yet firefighters still rush into heavily involved vacant structures. Firefighters know that their health is their first line of defense and their greatest asset in enabling them to perform their job. Yet some continue to overeat, smoke, consume alcohol in excess and refuse to exercise. And through all of this, they are dying.

Typical reviews, evaluations and comments regarding firefighter line-of-duty deaths almost always focus solely on obvious and overt behaviors. The recommendations to prevent future incidents take the form of performance modifications or increased or adapted safety practices, such as those recommend by the National Institute for Occupational Safety and Health.

However, the mental developments that led to a firefighter being at that tragic place in time should be the starting point for reducing deaths and not a sidebar discussion. The practical actions, so often the focus of investigations, discussions, and recommendations, should be primarily support material. The 16 Firefighter Life Safety Initiatives developed several years ago at the National Line of Duty Death Prevention Summit appear to be derived from those practical actions and not from the thought and decision-making processes that put a firefighter there in the first place.

Without a thorough review of the psychological and cognitive processes leading up to and occurring during line-of-duty incidents, the fire service is overlooking key elements in reducing and eliminating firefighter line-of-duty deaths. This includes instances where a firefighter believes that dying in the line of duty is part of the job or actually has a rewarding aspect. Such aspects are found in a theory referred to here as the firefighter duty-to-die syndrome.

The syndrome is a firefighter's behavior that reflects a sense of obligation and duty to unnecessarily risk personal and others' safety above what is appropriate or required according to standards. The firefighter does this to fulfill an intrinsic, environmental or cultural notion that this risk is expected and acceptable, even to the point of death. This can be a partial or full condition, with the range often depending on the level of the institutionalization of risky behavior by the culture of the department, groups or organizations of which the firefighter is a member.

Duty-related firefighter fatalities stand at an average of 100 per year in the United States. Since the beginning of this decade (more specifically since Sept. 11, 2001), a great deal of effort has gone in to minimize or eliminate these incidents. Most of these efforts have concentrated on increasing such things as the awareness of the dangers of firefighting through training and education, levels of protective equipment, accountability, firefighter health and wellness, and tactical considerations at emergency operations. Yet one contributing cause to some line-of-duty deaths may be getting overlooked. It involves the psychological properties that perpetuate a cultural belief that firefighters have a duty to die.

Some of the extraordinary efforts designed to minimize firefighter line-of-duty deaths have not been as successful as hoped. So what else is there to do? Firefighters already know that their chances of surviving a motor vehicle crash are increased substantially by using seatbelts. Yet some still refuse to wear them. Firefighters already know, as Acting U.S. Fire Administrator Charlie Dickinson recently said, that the only reason a firefighter should die in the line-of-duty is if he or she is trying to save a life. Yet firefighters still rush into heavily involved vacant structures. Firefighters know that their health is their first line of defense and their greatest asset in enabling them to perform their job. Yet some continue to overeat, smoke, consume alcohol in excess and refuse to exercise. And through all of this, they are dying.

Typical reviews, evaluations and comments regarding firefighter line-of-duty deaths almost always focus solely on obvious and overt behaviors. The recommendations to prevent future incidents take the form of performance modifications or increased or adapted safety practices, such as those recommend by the National Institute for Occupational Safety and Health.

However, the mental developments that led to a firefighter being at that tragic place in time should be the starting point for reducing deaths and not a sidebar discussion. The practical actions, so often the focus of investigations, discussions, and recommendations, should be primarily support material. The 16 Firefighter Life Safety Initiatives developed several years ago at the National Line of Duty Death Prevention Summit appear to be derived from those practical actions and not from the thought and decision-making processes that put a firefighter there in the first place.

Without a thorough review of the psychological and cognitive processes leading up to and occurring during line-of-duty incidents, the fire service is overlooking key elements in reducing and eliminating firefighter line-of-duty deaths. This includes instances where a firefighter believes that dying in the line of duty is part of the job or actually has a rewarding aspect. Such aspects are found in a theory referred to here as the firefighter duty-to-die syndrome.

The syndrome is a firefighter's behavior that reflects a sense of obligation and duty to unnecessarily risk personal and others' safety above what is appropriate or required according to standards. The firefighter does this to fulfill an intrinsic, environmental or cultural notion that this risk is expected and acceptable, even to the point of death. This can be a partial or full condition, with the range often depending on the level of the institutionalization of risky behavior by the culture of the department, groups or organizations of which the firefighter is a member.

Institutionalized unsafe and careless behavior can be demonstrated by:

• A lack of regard for safe workplace practices and national standards,
• A high number of incidents involving injuries and accidents,
• Praise and admiration of individuals or groups who demonstrate risky and unsafe behavior, and
• No penalty or punishment for risky and unsafe behavior.

How big of a role could a firefighter duty-to-die syndrome play in current line-of-duty deaths? For some it may be significant to minimal, while for others it may be completely nonexistent. For those departments that demonstrate a lackadaisical attitude toward safety in the workplace and view risky behavior as courageous and brave, the effects of FDTDS can be increased and dependant on the level of acceptance of the culture. To discover what is at the root of these behaviors, one must look at how the mind works.

All drives and motivation by the conscious or subconscious are either inherent or learned. Those that are inherent are biological in nature. These drives occur when the brain receives signals from the body during physiological shifts away from homeostasis. One example is when low blood sugar causes hunger impulses to be sent to the brain. This drive will intensify until it is met, at which point it will reset. Learned drives are developed over time and are sociological in nature. Generally with sociological drives, each rewarding experience or avoidance of punishment in satisfying the drive will increase it in intensity.

Firefighters who develop an internal drive to take unnecessary risks to reach some level of satisfaction fall into the sociological category. The key to this behavior increasing or decreasing is the reward or lack thereof. If a firefighter drives recklessly but is later praised for his quick response, the chances are increased that he will repeat the behavior. Additionally, if the same firefighter is demonstrating this behavior to avoid a negative consequence, such as getting a hard time for being the last to arrive, the same motivation prevails and encourages repeat behavior.

Firefighters who are praised for unsafe actions often rely on the ends to justify the means. If a victim was rescued and the fire extinguished, these firefighters believe their dangerous behavior is irrelevant, even if performing the task in a safer manner would have produced the same results. Some rely on the results to deflect attention from any unsafe action that they took. Sooner or later the end will not justify the means, such as when a firefighter dies in a vacant house fire. The odds of tragedy are increased by the syndrome's snowballing effect.

In most cases a desired reward will not come as quickly or as often if the behavior is repeated at the same level. FDTDS may lead firefighters to cross the line sooner and go deeper into an unsafe situation to reach a level of satisfaction. It simply becomes a law of scientific probabilities: The more opportunities a firefighter is exposed to increasingly unsafe situations, the more likely a negative consequence will result.

Another prevailing mechanism in FDTDS is risky behavior. Some individuals are genetically predisposed risk-takers. Most people will do whatever is necessary to avoid or escape stressful situations, bringing their bodies back to a state of homeostasis. Risk-takers have a drive to seek situations where the reward is a rush of excitement that stimulates the senses.

In ordinary situations, risk-seekers can be found doing such things as bungee jumping, skydiving or participating in extreme sports. But what about firefighters who are risk-seekers? They may demonstrate some of the behavior by participating in thrilling activities off-duty. But this predisposition can affect their behavior on-duty. If so, they may place themselves and others at risk beyond what is called for just for the physiological sensation that comes with living on the edge.

In the case of a risk-taker, the drive to reach stimulation again increases as time passes without an opportunity. Civilian risk-seekers can create their own excitement. Yet, firefighters seeking that fulfillment on-duty must wait for the opportunity to come to them. However, some can't wait. They create their own opportunity by engaging in illegal activity, usually by setting an arson fire and then taking part in the emergency response.

Those who crave that rush of excitement over a prolonged period of time have in a way become addicted to the sensation of the body's natural chemical release when placed in high-stress situations. The body's release of adrenalin (epinephrine) and norepinephrine is a natural response to danger, stress or excitement and primes the body for action (its fight-or-flight mode). In most cases, this chemical release is essential for firefighters to perform in extreme situations by controlling its effects and channeling the increased energy into ways that provide better cognitive skills along with better practical and sensory initiatives.

There are plenty of outside influences that can reinforce FDTDS; some are close to home. If there is one term that has become synonymous with American firefighters and the profession itself, it is “hero.” It is used, and some argue overused, by the public and the fire service in everyday language when characterizing firefighters.

Without question, actions of firefighters are heroic. But does constant reference of the term hero place undue pressure on the fire service culture and individual firefighters to try to live up to what might be an unattainable and mythical standard? The indoctrination of the word into firefighters culture appears to play into firefighters' decision-making when they are at or en route to an emergency scene.

Before beginning their careers, most firefighters have a notion about what the job involves. This comes through imaging and role-model exposure from news events, television shows and movies depicting firefighters. Other impressions can come from friends or relatives who were firefighters. These first impressions are usually of a busy firefighter, running from one life-saving incident to another. However, after beginning work, new firefighters soon learn that high-impact incidents do not occur as often as first thought.

This revelation can cause firefighters to view their opportunities to be heroes as limited. If the hero image is reinforced constantly through the culture, it can lead to frustration for some and produce one of two effects: practical overreaction and opportunistic risk. Practical overreaction happens when a firefighter, in an attempt to earn recognition, demonstrates exaggerated behavior in response to common incidents where no great or extraordinary measures are necessary. In opportunistic risk, firefighters during a high-impact incident see an opportunity to be recognized and may engage in extremely risky behavior.

Those who praise and admire risky behavior may not realize that they may be enabling firefighters to believe that their actions are acceptable and expected. The television and film industries repeatedly show firefighters in high-risk situations demonstrating unsafe behavior. But these are all very controlled situations. Is this Hollywood depicting its perception of the fire service? Or in the case of FDTDS, do firefighters lose their lives trying live up to a larger-than-life Hollywood image? Situations on actual emergency scenes are dynamic, unpredictable and sometimes volatile. They require stable thought processes based on sound tactical decisions to minimize the danger while simultaneously maintaining the firefighter's personal safety.

Oddly enough, the very things that protect firefighters may contribute to FDTDS. With the advances in protective gear over the last decade — positive-pressure ventilation, electronic monitoring SCBAS, better and more durable bunker gear, and hoods and PASS devices (which have recently become suspect) — firefighters may have a false sense of security. The truth is that firefighters have the same level of vulnerability today as they did 20 or 30 years ago if they have they believe their equipment and gear will insulate them from all dangers.

Some have argued that this false sense of security may even cause firefighters to go beyond their level of training or comfort. When this happens, firefighters have exceeded their tipping point and placed themselves and possibly their entire crew in danger. Most firefighters who find themselves in this situation intuitively know that they are outside their comfort zone and will reposition themselves to a more secure environment.

The problem comes when firefighters venture beyond the tipping point and escape unharmed. This increases their belief that because their behavior did not result in an injury, it must be OK. Unfortunately, some firefighters extend this venture further and further with each experience, ultimately leading to a serious injury or death.

Because of the stressful nature of firefighter work, it stands to reason that staying in physical shape would be a priority with firefighters, but that is not always the case. The majority of firefighters who are dying in the line of duty are doing so because of sudden cardiac arrest, precipitated by, during or within 24 hours of an emergency event. Some have a history of maintaining poor physical health, diet and overall lifestyle. Do they believe this is the image of a firefighter and if their physical condition contributes to their death, it just goes with the territory? Is this belief being reinforced by the culture?

The image of a strapping firefighter rescuing a fire victim still plays in the minds of most Americans when they think about the fire service. The reality is a muscular, lean and cardio-fit firefighter would not only do a better job but live longer to tell about it. The work-hard, play-hard attitude of some firefighters who eat poorly, smoke, and consume excessive amounts of alcohol (off-duty) may lead to an increased occurrence of on-the-job serious injuries and deaths.

Work schedules of 24 hours-on for most, and a zero to 60mph, stop-and-start workload should have firefighters and their support organizations considering every advantage for maintaining a healthy lifestyle. To its credit the International Association of Fire Fighters/International Association of Fire Chiefs Wellness-Fitness Initiative is an excellent tool to provide firefighters with baseline health information they can use to recognize problem areas.

The business of firefighting is inherently hazardous. Some firefighters will die despite every precaution, safe workplace practice and healthy lifestyle effort made to minimize their risk. As firefighter line-of-duty deaths continue to remain near 100 each year, the fire service must begin to look beyond its traditional explanations and practical recommendations. It must expand those discussions to more aptly include psychological components such as those found in FDTDS.

Without including serious discussion and research into the psychological cognitive components to address why some fire department cultures, groups and individual firefighters believe that unnecessary risk and unsafe behavior are an acceptable part of the occupation, the fire service is missing the mark and possibly a chance to save the life of one or more of its own.

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Brian A. Crawford is an assistant chief and 22-year veteran of the Shreveport (La.) Fire Department. He is a member of the IAFC Human Relations Committee and the FIRE CHIEF Editorial Advisory Board, and serves as executive consultant to the National Association of Hispanic Firefighters. He is a National Fire Academy resident instructor and Maryland Fire Rescue Institute staff and command faculty member, an NFA Executive Fire Officer Program graduate, and an IAEM-certified emergency manager. He is a 2006 recipient of the U.S. Fire Administration's Harvard Fellowship and graduate of the university's Kennedy School of Senior Executives in State and Local Government. He holds an associate's in paramedic, a bachelor's in organizational management and a master's in industrial psychology. He can be reached at 318-673-6652 and brian.crawford@ci.shreveport.la.us.

Duty-to-Die Syndrome Signs & Recommendations

When it comes to FDTDS, there are some tell-tale signs. And when enough signs are observed, there are some clear steps to change firefighter behavior.

Signs

Cultural and individual signs of FDTDS are prevalent to some degree in almost all fire departments. Having one or more of the following indicators does not point to its existence. However, the syndrome does exist when the overall profile of behavior reflects these characteristics.

• Overly aggressive behavior at routine emergency incidents.
• Taking unnecessary risks and demonstrating hazardous behavior during high-impact emergency incidents.
• Talk of dying on the job.
• Disregard for basic safety applications leading to almost no compliance with major safety precautions.
• Increasingly risky behavior by firefighters who eventually cross their tipping point at emergency scenes.
• High number of injuries that may increase in severity.
• Careless and reckless operation of vehicles when responding to emergency incidents.
• Multiple number of disciplinary actions for unsafe or reckless behavior.
• Delusions of grandeur or hero status.
• High level of risk-seeking off the job.
• Unhealthy lifestyle of diet and exercise and a “work hard, play hard” attitude.
• Increasing drive to be rewarded or recognized for emergency incident performance.

Recommendations

FDTDS and other cultural fixation disorders are social. They are learned and entrenched over time through cognitive rationalization and reinforcement. However, they can be unlearned using the following steps.

• Expose and acknowledge the problem.
• Conduct a comprehensive psychological study of the problem with recommendations for its minimization or elimination.
• Have cognitive education for groups or departments on psychological factors that lead to firefighters making poor decisions.
• Create role model and mentoring programs for young firefighters, and introduce psychological methodology that can instill a culture of firefighter safety and wellness.
• Use individual counseling through Employee Assistance Programs for firefighters who demonstrate an unusually high degree of risky and unsafe behavior.
• Give positive reinforcement for safe practices through classical conditioning.
• Establish zero tolerance or negative consequences for unsafe, unnecessary hazardous behavior.
• Create a safety climate through administrative procedures and peer-driven motivation.
• The odds of tragedy are increased by the syndrome's snowballing effect.”