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• Incident Management Stress
• Stress
• Physiological Stress
• Summary

Incident Management Stress

MTDC and its cooperators at the University of Montana (UM) have been conducting field studies on wildland firefighters for several decades. During this time, incident management team members have requested MTDC to focus on issues related to their activities. Members of these teams have much of the practical institutional knowledge about wildland firefighting. Agencies need to promote good health habits to help these team members stay healthy and effective on the job.

2006 Studies—During the summer of 2006, we gathered data to evaluate the health status and the risk of coronary artery disease (CAD) in a sample of incident management team members. An e-mail survey was sent to team members in the Northern Rockies. The survey asked respondents about their risk factors for coronary artery disease, including lack of physical activity and use of medications that might indicate increased risk. The survey response rate was 72 percent.

The responses of 66 team members were evaluated (52 males and 14 females). The members were 51.2 years old on average and had served an average of 8.5 years on a team. Overall, the team members mirror national demographics in terms of cardiovascular risk factors relative to their age. They had an average of 2.6 risk factors (table 1).

Table 1—Risk factors for coronary artery disease (CAD) reported by 66 incident management team members.

Risk factor	Percent reporting the factor
Overweight	35
High cholesterol	41
High blood pressure	39
Sedentary	39
Family history of CAD	17
Diabetic	3

Respondents reported above average levels of physical activity overall, with 22 percent reporting musculoskeletal problems. Members whose jobs required more physical activity reported fewer risk factors for coronary artery disease than did those in more sedentary positions. When evaluated by age (younger than 48, 48 to 55, older than 55), team members in the youngest group had few coronary artery disease risk factors and were more aerobically fit, while those in the two older groups were not statistically different from each other.

Incident management team members whose job positions require little or no physical activity have higher risk for coronary artery disease than members whose positions require extended walking and fireline activities (table 2). While this survey represents a small sample, there are clear trends in the risk for coronary artery disease associated with the positions held by members of incident management teams.

Table 2—The likelihood of risk factors for coronary artery disease and the physical activity required for an incident management team member.

Incident management team position	Average number of risk factors	Sedentary (percent)	Overweight (percent)
Requires extended activity	2	30	20
Requires little activity	3	54	46

2007 Studies—During the 2007 fire season, the UMMTDC research team collected additional data on incident management team members, including a blood profile and fitness test. To further evaluate the current health status, activity levels, and risks of coronary artery disease, we:

• Determined daily physical activity of team members at fire camp using electronic activity monitors
  
  
• Measured aerobic fitness of team members
  
  
• Evaluated blood samples to determine team members' risk for heart disease, as indicated by the presence of inflammation markers and blood lipids associated with coronary artery disease
  
  
• Evaluated the level of stress associated with the duties of team members

This project should provide data on team members' fitness and risk for heart disease. It may help identify strategies for reducing the risk of coronary artery disease and improving the health of team members and camp personnel involved in wildland firefighting (for a review of the 2007 study, see the Research section). Of 56 team members who responded, 17 reported above average or severe stress associated with their position on an incident management team.

The data from 2006 and 2007 suggest the need to reduce the risk of coronary artery disease and reduce stress, especially for team members whose positions require little or no physical activity. Additional work is needed to determine the effects of stress on work performance and health and to identify successful methods to reduce stress.

Stress

Stress has been implicated in the deterioration of job performance and in the incidence and severity of disease. There is little doubt that incident management team members are exposed to stress. They must perform their duties during natural or manmade disasters while living and working in fire camps or other temporary facilities. These conditions present a variety of day-to-day hassles, challenges, and annoyances that combine to create potentially stressful situations for team members. In addition, team members must respond to the demands of increasing fire complexity, both in terms of fire behavior and the challenges of fighting fire in the wildland-urban interface. The possibility that criminal and civil complaints might be filed against fire personnel also adds to stress. Effectively coping with stress plays an important role in maintaining the health and performance of team members.

In the context of incident management, stress occurs when team members conclude there is an imbalance between the demands of the situation and their ability to respond. This definition of stress focuses on individuals' perceptions and appraisals of their environment.

Coping behaviors are the changes individuals make to restore the balance between environmental demands and personal resources. Research on stress in work settings has identified at least three major coping behaviors:

• Changing one's own behavior
• Adjusting the way one thinks about a situation
• Taking direct action to change the environment that poses a challenge to one's resources

If firefighters are going to continue to work in incident management teams, they will need to deal with the stress of those jobs—not only to maintain their performance but to avoid some of the effects of stress.

The relationship between stress and human physiology has been studied for many years. Links between stressors and the hassles associated with particular environments have been linked to upper respiratory tract infections, impaired immune function, and elevated blood pressure. Recent studies of firefighters suggest that decisionmaking may be adversely affected by the demands experienced by firefighters in field command roles. A recent study of incident-related stress and psychological distress among firefighters in Northern Ireland noted the importance of certain coping strategies in mediating psychological distress for incident staff responding to large disasters.

A 1998 study by TriData Corp. indicated the importance of training incident management team members to cope with stress during fire assignments:

"Firefighters, especially those in supervisory and Incident Management Team positions, often have problems with stress, fatigue, and mental overload. There is little training or advice given on how to mentally prepare oneself for what is ahead, how to avoid the impacts of fatigue, or how to mentally "reload" during stress. Ways to mentally refresh have generally not been considered part of training, even for supervisors and senior managers … everyone from firefighters on up needed to be taught how to deal with large amounts of information in the field and how to recognize when critical pieces of information are missing, especially under stress."

The UM-MTDC preliminary studies, along with anecdotal evidence from discussions with incident management team members, suggest the need to document the stressors that members respond to while on assignment, the level of perceived stress they are experiencing, and the types of coping strategies they use.

Physiological Stress

Stress, tension, and reactive behavior patterns (such as road rage) have been associated with heart disease, hypertension, suppression of the immune system, and a variety of other ills. Emotions are mediated by structures in the brain, including the hypothalamus. When something excites or threatens us, the hypothalamus tells the anterior pituitary gland to secrete adrenocorticotropic hormone (ACTH), a chemical messenger that travels to the adrenal cortex and orders the release of hormones such as cortisol. These hormones allow the body to respond to stressful situations. In the physiological context, stress has been defined as anything that increases the release of ACTH or cortisol.

Physiological systems involved in the stress response.

Stressful situations also elicit a response in the sympathetic nervous system (SNS) that leads to secretion of hormones from the adrenal medulla, including epinephrine (adrenaline) and norepinephrine. These hormones mobilize energy and support the cardiovascular system's response to stress. This aspect of the stress response is called the fight-or-flight mechanism. The hormones prepare the body to fight or run, but they have other effects that can be bad for our health. Epinephrine makes the blood clot faster and increases blood pressure, advantages in a fight but a disadvantage in the workplace, where these physiological changes can precipitate a heart attack or a stroke.

Recent research suggests that some of us are "hot reactors," with exaggerated responses to everyday stressors. Hostile hot reactors become enraged when a driver cuts them off in traffic (road rage) or as a result of other psychosocial stressors. This hostility elicits a flood of hormones designed for combat. Blood pressure and heart rate increase, arteries constrict, clotting time shortens, and blood flow to the heart is impaired, increasing the risk of a heart attack.

While occasional stress is not a threat, prolonged exposure to stress hormones eventually suppresses the immune system and reduces resistance to infection. A recent study correlated subclinical coronary artery disease, as measured by electron beam computed tomography, to depression, anxiety, hostility, and stress.

Summary

In 2008, MTDC will study the relationship of stress to performance and health in incident management teams. We will document the stressors that confront team members and study the strategies they use to help them cope with stress. We will use physiological measures of stress to assess the relationship of stress to health and disease. The goal is to promote good health habits and coping strategies for members of incident management teams. We hope that these strategies also will enhance the team's overall performance by reducing the effects of stress on cognitive function, decisionmaking, team cohesion, and members' ability to take in new information and respond appropriately to changing conditions.

T. Miller and B. Sharkey, MTDC; C. Palmer, University of Montana.

When stress rises among team members, I find it more difficult to
obtain the information I need to perform my job.

Being able to detach from the incident is difficult
and sleep patterns get very disorganized.

Stress in varying forms is most apparent as it manifests
itself in interpersonal relationships.

Comments of incident management team members