By Doug Cupp
Years ago, while I was employed as a training chief and working on my executive fire officer (EFO) project, I was attempting to understand the normalization of deviance in the fire service, specifically why so many firefighters were injured, even killed, during training.
Normalization of deviance happens when we alter best practices, policies or procedures, or we take shortcuts to get the job done with no negative consequences. If we get away with it, it is likely we will repeat the behavior and, therefore, normalize it.
A good example of normalization of deviance is driving over the speed limit. It may just be 5 mph over the limit, but then 5 becomes 10, and so on. If you do not get a speeding ticket or crash the car, you will normalize speeding when you drive.
The same can happen with firefighter training. We can train our firefighters improperly, thereby normalizing incorrect behaviors and actions. Let’s dig further into how this happens.
Experience fills the gaps
The brain works in ways to be as efficient as possible when making decisions using heuristics, shortcuts and biases. Throughout my career, I have found that firefighters are extremely resilient, and if there are too many pressures (time, cost, criticism, punishment), they will create a workaround, finding a way to do their jobs.
Bounded rationality is the idea that rationality is limited when individuals make decisions, and under these limitations, rational individuals will select a decision that is satisfactory rather than optimal. When policies or guidelines cannot provide a solution to every problem, firefighters must use experience and education – what Dr. Gary Klein named recognition-primed decision-making (RPDM).
Risk manager Gordon Graham explains RPDM like this: Picture your mind as a hard drive or a slide deck. Your daily experiences help load this drive or deck. Everything you do and experience is loaded here. When you are involved in any task or incident, your brain quickly scans your hard drive or slide deck and looks for a close match. When your brain finds a match that correlates with a positive outcome, it executes the stored behavior. However, if you have not experienced the situation before or do not experience it regularly, then your brain cannot quickly locate a match. Without a match, the condition can deteriorate rapidly.
Why we do what we do
The National Institute for Occupational Safety and Health (NIOSH) has identified the top five causal factors of firefighter deaths and injuries on the fireground:
- Improper risk assessment
- Lack of incident command
- Lack of accountability
- Inadequate communications
- Lack of SOPs or failure to follow established SOPs
With these factors in mind, I set up a multi-company fireground training assessment. Five fire departments were put through the scenarios. Each scenario stressed the importance of these five causal factors. I gave the firefighters enough information to be successful and told them it was a straightforward scenario and there would be no “tricks” to trip them up. I informed them that I would follow up with interviews about why certain decisions or errors were made.
Where’s the baby? In one scenario, I provided a structure fire with a mother and child possibly asleep upstairs with a fire on the floor below. I placed the victims in a bed and in a crib on the second floor. Then I watched in utter frustration.
You could clearly see the culture of different departments. Some firefighters were fearful of making the wrong decision and thought the scenario was set up to show failure. They opened every exterior door or window, peeked inside, and said, “I can see a fire I’m not going to commit yet.”
When they went upstairs, visibility was slightly hazy, and the heat was moderate. Crews were crawling, searching slowly and extremely thoroughly. At one point they looked under the crib before they looked in the crib. They opened drawers and cabinets, and one firefighter even looked in the refrigerator. It was crazy to watch them search for the baby in every place but the crib.
It was obvious that some of them had instructors who had hidden victims in the most unrealistic places. Training had failed them; they were trained to the wrong criteria. It damaged their RPDM ability by creating bad slides in their memories.
In the interviews that followed, I learned that previous trainers would do such things to make firefighters constantly question themselves whether they performed the operation “right.”
Where’s the fire? In another scenario, I created a structure fire that started on Charlie side of the building and burned up the outside on the first floor but auto-extended through a window on the second floor. If they had done a proper 360-degree size-up, it would have been obvious where the seat of the fire was.
This highlights two of the five causal factors: improper risk assessment (size-up) and lack of following established SOPs. On arrival, crews saw smoke coming from the Alpha side of the second floor, did not complete the required 360 size-up, and deployed to what they thought was the fire floor.
In the interviews, crews that did not do a size-up missed locating the seat of the fire, had fire below them, and spoke of getting a line to the second floor faster than other crews. Success had been defined by speed, not good and timely decision-making based on accurate and pertinent information.
Build positive patterns
We do not want to create analysis paralysis by overwhelming firefighters with too much information that locks up their decision-making. This can occur when a trainer continually gives negative feedback even when the drill is performed well. For example, a trainer saying, “You did pretty good, but if that baby was up in the upper cabinet, you would have missed it.”
We must base our decisions on 70% of the information you have to build confidence that people can make great decisions with only 70% of the information that is available. If we wait for 100% of the information, the environment will make the decision for us. The most important thing that we can do in a training environment is to create successful exercises that build positive memory patterns in the brain.
There are two clear examples from law enforcement agencies that show the importance of creating good muscle memory for the brain. Training officers had the best of intentions but likely did not see the importance of how to train, not what to train.
One was observed in a shootout where an officer was observed picking up the spent casings because that was done every time they went to the range. Another officer had been trained to remove a weapon from an armed assailant. The failure in the training was that the weapon, once removed, would be handed back to the instructor to repeat the drill. In an unfortunate situation on duty, the officer removed the weapon from the assailant successfully, but due to muscle memory, he handed the weapon back as he did in training. This could have had deadly consequences for the officer had his partner not shot the armed assailant. Laurence Gonzales refers to this as a “training scar” in his book, “Everyday Survival: Why Smart People Do Stupid Things.”
Training tips
The instructor or training officer is one of the most important roles in an organization. They can define the safety culture and set the tone for success and failure. They can mold a learning and growth culture into the organization. They should have the knowledge of human behavior and performance, possess leadership development qualities, promote a culture of psychological safety, and understand adult learning. This is not a position for just any warm body. These positions have a huge responsibility, and the person who fills them must be passionate about developing future high-quality decision-makers. That is how we will keep our firefighters safe to perform at the highest levels in one of the most hazardous jobs on earth.
With that in mind, I’ll leave you with these tips for proper training:
- Create drills and exercises that provide positive memory loops through successes and achievable outcomes;
- Resist the urge to create scenarios that set students up for failure;
- Focus on specific desired outcomes, and don’t drift to only identifying what could have been done better; and
- Produce highly trained operators with keen decision-making abilities.
Additional resources
- Confronting the normalization of deviance in firefighter behavior
- Examining the role of culture in firefighter deaths
- Tips for ICs managing high-risk/low-frequency incidents
About the author
Doug Cupp is the fire chief at Greater Eagle Fire Protection District in Colorado. Cupp is a graduate of NFA’s Executive Fire Officer program and the Harvard National Preparedness Leadership Initiative, and holds a master’s degree in Emergency Management and Fire and Emergency Services Management. He is a public speaker and delivers courses based on his research on critical decision-making, leading to crisis and human error.