Wilderness and Rescue Medicine 8th Edition

Section VII: Roles, Responsibilities, and Technology 255

Marshall theorized that the men’s brains had been overwhelmed by extreme stress. Because real fighting was nothing like their training, and because shooting and killing people were unfamiliar tasks that only added to the pressure, Marshall pointed out that the amount of stress chemicals flowing through the soldiers must have been debilitating. As automated limbic responses usurped critical thinking, each man’s instinct to survive took over. Ultimately the U.S. military reevaluated its training methods and modified its techniques. Over time, drills became more realistic and more dangerous. Today highly realistic scenarios are routinely used to enhance performance. Stress Exposure Training, or SET, includes the use of scenarios that come as close as possible to what soldiers will actually see in wartime. Moulage, smoke, and pyrotechnics are used, and actors are brought in as role players. In some cases, actual fighting is allowed. To improve a soldier’s progress, and as advised by experts who teach about “building expertise,” trainers provide qual- ity and timely feedback so that the soldier has the opportunity to modify decisions and change behaviors. Marshall’s work along with the work of his predecessors ultimately served as a catalyst for a myriad of other researchers who have focused on the concept of performing under pressure. Although the details of the various studies differ, nearly all the researchers reached similar conclu- sions that can be easily applied to first responders and their trainers: • People’s abilities to think and reason dete- riorate in highly stressful situations, and this reality should be expected and anticipated. First responders can use this information to plan ahead, to minimize surprises, and to anticipate the situational and behavioral challenges that they might face. • People perform as they practice, at best, and rarely does a person’s proficiency improve when under pressure. Holding first respond- ers to high-levels of performance during prac- tice sessions is key, and the quality of practice matters. If possible, realistic scenarios and

drills should be used to enhance habits and proficiency. At Florida State’s Human Performance Lab, Anders Ericsson—an expert in how to develop expertise—and his team of researchers work to create elaborate simulations to test police officers, medical professionals, firefighters, and other par- ticipants in taxing situations. Their findings offer convincing evidence of the efficacy of practic- ing while under realistic and stressful situations. Echoing this sentiment military training masters such as Alex Horton and Dave Grossman claim that the more you can approximate true-to-life circumstances the greater the carryover is likely to be. “From cops in mock shoot-outs to ordi- nary people stuck in fire drills,” says Grossman, “in order for training to be effective, it must be as realistic as possible.”

Risk Versus Benefit Although realistic scenarios can be time consum- ing to create and implement, WMA International encourages first responders and their trainers to incorporate stress into their training regimens as much as possible, and rescue organizations should weigh the cost of time and labor against the verifiable benefits that can be achieved when drills and scenarios are realistic. Not only do high- stress drills help students learn to function under pressure, but they also provide the brain with rel- evant memories, or “search-engine hits,” that can be used at a later date. In addition, by teaching first responders about effective stress-control methods such as breath- ing techniques, self-talk, and imagery, medical