#1687 Wonder Woman - Dr. Sabrina Cohen-Hatton (PT2)

Is there a similar approach to train firefighters to be able to deal with that, because you can't perform under pressure if you're never under pressure.

and then you get better at it. But unless you're actually testing that skill under pressure, actually, how do you know that you're going to be able to use it when you need to use it, because by the way, that time is going to be under intense pressure, both in terms of the pressure of the environment, the moral pressure that you're under from people who are watching on the people that you might be trying to rescue, and

experiencing someone else. You know, when someone else is in pain or someone else has just experienced the death of someone that they love literally next to them in a car or in a house that you've managed to rescue one from, and someone else, there is nothing that prepares you for the emotion that you hear in that person's There is nothing that prepares you for that. But you have to carry on. You have to be able to do what you need to do. And I'm particularly interested

in non technical skills. In the UK, we term them command skills, so your ability to make decisions, your situational awareness, your communication skills, your leadership skills, your ability to work as a part of a team. You know, all of these things are skills. They're not you know, they're not. They're not some kind of higher gift that you get that you know you're kind of born with. If you're either a great decision maker or you're not, you've got

to work at it. And working at it means doing it in the kind of environment that you're readily going to expect to use it in, and in our world, that means that it's going to be emotionally charged, dynamically changing, with little or incomplete information, sometimes inaccurate information, and it's really tough. And it's a bit like swimming. If you wanted to swim the length of the channel or swim in the sea, but you only ever trained in an

Olympic sized swimming pool. You know what, you might be the fastest, the best, that you might have the greatest endurance in a pool, but as soon as you get out in the sea, even though it's the same skill the context is so different, the application changes and so you're not going to be able to do it in the same way. And those kind of non technical skills, the development of those are similar. So whatever technical skill you might be doing under pressure, it is determined by

your non technical skills. Your ability to make a judgment on when that needs to applied or how that needs to be applied, Your ability to communicate your intentions, your ability to absorb the information from around you that you need to create, your situational awareness, your mental picture, that which is the basis of every single decision and every

single judgment that you make. That is tough, and if you want to do that under pressure, we need to recognize that stress affects the processing capacity that you have available. It reduces it, so you have less processing capacity available to absorb that information. You have less processing capacity available to make a decision, You have less processing capacity available to think about the message that you're trying to communicate and whether or not that meaning has landed in the

way that you intended it to land. These are all really important factors for the success of the overarching incident because it's complex. So if you want those to work effectively, you have to train them under pressure. Is no good just doing it in slow time. You have to train under pressure, and so making people feel uncomfortable by putting if you're doing a command at exercise, for example, by throwing lots of injects in so you don't have time

to think about something. You don't have the luxury of being able to hold lots of things together in your mind at one point. It creates that sense of pressure where you then have to prioritize your activity. And actually, even if in real time the situation might not be like that for the full duration of the hour that your command exercise is, actually you're compressing it and so

what you get is like really deep practice. If you've heard the term deep practice, it's what you're kind of synthesizing, and it's about feeling uncomfortable. It's about doing things wrong and then repeating them in a different way so that you can do it better next time. But creating that sense of pressure in whatever way you can do it is super important. I'm a really big fan of realistic exercises.

I know they're super expensive to do. I know it's hard, especially when you get places like I mean in the UK, we have the Casualties Union, who are an amazing group of people, many of whom are amputees who've been through traumatic incidents themselves, who will come in and role play that they have incredible makeup on to simulate, to simulate traumatic injuries, and they respond in a way that is really realistic. And these people are incredible because bear in

mind they've had their own traumas. To come in and to be able to do that those experiences to help develop the people that they know other people will rely on in the future to go and rescue them from similar circumstances is a level of courage that to me is absolutely god worthy. It is awesome. But that kind of realistic opportunity is worth waiting gold, absolutely worth its weight in gold. But whatever you're doing when you're training, don't just go through the motions. Don't just go to

get through the end of the exercise. Make it count. You can never train too hard for a job where you know people die.

day you wake up. You're the same person with the same potential and the same genetics, but now you've got new skills, new awareness, new resilience, new understanding, new insight. Same human but not really. And now you've got that you can perform under a level of pressure that you couldn't even think about when you're a white belt, because you didn't know what you were doing. You couldn't be calm,

you didn't know how to self regulate. And now five six, seven, eight, ten years down the track, you've got this high level of ability and skill to be able to do this thing that most people can't. And it's because you did the work, and it's because you weren't fucking around. It's because you had five dislocated elbows and these, it's because you've got a thousand black eyes, it's because you've got choked fifty times. It's like that's you can't get good

at the thing that you're not doing. You can't master the thing that you avoid. And you can read about it and hear about it and watch fucking videos on it and listen to lectures about it, but unless you're actually doing it, like unless you're actually at the coal face, rolling up your sleeves and doing the shit or a version of it, then when the storm cometh, Brothers and Sisters,

you capitulate. You know, We've had lots of people and speaking to that, just as an example, we've had people on the show and I can't say who, but it doesn't matter. Well, no, I can't say who. But even something like this where people can obviously, you know, they've got their expertise like you, they've got skill, knowledge, you know, all of that. They can communicate and sometimes they've written

a book and you know, some whatever. But then you put them on either I used to work in radio as well, and so you put them in a radio interview or on an interview with this where you say, you know, you give them a backstory of you know, how many people listen and what we do, and and all of a sudden and we're live. That person goes from being interesting and funny and articulate too. Yes, no, no, yeah, I'm like, fucking hell, somebody just removed his personality in

the last thirty seconds. And it's just it's terrible because to them, there's when you say, I used to say to people, there's only twenty thousand people, don't you know listening, don't worry, And I would say that's fuck around. I don't say it anymore, or how I can say it to you because you do this all the time. But like, and then people, especially if you're thinking of a stadium of humans or something, that's something that they do all

the time, which is talk and share and educate. Now you're doing it in a different context and they can't string three words together because there's a level, a self created level of pressure. Yeah, and maybe I influenced that a little bit.

it in that kind of enviroment. You need to know the places that your head is going to go blank, where you're going to stumble, so then you can go and focus on those bits and make sure you know it better.

their families. At the end of the day, there's not this great, big void left by someone that's no longer walking this planet. What a gift, What a gift.

go down, you know, sit on a dumbbell. But anyway, The Crab my training partner, Mark, who I lovingly call the Crab because he moves like a crab. He's like a large crustacean with biceps. But anyway, so we were training and he did a set of chin ups, held his breath the whole time. Sabrina did thirty chin ups,

not an exaggeration. X pro body built, a very strong, very big all of that did thirty chins, came down and went to his hands and knees, and I thought he was having a seizure, and he had a cardiac arrest and died in the gym, on the gym floor. So he came back to life, I need say that quickly, but he was dead for seventeen minutes. And and talk about, you know, people under pressure, I would say there was. There's probably twenty people in the gym, but in him

because there's there's levels to the gym. But within a couple of minutes there were thirty or forty people in the gym. And so i'd you know, his big unit is one hundred kilos, which I don't know what that is in stone, seventeen stone maybe, So I, you know, I got him on his back, I got him into a position where I could work on him, and I did that like as soon as I realized what had happened, which was quite quickly. So I started working on him

by myself. Now thirty people were standing on the other side of the gym, not one thing like looking terrified. Not one person went what can I do? Not one person said can I help? And so I just looked up and said I need somebody, and they all stood there like, nobody came, and so here's here's my friend on the floor. I'm doing the compressions and the breaths. I'm so I'm alternating, and I'm you know, I'm busy. I got shipped on and I look up and nobody

moved forward. Nobody came. They all just stood there looking terrified. And then this one bloke kind of looked semi like like he was thinking about it. And I said, what's your name? And he said his name? And I said, let's just go, Steve, and I said, Steven, get the fuck over here. He's like, I don't know what to do.

I go get the fuck over here. I'll tell you what to do, right and that that but that a maze, Well that was messy, and that was you know, like a daunting scenario, of course, but I was upon reflection later, I was amazed at how I don't know if nobody knew what to do, but nobody, nobody came forward. Like I literally had to swear at someone to get someone to help me. And that's, you know, because who's standing next to someone when they die. Very few people, you know,

not in not where we live anyway, you know. And then so you're right, people just don't know what to do. Yeah, and normally comfortable, competent, you know, pretty adaptable, flexible people fucking freeze in certain circumstances.

they feel deeply uncomfortable. There's been some really interesting research that's looked at how when in an emergency situation, if there's somebody that's already intervening, other people will stand by, will be less likely to come forward and help because they think it's dealt with. And it's really challenging because in that kind of circumstance, actually you need all the hands that you can get right, You need that help and you need that support, and some of it comes

from a lack of confidence, I think. And it's interesting, you know, because we almost had kind of the opposite

problem in the fire service. So there was one of the things that we introduced when we were doing all of the research and the policy changes on the back of the research was some work around something that we term operational discretion, and that's the flexibility to recognize when a policy doesn't apply that you will actually do what you think needs to be done, used your professional judgment to do whatever you need to do in that circumstance.

And there were some incidents, some really high profile incidents that we had in the UK where people had died because people were One of the contributing factors part of me. One of the contributing factors was that everybody was so focused on sticking to the policy that the policy wouldn't have worked for that situation. Sticking to the policy actually

made the outcome worse. There was one called there was one in Gosden Mine where a mine shaft had collapsed and a lady had fallen down the mine shaft and was trapped down there for a considerable amount of time, and one of the incident commanders, the fire commanders, wanted to adapt some equipment to be able to get them out, and another disagreed because it was outside of policy and stopped it all and insisted on waiting for the mine rescue, and the woman ended up being trapped down there for

so long that one of the contributing factors to her death was hypothermia. Now it would be wrong to say it was solely because of the the delay caused by that or sticking rigidly to the policy, but what was talked about by the judge afterwards when they were looking at her death is that that was one of the inflexibility was one of the contributing factors. So it's funny because if you were not in a uniform, you'd grab whatever you could grab and you would do what you

could to try to make it work right. But as soon as you put up that uniform, you have that different responsibility, that different level of accountability, and the judgments, I think, and the you know, the judgment that you would have after an event once you're wearing that uniform and representing one of the services is far greater than a member of the public would have if they were

just trying to do their best to help out. Of the things that we introduced was this concept of operational discretion, where if you recognize that adhering strictly to the policy either is going to make it worse because that happens sometimes, or the policy it's such a novel situation that the policy does apply, then it gives that kind of flexibility

to choose what to do in that circumstance. And we did some research on this, and we were looking at the impact of stress and uncertainty on decision making when applying operational discretion. That was our kind of driver for it, and we gave fire commanders two scenarios. One was really straightforward runn of the mail. It was a high rise fire where they knew what to do, they knew what to expect them, was a super superclear policy, no need to deviate. And the other one was similar to this.

It was a mind shaft. It had collapsed, a sinkhole, sorry, it had collapsed, and there was a group of children stuck at the bottom and it was outside of the reach of their normal equipment. So you would have to use operational discretion. And we took measures of stress as well, and rather than just relying on self report, because you could ask a firefighter with a mushroom cloud behind them how they are and they'd be like, yeah, everything's fine,

I got this under control. Even if the heart beating tens of the dozerts. So we took blood samples so that we could measure it was actually a leucocyte response rather than a single measure of corters are. We were looking more holistically at a range of measures, because when you experience stress, your cells respond differently, and so we looked at at the leukocyte response to give us a better measure. And what we found is the more uncertain

the situation, the higher the stress levels. Not surprising there, but the more uncertain the situation and the higher the stress levels, the more certain people were to reach for

a set of rules even when they didn't apply. And so this was a really interesting one because we all do this sometimes and we're making a decision under uncertainty or we're not quite sure what to do, and it's pressured, and we'll reach for something that might feel familiar because it gives us that sense of security, but it might not actually be the right thing for that set of circumstances.

So my advice to people, whether they're in the fire service or not, is if you are making a decision or under the decision under those circumstances and you find yourself reaching for something that makes you feel better, or something that gives you that sense of comfort, or something that's familiar to you. Just pause and just double check your assumptions to make sure that it's actually delivering the outcome that you're hoping it's going to deliver.

And when you see the way that people are judged after an event who might have got it wrong, but they've gone in genuinely wanting to do their best, you know, it could be really difficult then for someone to find the courage to take a leap to do the thing that they think needs to be done without that security of a set of rules. To wrap around them. I get it.

you'd be so good. Like you're such a brilliant communicator and storyteller, and you you're such a good science communicator too, because you explain complicated stuff in an uncomplicated way or what can be complicated stuff. Because we're a largely non academic you know, we've got a percentage of academics that listen, but you know it's not an academic show per se.

And so my constant, or my not every episode, but a lot of episodes, I'm trying to figure out, how do we say this, and how do we navigate this conversation and make it you know, interesting, but also really relevant stable so people can do something with it. And you just do that automatically. It's a real gift and a real skill. So well, done you. It's amazing.

So I took everything that we'd learned from more than twenty years of firefighting and more than a decade of research about how we make decisions in the heat of the moment, when we're experiencing pressure, and I wanted to talk about it in a way that could be then

applied to everyday life. So each chapter talks about a specific aspect of decision making with it gut decision making, whether it's you know, the way that you develop your situational awareness, whether it's the way that you communicate all

of these concepts. And it opens with an incident that I've been to and so that you can see that part of that aspect of how your brain is working actually kind of at a real life incident in reality, and then I unpick the research that's relevant to it, and then I kind of talk about how it applies to everyday life as well. So, yeah, that was a real That was a real labor of love to write.

It was a real joy. Actually, It's just nice to be able to share what we've done with the broad or audience because I think, you know, there are some really important lessons that we've learned in the fire service, and they've been learned through a lot of pain, as I described earlier on. And so isn't it great that you can share that with as many people as possible and not just limit it to those that were the same color perform as you?

are today than they were before. I think they just wont allowed to show it before because of the societal pressures that people were experiencing. I think the world was super different, wasn't it. So I think there's that element. I mean, there are things that make us feel anxious today that weren't around before. Exposure or social media, I think is a key one. I mean, I can have firefighters at a job and the job will be uploaded onto YouTube by someone with their camera phone before they've

even packed up and left the scene. You know, so previously it would never be like that. You never had to kind of worry about those kind of things. So I think my point is if someone does make a mistake, it's usually recorded and there forever and You've seen the way that people respond publicly to people who've made mistakes, and it's kind of huge debate, isn't there around cancel culture and things like that? So I think there is.

I think whilst judgments would have been the same across the ages, I think that they are a lot more public now than they perhaps were previously. So it's really difficult, isn't it to compare times to say whether people were more anxious thirty years ago or whether they're more anxious today, because I think the context is so different that it's really tricky to kind of weigh everything up and go

one or the other. But I certainly think that there are things today that can make you feel anxious that you didn't have thirty years ago. I think we have the luxury today of being able to be really open about being anxious, which means you can deal with it better than you might have been able to do thirty years ago. So there's definitely a silver lining there.

you know, being the best you can be. And are there any other fire serve around the world that you look at in any country or it might just anywhere in the world where you go, they're the best, They are amazing for these reasons.

you might have thought they were outside. So I think there's real value if you are looking for the best in looking really specifically at what you want to see the best of and not stopping until you've turned over all the stones that you can to find it, because the places that you might find it might just surprise you.

of incidents, and they are exhausting. So your first responders, I have to say, I think are exemplary in the way that they have They've dealt with that and shown incredible resilience and courage in the face of doing so, as have been your communities actually who I've seen a huge amount of resilience from having gone through those incidents

and they are utterly devastating. And one of the things that we are thinking about more and more now as fire services is the impact of climate change on weather related incidents. You know, we've been having some awful wildfires here in the UK, not like not to the extent that you do in Australia, because our demography is very different.

You know, we don't have the same kind of forested areas that you do there and the expanse that you do there, but they have been devastating for the wildlife that we do have here, and they're happening more and

more regularly. Same with flooding. So actually thinking about what we can do to prevent those happening in the first place, to really get ahead of that is something that's super important to us, and we're doing a lot of work at the moment in my own fire department looking at how we can kind of improve the work that we do in rural communities to stop those kind of incidents happening in the first place.