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Crisis response

Good in a storm

In emergencies many people will instinctively do things unlikely to save them. But you can rectify that. 

Our immediate response to a major hazard that manifests close to us often determines our survival. Paradoxically, people faced with sudden, unexpected incidents do not always behave in ways that make their survival most likely. Sometimes they do the exact opposite. During Iraqi missile attacks on Israel during the Gulf War in 1991, an estimated 70% of Israeli civilian hospital admissions were a direct result of behaviour ill-matched to the incident. People were injured as a result of running into doors or suffocating because they had not opened the filters on their respirators.

Many people who function normally each day show an impaired ability to cope in an emergency. Yet these common but flawed responses can be overcome.

Loss of initiative

A common initial response to danger is an inability to think or plan. One survivor of the ferry MV Estonia that sank off Finland in 1994 with the loss of 852 lives, said: “I didn’t think. Shock is so disorienting it doesn’t allow us to think clearly.” The explosion and collapse of the Piper Alpha oil platform in 1988 resulted in the deaths of 167 men – see "Piper Alpha: regime changer", IOSH Magazine, July 2018 issue (bit.ly/2KDWRlE). The official inquiry found that the death toll was considerably greater than it would have been had crew members taken the initiative to escape, but apparently many made no attempt to leave the accommodation module.

“Individual actions are not encouraged on oil platforms,” said Judith Cook in A Disaster Waiting to Happen, which analysed landmark UK disasters, including Piper Alpha and the King’s Cross fire on the London underground in 1987. “But in this case it was those who took matters into their own hands who survived. The rest did not.”

Michael Thexton, a hostage taken by Palestinian terrorists aboard a Boeing 747 airliner at Karachi in 1973 described his initial psychological response: “I didn’t duck, or go to help, or shout, or run away, or anything […] At first it was numbing. I couldn’t respond, I was so stunned.”

Stereotypy

human-response-to-emergencies-hypoactivityAircraft evacuation testimonies often report passengers stopping to retrieve their carry-on baggage from the overhead bins – despite instructions not to do so – instead of exiting the aircraft immediately. When a Boeing 737’s engine caught fire at Manchester Airport in 1985, the aircraft was stopped on the runway and an evacuation ordered yet there were 55 fatalities. The Air Accident Investigation Board’s report quoted a member of the crew: “Despite being advised to leave everything behind, many passengers insisted on retrieving their carry-on baggage. When confronted at the exits by cabin attendants, some passengers tried to return to their seats to stow their baggage in the overhead bins.”

During the 2001 attack on the World Trade Center in New York a woman is reported as having broken away from her group saying that she was returning to fetch her bag – she perished; one man returned to get his mobile telephone while another wanted to return to collect his minidisk player.

One explanation for their behaviour is that this is what they always did before leaving the building at the end of the day. Actions acquired through habit can impede survival responses.

Thought/action perseveration

During an intensive military survival exercise a serviceman repeatedly gave his radio call-sign when prompted for his name. He continued to do so despite being told that his responses were incorrect. He gave his name only on the fifth prompt. Later, he said that although he knew his responses were incorrect, he was unable to break out of the response rut. This experience has been reported by others under stress. In the Boeing 737 fire at Manchester Airport, a passenger was instructed to open the emergency over-wing exit door positioned next to her seat. Releasing the door involved lifting a lever, but the passenger was seen instead to be pulling repeatedly on the armrest of her seat.

Action disorders

Three types of abnormal behaviour commonly observed in emergencies are hypoactivity, hyperactivity and cognitive paralysis.

human-response-to-emergencies-hyperactivityHypoactivity is a decrease in both cognitive and motor functions (hypokinesia) coupled with emotional demotivation and a cognitive withdrawal from the situation. After the cruise liner Andrea Doria sunk in a collision off the east coast of the US in 1956 survivors observed by two psychiatrists on a rescue ship “presented themselves for the most part as an amorphous mass of people tending to act passively and compliantly. They displayed psychomotor retardation, flattening of affect, somnolence and, in some instances, amnesia for data of personal identification. They were nonchalant and easily suggestible.”

Hyperactivity is characterised by an intense but undirected liveliness or restlessness (hyperkinesia) and a degree of temporary excitement and garrulousness. Victims are prone to distraction, often flitting from task to task. One survivor of a military aircraft that crashed in the Arctic became agitated, kept crawling over his companions, periodically removed his gloves and continually proposed implausible plans of action. He was dissuaded by his colleagues but died before rescue.

During the rapid sinking of a tug one midwinter in Canada’s Gulf of St Lawrence, two experienced master mariners paced backwards and forwards from one wing of the bridge to the other and did nothing as the water rose above their knees. They drowned, yet a much younger, less experienced deckhand standing next to them quickly donned his survival suit and lived.

Cognitive paralysis can lead to “freezing” behaviour (akinesia) in the face of danger. A survivor of the Estonia sinking talked of “people just sitting in complete shock and me not understanding why they’re not doing something to help themselves. They just sat there being swamped by the water when it came in.”

human-response-to-emergencies-cognitive-paralysisIn an airline evacuation a passenger sitting next to an emergency exit made no attempt to open the door, even when directed by the cabin attendant. During the Manchester Boeing 737 fire passengers were reported as sitting immobile in their seats until overtaken by smoke and toxic fumes. An empirical study prompted by the incident observed some volunteers in an airliner simulator as being similarly “behaviourally inactive”.

The above examples are drawn from different types of emergency but they have been recorded as occurring collectively in a single disaster. An explosion and fire destroyed a Norwegian industrial paint factory in 1976, killing six workers and injuring 23. A report on the first 15 minutes from the point of the blast until most of the 125 workers had reached safety reported “motor hyperactivity” among the escapees.

It is impossible to think ahead when events unfold faster than the cognitive system can process them

It stated: “Motoric paralysis as part of a psychic shock reaction was the most frequent behavioural disturbance. These individuals became stupefied, torpid or completely motionless as in a freezing response, or their movements were rigid, slow and mechanical, lasting from a few seconds to hours, thus in some continuing into the shock reaction of the immediate aftermath. The other main types of disturbances were various degrees of uncontrolled flight behaviour and stereotypical or habitual actions.”

The report added: “Losses of cognitive functions were frequent and of considerable intensity – substantial proportions of the groups appeared to have totally or nearly totally lost their capacity to perceive and think. In the middle range of the disturbed cognitive functions [were] fixation to one idea, response perseverance and stereotypical thinking.”

A closer examination of the above responses reveals a symptomatic subset of behaviour. As different components of the cognitive system fail to cope with the sudden change from an environment of routine to one of unfolding danger, the incoming environmental information is processed in a way that produces behaviour that has an internal logic but is externally maladaptive. The emergency produces cognitive degradation but not disintegration, a condition termed dysexecutive survivor syndrome.

Cognitive architecture

To understand why these types of behaviour occur during an emergency, we have to examine three components of our cognitive architecture: supervisory system, executive attention and working memory.

The supervisory system provides top-down regulation of our behaviour, thoughts and emotions, enables goals to be formulated and plans to be made. However, it takes between eight and ten seconds for the supervisory system to create a new response or initiate unplanned behaviour. It is impossible to think ahead when events unfold faster than the cognitive system can process them and during an emergency people are often unable to generate a new schema of behaviour in time and so will initiate an ill-matched but previously planned behaviour or will freeze.

Executive attention controls and regulates attentional resources, combining selective and sustained attention that enables modulation of working memory to maintain operational (conscious) information in an active and quickly retrievable state. Executive attention also blocks unwanted distracting information, resolves conflicts between incompatible sources of information, focuses cognitive resources on important tasks and plays a role in self-regulation. It is the functional link between the supervisory system and working memory and can be considered as the guidance structure to enable goal-directed behaviour. Impairment in executive attention during an emergency compromises our ability to coordinate and adapt useful behaviour and to avoid distractions by irrelevant environmental stimuli.

Working memory monitors the external world. It manipulates and integrates environmental stimuli with information recalled from long-term memory to produce adaptive behaviour. This third component is used by the supervisory system to initiate and modulate thoughts and actions but, as with any other information-processing system, working memory is limited in its storage capacity. An emergency can deplete working memory capacity, leading to task-irrelevant processing and a selectivity about which information to process. This can lead to the neglect or forgetting of important information and to strategies that are less demanding and less time-consuming but also less adaptive.

Cognitive function

The supervisory system and working memory functions are located in the prefrontal cortex of the brain. Executive attention lies contiguous to the prefrontal cortex and this explains the behaviour witnessed in an emergency. Perceived danger increases the production of adrenaline, noradrenaline and dopamine, but it has only recently been discovered that these catecholamines have different effects on different brain regions. Notably, an increase in catecholamine impairs higher-order prefrontal cortex functions but enhances the more rapid and reactive functions of the remaining subcortical brain structures that handle moment-to-moment responses.

The brain switches from a slow, reflective, top-down control of thought, emotion and action to a rapid, reactive, habitual, bottom-up behaviour triggered by environmental stimuli. The emergency environment shifts processing away from goal-directed tasks and towards stimulus-driven acts. These mechanisms might save your life when you are in danger and need to react rapidly, but they can be detrimental when you need to make choices that require thoughtful analysis and inhibitory control.

So, why does working memory not work when it is most needed? The supervisory system is resource-intensive, so its role in promoting adaptive behaviour in an emergency must be more subtle than operating simply as a real-time cognitive processor. Supervisory system impairment does not necessarily impede naturalistic action if our action response sequence has been learned and stored in the brain’s subcortical regions. These stored responses are activated by matching environmental and perceptual triggers. The stereotypical behaviour described earlier as a problem when it is inappropriate can be learned as the correct response through training.

Helicopter underwater escape training, for example, instills behavioural patterns that a person can initiate reflexively to help them survive a ditched and submerged aircraft. Someone who has been through the training will initiate an escape response rapidly, in the correct sequence and independently of the supervisory system (conscious thought): it has become “second nature”. Once the response has been learned, the brain no longer needs deliberation or higher-order cognition to compose the correct behaviour but has only to select between a set of learned responses.

The prefrontal cortex helps us to survive by letting us model dangerous scenarios mentally and devise and rehearse effective responses that we can then store in the brain’s subcortical regions. Under threat, the slow-acting prefrontal cortex is deliberately degraded (taken offline) while the subcortical reactive functions are enhanced, enabling rapid triggering of behavioural responses. That makes it important to train people for foreseeable emergencies so the response stored in the subcortex is the correct one and they avoid the freezing, hypoactivity and hyperactivity that can result in fatal outcomes.

Having the correct responses in memory through training also increases the feeling of control over the emergency. In turn, this decreases the stress response, allowing the supervisory system to maintain control through flexible, goal-directed behaviour.

Dr John Leach is visiting senior research fellow at the University of Portsmouth’s Extreme Environmental Medicine and Science Group

Comments

What a fascinating article.
Explains some of the stories of people "refusing to evacuate" buildings in emergencies.
Must incorporate something into our fire training to acknowledge this.

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