In the U.S., the number of active shooter incidents increased by 60% from 2019 to 2023, according to an FBI report released in June 2024. Even more alarming, the report found the number of active shooter scenes increased 89% between 2019-2023 when compared to the previous 5-year period.
Due to the all-hazards response of emergency services, firefighters and EMS providers are increasingly on scene during active shooter events – despite many lacking the training to effectively respond in those situations.
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I spoke with Dr. Melis Yilmaz Balban, an expert in stress response mechanisms, on what the body goes through when it perceives a threat and the impact that response has on an individual’s decision-making abilities.
“When you’re anxious or stressed, you lose awareness of your body and your internal state,” Balban said. “Decision-making gets severely impaired under a high-stress perception.”
A 10-year fire service veteran can keep a cool head on the fireground due to years of experience and training. If an active shooter emerges from an engulfed home, however, that threat response is kicked into high gear, which can lead to poor decision making if you’re not prepared for your body’s reaction, Balban said.
As the founder and CEO of NeuroSmart, Balban works with law enforcement agencies to provide biofeedback data to officers during training scenarios, allowing them to map their body’s response to the situation and gain insight into their reactions.
In her work with law enforcement, Balban teaches officers how to regulate their breathing and emotions during an active scene. These techniques, when integrated into training and then an active response, can help reduce the stress felt by responders in the heat of the moment, allowing them to think more clearly and make decisions without the onslaught of adrenaline on their senses.
How to train for the unknown: Decrease your threat perception
While it’s impossible to plan for every potential danger, first responders who are trained in stress response and regulation are better prepared to detect a significant threat and act with clarity in the moment.
“The way the way that our nervous system works, it’s a prediction machine,” Balban said. “We predict what’s going to happen, because it makes sense to prepare us and get the least amount of damage from the experience, or to protect us both from physical and psychological dangers.”
“Obviously, the more training you have, the more you know what to expect.”
Just like intubating a patient or throwing a ladder, emotional regulation takes active practice to form muscle – and neurological – memory.
If an emergency situation, like an active shooter does occur, “it sends the brain a signal: ‘OK, this is here now. What am I supposed to do? Oh, OK, here’s what we’ve practiced. Let’s do that,’” she said. “That’s why training is super important.”
Integrating emotional regulation into physical training exercises teaches first responders to remain connected to their body during high-stress situations, leading to better decision-making abilities.
Ideally, Balban said, instructors should be professionally trained to integrate emotional regulation and stress response analyzation into their physical and situational training for new members, so it becomes the default process from day 1.
Without the connection to the physical training and understanding why and when they feel a stress response in a specific scenario, the training will not work as designed, Balban said. “You can’t expect a [first responder] to breathe their way out of a terrible situation they have not been trained for.”
When working with law enforcement on use-of-force training, Balban provides biofeedback mapping ,which allows officers to see exactly when they experience a stress response, and learn to moderate their breathing and reaction to the stimuli.
“It gives them a tool to explain what happened in their minds,” she said. “The cop might not even remember what happened because of their brain state, but when they see the data, they’re like, ‘OK, yeah, this is what happened.’”
That information, in turn, helps instructors better understand where a trainee might need support, Balban noted. One law enforcement academy official told her: “When people get sent to the academy after they’ve been on the street to retrain, that’s always a question – is it a knowledge issue? Is there anything we can teach them from a knowledge perspective or is it an emotional issue?”
The danger of a stressed nervous system
If a fire/EMS scene turns violent, or if crews are called to a violent scene due to multiple casualties, and those members have not been trained how to react, their ability to make decisions is impacted, and their risk level goes up.
“First responders don’t really have an option in the fight or flight,” Balban said. “They don’t have the option of flight – they can’t escape the situation. So, very fast, you go from a freeze to a fight response.”
Responders who find themselves in dangerous situations without the proper training and tools are also at risk for long-term traumatic stress symptoms, such as hyper vigilance both on and off duty.
“You are more likely to make poor decisions,” Balban said, “which has big consequences for both departments and community relationships. It spills over to your private life as well because you’re now with this brain that’s always looking for threats; it decreases your quality of life.”
However, responders who are trained to recognize their emotional triggers during a stressful situation are better prepared to tackle the unknown, she said.
Training not only prepares you to respond to a threat, but also reduces the perception of the threat, Balban explained, “because when you’re prepared, it’s not as big of a threat.”
‘Anything that helps’
While most departments do not have the funding or bandwidth to professionally integrate emotional regulation training into their academy or instructional curriculum, practicing self-regulation daily can assist on scene in the heat of the moment.
“I don’t recommend one specific intervention over another,” Balban said. “I recommend anything that helps them. It could be a 10-minute run, a 5-minute meditation, or 5 minutes of breathwork. Whatever it is, it’s important to do it daily.”
ABOUT THE AUTHOR
Dr. Melis Balban received her PhD from Harvard University, and studied human stress responses and interventions as a postdoctoral fellow at Stanford School of Medicine. She is the leading author on several peer reviewed articles on the stress response. For more information about NeuroSmart, email melis@neurosmarttinc.com.
