OVER THE last 25 years much research has been conducted into incidents and disasters in tunnels. After the serious disasters in the Mont Blanc Tunnel (1999) and in the Kitzsteinhorn tunnel (2000), many improvements in tunnel safety were carried out. These improvements are mainly within the technical aspect of tunnel safety: detection systems, ventilation and escape possibilities for users have been improved and measures and procedures for operators have been revised. The research also looks carefully at the role of the tunnel operator (hereafter called "operator") and the role of the road user. Insight into the action and inaction of the road user has led to many adjustments to procedures and protocols. The role of the operator has been carefully studied and analysed. In the procedures that help the operator in preventing incidents, important points of improvement have surfaced and been implemented in the operator protocols.

This has contributed to an increased self-rescue phase and consequently to a reduction in the seriousness of incidents. However, using elaborate and detailed procedures and protocols brings with it the risk that the operator makes mistakes. J. Rasmussen (1988) identifies three types of human failure: Skillbased, Rule-based and Knowledge-based errors. The solution Rasmussen suggests to prevent such human failure is to improve procedures and make ergonomic adjustments.

In the extensive UPTUN research by P. Papaioannou and G. Georgiou (2008) attention is paid to the role and behavior of the operator during an incident and here too the recommendations are mostly of a process-based nature. The EU research project UPSAFETY (2011) provides clear guidelines and a standard format for an Education, Training and Practice program ensuring that operators and first responders know the procedures and protocols, thus reducing the risk of human failure by first responders and operators.

OPERATOR RESPONSE

All research up until now neglected the neurophysiological process that influences decision making. This article focuses on this neurophysiological process: the subconscious process that lies at the basis of the action or inaction of the operator. This process is also the basis of stress and occurs with the operator before and during an incident or calamity. It is comparable with the action or inaction of road users in a tunnel incident.

It is a process within the brain that lies at the basis of human failure. We will provide a clear insight into this process and we will describe how we successfully bring it to the attention of the operators, making them more aware of their actions and ultimately saving lives. Because this process also occurs with road users, it is of vital importance that the operator is made aware of this ever-present mechanism and of the techniques that help him to continue to function properly.

Tension, stress and the workings of our Threat/self-protection system

There are many definitions of stress. In a general sense, stress is the reaction to a stimulation that causes tension. Within the context of this research, we regard stress as a process that is caused by a stressor (the condition that triggers the stress) and it is the reason for the stress response (the reaction to the stressor).

Research by Joseph LeDoux (1998) indicates that a small part of our brain is involved in the regulation of negative emotions, the amygdala. This almond-shaped core is located in the temporal lobe and is part of our limbic system. The amygdala establishes connections between information from different sensory inputs and links these to emotions (internal stimuli). Information reaches the amygdala in two ways:

  • The direct way (Low Road according to LeDoux)
  • The indirect way (High Road according to LeDoux)

The direct way is shorter and therefore faster than the indirect way but, on the other hand, also gives less precise information. The direct way transmits information through the thalamus directly to the amygdala and enables us to react before we know exactly what is happening. The thalamus is our reptilian brain, the oldest part of our brain.

This primal instinct is useful for, amongst other things, defense and hunting. In dangerous situations it is of great benefit: you fight or you flee. In primitive times, when a wild animal approached, this was a useful response. However, when this system is triggered without the presence of a direct threat, the fight- or-flight response can be a hindrance (MacLean, 1990; Hanson, 2009).

The indirect way transmits information through the thalamus to the neo-cortex. The neo-cortex analyses the information before it is sent through to the amygdala. The thalamus acts as a filter for external and internal stimuli (emotions) before transmitting these to the neo-cortex, which generates a more detailed representation of the information. This process takes more time than the direct way.

This more time consuming approach takes place in a newer part of the brain, the so called neo- mammalian brain. This is the youngest and most flexible part of our brain, where development and adaptability reside. The processes of analysis, insight, learning and development take place here.

As soon as we spot danger, the amygdala engages the hypothalamus, which in turn tells the pituitary gland to produce stress hormones. These hormones prepare the body for fight or flight. Physically, this manifests itself in an accelerated heartbeat, faster flowing blood, increased muscle tension, and the quickening and shortening of breath.

Consequences of stress

The hypothalamus also activates the sympathetic nervous system. The sympathetic nerves are responsible for the production of adrenalin. This adrenalin makes your heart beat faster, causes you to sweat and energy to be directed to your arms and legs. This is necessary to flee or flight.

When stress is prolonged, or presents itself too often, it will cause you to slowly exhaust yourself. The body is literally in a constant state of readiness for fight or flight. The produced adrenalin cannot drain off and tension builds. This causes an unhealthy and unnecessary tension, which can eventually lead to burnout.

LEARNING ABILITY AND STRESS

Our body is an intelligent system. Many of our daily activities, some of which are quite complex, have been learned, never to be forgotten again. We are not consciously aware of many of the tasks and actions we perform regularly. Ultimately, the learned action is performed without thought. For example, the use of a computer keyboard, and tapping the keys on that keyboard, happens automatically. Nevertheless, an ingenious mechanism lies at the basis of this.

Another characteristic of our body is that it learns from experiences and remembers that which it learns. If you are in a scary situation and your subconscious impulse is to flee, then recollecting that occurrence is enough to provoke a similar physical response. Our body learns from events. This process can be observed in operators in their experiences with incidents. A simple rear end collision will, when first experienced, release stress hormones and put the amygdala to the test. During a second rear end collision our body will immediately refer to the earlier experience and adjust its response appropriately. Less stress hormones are released and we will be better able to use the information from the neocortex. We are more conscious of our actions and decisions.

It is possible to acquire this learning ability, which our body is already subconsciously applying, for use in unexpected situations. By putting our body in a simulated, unknown stress situation the stress reaction is brought out. Our brain is constantly communicating with itself and with the rest of our body to analyse and preserve contact with the external environment and intervene where necessary. An important element in this relationship is our internal "emergency button": fight, flight or freeze. This reaction is subconscious; we cannot turn it off.

We can train to become conscious of that subconscious mechanism. This causes an awareness of the internal process and gives the possibility to intervene earlier in the flght or- flight-or-fright response and to give preference to the information coming from the neo-cortex.

By being present, with full attention, in the here and now, we can remain in contact with our body (physical stimuli) and with our mind (physiological process). This insight provides the best chance to fully understand your own reaction and make a rational choice that has the most chance of providing an effective response. Man has a rational way of thinking, which functions well if it is not disrupted too much by tension that he has no way of dealing with. As soon as an event causes a disturbance, the mechanism that prepares for conflict is triggered.

For an operator who needs to function, this mechanism is not wanted.

THE MECHANISM THAT DRIVES THE RESPONSE

Emotion is a response of our brain to an affective stimulus. This manifests itself in behavior and physical reaction. These reactions can be conscious and subconscious. From an evolutionary standpoint, all emotions are useful. While our emotional life is complex, it’s possible to distinguish three basic types of emotion regulation (Gilbert 2009). important during an incident that the contentment system can be utilised. When, on the other hand, the threat/ self-protection system is activated, all symptoms that result from this system stand in the way of functioning effectively. It is aimed at selfpreservation and not at helping others.

The exercises and techniques used to teach the operator awareness and attention originate from Mindfulness. Mindfulness is the awareness that comes from purposefully giving attention to things as they are, in the moment and without judgment.

PRACTICAL TRAINING MODULE

To make operators aware of their own stress and tension and the effect of that tension on their functioning capabilities, we have developed a series of exercises.

The mechanisms that can occur during an incident are purposefully triggered in a simulated setting. These are discussed, analysed and experienced once more. This provides insight into the conscious behavior. In the exercise we ask the participants to focus on their own breathing, muscle tension and thoughts. This is a first introduction to one’s own physical reactions in cases of tension. Next, the participants are placed apart from each other in the room. A simulation actor performs the same exercise with each participant. He stands behind the participant and approaches them, then he stands next to the participant, and finally he stands in front of the participant and approaches them from there. There is no physical contact and there is no talking during the exercise.

After this first round, we discuss what the participant has experienced and what the actor and trainer have noticed.

Each time, we discuss what the participant experienced in regards to breathing, muscle tension and thoughts. Based on the experiences, the participant is given a piece of advice to use in the next round. This advice can concern breathing, muscle tension or thoughts.

An example of such advice is: "be aware of your breathing and make sure it remains slow."

Next, we do an exercise and provide advice about becoming aware of your own breathing. Then we do the same exercises again and the participants are given the opportunity to apply the advice they have been given. In a following exercise we consciously trigger the fight-or-flight-or-fright response, thereby providing an insight into its effect on one’s functioning. Operators often indicate that the exercise makes them aware of the effects of being fully present. They start to experience when tension is noticeable and become aware of the mechanism of fight, flight or freeze and experience the influence they have on their own thoughts and breathing and their ability to control them. They start acting more aware.

THE RESULTS

Relaxation

Stress awareness exercises lead to relaxation in the long term (Benson, 2000). Heart rate, oxygen use and blood lactate values (a chemical substance that, when found in high concentrations, is associated with fear, and, in low concentrations, with rest and relaxation) dropped during meditation. Long-lasting stress has a negative influence on physical and mental health that can cause lack of motivation, sick leave and even burn-out. On the short term the benefit for the operator is that the relaxed state means that the operator is able to start the incident at a lower stress level enabling him to focus on his tasks more effectively. The operator recognises rising stress levels and can respond adequately.

Thoughts

We experience about 40,000 thoughts per day. Luckily, we are not aware of each of those thoughts, but they do influence and subconsciously guide us throughout the day. Thoughts can be helpful or unhelpful. This determines whether tension increases or not. Giving guidance can prevent tension from building. For the operator this competence is valuable in two ways. The operator has a standardised job.

When everything goes well, those thoughts can direct him away from his primary tasks. Being aware of this process allows the operator consciously focus on his tasks. When an incident happens a lot of tasks have to happen in a short period of time and a lot of information is send to the operator and create thoughts and actions that can lead to tension.

Preventing tension to rise allows the operator to stay in control.

Acceptance

No matter how well-trained operators are, how elaborate the procedures are and no matter how many difficult situations they have been through, there are always incidents and calamities that are new and different to them. Understanding how your body reacts in such an event helps the operator in controlling his reaction.

Being aware that these stressful unexpected events can happen helps the operator to stay focused. Accepting that road users and operators or other first responders sometimes will act unexpectedly allows them to act flexible and sometimes deviate from the standard procedures when it is best to support the self-rescue phase or other phases related to incident management. Evaluating the deviations help in improving procedures.

Compassion

Stress awareness helps you focus your attention. Receiving attention gives one the feeling of being understood. Also, we often know immediately when someone is not paying attention and is occupied with something else. By focusing our attention we focus on the other person (The road user) , thereby making them feel taken serious and understood.

The road user will then be more inclined to have that same attitude towards you, and will be more likely to follow instructions. Adding focused attention will increase the effectiveness of the communication. Understanding that road users can also face a primary impulse responses helps for better understanding.

Insight provides choice

Stress awareness gives insight into coping strategies and the operator’s own preferred strategy. A coping strategy is the way in which one deals with stress and problems. Through stress awareness exercises insight is gained into one’s own coping strategy. Through observation of internal processes, feedback from observers and advice, operators can practice developing a more effective strategy.

Frequent meditation has been proven to have effected structural changes in the medial prefrontal cortex (Siegel, 2007). This means that one develops a larger range of coping strategies and is able to choose more quickly. For the operator this means that he can quicker understand his behavior and decide to change to the contentment strategy.

CONCLUSION

Over the last few years, enormous progress has been made in the prevention and containment of incidents and calamities. Many adjustments and improvements concerning the revision of procedures and protocols have been implemented. The neurophysiological process which occurs with both the operator and the road user (that causes stress) can now be incorporated in the education, training and exercise programs of operators. These exercises determine whether an operator is able to function or not. The insight into the stress mechanism and the functioning of our emergency system is the missing link in the process to reach maximum safety.

Awareness exercises help operators develop techniques to become more aware and present. This alertness makes it possible for the operator to make a rational decision, thereby providing the greatest chance of an effective response. This is in addition to improvements in procedures and protocols that resulted from previous research. Up until now, no investments have been made into the awareness of the mechanisms that occur when an incident takes place. The insight that neurophysiology provides us with, opens a range of possibilities for operators to more effectively act during an incident. Acknowledging neurophysiological processes helps the operator in finding a successful coping strategy for stressful situations where it is necessary to deviate from procedures and protocols. Making sure that an operator can quickly appeal to his soothing/contentment system and is aware of the consequences of the threat/self-protection system, can prevent a lot of casualties. Actively training for this reduces costs and casualties on the short term. An additional long term advantage is the prevention of burnout and posttraumatic stress disorder.

The stress awareness module is recently successfully used in the Education, Training and Exercise program for operators in the Netherlands. During this program operators gain insight in the technical tunnel system, the procedures and organisational aspects to operate and maintain a tunnel and their specific role that connects the technical and procedural systems together. In continuation courses we go deeper into the material and repeat the exercises. Apart from that, we also discuss and analyse tension awareness and the experienced primary reactions during Virtual Reality and Mono- and multidisciplinary exercises. Stress awareness has become a third pillar on which the education program is founded.

RECOMMENDATION

The regular training of the awareness of internal processes during stress, the insight into one’s own primary reactions, and techniques that help in employing more effective behavior all help make operators more relaxed and effective.

Our recommendation is to make these exercises a part of the operator’s training and to implement refresher courses with the possibility to go deeper into the material. Organisations that incorporate this module in their training program should also give attention to the follow up of incidents through means of evaluations. Especially, during a "hot-debrief" session shortly after an incident, the operator is able to indicate how, when dealing with the process, he experienced his internal fight-or flight- or-freeze reaction and which system (threat/self-protection, incentive/ resource- seeking, contentment) was first utilised. By being aware of these physiological processes, the operator can act more effectively during an incident. This effective acting saves costs for the organisation, and more importantly it saves lives.