The personality profile of the emergency service worker is one that is action oriented
tainted with the concept of control. It is not hard to figure out what drives the average
emergency service worker. It is the adrenaline rush that is produced from responding to a
working structure fire that has been upgraded by the first arriving unit to a second alarm
assignment to a gunshot wound to the chest that requires the medical responder to
provide a vast array of life saving skills. To many these are routine responses and
probably will be handled in a customary manner with little psychological distress
involved. Why? Because, we have programmed ourselves to become emotionally
guarded, protecting us from the psychological stress that is associated with our job. Is
this what really happens or do we just convince ourselves that is what has happened.
When in fact we are adding additional baggage to the loads of stress that we carry and
deal with daily.
We, as emergency responders, are faced with many stressful situations daily that can
alter our lives in many facets. Our jobs usually follow us home whether we know it or
not. In our professional lives we have to make rapid decisions and have to be in control
of many out of control situations. As the job follows us to the home environment so does
the stress. We often times defuse in the home environment and find ourselves extremely
fatigued. These are common signs of stress. When we are at work we find ourselves in
the 0-60 mode quite often, that is from business of a routine nature to emergency
response mode in seconds. This life style that emergency responders are susceptible to is
extremely stressful.
Stress is defined as bodily or mental tension resulting from factors that tend to alter an
existing equilibrium. Stress is precipitated by a stressor, which is, defined as an inherent
factor upon the human body that produces a response resulting in an emotional, physical
and/or behavioral reaction. There are two types of stress: physical and psychological.
Physical stress is what is placed upon the body when exertion of energy takes place, or
injury to the body occurs. (Example: Firefighters working several hours to bring a fire
under control in adverse heat conditions.) The second type of stress is psychological
stress which is divided into two categories, bioecological and psychosocial.
Bioecological is a branch of science concerned with the interrelationships of organisms
and their environment. Psychosocial is a branch of science involving both the
psychological and social aspects. (Example: Loss of a co-worker) There are four
divisions of psychological stress can be categorized: acute, cumulative, delayed and
post traumatic stress disorder (PTSD).
Stress as we see comes in many different fashions and has many different symptoms.
The four major divisions of stress symptoms are cognitive, emotional, physical and
behavioral. As stress affects the cognitive aspects of our lives we often find that we have
memory problems and poor attention spans. This is due to the mind trying to work
through the crisis and is unable to dedicate the full capabilities to the tasks at hand. We
are also faced with difficulties making decisions and slowed problem solving skills. As
stress affects you emotionally we see the losses of emotional control, guilt, grief, anxiety
and a feeling of being overwhelmed. Physically emergency responders are in
excellent health. However, in this case, we see that responders often times have physical
symptoms such as; muscle tremors, chest pain, gastro-intestinal distress, difficulty in
breathing in the building, respiratory distress, headaches and hypertension. As the stress
effects behavioral capacities we find that the symptoms are profound. They can include
change in activity, withdrawal socially, emotional outbursts, alcohol consumption and
even changes in sexual functioning. These symptoms that are associated to the four
divisions of stress are warning signs. They are saying DANGER! These signs and others
like suicidal attempts, substance abuse and violence are indicators that stress may be the
underlying cause. These signs and symptoms of stress can be acute in nature occurring
instantly or shortly following an incident. An example of this type of stress I witnessed
several years ago in my career. Two paramedics responded to a motor vehicle crash,
which involved a young child. The child was critically injured from being ejected from
the back of a pick up truck. The injuries proved to be fatal to the child. The two
paramedics that responded were well respected and were seasoned veterans of the
business. They both had children at home who were near the age of the deceased. The
two paramedics were victims of stress. The magnitude of the stress ended both of their
careers as they resigned from their positions within a week following the incident. At the
emergency room their ability to function was severely impeded by stress, as they were
not capable of making the decision to go back into service. This incident can also be one
that would describe a cumulative stress incident. Where as, they had prior responses on
children who were severely injured or killed. However, this one could have pushed them
to their limits. Delayed stress is seen when the signs and symptoms present themselves a
period of time following an incident. Many times the incident and the stress is repressed
and over a period of times finds its way back to the conscious level. These are examples
of what is defined as Post Traumatic Stress Disorder, often in emergency services we
refer to this as Critical Incident Stress. Critical Incident Stress is defined as events that
are powerful enough to overwhelm your usual ability to function in a normal capacity.
This is exactly what happened to the two paramedics.
What causes this phenomenon of stress? We relate stress to some type of stressor,
whether it is routine or variable. Routine stressors are those that we deal with on a
frequent basis or everyday life if you will. Items like money, bills, the kids, long hours,
interrupted days off, multiple jobs and even sex are all great examples that are routine
stressors. These stressors add enough stress to our routine daily life styles without the
influx of any additional loads of variable stressors. Variable stressors come in a vast
array of shapes and sizes. The type of response or the pace of a system will have dramatic
effects on the emergency responder. When we add in the death exposure and the vast
responsibilities that accompany different positions in the emergency services we increase
stress levels to magnitudes that are not comprehendible by lay persons. On the extreme
side, family members being victims becomes superadditional to stress levels.
The stress symptoms effect us as individuals, organizations and as family units. It is
imperative that we be able to identify the signs and symptoms of stress. The treatment of
stress and stress related symptoms begins long before stress actually occurs. We need to
take a pro-active approach in preventing the occurrence from taking place or limiting it to
a controllable task. That is we need to do a good job of educating our personnel about
stress and the inherent effects that can occur from it. We need to take the education to a
level that is not addressed often in the emergency services. We need to educate not only
the family that we work with but the significant others. As emergency responders we
rely upon two support groups: our co-workers and our significant others for support
during stressful times. Most of the emergency services family is aware of and excepts the
stress and stress levels that must be endured. The group that is least aware of
stress and the signs and symptoms that accompany stress is the significant others. We
must use a prevention approach and pre-educate this group to be cognizant of the signs
and symptoms and also the survival techniques that are required to overcome a stressful
event.
Survival techniques include being able to identify the stressor. Without identifying
the stressor you have not found the root problem and you would only be treating the
superficial symptoms. This becomes a family issue, not just coworkers but also the
significant others. Look for solutions and take a solution-oriented approach. This will
allow you to stay focused and in good spirits. For families, be tolerant of the stressed
individual. You cannot sympathize with them you can only offer support. Remember this
is a time that emotions are running rampant and in a multitude of directions. Family
cohesion will help support and maintain a healing environment. Finally communication
is a key factor. Talk about the issues as they come up. Families need to be active
listeners.
Finally, how do we educate our significant others? First we must overcome the
"complacency" that is present in the emergency services and realize that we are not
invincible. The next step is to get the significant others involve by providing them stress
education as well as the emergency responders. After critical incidents that effect
the significant others, such as a line of duty death, have Critical Incident Debriefings that
target the significant others. Additionally, there are programs that address Critical
Incidents and Significant Others education. The significant others are a support group that has been over looked when it comes to the role that they play in Critical Incident Stress Management (CISM). We spend as approximately one third of our life at work. In theory we spend two thirds of our lives with our significant others. So with that in mind who really needs to understand the effects of stress and how to be proactive in therapeutic techniques
In large areas it is not as common practice as small areas to have whole families
engaged in Emergency Services of that community. The reason being is the population
difference. In small communities it is not uncommon that parents, children and other
family members are involved. What type of impact does this create if there is a
significant incident. An example may be a fatal motor vehicle crash that involves a
person of the community. Often times in small communities the responders will often
times be related or close personal relationship with that individual. Thus it impacts the
entire community. To expand that same thought to the other end of the spectrum…a line
of duty death. It is documented that family members have been on scene engaged in
emergency scene operations when this event occurs. What type of stress level does this
produce? What is the emotional impact both short and long term? Both can have a
catastrophic effect on the lives of small community responders.
We provide a critical portion to the mitigation of emergencies in our society. We
must take preventative actions to protect ourselves and our families from stress related
events through stress education. We must change the idiosyncrasies of the emergency
services as people who can handle it. Programs which address Critical Incident Stress
education are crucial and it can make an astonishing difference in the well being of
Emergency Responders. There are many program available to help you deal with stress
and the prevention of stress. Take time to be proactive rather than reactive.
For further information on Critical Incident Stress and Significant Others Education
programs you may contact the author of this article at [email protected]
