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.
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 zero to 60 modes quite often — 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. An example would be 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. An example would be the loss of a co-worker.
The four divisions of psychological stress can be categorized: acute, cumulative, delayed and posttraumatic 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. I witnessed an example of this type of stress several years ago. 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 of 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 are repressed and over a period of times find 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 and children; 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 laypersons. On the extreme side, family members being victims becomes superadditional to stress levels.
The stress symptoms affect 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 begin long before stress actually occurs. We need to take a proactive 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 accepts 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 involved by providing them stress education — them 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.
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 might be related to or close personal friends 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 and must take preventative actions through stress education to protect our selves and our families from stress-related events. We must change the philosophy of the emergency services; “people who can handle it.” Programs that address Critical Incident Stress education are crucial and it can make an astonishing difference in the well being of Emergency Responders.
For more information on Critical Incident Stress education for significant others contact the author of this program or your local CISM team.
Douglas Cline is a 32-year veteran and student of the Fire Service serving as Assistant Chief of Operations with Horry County Fire Rescue. Cline, a former Fire Chief, is a North Carolina Level II Fire Instructor, National Fire Academy Instructor and an EMT-Paramedic instructor for the North Carolina Office of Emergency Medical Services. Chief Cline is President of the International Society of Fire Service Instructors (ISFSI) and the Immediate Past President of the Southeastern Association of Fire Chiefs (SEAFC).