(This is part three of a three part series.)
Throughout recent articles we’ve discussed the importance of self-assessment, prevention of unnecessary stress and understanding the importance of recognizing the symptoms of chronic stress. If not maintained properly, stress can easily transition from a necessary adrenalin pumping reaction to an unhealthy long-term illness. Excessive stress can manifest as symptoms of digestive problems, loss of appetite, high blood pressure, migraines, depression, extreme anxiety and even heart failure. It is crucial for firefighters to recognize the symptoms of chronic stress, how to prevent good stress from turning deadly and how to mentally maintain a healthy lifestyle. These factors help firefighters work more effectively and can help prevent stress from becoming a debilitating and life-threatening disease.
Along with prevention and proper destressing techniques, practicing the right recovery techniques from regular or chronic stress is just as important. Recovering from any type of trauma, whether it be a call that wakes you in the middle of the night, or responding to a fatal accident at the beginning of your shift, what you do after that call is just as important as what you do to prepare for it. Proper recovery from chronic stress is the everyday life of a firefighter. Constantly recovering and needing to carve out time to destress and debrief is vital to maintaining a healthy life under such demanding circumstances.
We easily forget how important it is to take care of our own bodies first and foremost before attempting to help others. It is your responsibility to encourage and create a space that feels and promotes healthy practices within a firehouse. Whether it be by creating a comfortable lounge area to enhance social interaction and encourage communication among team members even providing a separate room for each team member to have a few moments to relax and reflect, encouragement of this behavior is essential for the wellness of your firehouse.
Unfortunately, we’re in a place in our country’s history where first responders may be called to a mass shooting, or an out of control riot — never knowing what tomorrow will bring or where the next call will take you. With the pressure at its greatest and the calls at their most dangerous, it is more important than ever for firefighters to take care of themselves. Some firefighters on their shift have no problem sleeping, others just can’t seem to relax because of one end nerves waiting for that call that could happen at any time. As a way of combatting this unsettling feeling it’s important to create as comfortable of a space as possible. Proper ventilation, enough personal space for each person, comfortable mattresses and bedding is also important.
It is more important now than ever that our first responders are well rested and have the environment to de-stress and relax. Preventative actions are like what should be done for recovery, unfortunately with the intense work pace that comes with being an emergency responder there isn’t a lot of time to pour into recovering from an emotionally physically taxing call. Short and meaningful breaks are vital to a responder’s well being. Much of the following information derives from an International Fire Chief’s Association sleep deprivation report. It discusses the importance of sleep, the effects of sleep deprivation and the importance of much needed breaks, including naps; as well as actions that can be taken to encourage exercise and overall health.
The relationship between sleep deprivation and decreased performance is predominant in many studies done in firehouses. Being awake for 18 hours produces impairment equal to a blood alcohol concentration (BAC) of 0.05. A recent analysis of U.S. workers involving more than 110,000 job records over 12 years, controlled for age and occupation, revealed an almost linear increase in injuries with the number of hours worked per day (or per week). Working 12 hours per day was associated with a 37 percent increased hazard rate, and 60 hours per week increased injuries 23 percent.
There are plenty of actions that can be taken in a firehouse to either encourage relaxation or quite the opposite. Environmental conditions can be adjusted to maximize alertness by controlling lighting and temperature. Bright lighting enhances alertness. Keeping the temperature at a setting where a light sweater is comfortable also helps to counteract drowsiness. Organizing work tasks to have the most tedious activities early in a shift, allowing for social interchange and providing patterns of non-monotonous sounds also will contribute to an attention-stimulating environment. Simple measures, such as walking up and down stairs instead of taking the elevator, and using software programs that cues workers to move around and stretch at intervals can be helpful. Exercise is not a substitute for sleep. While exercise increases alertness in the short term, when assessed in a cross over study, in the long run, individuals who exercised during sleep deprivation had worse performance and felt more fatigue than when sleep deprived without.
There are many actions that can be taken to recover from traumatic experiences. Napping, although usually frowned upon on the job, is vital to the well being of EMS responders and can be used on and off work. Naps can be taken in anticipation of a long night or during prolonged work times, and used in that way, they can attenuate fatigue. They can also be used for recovery from chronic and every day stress. Particularly when starting a series of night shifts, a two hour nap taken in the evening before the work can improve alertness. A nap is sleep that lasts less than half of the typical daily major sleep episode. It’s important to understand that resting without sleeping is not a nap. Environmental conditions that promote sleep, such as a cool, quiet environment and reclining more than 45 degrees from vertical, enhance the quality of sleep obtained during a nap. Naps as short as 20 minutes can be effective in restoring mental abilities, and naps of two hours during long work shifts can be highly restorative. Based on the disproportionate recovery potential of relatively short (less than 45 minutes) periods, these “power naps” have been investigated as a strategy to attenuate performance deficits during and following periods of sleep deprivation. Studies by NASA showed that planned naps by pilots on long-haul flights improved alertness when landing. For most types of night work, nap breaks are generally not an option, despite their potential for suppressing sleepiness. However, some industrial organizations have begun promoting napping to improve conditions, work performance and safety. With everyone catching on to its importance, hopefully naps will be looked at in a more positive light.
Stanford researchers have examined emergency room doctors and found that short naps during a 12 hour night shift resulted in better performance on written memory tests, a simulated car drive and simulated intravenous line insertion. As a result, their hospital instituted a sanctioned napping program. Suggestions for emergency room staffing patterns have included recommendations to allow strategic napping prior to work and following 12-hour shifts before driving home. Naps longer than 45 minutes can result in awakening during the deeper stages of sleep and greater grogginess and reduced cognitive performance than if awoken from stage one or two of non-rapid eye movement (NREM) or from REM sleep. Immediately upon awakening, a person’s ability to make decisions may be half that of the ability when rested and fully awake, and even 30 minutes later, decision making may not be back to normal.
In addition to the duration of a nap, the circumstances of awakening affect sleep inertia. Paradoxically, abrupt awakening, such as might occur with a fire alarm, may result in longer persistence of grogginess. In addition, those with chronic sleep deprivation are more affected by sleep inertia. Thus, if an individual is required to be alert upon awakening, naps are best when either short or approximately two hours in duration, when the individual would be expected to be dreaming or in the early phases of the next sleep cycle.
All of this to say, studies have shown that regular and planned relaxation and timed sleep can result in a more productive and alert crew. A team that is well rested, recovered and prepared can take on any call, at any time at full potential. Although everyone has different ways of coping with stress, relaxing and even managing sleep throughout their home life and career, these are general tips that can always improve overall mental health and wellness.