Ways EMTs Can Better Manage Stress

As EMS chiefs we are responsible for planning for and ensuring the needs of our crews are met during regular operations, as well as unique incidents or long-duration operations. For my service, the ongoing events in Ferguson, Mo. pushed and stressed our leadership team.

As we determine our response plan, first and foremost is the importance of keeping crews safe. We need to ensure our crews go home at the end of their shift. Having to make a visit to an employee’s home to deliver bad news is not on my things to do list.

As we looked at the lessons learned from the events in August 2014 and set our plan going forward, it was quickly noticed my leadership team was feeling stressed and a lesson on stress management was needed. Let’s reflect on how to manage the stress we face every day.

Stress defined

EMS can be stressful. It might be the 10th transfer of the day or trying to resuscitate a 3-month-old in cardiac arrest. We all have our own definition of stress and sometimes we may not even recognize that we are under stress. Failing to recognize stress and combat its effects on us could lead to health issues, career burnout, or worse first responder suicide.

So what is the definition of stress? One of the most common definitions, attributed to Richard Lazarus a physiology professor from the University of California Berkeley, states “stress is a condition or feeling experienced when a person perceives that demands exceed the personal and social resources the individual is able to mobilize.” In short, stress is what we feel when we think we’ve lost control of events.

Reactions to stress

There are two specific nervous system reactions that leads to our stress response. These are “fight or flight” response and the General Adaptation Syndrome (GAS). The fight or flight response was identified as early as 1932, and describes our short time survival response when we experience a shock or perceive a threat. Once our brains sense these responses, a hormone is released that prepare the body to run from the threat or fight it. This hormonal release energizes us which in turn makes us excitable, anxious, and even irritable.

The challenge with the fight or flight response is that, while it helps us deal with the life threatening events, it is also part of our everyday workplace situations. Think of the folks you come in contact with every day that are excitable, anxious, and irritable – a perfect set of ingredients for the stress recipe. The GAS was identified in the 1950’s which deals with long-term exposure to stress.

Both of these reactions can happen at the same time. GAS defines coping with stress in three distinct phases:

• Alarm phase: where we react to the stressor.
• Resistance phase: where we adapt to, and cope with, the stressor. The body can’t keep up resistance indefinitely, so our physical and emotional resources are gradually depleted.
• Exhaustion phase: where, eventually, we’re “worn down” and we cannot function normally.

The fight or flight response and the GAS are linked. The exhaustion phase of the GAS is from an accumulation of countless fight or flight responses over a long period.

What we think about stress

Usually when stress is encountered we unconsciously make two judgments about it:

• Is the situation threatening? This does not have to be a physical threat alone, but a threat to our social standing, our values, or even our reputation. This triggers our fight or flight response as well as the alarm phase of the GAS.
• Do we have the resources to meet our perceived threat? These resources can include knowledge, emotional reserves, positive energy, and strength. Basically, how we feel about a stressful situation depends on how far out of control we feel and if we have the resources to fight this threat.

Signs of stress

On a daily basis our EMS responsibilities plunge us into the stress reactor, sometimes without relief. In your EMS career running back-to-back cardiac arrests, with a multi-patient motor vehicle collision could be a daily event. The stress reaction is different for everyone. Some common signs of stressinclude:

• Frequent headaches
• Cold or sweaty hands and feet
• Frequent heartburn, stomach pain, or nausea
• Panic attacks
• Excessive sleeping, or insomnia
• Persistent difficulty concentrating
• Obsessive or compulsive behaviors
• Social withdrawal or isolation
• Constant fatigue
• Irritability and angry episodes
• Significant weight gain or loss
• Consistent feelings of being overwhelmed or overloaded

As you read through the list, did you may recognize any signs that you are experiencing? You may be stressed. Seeking help with these signs and symptoms is okay. Just like we learned how to intubate and start an IV, stress management skills need to be learned as well.

Track your stressors

You should know the things that push you over the edge and make you feel stress. Maybe it’s a person, co-workers that are late, missing a deadline, or countless other things. If you do not know what causes you stress, it will constantly sneak up on you. Try keeping a ‘stress journal’ and list not only the things that stress you out, but how you reacted to them.

React in positive ways

We are going to experience stressful situations and we cannot really control when they occur, the only thing we can control is our reaction to them.

• Establish limits: You may have that one person that is always negative and just sucks the energy right out of the room. If you are listening to the negativity they always seem to spew, we will eventually be in a position to feel negative as well. When the negative barrage begins, put a stop to it and set the expectation that you work in a positive zone, and it needs to be respected.
• Take time away: Sometimes we just have to get away from work, people, the 24 hour ability to be connected to the internet and just recharge. Find a place that you enjoy and switch off the world and do something that truly makes you happy.
• Learn how to relax: Taking time away only works if you know how to relax once you are there. Sitting in the truck is very stressful as we wait for that next call. As you take time away, find ways to relax your mind, body and spirit. Try mediation or deep breathing techniques, taking a walk, or working out. This is your time, make the most of it.
• Talk to a friend or supervisor: Having someone close to you is an important component of reducing stress. Your EMS leadership has been where you are, tell them how you feel and ask how they dealt with their stress and feelings. What worked for them, may not work for you, but it’s good to know someone went through the same stresses.

You truly have to understand that stress is a killer. Continuous stress shortens an EMS career, causes physical challenges and those physical challenges can kill you. Join me in supporting The Code Green Campaign, a group that is there for you to discuss your feelings, share your stories, and listen to like-minded peers.

The Code Green Campaign shared with me that in 2014 58 first responders have died from suicide. Brothers and sisters, you are not alone. We are in the business of compassion and you deserve some too. If you need someone to talk to immediately call a suicide hotline.