Are EMTs resilient enough?

By Bryan Fass

While even normal people outside of public safety experience job-related stress as a fact of life, it seems like ours is much worse. Those of us who've in the business for a while can remember a time where the topic of stress and stress management were never discussed. Thankfully, EMS has taken a great leap forward bringing to light the depth and severity of our mental health.

Stress can be good and bad. Exercise induced stress is good. It forces our body to grow, heal and improve. The stress you experience prior to a protocol test increases your mental acuity.

The trouble starts when the stress response is constant and your body has no time to reset and rebalance. As call volumes have increased, so have resiliency issues for EMS providers.   

As a paramedic and as a strength coach I have often wondered what has changed.

• Why has the rate of suicide and mental health issues increased?
• Is it the call volume, is it the type of calls or have we changed?

Next read these questions. I want to spark a conversation. Share your answers with me in the comments or send me an email. Together, we can hopefully steer the profession in a healthier direction.

• Is our inability to handle stress because we have lost the ability to separate from the job?
• Have we lost the ability for physical outlets to help manage the stress?
• Are we poisoning ourselves with a toxic combination of overtime, poor eating habits and reliance on stimulants?

I can recall as a green medic running my first pediatric traumatic arrest. Sure, I had read about it, studied it and even did hours of training in the NICU. Yet having to manage the scene, intubate the child while en route, start compressions, start an IO and then carry a child I knew was deceased into the emergency department was very foreign to me.

I recall standing there as the trauma team worked the child, being expected to calmly and accurately give a report and then go write my patient care report. I had no training for that and no way to manage those emotions. Yes, that call weighed on me the rest of the shift, but I pushed on.

Exercise to increase resiliency
However as soon as my shift ended I drove right to the gym and hammered myself with an epic workout; that was and is my outlet, my relief valve. Studies show that exercise, any exercise, calms the mind and releases endorphins that help promote wellness [1, 2, 3].

Exercise is by far the best medicine for building resiliency. The data is clear. Any exercise is beneficial with cardiovascular exercise shown to be slightly superior. As I have said in multiple EMS1 columns move well and move often but just move. 

Another issue is our addiction to technology. When I was a street medic you were connected only if you had a Nextel phone (the walkie talkie phone). Now there is an app for constant communication. I often wonder if after a series of difficult calls when an EMT should disconnect from the stressor and find an outlet if the news feeds, photos, texts and instant messages that flood in slowly elevate the long-term stress response. 

Disconnect from the world and get after it. The stronger you are and the more fit you are, the less pain you experience. Exercise will boost your resiliency and help to improve your sleep and nutrition.

Let's face it the EMS diet is not so good. Not only do you have to contend with the call volume and missed meals; bringing your food with you will fix that. We have to deal with stress eating and fatigue eating. There is a reason that you crave the foods that are bad and understanding is the first step.

Eat better to improve resiliency
The overconsumption of sugars and caffeine plus a diet devoid of beneficial nutrition when tied into the over stimulation of the stress response throws the serotonin, cortisol, adrenalin response and more importantly recovery process so far out of whack that we are essentially poisoning ourselves and making ourselves vulnerable to the cumulative dangers of bad stress [4]. Soldiers that died by suicide were 62 percent more likely to have extremely low levels of DHA (the good fat in fish and chia/flax that helps your brain) then soldiers that did not attempt [5].

On top of that too many first responders are self-medicating with alcohol and drugs. This destroys the allostatic balance leading responders into a deep, dark hole.  

A key to boosting resiliency in EMS requires that EMT's have a physical outlet for their stress. Tie in good nutrition that heals, and you can boost your resiliency and wellness at the same time.

References

1. Perspectives in Rehabilitation. Exercise therapy improves both mental and physical health in patients with major depression. DOI: 10.3109/09638288.2014.972579. Knapen, Davy Vancampfort, Yves Moriën and Yannick Marchal. Pages 1490-1495
2. Exercise and well-being: a review of mental and physical health benefits associated with physical activity Penedo, Frank J; Dahn, Jason R
3. http://ift.tt/2bzVlli
4. http://ift.tt/1GsrWTc
5. Lewis, Michael et.al. "Suicide of active duty us military and omegs-3 fatty acid status. The Journal of Clinical Psychiatry 72.12 (2011): 1585.

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