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Emotional Survival of First Responders

Emotional Survival of First Responders
Todays First Responders face a multitude of challenges on a variety of fronts.  Technology not only can make our jobs easier, but also may cause complications with recordings, videos, and just plain old computer issues.  Litigation is ever present and the explosion of various media sources and blogs can push false narratives or continue placing issues and calls of activism in front of a population for a much longer time than previous generations ever could dream possible. There is Specialized and societal mandated training.  Added to what is already a highly stressful work environment - the effects on the First Responder is immense.  A career where batting .300 such as in baseball is considered good - doesn’t even come close.  Perfection is demanded and expected of us. If not, then people can get hurt or die, lawsuits initiated, and internal investigations opened.  Not to mention protests and negative media coverage.  Whether law enforcement, Fire, EMS, dispatch, or corrections, all careers face their own special work pressures.  We are easily recognizable and if people want to do us harm - all they have to do is call 911 and we offer drive-up service.

Employers try to hire the best and fittest - written exams, physical tests, medical screening, background checks, oral boards.  Training academies, on the job training, probationary periods and even psychological exams.  After all that, we release the new employee and continue in-service training on a variety of issues.  Firearms, Hazmat, Defensive Tactics, dealing with emotionally or mentally ill citizens, crisis management, driving skills, verbal skills, first aid, CPR and medical training.  But when do we ever look at the employee again or offer support and training for the ongoing stress, pressures, and grief of just doing the job?  Sure we have Employee Assistance Programs for employees or fit-for-duty evaluations, but those are after the fact.  One of my officers went to a therapist from EAP.  Upon his return, I asked him how things went. Sarcastically he stated “Just fine.  She had no idea what I do, and when I started talking about the deaths and injuries and trauma I've seen - she became ill and startled.  So all I succeeded in doing was traumatizing my therapist and wasting my time.” 

Other careers dream about retirement and their IRAs while First Responders just dream of surviving.  Then the question becomes in what condition will you be in if you reach retirement.  With the higher than normal populate rate of divorce, alcoholism, and suicides, retirement is not always a given.  We have all seen the employee that puts in their time and when retirement rolls around - all they have ever known was their job.  They have no other interests, hobbies, friends or connections.  They show up to see their “family”, maybe have a cup of coffee, but it seems no one has time anymore.   The machine continues to roll on - calls and work require attention.  So they are lost, alone and feel abandoned.  The career choice is tough, and retirement can be tougher.  

While the job and stressors and trauma can’t be changed, how we live our lives and prepare ourselves can have a positive effect.  For the most part, First Responders are Type A people and “doers” and willing to take a more proactive approach so that when the crisis does hit, we have systems and mechanisms in place and established already.  As always, it starts with having good intel - or in this case information - to give a basis as to what is occurring to us.  

First some basic information on stress.  Stress is a normal physical response to events that make you feel threatened or upset your balance in some way. When you sense danger—whether it’s real or imagined—the body’s defenses kick into high gear in a rapid, automatic process known as the “fight-or-flight-or-freeze” reaction, or the stress response.

The stress response is the body’s way of protecting you. When working properly, it helps you stay focused, energetic, and alert. In emergency situations, stress can save your life—giving you extra strength to defend yourself, spurring you to slam on the brakes to avoid an accident, hearing occlusion in dispatchers so they concentrate on the call or situation more, tunnel vision or slow motion vision to help focus on the danger immediately in front of you.

First Responders deal with 6 major stress groups.  Traumatic stress, which used to be referred to as Critical Incident stress; delayed; cumulative; compassion fatigue; work; and burnout.

Traumatic stress is a NORMAL response to ABNORMAL events.  This occurs when you experience an unusual or extreme emotional reaction after exposure to an event that is overwhelming to you. This is subjective based on each individual’s life experience and belief systems. People react in different ways to disasters and traumatic events What is overwhelming to one person may not be overwhelming to another person. Natural disasters and other catastrophic events, such as motor vehicle accidents, plane crashes, line of duty deaths, and terrorist attacks are extraordinarily stressful—both to survivors and observers. Such disasters shatter your sense of security, making you feel helpless and vulnerable in a dangerous world. Whether or not you were directly impacted by the traumatic event, it’s normal to feel anxious, scared, and uncertain about what the future may bring.

Usually, these unsettling thoughts and feelings fade as life starts to return to normal. You can assist the process by keeping the following in mind: people react in different ways to disasters and traumatic events. There is no “right” or “wrong” way to think, feel, or respond. Be tolerant of your own reactions and feelings, as well as the reactions and feelings of others. Don’t tell yourself (or anyone else) what you should be thinking, feeling, or doing. YOU FEEL HOW YOU FEEL.

Following a traumatic event, it’s normal to feel a wide range of intense emotions and physical reactions. These emotional reactions often come and go in waves. There may be times when you feel jumpy and anxious, and other times when you feel disconnected and numb. Normal emotional responses include shock and disbelief, fear, sadness, helplessness, guilt maybe that you survived, anger, shame in your reactions, even relief when its over.  Reactions may include numbness, confusion, non directed activity, disorientation, tunnel vision, crying, muscle tension (clenched jaw), profuse sweating, chest pain or increased heart rate. Emotional and psychological trauma is the result of extraordinarily stressful events that shatter your sense of security, making you feel helpless and vulnerable in a dangerous world. Emotional and psychological trauma can be caused by single-blow, one-time events, such as a horrible accident, a natural disaster, or a violent attack. Trauma can also stem from ongoing, relentless stress, such as living in a crime-ridden neighborhood or struggling with a life-threatening disease like cancer.

Delayed stress is where stress reactions to an overwhelming event do not occur until days, weeks, months or even years later.  They are just as debilitating and impacting as a recent event.  Delayed stress can occur when people go into shock after an event, refuse to acknowledge the impact of the event, or when exposure to an event is prolonged. Some cases stress reactions to an overwhelming event do not occur until days, weeks, months or even years later.  They are just as debilitating and impacting as a recent event.  Delayed stress can occur when people go into shock after an event, refuse to acknowledge the impact of the event, or when exposure to an event is prolonged. Cumulative stress occurs when a person’s normal coping mechanism are continuously overwhelmed.  It can also occur when you don’t build in daily self-care activities that are regenerative and stress reducing.  Cumulative stress reactions are very debilitating.  People begin to believe that frequent headaches, acid stomach, irritability, poor concentration, are normal.  This produces further stress which can lead to serious physical and emotional illnesses.

Compassion Fatigue occurs when first responders become tired from emotionally investing themselves. Personal issues, chronic worry, and body tension all contribute to a responder’s Compassion Fatigue.  Compassion Fatigue leads to cynicism & pessimism which can impair a responder’s judgment.

Workplace stress can include fear of being laid off, more overtime due to staff cutbacks, pressure to perform to meet rising expectations but with no increase in job satisfaction, pressure to work at optimum levels all the time, feeling like you have little or no control over your work, lack of recognition or rewards for good work, unclear or overly demanding job expectations, doing work that’s monotonous or unchallenging, working in a chaotic or high-pressure environment.

Burnout is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed and unable to meet constant demands. As the stress continues, you begin to lose the interest or motivation that led you to take on a certain role in the first place. Burnout reduces your productivity and saps your energy, leaving you feeling increasingly helpless, hopeless, cynical, and resentful. Eventually, you may feel like you have nothing more to give. 

The effects of stress on the body are wide ranging.  Stress can cause mood swings, depression, irritability, loss of energy, sadness, headaches, mental health issues such as anxiety disorders and panic attacks.  Stress can cause sleeping issues and skin conditions such as acne.  It can lead to increased heart rate and blood pressure, high cholesterol and even heart attacks. Stress has been known to cause diabetes, constipation and diarrhea, muscle aches and pains, stomach cramps, nausea, irritable bowel syndrome, and issues with the reproductive system.  

Post-traumatic stress disorder (PTSD) can develop following a traumatic event that threatens your safety or makes you feel helpless. Most people associate PTSD with battle-scarred soldiers—and military combat is the most common cause in men—but any overwhelming life experience can trigger PTSD, especially if the event feels unpredictable and uncontrollable. PTSD can affect those who personally experience the catastrophe, those who witness it, and those who pick up the pieces afterward, including emergency workers and law enforcement officers. It can even occur in the friends or family members of those who went through the actual trauma. PTSD develops differently from person to person. While the symptoms of PTSD most commonly develop in the hours or days following the traumatic event, it can sometimes take weeks, months, or even years before they appear. Symptoms can arise suddenly, gradually, or come and go over time. Sometimes symptoms appear seemingly out of the blue. At other times, they are triggered by something that reminds you of the original traumatic event, such as a noise, an image, certain words, or a smell. It is important to remember that just because someone experiences traumatic stress, does not mean that the will develop PTSD.

There are steps that we can take to reduce stress to increase our emotional survival:
  • Make connections: good relationships with others are important, especially after stressful events.  
  • Accept help and support from those who care about you.  
  • Being active in civic groups, faith-based organizations or other local group provides social support and can help with reclaiming hope. 
  • Avoid seeing crises as insurmountable problems:  You can’t change the fact that events happen, but you can change how you interpret and respond to them.  
  • Try looking beyond the present in order to consider how future circumstances may be better. 
  • Note any subtle ways in which one might feel somewhat better as one deals with difficult situations.
  • Accept that change is part of living: Certain goals may no longer be reachable. Make new goals to set.  
  • Accept circumstances that cannot be changed and focus on new possibilities. 
  • Make movement by developing realistic goals. Focusing on unachievable goals only adds to the stress.  Ask, “What is one thing I know I can accomplish today that helps me move in the direction I want to go?”
  • Taking decisive actions:  Act on adverse situations as much as you can.  Avoiding them will only make things worse.  Taking actions that you can empowers you. 
  • Look for opportunities for self-discovery: People often find that they have grown in some way from their struggle with loss or difficulty. 
    Many people who have experienced tragedies and hardship have reported better relationships, a greater sense of personal strength, even while feeling vulnerable, increased sense of self-worth, a more developed spirituality, and heightened appreciation for their life. 
  • Nurturing a positive view of one’s self: Develop confidence in your ability to solve problems and trust your instincts.  
  • Keep things in perspective: Consider the stressful situation in a larger context.  Maintain a long-term perspective.  Avoid blowing the event out of proportion. 
  • Although grief has similar emotional, physical, mental and psychological reactions as critical incident stress, it impacts people for a longer time.  

Grief is a natural response to loss. It’s the emotional suffering you feel when something or someone you love is taken away. The more significant the loss, the more intense the grief will be. You may associate grief with the death of a loved one—which is often the cause of the most intense type of grief—but any loss can cause grief.  This can include divorce, loss of health, a friendship, employment, a pet.  Even selling the family home or loss of financial security.

The more significant the loss, the more intense the grief. However, even subtle losses can lead to grief.  As with stress, grief is cumulative.  If you don’t address or process through the grief, it will continue to stack up and compound the issue.

Grieving is a personal and highly individual experience. How you grieve depends on many factors, including your personality and coping style, your life experience, your faith, and the nature of the loss. The grieving process takes time. Healing happens gradually; it can’t be forced or hurried—and there is no “normal” timetable for grieving. Some people start to feel better in weeks or months. For others, the grieving process is measured in years. Whatever your grief experience, it’s important to be patient with yourself and allow the process to naturally unfold.

In 1969, psychiatrist Elisabeth Kübler-Ross introduced what became known as the “five stages of grief.” These stages of grief were based on her studies of the feelings of patients facing a terminal illness, but many people have generalized them to other types of negative life changes and losses, such as the death of a loved one or a break-up. The five stages of grief she listed were Denial, Anger, Bargaining, Depression, and Acceptance.  Dr. Kübler-Ross never intended for these stages to be a rigid framework that applies to everyone who mourns. “They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grieving is as individual as our lives.”

An analogy used by The Hospice Foundation of America relates grief to a roller coaster. Instead of a series of stages, we might also think of the grieving process as a roller coaster, full of ups and downs, highs and lows. Like many roller coasters, the ride tends to be rougher in the beginning, the lows may be deeper and longer. The difficult periods should become less intense and shorter as time goes by, but it takes time to work through a loss. Even years after a loss, especially at special events such as a family wedding or the birth of a child, we may still experience a strong sense of grief.

Strategies for self-help are similar to those for stress. Reach out to others for support. You may be tempted to withdraw from social activities and your loved ones. But it’s important to stay connected to life and the people who care about you. Support groups can also help and many are listed online.

Avoid alcohol and drugs. When you’re struggling with difficult emotions and traumatic memories, you may be tempted to self-medicate with alcohol or drugs. But while alcohol or drugs may temporarily make you feel better, substance use worsens many symptoms, including emotional numbing, social isolation, anger, and depression. It also interferes with treatment and can add to problems at home and in your relationships.

Challenge your sense of helplessness. Grief leaves you feeling powerless and vulnerable. It’s important to remind yourself that you have strengths and coping skills that can get you through tough times. One of the best ways to reclaim your sense of power is by helping others: volunteer your time, give blood, reach out to a friend in need, or donate to your favorite charity. 

To prepare ourselves for the onslaught of stress, pressure, and grief, the more support systems that are in place ahead of time, the better the emotional survival rate.  If we think of our support systems as a stool - the more legs you have, the better.  Those that have only work as a survival system, for instance, when they retire or the issue stems from work - they fall over as the only support system they have is gone. Support systems include Diet, Physical Exercise, Sleep, Job and Finances, Family, Friends, Restorative Activities, and Spirituality or Moral Beliefs.

Diet is basically fueling your body for Peak Performance.  Like an athlete prepares themselves to be at their best, a diet of donuts, fast foods, etc -does not serve a First Responder well. Find out what food works best for YOUR body.  Some bodies do better with meats, poultry, fish, while some do better with a vegetarian diet.  Just because a food is “healthy” does not mean its good for your body.  Some foods have negative effects that may include:

  • Chronic Illness
  • Physical Complaints
  • Sleep disruption
  • Emotional Response
  • Allergies 
  • Energy Depletion
  • Inability to Concentrate
Physical Exercise includes cardio, muscle strength and flexibility.  So whether you run, lift weights or do yoga, exercise is critical for the development of certain neurotransmitters in the brain, called endorphins.  Endorphins help us develop a sense of well being. Aerobic activity after a stressful event will help release the stress response from the muscle. But don’t start running if you never have. Stick with an exercise you are already engaged in. Exercise can conflict with the immune system during times of illness, so you might need to rest while it is regenerating.
 
Sleep is not an excuse or crutch. Sleep is critical in overall well-being.  It is one of the most important aspects of your life that will create stability.  Research shows that having a stable sleep schedule and enough sleep every day is essential to physical and psychological health. It takes 30 days for your body to readjust every time you change your sleep schedule or get less sleep than your body needs.   You cannot “make-up” sleep you can only get back into balance. Symptoms of Sleep Deprivation include:

  • Difficulty concentrating
  • Irritability, depression
  • Memory loss
  • Cognitive disorganization (can’t think clearly)
  • Chronic fatigue, anxiety

Workers who are subjected to chronic changes in sleep schedule have a higher risk for cardiovascular disease, neurotic disorders and depression; poor diet: disruptions in appetite, diarrhea, constipation.
 
Job and Finances are a frequent stressor in life.  People often define who they are by their job and/or wealth.  To have an effective system, stay within your means.  

Occasional overtime is fine, but don’t become depended upon it. If people ask about you and you first define your self by your employment other than family or interests, your life priorities may need to be redefined

Family.  Human beings are social by nature. Humans are nurtured by love from one another.  Families are an important source of support and help regenerate you.  But families can also be a source of stress, so having good conflict resolution skills is critical.  Good communication skills and open discussion are a must 
Emergency services is an extended family. There is never a good reason to neglect time with family.

Friends are important to maintaining a balance.  But cultivate friends outside of your work. Time to play and interact with others is critical.  Work friendships mean “No shop talk” while off duty. If on your days off you go out with your crew and just discuss work problems and Administration - chances are you aren’t relaxing. but maintaining that stress. Playing, laughing, time to share opinions and receive support all help bring a sense of well-being and stability emotionally and psychologically.  Enjoyment and fun help your physical body release tension and stress.
 
Engaging in Restorative Activities that bring you a sense of peace, calm and accomplishment decreases stress in your life.  Meditation, prayer, fishing, woodworking, gardening are all restorative activities. Any type of hobbies or interests helps you to recover from stressful events much easier.  It is important to take time every week (every day if possible) to do things that calm your nervous system.

Spirituality can be the foundation to all of the previously covered areas.   Spiritual practice, religious beliefs, or a belief system where you live by a sense of ethics within yourself. It is important to have an internal moral compass and means to assess how you are with that moral compass. Finding time for yourself to review where you are with your ethical, moral, spiritual or religious beliefs is a proactive way of heading stress off and can reduce your vulnerability to stress reactions in a traumatic incident.
 

There is no secret means to deal with the emotional impact First Responders endure. Stress and grief are constants in our professions.  Some incidents may result in PTSD.  The effects on us are similar to stress and grief and so are the self-help recommendations.  Many First Responders are reluctant to ask for help, but in the majority of instances, the reactions are normal and not a sign of weakness nor is anything “wrong” with you. By living a life more in balance than having just one or two systems in place, helps you to manage the effects by providing a variety of outlets and systems to rely on and to provide support.  The key is to have those systems in place prior to an event or breakdown occurs.  Our personnel is the most important cog in the wheel of the organization. By helping ourselves, being proactive with our emotional health, we help provide better service to the public, have more productive employees, and most importantly, employees that are emotionally able to survive and have a balanced life. 

By Assistant Chief (RET) Bob Karnofski  BS, CHt

 


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Posted: May 31, 2018,
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