NCEMSF: Don’t Let the Bathtub Overflow

“Think of stress as a bathtub—resiliency can help us empty our bathtub faster,” said Ann Marie Farina, EMT-P in her session “Don’t Let the Bathtub Overflow: What Is Resiliency and Why Is it Important?” at the NCEMSF conference in Boston, Mass., March 1. Farina is one of the founders of Code Green, a campaign and storytelling project dedicated to tracking suicide data among first responders and providing education and outreach on mental health.

“Resiliency is being rubber instead of being glue,” Farina said. Resiliency can also be thought of as a callous, she said. When you first start working with your hands and develop callouses, it’s painful and difficult. But over time, your hands become stronger and working becomes easier. Building those “callouses” for your mental health is critical to your health as a first responder so you can bounce back when things get tough.

Farina emphasized that it’s okay to have ups and downs. “Resiliency can be lost and gained,” depending on how your week is going. A bad week can mean you get a call on Friday that upsets you that wouldn’t have upset you on Monday.

When a person experiences acute stress, they are forced to build resiliency, said Farina. This stress can be caused by complicated life experiences like illness, sudden death, and war. For example, a study showed that the suicide rate dropped in New York and New Jersey for a full two years following 9/11. The trauma of the terrorist attacks led to increased low-level peer support and solidarity to boost resiliency among a large population that experienced a very painful event together.

Traumatic incidents aside, main everyday sources of stress include financial hardship, problems in your home life, and chronic workplace stress, especially when it interferes with relationships and family time. General risk factors for PTSD involve being exposed to traumatic events, feeling helpless, using drugs or alcohol to suppress emotional reactions to the events, not processing emotions and dealing with stress at home. According to Farina, first responders are at increased risk for PTSD if subjected to the following:

• Regular stress in the work environment
• Guilt or self-blame
• No support network
• Wishful thinking (“I wish I did ABC instead of XYZ during this bad call”)
• Peritraumatic distress (the physiological and emotional stress experienced during or immediately after a traumatic event)
• Peritraumatic dissociation (emotional numbness and dissociative amnesia: e.g. if you’re forgetting what happened on calls between leaving and coming back to the station, that’s a major indicator you are not processing trauma)

If not dealt with, post-traumatic stress can cause physical problems, such as acid reflux, headaches, nausea and vomiting, increased risk of stroke, heart attack, and diabetes, suppressed immunity, and more. To avoid facing their trauma, some people will turn to sex, drugs, and alcohol, seclude themselves, work more hours, and bottle up their emotions. Farina recommended the following guidelines to developing your resiliency when facing stress and trauma.

Dealing With Stress Positively & Building Resiliency

Accept what you can’t change. You have to accept that you couldn’t have changed the outcome of certain calls. “Sometimes you have to sit there and argue with yourself—think about the physiology,” said Farina. If you’re kicking yourself after a cardiac arrest patient dies and it was an older adult who had had several heart attacks and other comorbidities, it didn’t matter what drugs you administered or interventions you made—it was that patient’s time.

Have a strong support network. This can be a group of individuals at work, outside of work, or both. Your friends and family can help talk you out of negative self-talk and bring a different perspective. If you hide away from others, you’re robbing yourself of the opportunity to get that nourishing peer support.

Invest in healthy coping mechanisms. Spend time enjoying your favorite hobbies or find new ones. Carve out time for exercise (yoga is particularly beneficial for managing stress). Practice mindfulness and breathing exercises. Don’t misuse drugs and alcohol.

Consider your personality, too—extroverts tend to benefit from social interactions with large groups of people while introverts may want to just have a one-on-one conversation with a trusted colleague or friend over coffee.

Farina discussed the use of dark humor and engagement in adrenaline junkie activities. Dark humor is okay for coping until you get to the point where you are dehumanizing patients (e.g. the term “crispy critters” for patients who die in fires is unacceptable). For those who engage in risky behaviors, Farina warns of passive suicidality: people who have this take risks because they want to die but don’t have a plan. They compromise their safety because they don’t care if they live or die. These are other signs that someone is experiencing post-traumatic stress.

Develop a feedback program for your staff. If providers can find out about the outcomes of their patients, they can learn from what they did well or didn’t do well instead of agonizing over the call, unsure of whether they made the right treatment decisions.

Practice mindfulness. “Mindfulness gets beaten out of us because we’re told it doesn’t matter if we’re hungry, cold, tired, or if our feet are wet—what matters is taking care of the patient and getting the job done, so we become detached” from our physical and emotional states, said Farina. Mindfulness means turning off the auto-pilot mode and paying attention to those states. Recognize what you’re feeling and don’t judge yourself.

When experiencing extremely stressful emotions, try the Navy SEAL box breathing technique. Inhale for four seconds, hold for four seconds, exhale for four seconds, hold again, and repeat. The 5 Senses technique also serves as a mental reset, especially during panic attacks. Name five sights you see (the sky, your desk), four things you can touch or feel (the carpet you’re standing on, your dog), three sounds you hear, two scents you smell, and one thing you can taste.

Valerie Amato is assistant editor of EMS World. Reach Val at vamato@emsworld.com.