In Search of Grit

The adrenaline rush that helped lead Ethan Fraize into the emergency services has begun to fade. The love he once held for the flashing lights of an ambulance, the intensity he felt with every siren, the cascade of emotions once associated with each run aren’t quite what they once were. 

That’s not to suggest Fraize, 4 years removed from becoming an EMT and a mere 18 months into working as a paramedic, is not still motivated as a health care provider. Rather, his sources of motivation have evolved as his experience in the field has grown. He has accepted that the inspiration that enables him to suit up as a medic may not come from the same place it once did, especially on those days when he’s exhausted by the symptoms of occupational stress that can become part of the job’s reality. 

Perhaps with time Fraize no longer needs an adrenaline rush to remain passionate about his work. Maybe he has developed coping mechanisms against the stress that can threaten his wellness. Or perhaps he possesses an innate sense of grit, a term that is gaining traction today throughout the EMS industry, academia, and research as a defining characteristic among those who remain healthy practitioners.

These are the questions Fraize and some peers from Radford University Carilion in Roanoke, Virginia are seeking to answer through a nationwide study. The data they’re gathering is expected to set a baseline for how an EMS provider’s level of grit might be measured and how that grit might impact their coping strategies and the overall effect stress has on their health and job performance.

“I don’t think it’s any secret in this field that people are stressed and coping is necessary,” says Fraize, a medic with a local Virginia department. “I think this research will cover an incredibly important subject.”

Surveys were sent out in mid-December, and preliminary results were expected by spring. There’s already some truth realized, however, through the experiences Fraize and his fellow researchers have lived through. 

Grit and the Grind

Gavin Gorecki, an EMT-turned-paramedic who’s involved in the study, says he has absolutely noticed an escalation in on-the-job stress with his newer role and responsibilities and has already had to question his resolve.

“There’s been more stress for me as a paramedic,” says Gorecki, who graduated from Radford in 2020. “There’s more medication management. You’re the attendant in charge of your patients. Ultimately everything is your responsibility. I have found myself depressed while showing signs of compassion fatigue. But this research and what it contains has given me hope and showed me I need to restructure how I personally deal with traumatizing calls.”

“Everyone at some point over the past two years has felt the burnout, stress, or just sheer awe of this pandemic,” says Amber Quinn, another researcher involved with the study, who has worked through not just COVID-19 but also the Zika and Ebola epidemics during her 11 years in EMS. 

“Those epidemics feel like little blips on the screen compared to COVID,” she says. “In some aspects of the job, COVID has become the everyday, the mundane, but there’s also a lot of misinformation out there. We want to learn about how people feel and how they’re dealing with things the way they are today, which is going to be a great measuring tool to determine how our peers are coping.”

EMS endured a high turnover rate even before COVID-19. According to the Firefighter Behavioral Health Alliance, a mental health advocacy group, the industry is losing medics and firefighters to suicide at a rate that’s almost twice the line-of-duty rate. 

“For some people burnout can be due to a traumatic event, but for many it’s a slow buildup every single day that causes you to develop anxiety or depression or commit suicide,” Quinn says. “Something very important about this research we’re doing is learning whether the pandemic could serve as a catalyst for those struggling over time.”

This resiliency—the notion of possessing grit—has been linked to the duration of time an EMS provider can be expected to remain in the field by researchers who concluded in 2019 that grit can actually be measured.¹ The Radford study, “The Association Between Self-Reported Grit and Coping Strategies Among Actively Practicing EMS Providers,” attempts to take things one step further to learn if the grit trait can be acquired through education or if it’s more of an innate quality. 

The backdrop of the pandemic could provide additional insight about how stress is likely to manifest and how one’s potential for grit determines a positive or negative approach to how that stress is personally managed when considering the more traditional sources of occupational stress in EMS.

Learning to Learn

A cross-sectional study utilizing a snowball sampling to recruit current EMS professionals 18 and older, the survey consists of 2 validated, publicly available instruments, the Grit-S scale and Brief COPE score (see sidebars). An additional set of questions written by the research team is used to capture targeted aspects of EMS backgrounds and demographic attributes. 

Demographic and background questions were chosen in a manner consistent with the attributes reported in studies of the same population and factors shown to be predictive of trait-level grit, says Elliot Carhart, EdD, FAEMS, an associate professor of emergency services in Radford’s Department of Clinical Health Professions. The scores derived from the surveys will then serve as the basis for correlational analysis to answer the study’s main questions. Responses to the remaining demographic information gathered as part of the study will be used for post-hoc comparisons to help assess the generalizability of the study’s findings. This, in turn, could help set the stage for future studies to drill into the concept further.

“I think what we’re doing with our research-oriented curriculum could certainly be modeled,” says Carhart, who has taught Quinn, Gorecki, and Fraize in the classroom, including the course “Foundations of Evidence-Based Practice,” a component of the research-oriented curriculum within Radford’s emergency services baccalaureate degree program. 

The focus on research, which also includes courses in basic statistics and research methodology, is intended to establish a common mental framework for how students consume and interact with information as they move through their studies and into the field. The National EMS Research Agenda noted a scarcity of skilled EMS researchers and recommended development of career investigators and training programs that teach research methodologies.

“We want them to have strategies they can fall back on for lifelong learning,” says Carhart, who developed the program’s slate of research courses since joining its faculty in 2012 and helped bring this crop of researchers together for this project. “We’re trying to plant that seed by introducing students to the basic concepts of research.” 

Education Onward

While the purpose of the study is to explore different types of coping strategies that can mitigate EMS professionals’ stress and compare strategies with the degree to which they’re perceived to display grit, an alternative solution could result in fostering initiatives and education that teach providers optimal coping mechanisms based on their specific stressors and personal characteristics. Such knowledge could potentially help address workforce shortages, improve employee retention rates, and mitigate the impact of occupational stress in the EMS workforce.

“There could also be a circle-back impact on educational curriculum,” Carhart says. “Those types of changes take time, but there could be long-term educational benefits. That might rely on expecting educators to be proficient with current literature. We’re not sure we can directly manipulate grit as a character trait, assuming it is desirable, but if we can identify a relationship between coping mechanisms and grit, then perhaps we can use that as a proxy and target initiatives at teaching coping mechanisms.”

Among the researchers there’s hope to see real-world proof that their study can produce tangible improvements in the lives and working conditions of their peers, beginning with more productive communication in the workspace.

“This has transitioned from a class project to something we really feel passionate about ongoing,” Quinn says. “We want to be able to help our providers be more mentally prepared and safe. Can we prepare providers for mental health the same way we teach them how to perform CPR?”

The pandemic could actually contribute to enhanced communication in the field when all is said and done. “Things aren’t the way they once were, from what I’ve heard, when you were expected to just suck it up and keep working through your problems,” Fraize says. “People today realize it’s not good enough to have that approach.”

Raising more general awareness of burnout among providers of all experience levels is also an anticipated outcome. 

“Many people try to put it past them, but burnout is a real thing,” says Gorecki. “Hopefully this study will help us learn how those who have had long careers in EMS have found helpful ways to cope.”  

Sidebar: The Grit-S Scale

The 8-item Grit-S is a short form of the original 12-item Grit-O scale. This scale measures grit as an individual difference. It consists of 2 subscales: consistency of interest (eg, “I have been obsessed with a certain idea or project for a short time but later lost interest”) and perseverance of effort (eg, “I finish whatever I begin”).

—Source: Science of Behavior Change, https://scienceofbehaviorchange.org/measures/grit-s/

Sidebar: Brief COPE

The Brief COPE instrument is a 28-item multidimensional measure of strategies used for coping or regulating cognitions in response to stressors. Its items assess the frequency with which a person uses different coping strategies (eg, “I’ve been turning to work or other activities to take my mind off things,” “I’ve been making fun of the situation,” “I’ve been criticizing myself”) rated on a scale from 1 (not at all) to 4 (a lot). It has 14 2-item subscales analyzed separately: self-distraction, active coping, denial, substance use, use of emotional support, use of instrumental support, behavioral disengagement, venting, positive reframing, planning, humor, acceptance, religion, and self-blame.

—Source: Science of Behavior Change, https://scienceofbehaviorchange.org/measures/brief-cope/

Reference

1. Musso M, Tatum D, Hamer D, et al. The Relationship Between Grit and Resilience in Emergency Medical Service Personnel. Ochsner J. 2019; 19(3): 199–203. doi: 10.31486/toj.18.0144

Joe Darrah is a freelance author based in the Philadelphia region. He has covered the health care field since 2004. Reach him at jdarrah17@yahoo.com.