When we think of first responders, such as paramedics and fire fighters, many of us correlate intense and critical incidents as being part of the job. But, many of us fail to consider the effect of such incidents on the mental and physical well being of the individual. Many of these first responders end up diagnosed with post-traumatic stress disorder (PTSD), or even secondary traumatic stress disorder (STSD), with both possibly leading to suicide. In a survey, out of 4,022 responders, 86% said they have experienced some kind of stress related to a traumatic event, and 37% said they have contemplated suicide (Newland et al.). These numbers are about ten times as much as the statistics for adults in the US that are not first responders (Newland et al.).
There are three major types of stresses, all of which together can have a huge impact on mental health. General stresses are an everyday stress that “usually resolves within a day or two” (Types of Stress). Cumulative stress refers to stress that builds up over time and can “lead to adverse mental and/or physical consequences” (Types of Stress). The last type is critical incident stress. This type of stress is in response to a traumatic event and “produces considerable psychological distress” (Types of Stress). With a combination of these stresses, a first responder experiencing a variety of intense events is at a high risk for PTSD. PTSD is “a mental health condition that’s triggered by a terrifying event—either experiencing it or witnessing it” (Knox). It is a condition that affects people not only emotionally, but physically as well. Some symptoms include extreme nightmares and flashbacks, paranoia, depression, isolation, addictions, problems sleeping, irritability, problems eating, issues with urination, headaches, and much more (Recognizing PTSD).
In addition to the critical incidents one may come across, there are many other factors that lead to an unhealthy mental state. Most paramedics and EMTs work long hours, with a significant amount of physical labor (Erich). Also, many EMTs work part-time along with another job, resulting in no vacation or sick time for themselves (Erich). This can cause a great deal of stress, while leaving no room for one to relax or help focus on one’s health. Over time, it can lead to sleep deprivation, poor nutrition, and even poor exercise (Newland et al.). Additionally, stresses in the work environment can also contribute greatly. There is a stigma attached to needing help and many individuals that try to reach out for help end up being bullied and harassed by co-workers (Erich). It seems as if providers are more empathetic towards patients than they are to peers (Erich). When providers are asked what has hindered them from reaching out for help, many of them said they are afraid of being ridiculed, losing their job, and even losing respect (Newland et al.). One individual was even told she “signed up for it so deal with it” (Newland et al.)
To help deal with the stress that comes with the job, there are different programs such as critical incident stress management (CISM) and employee assistance programs (EAP). But, there is no evidence “that single session individual psychological debriefing is a useful treatment for the prevention of post-traumatic stress disorder (PTSD) after traumatic incidents” (Touchstone). Many complain of these programs not being helpful at all, especially since it takes more than one session to be effective and the financial aspect is usually too much of a burden (Touchstone). But, there are other alternatives to CISM and EAP such as The First Response Resiliency. They believe that although no one will be able to prevent critical incidents from ever happening, they can “help people bounce back from these things” (Erich).
A less common known effect of work experiences on medical providers is called compassion fatigue. It also known as secondary traumatic stress disorder (STSD) and usually “applies to those emotionally affected by trauma of another individual” (Swayze). Both PTSD and STSD are “associated with an increased risk for depression, heart disease, increased healthcare utilization and premature death” (Swayze) . But, PTSD is a disorder that is often seen in caregivers for populations such as “pediatric, veteran, and cancer patients” (Swayze). The professionals most at risk for such a disorder are community paramedics since they share a deeper relationship with the patient and usually a more time consuming one (Swayze). Some signs and symptoms include moodiness, irritability, avoidance, intrusive thoughts and dreams, apathy, and reduced productivity (Swayze). Many community paramedics feel as if they must be a savior to every patient and in some cases, have patients that are extremely demanding of their time (Swayze).
Many of these first responders have a huge emotional burden. They sometimes sacrifice their own health to save the lives of other people. There is much stigma around seeking help, especially within the profession. But in addition to expected critical incidents, there should also be expected mental damage. These providers are still human beings with emotions, and should be encouraged to seek help rather than being shot down with negativity.
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