In order for one to become certified as a first medical responder such as a Paramedic, a student must be instructed through an institution, such as a college or fire department, and must learn objectives that meet the current standards of care. Those standards include care for someone having a heart attack, stroke, has been involved in an automobile accident and so on. During that training, there is a chapter labeled “Wellness of the EMT.” Within this chapter is a very small section that pertains to the Paramedic taking care of themselves when they are not taking care of patients. The stress that is accrued during care of others is not something new. It is this stress that builds up over time that can cause damage and sometimes irreversible harm to oneself or others also.
When tragedy does strike, stress is a major factor. There are typically two sides to a stressful situation, those who are going through a stressful situation and those who help others during a stressful situation. That is where first responders come in. During the training of becoming a first responder, one learns a vast amount about how to care for someone who is hurt or sick physically or emotionally. In the midst of all that training, there is a topic known as “Wellness of the first responder,” which refers to the responder’s taking care of himself or herself as opposed to taking care of someone else. A survey was conducted privately by a group of individuals that wanted to find out how many first responders had been affected by stress in one way or another (Newland et al, 2015). The results were phenomenal (85%). On the other hand, the current president of the World Psychiatric Association says that he believes that PTSD is a diagnosis that American doctors use to label their patients “at the drop of a hat” (Strudwick, 2015). The training that first responders receive on how to take care of themselves and what to do if they become overwhelmed with stress is only a fraction of one chapter in the training manual that is used in first responder training. The authors from the survey previously mentioned reported that their results of first responders that had either thought about suicide (37%) or had attempted it (6.6%) were ten times that of a survey that the Centers for Disease Control and Prevention (CDC) that had been conducted in 2012 (Newland et al, 2015). First responders need to receive more training on how to deal with stress and what to do if they become overwhelmed with stress. Often times, the younger generations has been conditioned to believe that “we don’t call 911, we are 911.” On the other hand, the older generation tells the younger generation “If you can’t handle the stress, you need to find another job.” While most first responders believe they will never be affected by stress, the current training received by first responders does not adequately prepare them to deal with stress.
A Brief Look at the Effects of Stress
Stress to oneself can manifest on multiple ways. Dr. Amtmann (2009) reports that the physical effects of long term stress include heart problems and high blood pressure. The University of Wisconsin-Madison conducted a study with rodents that revealed stress induced PTSD within a month of exposure to the stimulus. These same researchers found this to be the equivalency on humans within two to three years. The study was based on the biochemistry that occurs during PTSD (Smith, 2015). The effects of decreasing the stress that one goes through results in a decrease in the negative effects of stress. Dr. Amtmann (2009) discusses the use of meditation and relaxation that results in a decrease in blood pressure and thus a decrease in heart problems. Stress can develop with the simple visualization of a traumatic event. It is the excess buildup of stress that causes the negative effects that are being discussed.
How Excess Stress can be Manifested
Post-traumatic Stress Disorder (PTSD) is defined by the Mayo Clinic as a mental health condition that’s triggered by a terrifying event - either experiencing it or witnessing it (Mayo, 2016). First responders witness terrifying events all the time with automobile accidents, gun related violence and the mental health that the general public experiences. If not careful, the stress that is developed during the experience will still be there during the next experience of stress. This accumulation of stress can then weaken the first responder’s ability to deflect stress and then the next traumatic visualization leaves an impression on the first responder’s mind that can’t be handled, thus causing PTSD. The signs of PTSD include unwanted daytime memories or flashbacks, panic attacks, self-isolation, inability to trust others, fits of rage, poor memory and many many more (PTSD Foundation, 2012). A survey that gained over four thousand responses revealed that nearly 1000 first responders had sought help for stress induced mental health issues while on duty. The mental health issues included, but were not limited to depression, PTSD and suicidal ideation. This same survey revealed that almost 1500 first responders had either thought about suicide or had attempted suicide as a result of accumulated stress while on duty (Newland et al, 2015). These same stress induced symptoms that were found in veterans after returning from war have been found in first responders with repeated exposure to traumatic experiences.
Is PTSD Real?
Many of the seasoned first responders have been conditioned to deal with stress either appropriately or inappropriately. Either way, when it was all said and done the stress was dealt with. With that said, when newcomers arrive and find themselves overcome by stress, they look to the seasoned veterans for advice and they are told that they knew stress was part of the package when they signed up for the job. Other younger First Responders have reported instances where they were afraid that they would be terminated and that their service doesn’t offer any form of Critical Incident Stress Management (CISM) (Newland et al, 2015). Some veteran First Responders even reported that stress doesn’t bother them and that if someone can’t handle the stress then they were not cut out to be a first responder. At the same time, Professor Bhugra of the World Psychiatric Association thinks that American Physicians diagnose so many people with PTSD for monetary reasons. Professor Bhugra thinks that because patients are diagnosed incorrectly, the patient isn’t receiving the proper care (Strudwick, 2015).
First responders, for the most part, are a special kind of person that can deal with stress in a way that the general public typically is not able to do. First responders have become stereotyped and conditioned to think that stress will never bother them. Because of that, more and more first responders are not being taught how to deal with stress appropriately and how to recognize the warning signs that they are being overwhelmed emotionally. This repeated “tradition” of a lack of self-awareness has caused those that have been in the profession for a while to look down on the young followers that look up to these, for lack of better terms, forefathers. As a result, the fear of asking for help sets in and the end product is becoming emotionally exhausted that manifests itself as PTSD, Depression, Burnout, suicidal ideations, or even death by suicide. If more education and awareness is not emphasized more than it currently is, first responders will continue to be overwhelmed with stress and PTSD, Depression and Suicide among first responders will continue to rise every year. First responders need to be better educated about the effects of stress and they also need to understand that everyone is subject to the effects of stress, especially first responders. Resources such as Code Green Campaign and The Firefighter Behavioral Health Alliance need to be more recognized and utilized for the help they can provide.
Many people have said this quote, “The first step to solving a problem is recognizing that there is a problem.” In order to reduce the number of casualties of first responders to Mental Health diseases such as PTSD, Depression and others, this arrogance that has been so well taught, “we don’t call 911, we are 911” is going to have to stop. When you are the one who calls 911, who answers that call?
Amtmann, J. (2009). A Stress Management Tool for EMS Professionals. Journal of Emergency Medical Services. Retrieved from http://www.jems.com/articles/2009/06/stress-management-tool-ems-pro.html
Mayo Clinic (2014, April 15). Post-traumatic stress disorder (PTSD). Retrieved from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/basics/symptoms/con-20022540?p=1
Newland, C., Barber, E., Rose, M., & Young, A. (2015, September 28). Survey Reveals Alarming Rates of EMS Provider Stress and Thoughts of Suicide. Retrieved from Journal of Emergency Medical Services: http://www.jems.com/articles/print/volume-40/issue-10/features/survey-reveals-alarming-rates-of-ems-provider-stress-and-thoughts-of-suicide.html
Smith, S. L. (2015, November 09). Neuroscientists describe brain chemicals that create PTSD response. Journal of Neuroscience. Retrieved from http://news.wisc.edu/uw-neuroscientists-describe-brain-chemicals-that-create-ptsd-response/
Strudwick, P. (2015, February 28). Post-Traumatic Stress? It doesn't even exist! Top Psychiatrist his out at doctors who diagnose disorder at the 'drop of a hat'. Retrieved from Daily Mail Online: http://www.dailymail.co.uk/health/article-2973467/Post-traumatic-stress-doesnt-exist-says-psychiatrist.html
Jonathon Walker has been a Licensed Paramedic in Texas since 2002. He has a Bachelor's degree in EMS Administration from Columbia Southern University and has been teaching EMS since 2010, for various services.