Coping with Stress a Critical EMS Survival Skill

by Becca Gladden
Contributing writer for Public Safety Degrees

Ask any serious fisherman about his most memorable day on the water, and you're just as likely to hear a story about the one that got away as the big haul.

When racecar drivers talk about an unforgettable finish, it's typically the race they lost by hundredths of a second, not the one they won with ease.

It seems that most people who accept challenges, become good at their craft, and take particular pride in a job well done have difficulty coping with the times when they are not 100% successful.

When an angler let's his catch slip off the line or a racecar driver finishes an event a close second, it can certainly be disappointing, even troubling.

But experiencing "failure" in an EMS role can be haunting. Why? In many cases, lives are literally hanging in the balance. And "the one that got away" could very well be someone's life.

Sometimes everything goes right with your patient - you identify the problem quickly, get the IV on the first try, intubate them without difficulty - and the outcome might still be bad. When resuscitation efforts don't go that smoothly, the subsequent feelings of guilt are compounded.

Self-recrimination is just one of the stresses of working in an emergency medical services field. Most positions involve long hours, low pay relative to responsibilities, irregular eating and sleeping times, dealing with difficult patients, managing budget cutbacks, and numerous other challenges - all in a setting where one slip-up can result in death or disability to patients who are depending on you to never make a mistake.

And that's not to mention the many potentially traumatizing scenes that EMS workers are exposed to: the suicide patients, pediatric traumas, child abuse cases, assault and rape victims, and a host of other upsetting and tragic situations that the average citizen may go an entire lifetime not encountering.

A 2006 article in Northwest Public Health states that most studies estimate the prevalence of Post-Traumatic Stress Disorder (PTSD) among EMS personnel as ranging from 15 to 20 percent. While it may not sound like much, 1 in 5 workers with PTSD is a statistic that cannot be ignored. No doubt many other workers suffer from less serious symptoms of stress and anxiety.

These days, large EMS organizations like hospitals and urban fire departments take measures to help public safety professionals deal with the stress of the job and the toll it can take. Some agencies offer free services such as grief counseling, drug and alcohol abuse prevention and treatment, and even spiritual counseling. Others require employees who've been involved in particularly traumatic events to participate in mandatory Critical Incident Stress Debriefing (CISD) sessions. Smaller agencies may not offer as wide an array of employee services, and even larger ones have been forced to cut back in the slumping economy.

Ultimately, finding coping strategies that work is as personal and individual a process as choosing the right stethoscope or finding a compatible EMS partner. No single solution fits for everyone, but taking steps to modulate the negative effects of stress is imperative, particularly for those wanting to make a career of public safety work.

Field-based EMS workers are taught from the first day of training that securing the scene is of paramount importance. As the saying goes, you can't rescue others if you need rescuing yourself. Scene safety usually refers to imminent physical hazards, like downed power lines or a patient with a weapon. But the same premise applies to the everyday physical and emotional well-being of EMS workers.

Here are a few ideas for managing stress that may help you become a more valuable employee and ultimately a better lifesaver:

• Learn to recognize possible signs of stress and get help if you think you need it. According to the Mayo Clinic website, symptoms of stress may include:
• Physical - headache, back pain, chest pain, heart disease, heart palpitations, high blood pressure, decreased immunity, stomach upset, sleep problems.
• Mental and emotional - anxiety, restlessness, worrying, irritability, depression, sadness, anger, feeling insecure, lack of focus, burnout, forgetfulness.
• Behavioral - overeating, undereating, angry outbursts, drug or alcohol abuse, increased smoking, social withdrawal, crying spells, relationship conflicts.
  
  The website advises, "If you do have stress symptoms, taking steps to manage your stress can have numerous health benefits. Stress management can include: physical activity, relaxation techniques, meditation, yoga, tai chi."
  
  In the internet age, technology also facilitates communicating with colleagues about difficult situations and sharing suggestions for coping strategies. Find a few EMS forums or social media groups that seem interesting and join in the conversation.
• Take advantage of free employer resources. As noted above, organizations have begun to recognize the toll of stress on public safety workers and have implemented various programs to help. These may include Employee Assistance Programs (EAPs) that provide counseling for workers under stress, access to a gym or workout equipment, an active CISD team, and even spiritual counseling - for example, a fire department or hospital chaplain. Using available time off in the form of paid vacation or mental health days is another way to escape the pressures of the job and return to work feeling refreshed.
• Learn from your mistakes. One of the hardest parts of working in emergency medical services is that people's lives depend on your actions. But the truth is that caregivers are not robots, and no one comes out of paramedic or nursing school being perfectly skilled and adept. That is certainly not an excuse for being careless, but even when you try your hardest, the outcome may be less than ideal. Take every opportunity to talk things over with your team members, supervising physician, and others who can share their experiences and wisdom and help you improve your skills and achieve better results. Pursue continuing education and strive to upgrade your diagnostic and technical knowledge and abilities.
• Accept the things you cannot change. Most stress management experts believe that a great deal of stress comes from trying to "control the uncontrollable." While it is valiant to want to help people - the goal of nearly everyone who pursues an EMS career - the fact is there will always be elements of the job that are beyond your control.

Perhaps the best coping strategy is simply to revel in your accomplishments. Focus on the lives you've saved, the patients you've helped and the colleagues you've taught.

While stress can never be completely eliminated, you can mitigate its effects by managing it before it starts managing you.