Resilience can mean different things depending on your profession, last challenge, perspective, or current reading material. A few definitions are: bouncing back from adversity; managing occupational trauma exposures; and returning to a functional baseline. For some, resilience incorporates mindfulness and living in the moment without judging, and for others, it is a process. Whatever your reference, most can agree that getting through and beyond the challenges of traumatic exposures is a shared struggle for emergency responders. Because of the expectation to perform optimally under the worst circumstances, and then turn around and do it again (and again), responders tend to develop better resilience and coping skills.
Have you ever thought about how you do that, how you cope? I had an old medic partner who cranked up the music as loud as the sirens, rolled down the windows (in all weather), and amped himself up in preparation for unknown challenges. I dipped my head, said a quick prayer, and took a couple of deep breaths. Our priming was different, our activities after the call light years apart, but during the call our practices for coping and resilience were pretty aligned and consistent. When we got to the EMS call, we slipped into task mode, and followed algorithms, company protocols, and established pre-hospital radio scripts.
Resilience is not always a fixed thing. It is malleable, but awareness of your coping skills and practices can help you to get through in a healthier way. Do you push negative thoughts out of your mind? Do you distract with (sometimes inappropriate) humor? Do you row along the river of denial (nothing affects me)? Or do you concentrate on the problem at hand, work through it, and deal with the emotions later when you can process them away from work?
The last method is the most adaptive and active strategy. Task mode can turn challenging situations into positive victories, enhance resilience, and increase compassion satisfaction. Concentrating on the problem at hand helps to get through the situation. Often workers feel powerless in trauma, and focusing on the completion of tasks permits some level of situational control. Workers concentrate on duties, skills, and procedures to try to moderate stress. Resilient individuals will draw from the positives as they review and process the call (‘what did I do right/well; what can I learn from this call; what items were beyond my control; if I could change one thing without changing the outcome, what would I change; how can I make myself better; and how does this call affect my worldview”).
Deferring emotions stirred by occupational trauma needs to come with an inner promise to follow through with examining and dealing with them. We all know the results of burying emotions: they will eventually, often unexpectedly, and usually negatively, come back to haunt. So how do you make sure you de-escalate after the fact? Do you set aside a regular time (weekly, etc.), do you use meditation, music, or spirituality? Make a work through it commitment to yourself. Developing good habits helps you, sharing behaviors that work with coworkers helps others.
One tool used to build resilience is the Three Blessings (or three good things) Exercise by Dr. Martin Seligman. Like task-focused coping, it is an action exercise in optimism. Home is often a safe place and time to process thoughts and feelings.
- Before bed, Think of three things that went well, either work-related, or something like Tim Horton’s remembering your regular food/coffee order.
- Write the three things down in a place you can refer to, like a journal, notebook, or using the notes feature on your cell phone.
- Reflect about why each thing happened (why is important). Maybe the rescue-assist team you led that day remarked that it was the best call they had ever run because you were so calm.
Workers need to process feelings they may have suppressed during a trauma. Task focus works best if folks process that Dreaded F Word; Feelings (P. Volkmann) when the call is over. Sometimes with multiple calls, processing happens after work, which can interfere with transitioning back to home and family roles. Resilient people are more aware, and may ask the family to give them time to work through a bad call (see the link below, Post-Deployment Guide for Families …”).
As Mike Murphy wrote in an earlier issue of MCRA Connections, resilience is a tool. Most folks in health care and especially emergency services have a problem-solving, task-oriented mindset and use that tool with ease. Others need some training and reinforcement. Please make an effort to obtain or enhance that tool for yourselves and your teams. The list below contains written resources, and your MCRA Board can refer you to other sources for building and maintaining resilience.
Resources are readily available to introduce or reinforce resilience and adaptive coping. The U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA), brochures are often free (plus shipping). Here are some that might be of help to you:
- The SAMHSA Disaster Distress Line is a national crisis hotline that offers help for those in distress from human or natural disasters, coping tips, and referrals to local assistance.
- Psychological First Aid: A Guide for Emergency & Disaster Response Workers offers tips for responders to encourage calm in a storm.
- A Guide to Managing Stress in Crisis Response Professions provides ongoing teaching tools about the stress cycle and reactions, preventing and mitigating stress responses, creating a healthier workplace, self-care tips, and more resources.
- Sometimes coping strategies fail and instead of building resilience we find ourselves supporting those who need help. Know the warning signs so you can help: Tips for Disaster Responders: Identifying Substance Misuse in the Responder Community.
- Deployment is not always to another country, state, or after a declared disaster. Responders are deployed when leaving the station on a call. A Post-Deployment Guide for Families of Emergency & Disaster Response Workers provides information for workers and families. Educating about resistance, resiliency, and recovery provides responders with tools to promote and strengthen wellness.