First responders work with people and each other in situations that are loaded with stress, grief, fear and pain.  Dealing with trauma on a daily basis, with both big and small trauma and stress, adds up. It is obvious that first responders are in what is considered “high-risk” occupations and that the build up of stress takes a toll on the individual, work performance, work relationships, family and friends.

The words self-care and resilience are tossed around in Dispatch, Fire, EMS and Police Departments. It is well known that it is easy to become overworked, overwhelmed and overcome by the demands of the job.  Providing support and assistance to people in crisis daily drains energy and impacts focus. Developing some sort of self-care is fundamental for every first responder.

It is all about having self-regulation, a balance between the physical and mental processes of life. It is the reality that to take care of others, first responders must first take care of themselves. First responders are trained to always be at the ready and to control or suppress emotions to allow logical, focused and necessary actions. The “normal” reactions to trauma and crisis get ignored, suppressed or avoided. Development of a self-care routine is essential to having a life worth living both on the job and in life outside work.

Learning to recognize the symptoms of stress and burnout are the first steps to reduce and treat its symptoms.  Prevention and development of coping skills before problems develop is necessary. Having a self-care habit, routine, plan, method, or steps ensures that first responders take care of themselves as well as the people that they assist all in a day’s work. Choosing to stay in top performance on and off the job requires that every first responder have a self-care plan.
 
TIPS THAT HELP
1.  Take time off                    

Regardless of their role, first responders are unique and exceptional people committed to helping.While this dedication is admirable it often leads to a failure to use leave time, breaks, and lunches.Being the best requires that time is taken to regroup, reinvest and recharge. Try to limit shifts to 12 hours. Learn when to say “NO”! Boundaries are healthy!
 
2.  Exercise Regularly          
The work of first responders is demanding both physically and mentally. Research indicates that having a regular practice of exercise for at least 30 minutes a day increases the body’s level of endorphins, improves mood, enhances concentration, and clears the mind.That is in addition to supporting a healthy weight. Exercise is not just about going to the gym or lifting weights.It could be a walk, dancing, or plaing with the kids.Choose fun fitness routines.Join a class, group, or team to help maintain motivation.

3.  Eat Healthy                       
Expecting to have interrupted meals is common for first responders and it doesn’t have to mean that nutrition is sacrificed. Choosing to load up on quick snacks filled with carbs, fat, sugar and salt are easy and impact overall health in a negative way. Failing to eat from all the food groups at each meal impacts concentration, strength, energy and mood. Meal and snack prep help ensure that meals and snacks are healthy with whole grains, lean proteins, fruits and vegetables. Most of all drink water!The average adult needs at least two liters daily. Being a first responder means that a higher demand is placed on energy aim for three to four liters daily.

4.  Adequate Sleep              
The human body requires 8 hours of sleep or two four-hour sleep cycles to function at peak performance.Napping is good if it is only for 20-30 minutes. More than a 30-minute nap means entering deep sleep and waking before the sleep cycle completes. That ends with waking-up unrested, groggy, irritable and unable to concentrate.Plan for sleep and try to establish a regular routine with bed and waking times around the same time on or off shift. Nothing is worse for a first responder than flip-flopping shifts.

5.  Treat your Self 
Everyone likes to feel special and to get something unexpected.Treat yourself to a meal, new clothing, new tool, video game, event.Do something that makes you smile.

6.  Escape Reality                  
Relax, let go of the busy shift or day. Take a moment to watch TV, listen to music, go fishing, build something, make something, sit outside and just feel the breeze or hear the birds.Take a few moments to relax and reboot your mind.Try writing a journal.

7.  Humor 
Laughter is the best medicine!

8.  Meditation, Mindfulness, Yoga, Marshal Arts, Stretching, Prayer
Research shows that breathing, stretching and pausing are the most effective methods to combat stress. Meditation alone is shown to improve concentration, reduce anxiety, manage pain, and alleviates symptoms of depression. Even a practice of 5 minutes a day has been shown to have dramatic impact on stress.

9.  Talk to Other PeopleSpending time with others is the best way to reduce isolation and feeling alone. Talk to family, friends, co-workers, supervisors, and or teammates about feelings, fears, and experiences. Keeping it all inside doesn’t work. It is like blowing air in a balloon, you never know when it will pop.Instead, let the air out gently talk to those around you. Seek out a counselor, support group or crisis line.Talking with professionals an others who have experienced something similar is often a great way to develop an effective self-care plan.

10.  Avoid use of Substances
Mind, Mood or Energy increasing substances only mask the issues being dealt with and are guaranteed to make the situation worse.

 

A Few Resources that Help
 

American Foundation for Suicide Prevention

Toll-Free: 1-888-333-AFSP (2377)        Mailing Address:  120 Wall Street 29^th Floor
T: (212) 363-3500                                                                      New York NY 1005                 
F: (212) 363-6237
General Inquiries: info@afsp.org
Press Office: 347-826-3577

 

All Hands Working - https://www.facebook.com/allhandsworking
Badge of Life - https://www.badgeoflife.org/

Cops Alive - http://www.copsalive.com/

Share the Load Support Program for Fire and EMS - https://www.nvfc.org/programs/share-the-load-program/
 

If you are old enough to remember LifePak-10, Ferno Model 30 (manual lift) stretchers, how to make a traction splint ankle hitch out of a cravat, or Dance, Dance, Dance (Everybody Dance), you might be a Dinosaur. We are the folks who were tough enough to handle anything (because either you were or you weren’t). Many of us have broken bodies and hair the color of a battleship. Some of us have moved into other professions because the job was too much for our hearts, minds, bodies, or souls.

I am an EMS Dinosaur who retired from the profession before I heard snickering from the youngsters who could jump on and off the rig with ease. In the land before time, I was the skinny, 35-year old redhead who joined in the semi-serious ridiculing of the older folks who still hung around, still pulled shifts. I wondered if they had anything to contribute, “Don’t they know when enough is enough?” Fortunately, they bore our derision and hazing, waving it off like a persistent fly buzzing about their heads, shared tips and tricks (and wisdom) during and after shifts, and many have become ICs.

What amazes me now is that we talk. We failed to communicate effectively to one another for many years, keeping a ton of crap inside that contributed to stress illnesses, compassion fatigue, and job turnover (leaving “the best job I ever loved because of X”). We have conferences (with firepits and social hours). We have social media (with groups dedicated to our respective professions). We have texting (dinosaur moment: remember wearing 2-3 pagers on your belt?). We have sports competitions (like “Guns and Hoses”). We have CISM, EAP, and peer programs. Most of us can now open up and get rid of stress, and many of us know how to watch for those who need someone to have their six.

Recently I was escorting an EMS crew with a patient to the floor of the psychiatric hospital (talk about moving on!). As the intake clinical RN, I had the privilege of spending time with these guys and gals while the floor nurse gathered papers and prepared to accept patients. As I walked the folks out through multiple locked doors, we always made good use of the time, sharing brief quips or stories, letting the EMS crews vent, sometimes redirecting a few impatient souls who lost sight of the bigger picture.

One young man recently got my attention. He asked if I knew Dr. Don Benson. DB is an ED doc, former head of the residency program at St John Hospital and Medical Center in Detroit, who is a dinosaur in many categories (and my age). DB and I worked together for years at SJHMC, so the crew and I lingered in the hall a bit, and I listened to this young guy bubble over.

The young man talked about his medic class, what he was learning from DB, and how excited he was to take his medic class. His enthusiasm reminded me that we are still bringing up youngsters who need a little guidance, who are starting at a place we were long before we gained the wisdom we bear today. And then he asked The Question.

“Why don’t you come with us some time, pull a couple of shifts, to keep fresh. You know you want to …” Yes, I want to, but I cannot. I used to be the girl who could lift; now I’m the girl who dreads walking up any stairs. I wanted to bottle this kid’s passion and redistribute it amongst those who had lost theirs. He was looking at me, at his future, and I was looking at him, at my past.

The difference is that he has a better chance of making through with fewer emotional battle scars. He doesn’t have an almost certain future of compassion fatigue or burnout. He has the possibility of compassion satisfaction, helping others without paying the ultimate price for his caring.

Please remember to take these youngsters under your wing (if you’re a dinosaur like me). Guide them, coach them, mentor them. Teach them positive coping along with job skills. Combine the two, and as folks grow older, those skills will ride together, and the tough stuff will be easier to get through. If you don’t have a mentoring program, suggest one, or consider informal mentoring. If you’re a dinosaur, you can tell them about the old days, when …
 

When we take a CISM course, we learn the importance of ‘debriefing the debriefers’ or Post Activation Staff Support.  Over the course of time, however, we may start to neglect this important part of providing crisis response.  Really – PASS is the epitome of ‘place your oxygen mask first, and then see to the needs of others.’  In the long run, we can’t DO crisis response unless we see to the needs of crisis responders!!  We will burn out!  People will quit the team or just quit responding to requests for debriefers. 

As the coordinator of a county team I have seen this first hand.  I have felt sometimes it’s easier to just go DO a response than to find others who can go (I don’t believe anywhere in the job description of Team Coordinator does it say: – “coordinator shall respond on MOST events”).  I have recently become aware that some of our team members have felt “it” too.  In the past, when I have noticed that certain people are responding more often than others (several responses in a row or in a small-time frame) I will specifically NOT call those people for a time period.  However, sometimes I don’t KNOW that people have been affected, or have unresolved “after effects” from one or more responses until they stop responding to my requests for personnel. 
 

CISM responders react just like other humans to crises.  Sometimes we are affected because of the nature of the event.  Sometimes we are affected because of our previous life experience, (“baggage”), which makes an event hard.  And, really, it doesn’t matter in the end why we had a reaction to an event.  At least it doesn’t from my perspective as coordinator.  What matters is that the people who have responded to an activation go home as “healthy” as they were when they arrived.
 

This can be accomplished in one of two ways.  For most events that we respond to (smaller events), debriefers meet briefly after participants have left and do an “on the scene” PASS.  They follow the form laid out by ICISF: Each person says what went well; what they would change about what they said or what was done; how they are feeling; and how they are going to take care of themselves post activation.
 

For larger events, (that occur over multiple days and/or occur after very large/high profile/horrific events), we hold a PASS after the event is done, (while still having those involved touch base after each particular debriefing, etc), inviting all who took part in the response.  This PASS should be facilitated by someone who was NOT one of the debriefers involved in the crisis response.  It can follow a modified form of a CISD, though less formal.  Questions can include: What were key thoughts you had going into the response and how did they change once you got there; what went particularly well;  what would you do differently in the future; and  what will you do to take care of yourself?

We include information on PASS in packets provided when responders go on ANY crisis response as a reminder to not skip this important step of the crisis response process. 

After all, we must take care of ourselves so we can continue to do this important work!

 

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