Stress and Safety for Patrollers

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Patrollers, as First Responders, have by nature of their profession, occupational hazards. These hazards, also known as stress injury, affect our physical, mental and emotional well being.

PTSD is a part of Stress Injury. PTSD is more chronic and most likely occurs because of unaddressed stress injury.

Stress can lead to physical changes in our body. Stress causes an increase in cortisol secretion. Chronically elevated cortisol can lead to increased inflammation, sleep disruption, weight gain, pathological fractures, hypertension, hyperlipidemia, cardiac injuries, diabetes and perhaps, cancer.

Exposure from our job is an important piece; but its not the whole story. Most of us are volunteer patrollers. Many of us have day jobs that have their own occupational risk of stress, such as law enforcement, firefighters and EMS. Stress injuries from all aspects of our lives add up to a cumulative stress risk.

The Science:

Stress injury exposure affects all parts of our Brain. The brainstem (Reptilian brain) controls basic functions such as heart rate and breathing. The Limbic (Neo Mammalian brain) is the seat of emotional and hormonal regulation (the home of intrinsic memory). The neocortex is our executive thinking center and our incident command for survival.

Stress injury causes our sympathetic system (fight or flight - adrenalin) to be activated. Our parasympathetic system (vagus nerve) sends us the signal of “all clear” to calm us down. This balance of hormonal regulation (adaptation) is healthy and makes us resilient to future triggers for stress.

However, if we don’t get that “all clear” notification (parasympathetic calm down), we can remain in a state of sympathetically induced hyper-arousal and hyper-alertness. Our Brain is telling us that we are still in danger, keeping us in survival mode - even though the coast is clear. In this case, we may feel that everything is dangerous, preventing us from being in a safe place.

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Symptoms:

Prolonged arousal can lead to: sleep disturbances, irritable behavior, angry outbursts, difficulty concentrating, reckless self destructive behavior and depression. No place is a safe place. Negative thoughts can make a person isolate themselves from others. It is common for them to avoid memories, thoughts or feelings of the original experience and to avoid external reminders of the event. This is when patrollers stop taking care of kids, or stop running the scene, or just quit.
 

Stress Injury Early Changes: loss of vitality, dreading work, criticism, avoidance, lack of

motivation.

Stress Injury Later Changes: sleep disturbance, substance use, anxiety, irritability, isolation, hopelessness and depression.
Near miss trauma & cumulative stress puts us on a continuum from well being to major depression. This continuum was originally developed by the Military and ranges from the color Green to Red. Green (Emotionally healthy = good to go), Yellow (Reacting = early changes), Orange (Injured = start of late changes including fatigue & burnout), Red (Ill = late changes including thoughts of suicide).

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Stress Injury Continuum Model:

Reacting to Stressor (traumatic incident or situation)

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Psychological First Aid: These are first steps to mitigate the stress injury cascade; to reduce the initial distress; to foster adaptive functioning and coping.

Components of psychological first aid include:

• Create a sense of safety

• Create calm

• Create self & collective efficacy • Create connection

• Create hope

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What can we do? How can we intervene and mitigate against stress injury formation? The goal is to move toward the Green section of the Stress Injury Continuum.

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Goals for Staying GREEN and Getting to GREEN:

• I’m sleeping 8 hours per day without nightmares

• I’m not dreading going to work or patrol shift

• I’m not using booze or drugs to numb out what hurts • I’m laughing with my children, partner, spouse

• I can take pleasure in the small things • My body feels strong; it doesn’t hurt

• I can listen to my body’s cues

• I wake up looking forward to the day • I am meditating or praying

• I have time and desire to help others

• I like myself

• I have enough left over to care for my family • My friend’s tell me “I’m back”

• I head to the mountains regularly

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Ways to do this:

Refresher training to understand psychological first aid and the cause of stress injury

• Patrollers calculate their own stress continuum and develop personal green choices

• Create a “Culture of Safety” with emphasis on connection, time off for rest, exercise,

  mindfulness

• Re-think the Critical Incident Stress Debriefing (CISD) tool: Change it from delayed reaction

  to early action and to better shield ourselves from stress injury formation by preparedness that is patrol directed.

  Melinda Mingus, MD - Eastern Division Safety Advisor
  Eastern Division Safety Team: Sadie Prescott (Western NY), Dave Sacchitella (Western MA), Bryant Hall (WAPP), Wendy Aarnio (Southern VT), Jesse Remmey (Northern VT), Bob Wright (NH), Timothy Bruce (Maine), Dallas Coffman (EMARI), James Policelli (Eastern PA)
  Laura McGladrey, RN, EMT-W, FNP, FAWM