Stress and Sleep Deprivation in EMS

Stress seems like it should be a four-letter word with the negative connotation that it holds. Visions of stressed-out, exhausted responders running calls all through the night come to mind, one call after the other, devoid of emotion. It seems that to have a career in public safety means simply accepting the nasty side effects of stress and fatigue, but it does not have to be this way. There are simple and effective techniques you can practice to limit and even reverse the effects of fatigue and stress.

Strange as it seems, not all stress is bad. There is good stress and bad stress. Good stress helps your mind and body prepare for an event, tests, sports and running calls. Exercise is good stress: Your body grows and becomes stronger when you stress it. Stress becomes bad when the stress mechanism and stress response do not shut off. Remember the sympathetic vs. parasympathetic nervous system--flight or fight? In the early days, if a caveman was challenged by a tiger, there were two options: run or fight. If he survived the encounter, the natural response was to rest and heal, thus resetting the stress response. In today's busy public safety world, the stress response looks like Figure 1.

Today, the stress mechanism functions just as it did in the days of cavemen. The problem is that the stress response does not discriminate a real threat from a perceived threat. Does this scenario sound familiar? You’re sitting in heavy rush-hour traffic when you get a call for a shooting. You feel your blood pressure skyrocket, and your mind races as the red lights and traffic threaten your ability to reach the scene. You arrive at the call, where media and bystanders seem as menacing as the sabertooth tiger appeared to your caveman ancestor. Your heart pumps faster as blood rushes to the large muscles in preparation for your mad dash to the trauma center. You make it to the ER, and now it is time to calm down and write your report, but your supervisor is calling and the media are asking questions. You notice your breathing getting heavier, and you start to feel a little queasy. Your mind begins to race and, unlike the caveman whose primitive mind was focused solely on life and death, you find it hard to focus on your report when your mind is bombarded with myriad scattered thoughts. You make it through the call and, after a less-than-nutritious fast-food snack and a soda, you check back in, ready for the next call. The problem here is that the caveman was under stress in relatively short spurts in an average day, while EMS responders face an onslaught of figurative sabertooths that keep the stress response on at all times.

Compounding the effects of stress is sleep deprivation. Unfortunately, fatigue and public safety are married, and the more tired you become, the less your body is able to deal with stress. It’s a vicious cycle. Many of the diseases we treat in EMS are a direct result of stress and fatigue. When the two get going, the body is unable to heal, immunity decreases and markers of total body inflammation increase. The body simply cannot rest and rebuild when circadian rhythms are frequently disrupted. For example, you may work the night shift five nights in a row, followed by two days off. During the two days off, you resume normal daytime (diurnal) activity with family or friends. This disrupts your previously adjusted circadian rhythm, and you must readjust your sleep-wake pattern when you return to work. Without a constant sleep-wake pattern, biological rhythms remain out of synch.

Generally, mood cycles and physiological processes, like the fluctuation of hormone levels, play significant roles in sleep routine. These factors are, in turn, altered by frequently changing sleep habits. So there may be complications for a shift worker who suffers from seasonal affective disorder or depression. Spending nights awake and days asleep may intensify the effects on a person with a psychiatric disorder.