We know not everyone can make it to EMS World Expo every year. For that reason we are pleased to offer a new series, Expo ICYMI (that's In Case You Missed It, if you're not hip to social media acronyms), in which Expo speakers will summarize their presentations into short print articles.
Resiliency is all the talk in EMS and fire-rescue. How do we improve it, how do we test for it, how do we stop the cycle of suicide and PTSD? Yet few first responders have any idea what resiliency is, let alone how to improve it. Even fewer know how to recognize warning signs in their peers or acknowledge the cascade effects of symptom in themselves.
Resiliency is toughness, or the capacity to recover quickly from difficulties. But with the constant barrage of calls, stress, poor staffing, and fatigue in EMS, there is little time to recover.
So, do we make resiliency too complicated? Are all the well-meaning helpers diluting the low-hanging solutions to boosting provider resiliency? With all the social media noise right now, it’s very confusing for the boots on the ground to decipher truth. But here are three tested strategies that can help.
Sleep is by far the No. 1 solution to fixing resiliency—and, for that matter, many of the wellness issues in EMS. I’m not going to preach at you about the importance of sleep; we all know it. But what you need to know is this:
First responders die up to 12 years sooner than civilians.
Sleep is the only time you are getting better. It sets your appetite and hormone cycles.
Sleepy driving is the same as drunk driving.
Poor sleep, HPA (hypothalamus pituitary adrenal) axis dysfunction, stress, poor diet, and poor fitness cause the low amounts of free testosterone common in first responders. This directly impacts first responder morbidity and mortality.
Insufficient sleep and poor wellness accelerate death. Cumulatively they make us dumber, fatter, slower, and weaker.
The only way to fix this is deep normal sleep. This allows normal secretion of testosterone and GH (growth hormone). Ever seen someone come back from an injury saying the three weeks off left them the best they ever felt? It’s because they got back on a normal sleep/wake cycle.
Normal deep sleep and HPA axis balance are key to provider resiliency. Most psychotic events and suicide attempts are preceded by long periods of insomnia or poor sleep.
There is a four times higher risk of PTSD when in a state of chronic fatigue and HPA axis dysfunction.
Movement is critical to humans. We were never meant to be stationary in a chair. To boost resiliency and reduce the effects of PTSD, you need to get outside and move. Exposure to sunlight while doing moderate exercise is an easy way to mitigate the negative effects of stress.
Lift heavy! Interestingly, high-intensity or long-duration exercise can make the effects of fatigue and HPA axis dysfunction much worse. Instead do something that will not only reduce your risk of injury (by getting stronger) but also help reset your body’s rhythm. Lift heavy stuff, use low repetitions, and get strong. This works because the body craves the fatigue caused by a good stress, exercise. The fatigue it craves is one from which it can recover, becoming stronger. Heavy weight and low repetitions stimulate the body to balance the hormonal cascade of testosterone, cortisol, norepinephrine, and the glucocorticoids.
Weightlifters are more resilient than distance runners becaus they do not take an already-exhausted body and exhaust it further—rest and recovery strategies are built into their exercise. A weightlifter is more strategic, fatigue patterns are less stressful, and resistance training boosts free ‘T.’ But a good long walk in the sun never hurts!
What you’ve just seen happen is bad—in fact, it’s horrible. You’re unique in the fact that few humans ever have to see and do what you do. It’s not OK to just shrug it off as part of the job. That dead baby you just carried into the ER could haunt you forever—now talk about it! Sit down with a peer and admit that what you just had to do was horrible. Find an outlet for that pain, anger, numbness, and sadness. As a peer, when you know your shift member just had “that call,” take them out of service. Have the conversation now and tomorrow and in a month. You are human, and it’s OK to not be OK; just know what your outlet is. Mine was an ass-kicking workout. Yours will be something totally different, but never deny what you just did wasn’t normal.
As a side note, when you take an EMT off the street for a few days, make sure to pay them. If they can’t pay their bills, they will keep running calls even if they need the mental time off, making the whole process worse. Employees are an asset, and they need to be treated that way.
Invest in yourself and your department. Learn why your resiliency is poor. Understand that how you fuel the machine (that’s you) makes a big difference. Learn how to employ sleep hygiene (turn off the screens, meditate, keep a stress journal). Get or stay fit for duty, and when in doubt have fun. But never be afraid to ask for help.
Bryan Fass, BA, ATCL, CSCS, NREMT-P, has dedicated the past 10 years to changing the culture of fire-EMS from one of pain, injury, and disease to one of ergonomic excellence and provider wellness. Fass has leveraged his sports medicine, athletic training, spine rehabilitation, strength and conditioning, and paramedic experience to become an expert on prehospital patient handling and first responder wellness. Reach him through www.fitresponder.com.