1. Chapter 4 Stress in Emergency Medical Services

2. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview  Stress Defined  Call-related Stress  Stress related to Job Dynamics  Stress related to the Home Environment  Managing Personal Stress  Managing Stress of Patients and Families

3. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 3  Stress is the physical, emotional, and behavioral response of the body to changing conditions in our lives  Events that trigger stress are known as stressors Stress Defined

4. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 4 Stress Defined  Emotional response –Feelings we experience during a stress response may be very powerful, even overwhelming –EMS providers must be cognizant of the vast array of positive as well as negative emotions they are bound to encounter

5. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 5 Stress Defined  Physical response –Fight or flight response Originates in the sympathetic nervous system Cardiovascular and respiratory effects >Increased heart rate >Increased blood pressure >Rapid, shallow breathing

6. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 6 Stress Defined  Physical response –Fight or flight response Neurologic effects >Dizziness >Headache >Dilated pupils >Gastrointestinal response >Nausea >Altered appetite >Diarrhea or constipation

7. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 7 Stress Defined  Physical response –Fight or flight response Genitourinary effects >Frequent urination Musculoskeletal effects >Tension >Twitching Endocrine effects >Increased blood glucose and cortisol

8. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 8 Stress Defined  Physical response –Fight or flight response Psychological effects >Irritability >Increased sensitivity >Sadness, depression >Feeling on edge

9. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 9 Stress Defined  Physical response –Fight or flight response Cognitive effects >Impaired memory >Confusion >Impaired judgment >Poor decision making >Delayed response time >Altered perceptions >Inability to concentrate

10. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 10 Stress Defined  Physical response –Fight or flight response Behavioral effects >Pacing >Sweaty palms >Rapid speech >Insomnia >Withdrawal >Exaggerated startle reflex

11. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 11 Stress Defined  Physical response –Fight or flight response Spiritual effects >Alienation >Social isolation >Feeling of emptiness

12. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 12 Call Related Stress  Death –One of the most stressful events an EMT will experience –The EMT may experience feelings of helplessness, despair, or even failure when treating a dying patient

13. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 13 Call Related Stress  Trauma –Trauma can affect people of all ages and has the potential to devastate lives –EMTs may have encountered a traumatic incident similar to the one they are responding to Courtesy of Craig Smith.

14. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 14 Call Related Stress  Trauma –Trauma can create overwhelming feelings of fear, anxiety, and frustration –Scenes such as amputations, shootings, decapitations, and injuries to children can provoke strong emotions –EMTs must gain control of their emotions; this may require one to “get a grip” in order to be able to render care

15. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 15 Call Related Stress  Family, friends, and coworkers as patients –Caring for someone with whom you have emotional ties is difficult

16. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 16 Call Related Stress  Abuse –Withhold blame, remain impartial, and treat nonjudgmentally –It is not within the scope of an EMT’s duty to determine guilt or innocence of a potential abuser

17. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 17 Call Related Stress  Disasters –Can be man-made or acts of terrorism –Often involve multiple injured patients; often termed a multiple casualty incident or MCI –Special training is required to deal with a disaster or MCI

18. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 18 Stop and Review  Name five positive stressors.  Name five negative stressors.  What emotional responses occur related to stress?  What physical responses occur related to stress?  Name five job-specific stressors an EMT may encounter.

19. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 19 Stress Related to Job Dynamics  Training –Schedule of learning in classroom may prove to be stressful  Work hours –Long shifts (12–24 hours) can be physically and emotionally demanding  Pay –EMTs are compensated poorly in most areas of the country

20. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 20  Poor sleeping and eating opportunities –Poor eating habits can contribute to the body’s inability to cope with stressors  Lack of formal rewards –Formal rewards are received infrequently in EMS Stress Related to Job Dynamics

21. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 21 Stress Related to the Home Environment  Time issues –EMTs work long hours; overtime and shift work may be difficult for a family to deal with –Being on call while at home makes planning difficult for family members –EMTs should keep a significant period of time completely free for family activities

22. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 22  Social life –It is important for the EMT to spend time with friends –Unwind time, or a break away from the stresses of family and work, is essential for good mental and physical well-being Stress Related to the Home Environment

23. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 23 Managing Personal Stress  Personal well-being –EMTs need to allow enough time for nonstressful activities such as hobbies or exercise –Persistent stress can actually decrease the body’s immune capabilities –Prolonged stress can result in physical health problems such as heart disease and stomach ulcers

24. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 24 Managing Personal Stress  Healthy lifestyle –Exercise –Balanced diet –Elimination of unhealthy habits such as smoking

25. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 25 Managing Personal Stress  Immunizations –Stay up to date with immunizations Consider: >Hepatitis B vaccine >Tetanus vaccine >Measles, mumps, rubella vaccine >Influenza vaccine >Regular tuberculosis testing

26. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 26 Managing Personal Stress  Body substance isolation –Take measures to protect yourself from infectious diseases such as: Tuberculosis Hepatitis A Hepatitis C Hepatitis D HIV

27. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 27 Managing Personal Stress  Body substance isolation –Decrease your personal stress; wear your: Gloves! Masks! Gowns!

28. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 28 Managing Personal Stress  Scene safety –Take precautions to prevent harm from coming to: Yourself Crew Patient Bystanders

29. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 29 Managing Personal Stress  Stress relief techniques –Relaxation exercises Deep breathing exercises –Diversionary techniques Help dissipate stressful events Physical exercise such as jogging, swimming, walking, etc., can be useful to release pent-up energy from stress

30. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 30 Managing Personal Stress  Recognizing stress –Acute stress Single event creates a stress response Some stressful events can be mitigated

31. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 31 Managing Personal Stress  Recognizing stress –Chronic stress Repeated stressors result in chronic stress over a period of time Can cause significant physical and emotional harm Burnout is when an EMT no longer feels able to perform her duties because of the effects of chronic stress EMTs must recognize signs and symptoms of chronic stress and burnout and take action

32. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 32 Managing Personal Stress  Physical signs of chronic stress –Increased HR –GI discomfort –Anxiety –Headaches –Insomnia –Fatigue –Muscle tension  Emotional signs of chronic stress –Feeling on edge –Depression –Irritability –Anger

33. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 33 Managing Personal Stress  Behavioral signs of chronic stress –Avoidance –Withdrawal –Aggression –Procrastination –Increased alcohol or tobacco use –Drug abuse –Overeating

34. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 34 Managing Personal Stress  Stress management programs –Cross training –Change the way the stimulus is perceived –Comprehensive health and safety programs

35. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 35 Managing Personal Stress  Debriefing –Critical incident stress debriefing (CISD) –Critical incident stress management (CISM) Review of the literature suggests CISD and CISM are controversial Many professionals are no longer recommending formal CISD sessions

36. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 36 Managing Personal Stress  Debriefing –In the days following a traumatic event, psychological support, education, and screening to detect those in need of more complex intervention is appropriate

37. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 37 Managing Personal Stress  Suicide –Suicide is not uncommon in high-stress professions –EMTs are not immune –EMTs must learn to be aware of their own response to stress and that of their coworkers –EMTs do not always share their f eelings or problems!

38. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 38 Managing Stress of Patients and Families  The incident is stressful not only to the provider, but also to the patient!  Treat patients with dignity and respect  Provide honest explanations  Maintain privacy

39. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 39  Family members may also experience stress  EMTs should also reassure family members  Families should be given truthful information about the treatment you are providing  Show empathy and listen! Managing Stress of Patients and Families

40. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 40 Stop and Review  What is the difference between acute and chronic stress?  Identify the signs of chronic stress.  Name three techniques used to relieve stress.  What are the benefits of stress management programs?