bill prasad behavioral health coordinator stress and trauma on the job

Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator

Stress and Stress and Trauma on the JobTrauma on the Job


The Good, the Bad, the The Good, the Bad, the UglyUgly ““They watch children die and families grieve. They watch children die and families grieve.

They’re called to the aftermath of gun battles, They’re called to the aftermath of gun battles, car accidents and domestic rage. They’re car accidents and domestic rage. They’re cursed at, vomited and bled on, yet patients cursed at, vomited and bled on, yet patients seldom ask their names. The professional life of seldom ask their names. The professional life of a paramedic can be harsh and demeaning. a paramedic can be harsh and demeaning. Some survive the stress, some don’t. The Some survive the stress, some don’t. The national average for a paramedic to stay on the national average for a paramedic to stay on the job is just eight years.”job is just eight years.”

Los Angeles Business JournalLos Angeles Business Journal

1999 1999


Killing Me SlowlyKilling Me Slowly

Increased risk of heart disease: Increased risk of heart disease: Raised levels of homocysteine, an Raised levels of homocysteine, an amino acid that damages arterial amino acid that damages arterial walls. walls. Ohio State Ohio State UniversityUniversity

Gradual Brain damage: Altering and Gradual Brain damage: Altering and functioning of brain cells and atrophyfunctioning of brain cells and atrophy

““Your Miracle Brain”Your Miracle Brain”


How Important is this?How Important is this?

““Stress is one of the most serious Stress is one of the most serious occupational hazards facing the occupational hazards facing the modern fire service. It is important to modern fire service. It is important to recognize exactly how stress can recognize exactly how stress can adversely affect our health, job adversely affect our health, job performance, career decision making, performance, career decision making, morale and family life.”morale and family life.”

United States Fire AdministrationUnited States Fire Administration


Leading Cause of Leading Cause of DeathDeath

BurnsBurns Smoke InhalationSmoke Inhalation Heart AttackHeart Attack About 100 fire fighters die About 100 fire fighters die

on the job a year. Heart on the job a year. Heart attacks kill about 45% attacks kill about 45% Harvard StudyHarvard Study


Heart Breaking RiskHeart Breaking Risk New England Journal of Medicine New England Journal of Medicine

(2007)(2007)

0

5

10

15

20

25

30

35Fighting Fires

Returning fromfireIn House (nonemergency)Responding toalarmPhysical Training

EMS and otheremergencies


What is Stress?What is Stress?

Wear and tear on the body Wear and tear on the body caused by livingcaused by living

State of physical and State of physical and psychological arousalpsychological arousal

Response to the environmentResponse to the environment


Types of Stress and Types of Stress and TraumaTrauma

GeneralGeneral Psychosocial: Stress of livingPsychosocial: Stress of living Bioecological: Noise, Bioecological: Noise,

stimulantsstimulants Personality: Who we are, what Personality: Who we are, what

we do, how we handle we do, how we handle difficultiesdifficulties


Cumulative StressCumulative Stress

Incidents pile-up over timeIncidents pile-up over time Deterioration in job Deterioration in job

performance/relationship performance/relationship difficultiesdifficulties

Complicates handling of critical Complicates handling of critical incident stressincident stress


Symptoms of Symptoms of Cumulative StressCumulative Stress

CynicismCynicism LethargyLethargy Procrastination/LatenessProcrastination/Lateness IrresponsibilityIrresponsibility Sense of shortened futureSense of shortened future Suicidal/Homicidal IdeationSuicidal/Homicidal Ideation


Post Traumatic Stress Post Traumatic Stress DisorderDisorder

Experienced or witnessed or was Experienced or witnessed or was confronted with an event or confronted with an event or events that involved actual or events that involved actual or threatened death or serious injury threatened death or serious injury or serious threat to physical or serious threat to physical integrity of self or othersintegrity of self or others



The response must involve intense The response must involve intense fear, helplessness or horrorfear, helplessness or horror

Trauma that overwhelms a Trauma that overwhelms a person’s normal ability to copeperson’s normal ability to cope

80%: little or no reactions80%: little or no reactions 10%: acute reactions10%: acute reactions 10%: chronic reactions 10%: chronic reactions


PTSD PrevalencePTSD Prevalence

0

5

10

15

20

25

30

Iraq Police Fire

IraqPoliceFireAfghanistan


Normal Reaction to Normal Reaction to StressStress

Fight or flight: Rise in levels that Fight or flight: Rise in levels that include increase in adrenaline, include increase in adrenaline, norepinephrine, thyroid hormonesnorepinephrine, thyroid hormones

Increased heart rate, BP, changes Increased heart rate, BP, changes to muscles, senses and other to muscles, senses and other body structuresbody structures

Return to normal: Homeostatic Return to normal: Homeostatic loadload



Levels of stimulating hormones Levels of stimulating hormones stay highstay high

Physical changes continuePhysical changes continue Memory of event frozen in present Memory of event frozen in present

memory where it is re-experienced memory where it is re-experienced as if it were re-occurringas if it were re-occurring

Allostatic Load: Body kept on alertAllostatic Load: Body kept on alert


Influences in Influences in Development of PTSDDevelopment of PTSD

Characteristics and nature of eventCharacteristics and nature of event Number of incidentsNumber of incidents Intensity and duration of incidentsIntensity and duration of incidents Additional traumatic or stressful events Additional traumatic or stressful events

taking place in one’s personal lifetaking place in one’s personal life Level of social supportLevel of social support Age: As age increases, probability of Age: As age increases, probability of

trauma decreasestrauma decreases Guilt, humiliation and shame arising Guilt, humiliation and shame arising

from incidentfrom incident


Untreated PTSDUntreated PTSD

Higher resting and sleep heart ratesHigher resting and sleep heart rates High BPHigh BP Elevated cholesterolElevated cholesterol Compromised Immune system: illness, Compromised Immune system: illness,

infection, slow wound healinginfection, slow wound healing Chronic pain: back, headaches, Chronic pain: back, headaches,

stomach/intestinal problemsstomach/intestinal problems 95% fire fighters and paramedics 95% fire fighters and paramedics

reported pain complaint reported pain complaint


Traumatic IncidentsTraumatic Incidents

Line of duty deathLine of duty death Serious line of duty injury or threat of Serious line of duty injury or threat of

danger danger Suicide of colleagueSuicide of colleague Death of a childDeath of a child Mass causality incidentMass causality incident Terrorism/WMDTerrorism/WMD Victim known to rescuersVictim known to rescuers Excessive news media interestExcessive news media interest


Work Environment Work Environment StressorsStressors

Sound of alert toneSound of alert tone

Interrupted sleep cyclesInterrupted sleep cycles

Carrying heavy loadsCarrying heavy loads

Exposure to extreme hot and coldExposure to extreme hot and cold


Personal/Interpersonal Personal/Interpersonal StressorsStressors

Personality conflicts with co-Personality conflicts with co-workersworkers

Perceived lack of respect from Perceived lack of respect from managers/publicmanagers/public

BoredomBoredom Lack of job satisfactionLack of job satisfaction Concerns over promotions, Concerns over promotions,

transfers or retirementtransfers or retirement


Personal/Interpersonal Personal/Interpersonal StressorsStressors

Feelings of inadequacyFeelings of inadequacy Fear of failureFear of failure Family problemsFamily problems Financial problemsFinancial problems Parenting difficultiesParenting difficulties


Cognitive Symptoms of Cognitive Symptoms of StressStress

Memory/concentration difficultiesMemory/concentration difficulties Difficulty problem solvingDifficulty problem solving Feelings of Feelings of

helplessness/hopelessnesshelplessness/hopelessness Denial Denial


Emotional Symptoms Emotional Symptoms of Stressof Stress

AnxietyAnxiety DepressionDepression Flat affectFlat affect Heightened angerHeightened anger Panic attacksPanic attacks


Physical Symptoms of Physical Symptoms of StressStress

FatigueFatigue ManiaMania Muscle tremorsMuscle tremors Gastrointestinal distressGastrointestinal distress Chest pains/elevated BP Chest pains/elevated BP


Behavioral Symptoms Behavioral Symptoms of Stressof Stress

WithdrawalWithdrawal Dramatic change in behaviorDramatic change in behavior AggressivenessAggressiveness Change in eating/drinking Change in eating/drinking

patternspatterns Self medicationSelf medication


Building ResilienceBuilding Resilience

Understanding and capitalizing on Understanding and capitalizing on one’s strengthsone’s strengths

Recognizing and addressing one’s Recognizing and addressing one’s weaknessesweaknesses

Examination of one’s record of Examination of one’s record of handling stresshandling stress


Building ResilienceBuilding Resilience

Spirituality: Life long faith can Spirituality: Life long faith can provide meaning and hopeprovide meaning and hope

Trust your training: Use what Trust your training: Use what you’ve learned from parents, you’ve learned from parents, teachers and supervisorsteachers and supervisors

Core: Believe in who you are, Core: Believe in who you are, have integrity, use a moral have integrity, use a moral anchoranchor


StressStress vs. vs. CopingCoping

Avoiding feelingsAvoiding feelings Blaming othersBlaming others

IsolationIsolation

Guilt and shameGuilt and shame Work longer hoursWork longer hours Acting out/drinkingActing out/drinking

Accepting feelingsAccepting feelings Learning from Learning from

mistakesmistakes Using support Using support

systemsystem Testing your truthsTesting your truths Finding a balanceFinding a balance Healthy releaseHealthy release


Prescription for HealthPrescription for Health

At least 6 hours of sleepAt least 6 hours of sleep Nutrition/Exercise within 24 hrsNutrition/Exercise within 24 hrs DowntimeDowntime Don’t take unnecessary chancesDon’t take unnecessary chances Know and respect the enemyKnow and respect the enemy Assess/learn/teachAssess/learn/teach


Building a HomeBuilding a Home

Private space away from public and Private space away from public and other fire fightersother fire fighters

Room that is away from Room that is away from spouse/childrenspouse/children

Control over noise and media Control over noise and media pollutionpollution

Family atmosphere that is antithesis Family atmosphere that is antithesis of institutional quality of fire houseof institutional quality of fire house

Toledo Fire DepartmentToledo Fire Department


InterventionsInterventions

Crisis Response TeamCrisis Response Team Individual consultationsIndividual consultations On-going counselingOn-going counseling Employee Assistance ProgramEmployee Assistance Program FiRST TeamFiRST Team Chaplain TeamChaplain Team Woodburn Mobile Crisis UnitWoodburn Mobile Crisis Unit Occupational Health ClinicOccupational Health Clinic


Psychological WellnessPsychological Wellness

Understanding stress responseUnderstanding stress response Controlling stressControlling stress Managing stress reactionsManaging stress reactions Instillation of resilience building Instillation of resilience building

methodsmethods


Stress and Stress and Trauma on the Trauma on the

JobJob

bill prasad behavioral health coordinator stress and trauma on the job

Documents

stress of livingbioecological

serious injury

serious threat

functioning of brain

serious occupational

livingstate of physical

acute reactions10

family life