Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
Stress and Stress and Trauma on the JobTrauma on the Job
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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”
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
Post Traumatic Stress Post Traumatic Stress DisorderDisorder
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
PTSD PrevalencePTSD Prevalence
0
5
10
15
20
25
30
Iraq Police Fire
IraqPoliceFireAfghanistan
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
Post Traumatic Stress Post Traumatic Stress DisorderDisorder
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
Personal/Interpersonal Personal/Interpersonal StressorsStressors
Feelings of inadequacyFeelings of inadequacy Fear of failureFear of failure Family problemsFamily problems Financial problemsFinancial problems Parenting difficultiesParenting difficulties
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
Emotional Symptoms Emotional Symptoms of Stressof Stress
AnxietyAnxiety DepressionDepression Flat affectFlat affect Heightened angerHeightened anger Panic attacksPanic attacks
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
Physical Symptoms of Physical Symptoms of StressStress
FatigueFatigue ManiaMania Muscle tremorsMuscle tremors Gastrointestinal distressGastrointestinal distress Chest pains/elevated BP Chest pains/elevated BP
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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
Bill PrasadBill PrasadBehavioral Health CoordinatorBehavioral Health Coordinator
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