Chapter 2 Part 3

Stress in Paramedic Careers

• Stress significantly impacts job performance, health, and personal relationships in the paramedic profession.
• Stress is any event causing a bodily reaction or adaptation, regardless of being pleasant, unpleasant, mild, or intense.

Defining Stress

• Stress is the body's nonspecific response to any demand.
• It's a bodily reaction to any stressor requiring adaptation, which is essential for everyday life.
• Stress can be positive, motivating achievement (eustress), or negative, overwhelming and debilitating (distress).

Stress Triggers

• Stress responses are often initiated by events perceived as threatening or demanding; these responses vary from person to person.
• Common triggers involve loss, injury, major life events, and job-related stress.

Life Change Units (LCU)

• Life Change Units (LCU) are often examined in studies of paramedic stress levels.
• The Social Readjustment Rating Scale ranks 43 stress-producing events, assigning a score to each.
• Scores above 150 LCU may correlate with disease and illness development.
• Effective stress management involves identifying personal stress triggers and planning to minimize their effects.

Fight or Flight Response

• The fight or flight response is a fundamental stress response model.
• Physiological reactions are triggered by perceived threats, preparing the individual to fight or flee by activating the sympathetic nervous system.
• This response is less useful today because stressors are not usually resolved by fighting or running.
• Accumulating smaller stress events can result in a continuous state of alert, leading to negative stress responses.
• Prompt evaluation and handling of each stress event is important, even if negative.

Reactions to Stress

• Reactions to stress are categorized as acute, delayed, or cumulative.
• Acute stress reactions occur during a stressful situation causing nervousness, increased focus, or negative emotional and physical reactions if the situation is overwhelming.
• Delayed stress reactions manifest after the event, demonstrating the ability to focus during the crisis and lingering nervous/excited energy afterward.
• Cumulative stress reactions occur with prolonged exposure, causing difficulty shaking off effects, exhaustion, and potential physical symptoms.
• Identifying events causing delayed stress reactions and using stress management are crucial.

Physical and Psychological Symptoms of Stress

• Physical symptoms of cumulative stress include fatigue, appetite changes, GI problems, headaches, and sleep disturbances.
• Other physical symptoms are irritability, inability to concentrate, and hyperactivity or underactivity.
• Psychological reactions include fear, depression, anger, irritability, frustration, isolation, and substance abuse.
• Additional psychological reactions are dull behavior, oversensitivity, inability to concentrate, loss of interest etc.
• Prolonged stress can contribute to heart disease, hypertension, cancer, depression, and burnout.

Patient Responses to Stress

• Patients, families, bystanders, and healthcare professionals respond to critical illness or injury stressors.
• Patient responses are determined by personal methods of adapting to stress.

Common Reactions to Stress

• Common reactions include fear, depression, anxiety, anger, and confusion.
• Psychological defense mechanisms such as denial, regression, projection and displacement can come into play.
• Denial involves minimizing the seriousness of a situation.
• Regression is returning to an earlier age level of behavior, projection involves attributing feelings to others.
• Displacement is redirecting emotions to a substitute.
• Psychological stress responses are often not under the patient’s conscious control.

Cultural Considerations

• Reactions to illness/injury are rooted in culture, requiring respect of cultural backgrounds.
• Avoid attempting to change behavior based on cultural differences.
• Obtaining permission before physical contact is essential.

Responses of Families, Friends, and Bystanders

• Bystanders and family members may exhibit similar responses to patients.
• A calm reassurance can address the concerns of family and friends.
• Mass casualty situations may cause patients and bystanders to become dazed or disorganized requiring removal but not isolation.

Five Common Reactions during Mass Casualty

• Anxiety manifests as sweating, trembling, weakness, and nausea, and can recover quickly if properly directed.
• Blind panic involves disappearance of judgement, and having the potential to precipitate further mass panic.
• Depression presents as a numbed state where bystanders need grounding back to reality.
• Overreaction includes compulsive talking/joking and hyperactivity without accomplishment.
• Conversion hysteria involves subconscious anxiety conversion into bodily dysfunction.

Responding to Stress as a Paramedic

• Expect a range of feelings during stressful situations, and maintain calm to instill confidence
• Irritation towards patients with seemingly minor issues is a common reaction.
• It's important to consider that patients may be calling for something more due to a lack of medical understanding.
• Patients should be politely reminded that non-emergent issues can prevent responses to true emergencies.

Compassion Fatigue

• Compassion fatigue (secondary stress disorder) is common in healthcare and emergency services involving a gradual lessening of compassion over time.
• Compassion fatigue includes high absenteeism, difficult relationships, inability to work in teams, and aggressive behavior.
• It also can cause negative attitudes toward work, lack of empathy, judgmental attitudes, and preoccupation with non-work issues.
• Recognizing signs of compassion fatigue prevents it interfering with work and personal life

Coping with Stress

• Recognize early warning signs such as heart palpitations, rapid breathing, chest tightness, sweating, and changes in desires.
• Signs after fight or flight include rapid breathlessness and inappropriate language.
• Consider stress management techniques like controlled deep breathing and progressive relaxation.
• Professional assistance, focus on the immediate situation, avoiding stimulants, resting, and exercising are important.
• Identifying joyful people and activities, and befriending supportive coworkers are critical.

Burnout

• Burnout should be considered at the beginning of an EMS career to develop preventative habits, and is defined as the exhaustion of physical or emotional strength.
• It may result from chronic unrelieved stress.
• Interpersonal relationships, pay, prestige, and fringe benefits are all EMS-related stressors.
• Burnout varies among individuals.

Preventing Burnout

• Turn off alerting devices or phones when off duty to prevent burnout.
• One person's eustress may be another's distress, because distress is a learned reaction based on perception.
• False beliefs that could lead to burnout include a need to be perfect, needing to anticipate every danger, and total responsibility for patient outcomes.
• Other false beliefs are needing to know everything, showing emotion being a weakness and good paramedics never making mistakes.
• Stress prevention involves recognizing unrealistic beliefs.
• Burnout's signs and symptoms include chronic fatigue, cynicism, lack of desire to work, emotional instability, and changes in sleep.
• Other symptoms of burnout include feeling overwhelmed, loss of interest in hobbies, declining health, constant muscle tightness, and substance abuse.
• Paramedics who do not experience burnout have learned to respect and value themselves and use coping strategies.