9-1-1; What Is Your Emergency?

Monday, March 16, 2009

Stress 101

Stress can be a good thing and we dispatchers thrive on it, otherwise we wouldn't do what we do. But, too much stress is harmful and can ultimately destroy you and everything you love.

Stress has been a big 90's topic. We all have it in our lives, we know we have, we know we should do something about it, but where do you start? The amount of information on the subject is overwhelming. Additionally, the "normal" standards do not always apply in reference to dispatchers or any emergency service workers.

Specific Issue

Stress is any load placed on a system. Humanly speaking, it is a physical or physicological response to something in our environment. A stressor is a specific problem, issue or challenge as perceived by an indivicual. The word strain often tags along with the word stress. Strain is the prolonged impact of a stressor(s) on a system after a length of time.

The term for good stress, the kind that is enjoyable and helps us to perform at peak levels, is eustress. We all need some degree of stress to nudge us to higher and higher levels of achievment. It is only when there is too much stress in our lives or when we encounter something we perceive individually as negative, that the term distress becomes applicable.

So what does stress do to our bodies? When your body registers something stressful going on in your life many complicated chemical reactions start percolating. Epinephrine (adrenaline) is released and other hormonal levels fluctuate for optimal response. Your body will prepare itself by tensing up muscles, revving the metabolism and increasing respiration and pulse rates. Protein and fat levels rapidly increase in the blood stream to prepare for the anticipated energy needs and the liver will churn out ten times the amount of glucose than it does under non-emergency circumstances.

Is Stress a Problem for You?

Trying to determine if stress has become a problem in your life can be difficult. Self assessment is the best route but requires brutal self-honesty and admitting to weakness. Not many of us do that willingly. One way to start is being open to input from friends and loved ones. They are incredibly in tune with you can can notice a problem cropping up long before it pings on your internal radar.

The signs and symptoms of stress are a book on their own. And, as I mentioned earlier, each of us is very individual in our perceptions and reactions to stress. Some of the most common physical reactions include excessive sweating, back/neck/jaw tension and soreness, nausea, vomiting, sleep disturbances off all sorts and over all fatigue.

Emotional and behavioral signs and symptoms could include aggression, irritability, depression, nightmares, reduced self-esteem and becoming careless or accident prone. Finally, cognitive reactions might be increased forgetfulness, inability to concentrate, a preoccupation with and focusing on the past and diminshed productivity at work and at home.

These lists are very brief and you will know yourself what your best signs and symptoms are. The lists are meant to be used as pointers or suggestions, and in no way are complete or all inclusive. You may have some, all or none of the problems listed.

Having any of these does not mean you are a nut or even that you are suffering from stress overload. Stress is a normal human reaction when we are exposed to an event or situation that we perceive as threatening or unusual in our own personal frame of reference.

Stress Reactions

Reactions to stress come in many forms. These include acute, delayed and cumulative stress reactions as well as critical incident stress and post traumatic stress syndrome. Not dealing with these reactions and their effect on you can limit or cripple your ability to function.

Acute stress is an in-your-face-as-it's-happening reaction to an event. Some physical reactions can require immediate attention, such as chest pain, difficulty breathing, fainting or physical collapse, and need on the spot intervention.

Cognitive and behavioral reactions requiring medication can be more subtle. They may include hyper-alertness and hyperactivity, a serious disruption in thought processes or an extremely slowed thought process, problems recognizing familiar people or things and an inability to perform the most mundane of tasks. A person in the midst of an acute reaction may seem shocky, they may exhibit inappropriate emotions and may vocalize these reactions at really wrong times. Again, this is a partial listing only. If at all possible, the person experiencing these signs and symptoms should be removed from the stressor.

Okay, I hear you loud and clear. Just how exactly am I supposed to accomplish this? Many of us work alone at our consoles and have no back up, no way to distance ourselves. I can not answer that one conclusively. I'm a dispatcher, not a psychologist or psychiatrist. My best recommendation is acknowledge you are having an acute stress reaction, get through the stressor as best you can and then deal with the aftermath as soon as possible. Just acknowledging you are having a bit of trouble should bring relief on it's own.

A delayed stress reaction can be more confusing. Some people have no reaction to a highly stressful event. Either they don't have the time and luxury or it is their nature to automatically lock down emotionally. So, when odd things begin effecting their lives the connection to the stressor may not be immediately obvious.

One of the hallmark signs of a delayed reaction is intrusive images and/or thoughts. The scene may crop up without your willing it over and over and over again, interfering with your ability to focus, concentrate, and function efficiently. These images may creep into your dreams as well.

Flashbacks such as these can be prompted by external stimuli such as sight, sound, smell or touch. Research is building that highly traumatic events can actually carve a path biochemically into your psyche. The slightest stimulus can reactivate chemicals in your brain, vividly forcing you back into the original event.

Important point: I can not emphasize enough that these are normal reactions to an abnormal event. Just because these loaded images keep coming back at you does not mean you are crazy, obsessed or about to take the long walk off of a short pier. It does not mean you are weak, worthless or incapable of doing your job.

Cumulative stress is caused by an emotional layering and build up on many stresses from many sources. It is very difficult to recognize as the development may take years to reach a point where it shows its ugly little face. The signs and symptoms can be subtle and easily mimic other conditions or illnesses. Left untreated it can kill. In its final, fourth state it can create (or exacerbate) asthma, coronary disease, cancers and diabetes. It can so paralyze and brainwash the "sensible you" that suicidal or homicidal thoughts become acceptable, even welcoming.

Cumulative stress reactions typically progress through four stages. The warning phase may include vague feelings of anxiety, boredom with things you had previously enjoyed, and mild depression. Stage two is characterized by an increased depth to these feelings as well as the start of physical symptoms, such as increased number of headaches, chronic neck and back pain and disruption of sleep patterns. In the third stage all these feelings become so embedded that they almost seem normal. It is referred to as the entrenched stage. Additional physical signs and symptoms may include appetite dysfunctions, loss of sex drive, rigid thinking patterns and the onset of ulcers.

No Symptoms

Left unrecognized and untreated these phases do a death spiral down to the severe stage. In many cases professional help will be needed to assist in finding a way out. Having some of these signs doesn't necessarily mean you are a victim of cumulative stress reaction. Having none doesn't mean you aren't. This is a tricky one and it doesn't always follow the neat format listed. Cumulative stress is one of the most important reasons to deal with stress as you become aware of it, then the nasty build-up has less of a chance of even beginning.

Finally, there are two other types of stress that need mention. One is critical incident stress. Typically the term is used only in reference to those of us involved in emergency services. A critical incident is any event that overwhelms the coping skills of an individual worker or team. There are critical incident stress management teams available throughout the country. They are made up of a group of our peers and can be activated with one phone call. Their function is not to critique your actions at a scene but to help you get through the worst of a bad scene, provide you with some self help techniques and get you back in service as whole, and as quickly as possible.

Post traumatic stress syndrome (PTSD) was really first recognized in Vietnam vets, although the condition has been around much longer. You do not have to have gone through years of stressful, high incident scenes to develop PTSD. Sometimes all it takes is one over-the-top event. PTSD is not something to be self diagnosed and self treated. This one requires professional assistance. How do you know when you need this help? PTSD occurs when the process of working through the event(s) stops in its tracks.

The majority of the time you will be able to get through critical incidents by yourself and/or with the support and help of friends, loved ones and peers. If you can't seem to get past an event(s), if you experience flashbacks to the scene, avoid thinking about anything at all having to do with the scene, feel detached from the world in general like you are a balloon floating above it, and if you have mental anguish and distress around anniversary dates of bad ones you may be suffering from PTSD. Please see a professional to get their opinion and help.

Stress Sources

The sources of stress, well, you all know the bigger ones. Work, family, money...but how about some less than obvious? There is organizational stress, including things like task and role demands, structure and power grids within the organization and management style. Environmental stress -- sick building syndrome, uncomfortable work station design and seating, incorrect lighting, poor quality tools to work with. Psycho-acoustical stress is a big factor in our lives. Too much noise! Stop and think about the assault on your ears between multiple radio channels, multiple phone lines, multiple officers, multiple computers, multiple printers, people in your work space! And finally the biggest category to them all, the little stuff. Scientific research is finally proving what we've known for years, it really was a single straw that broke the camel's back.

Stress Management

So now it's time to do something about it. What? The most desirable answer is to eliminate the stressor. Decide if what is causing you the distress is really worth keeping in your life. This is a very good place to look at your own thought and self inflicted stress. Unload the unnecessary shoulda coulda hadta woulda pressures you apply to yourself.

Then there are those stressors we won't or can't surrender. Marriage, family, work! Applied stress management techniques will go a long way in saving your sanity. Management means acknowledging there is a problem with stress in your life and working out coping strategies and recovery techniques. Stress management can help you learn to see the early signs of stress reactions. By doing and effectively mitigating these reactions you will improve your quality of life and improve your productivity at work and at home.

There are no guarantees here, though. I cannot and will not say that by minimizing stress you will automatically lower your blood pressure, see your acne clear up, develop soft shiny hair and spearhead world peace. Ain't gonna happen. Stress management can boost the immune system, help lessen the symptoms and progression of chronic diseases, and maybe promote world peace. (You're on your own with the hair deal).

The three biggest and best management techniques are the hardest to follow. Watching your diet, exercise, and if you are smoking, quitting. Substances like sugar, caffeine, salt and fat can tax the available resources the body has available to fight a stress reaction. Caffeine also can extend and magnify many of the symptoms of stress overload.

Exercise is a two-pronged attack on stress. It can give you the sheer physical relief of blowing off the tension, and, while you are doing so it helps strengthen and prepare the body for the most stressful event. And, you've heart it before so I won't nag -- if you're smoking, please stop.

Turn Around

Try turning your perceptions on stress around. Remember how good it feels when you handle a "good" stressful call? When everything falls into place just so and you feel so powerful it borders on godlike? Next time an overwhelming stressful situation crops up, try to generate the same sense of power. Remind yourself that this is just another challenge to overcome and that you have the skills and training to do it.

Practice relaxation techniques whenever you get a moment. Deep breathing exercises, conscious muscle relaxation and mental imaging are all good ways to take a break without even walking away from the console. The benefits from even a five minute relaxation break have been show to last for over an hour afterwards.

An important point to remember is that the relaxation is not totally about letting your muscles go all loose and squishy. Relaxation responses are best induced and have the most value when mentally you relax as well. In other words, strangle the little voice saying, "Try harder, go faster, do better now now now!"

Develop a safety net of friends both inside and outside your profession. Many, many times the simple act of letting a problem see daylight will reduce its size and therefore, its effect on you. Take advantage of training and programs that might be offered through your place of employment, such as seminars on stress relief and in-house gyms to work out in.

Contact a local critical incident stress management team to set up a seminar for you and your co-workers. These teams not only respond after crises have come and gone but will happily come out and teach preventive management techniques. Often they will provide one on one peer counseling services in case you are uncomfortable with the thought of asking for or provoking a full blown debriefing.

Coping Skills

Take a look at someone you admire for their coping skills. How do they do it? Try and do some of the same things. Take a moment to check your perceptions and conclusions about a stressful event you feel went south. Do you think you screwed up? Ask someone. If you didn't, you've just eliminated a self induced stressor. And, well, if you did, hopefully the person you ask will tell you as kindly and tactfully as possible. If you learn from it, you will have gained a lesson and lessened your stress.

Intentionally imagine "what if's?" By role playing and planning coping strategies ahead of time, you are less likely to be overwhelmed when the real deal arrives. Another benefit of "what ifing" is that by repeatedly exposing yourself to these scenes, even just in your mind, you are desensitizing yourself to them. It's a mental equivalent of the flu shot.

Constantly keep building your skills, never stop learning. The more you learn about yourself and your job, the more competent you become to handle the occasional curve ball. Don't let stress and its consequent problems build up. Take things one stressor at a time and don't get discouraged (or stressed)! if it seems you lapse once in awhile. Just keep trying. By tackling stress reactions to the ground, you reaffirm what you already know: that you are a strong smart person who can cope, live and learn and get on with life.

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