Stress effects on emergency worker performance and well-being

Demands That Emergency Workers Are Exposed To

In this day and age, where no one is safe and emergency situations arise all the time, the people behind keeping the peace intact play a very important role. In recent studies it has been observed that emergency workers go through immense pressure and stress, which if gone undiagnosed can lead to major psychological problems. In this paper we will discuss at length the trauma that emergency workers suffer form and how to cope with it.

In the present day, United States is no more considered a safe and peaceful place to feel free, but rather it is more like an everyday war zone. Places like schools, offices, homes and even churches are no longer a safe ground like they were once considered to be, violence and hostility somehow find their way into them as well. Things like homicide, sexual and child abuse and road rage cases, which at one point in time were considered almost a taboo, are now increasing by the day. Such psychologically intense events understandably shake everyone, especially the emergency workers; the men and women serving their respective towns and communities as fire fighters and medical emergency caregivers (Jensen. 1999).

These professional go through traumatic, highly stressful and life-challenging experiences every day, which in turn in affects them mentally, emotionally and physically. This constant pressure to everyday challenges can cause long-term stress disorders, which can affect their health excessively and can cause ailments like cancer, high blood pressure, diabetes and increased chances of heart problems. The Substance Abuse and Mental Health Services Administration, (SAMHSA, 1995) states that chronic stress may also cause "psychological problems including depression, withdrawal, apathy, and relationship problems in general." The fact that no support or understanding is provided by the people, government agencies, and the business professionals, these heroes are left on their own and an increasing rate of divorce, substance abuse and health issues are being observed among the emergency workers. To add to the current atmosphere of frustration for these workers, the media does nothing except to exaggerate the situation, which in turn increases their anxiety levels (Jensen. 1999).

Effects of such an environment are both internal and external, in this paper we will discuss at length all the factors that participate in creating stressful situations for emergency

Workers and propose suitable solution for the effecting problems.

Common Problems Observed:

Some of the very common stress and psychological issues observed in emergency workers include physical burnout, psychological disorders, risk taking syndrome which includes substance abuse (McCall & Salama.1999). These workers are constantly exposed to long-term pressures and induce themselves in situations that exhaust them physically and more importantly mentally. Such constant pressure and stress can lead to low stress tolerance, which can be easily triggered by staying in an unstable and insecure environment. It is under these circumstances in which stress can increase to unhealthy proportions, the most common layman term used for such a condition is called "mental burnout." The process itself is a gradual one, and includes many stages defined by the many symptoms they represent (Kahlil, 1988). Below we will discuss each stage along with their representing symptoms.

Physical: On this level common fatigue shows up, symptoms like emotional and physical exhaustion, sleep deprival and specific physical ailments for example, headaches and gastronomical problems.

Emotional: When a person's emotional health is affected than signs like aggressive behavior, depression, guilt over a failed attempt to save some one's life, insensitivity, a sense of uselessness, petulance, anxiety and the most common sub-stance abuse has been brought forward by researchers.

Work Related: The amount of stress that emergency workers are exposed to on a daily basis, do not just affect them physically or emotionally but it can have a negative impact on their professional lives as well. If a person so exhausted in both terms then his work performance starts to decrease. Tardiness and poor performance takes center stage and the constant exhaustion can result in missing out on work days.

Interpersonal Communication: For emergency workers, normal life is a taboo, the only sense of normality they experience throughout their careers are the breaks between shifts that they are given to spend time with families. Workers use these days off to relieve themselves of exhaustion and fatigue. Thus compromising on their social skills, which in turn can result in withdrawal, poor or no communication, distancing one's self from loved ones and events (Kahill. 1988).

ASD and PTSD:

Acute stress disorder (ASD) and post traumatic stress disorder (PTSD) are the most common types of psychologically related observed in emergency workers. Both of these disorders are related to an extensive psychiatric diagnosis, symptom are always severe likes of which appear with a direct assault or abduction, which can also be termed as primary traumatisation and experience of the death of friend is called secondary traumatization. Such events leave a person a so sensitive, that non-relevant and non-existing situations may arise, for example a stress brain can imagine his own personal territories being tested and threatened hence also giving us tertiary traumatization (Jensen, 1999).

ASD is the first and the most common disorder to show up, which can show itself after experiencing any of the above mentioned incidents. Considering it's a volatile reaction, it can resolve on its own in a month as soon as it shows up, reactions include a variety of emotional reactions and cognitive changes such as confusion, and symptoms of mental and physical hyperactivity. PTSD can appear after the first month and stay until 3 months or more. Symptoms include "flashbacks" to a traumatized event which forces the brain to stay alert and hyper hence constantly forces ones nerves to stay under pressure such symptoms may become chronic and extremely debilitating with time, if left untreated (McCall & Salama.1999).

Problems Exacerbated by the Humanitarian Sector:

Many of the problems that emergency workers experience can be attributed to the many factors that the humanitarian sector fail to improve. The training that workers receive does not fully equip them with everything they need to know. Apart from the tightly knit unit with a clear command structure, workers need to be briefed about the psychological issues that they will experience during work. Acute stress conditions among emergency workers is now finally being recognized as medical disorder and a disability, which in extreme cases requires compensatory benefits provided to them if in the unfortunate event they cannot work due t o their illness, just like a physical injury would require them too. However in some states there is predefined limit for the consideration of compensatory benefits.

Dispatcher call:

The Ontario Workplace Safety and Insurance Board has a policy on "traumatic mental stress" that provides benefits if the stress is "an acute reaction to a sudden and unexpected traumatic event arising out of and in the course of employment." (Martin. 1981).

The event mentioned in the statement requires being clearly identifiable and evidently traumatic, and not something that can be expected in the regular routine in the workers job and environment Circumstances such as an officer worker experiencing violence or a fire at work could qualify (Smith, Agger, Danieli & Weisaeth.1996). Here the most basic question arises, how can a person be motivated enough even stress conditions are a regular and expected part of his job requirement? This question was brought forward in an incident where an Ontario police dispatcher, who had to quit his employment due to post traumatic stress disorder, which was caused by a call he had received during his shift and the entire situation got out of control by other calls of the same respect.

The dispatcher in discussion here was a senior officer with a 25-year experience, and was considered to be a model officer considering the department had no problems with him and vice versa, but a call he received to assist an officer in emergency left a lasting mark on him. Due to communication and technical error he couldn't initially locate the officer and for several minutes he was unaware of what the real situation was or what was happening. This particular incident led to sleep disorder and psychological disturbances for him. Later incidents where he spoke to a woman being stabbed and a man who had found his son committed suicide contributed to further stress. His mental condition required him to receive psychiatric counsel and psychological evaluation, obviously he had to take time off from because of that, but his request for "workers compensation" was initially rejected, but was later approved with the consideration that the Ontario Workplace Safety and Insurance Board felt that, "although these types of calls were a part of the job, the situation where he didn't know where the officer was or what was happening was unexpected. The circumstances prevented him from doing his job and that contributed to acute stress which prevented him from working." (Martin. 1981).

Should emergency workers for instance police dispatchers or relief workers be granted compensation due to stress disorders? Even though considering the situation mentioned above, the call was typical work call and keeping the nature of the work in mind shouldn't emergency and stress full calls apart of the job? Can incidents like this really be considered unexpected in the normal or daily course of employment such as this, which is usually a requirement for worker's compensation for acute stress-related conditions?

The answer to these questions is very simple yet logical, even if a situation is an expected one as part of the job, and in the light of a stress full situation, a worker somehow gets affected

Then due to normal protocol he cannot be expected to just "deal with it" sensitivity towards such situations is a must, not only does it prove the humanitarian approach towards ones employers but also towards, rising medical and social issues in the society and hence this provides one with an open mind to consider every possibility and encourage the people and one's self to find ways to deal with it. Floren (1984, p.43) suggests that there is a "strong need to provide a more humanistic approach in the training of emergency [service] personnel." Also, "we need to learn more about death and dying, the stages of grief, what to expect from a suddenly bereaved family and how we may most helpfully interact with family members." (Floren. 1984)

Also we need to educate and encourage emergency workers so that they can talk about the pressures they face in a stress full situation, so that they understand that they are not alone in their experiences and by sharing one's own experience they lean to understand and del with their problems. Floren continues, "Our training should emphasize the need for supportiveness and free expression of feelings" in stressful situations to help prevent serious problems. We need to be prepared for the internal conflicts that may surround a patient's death and know how our self-image may seem threatened by that event." (Floren. 1984)

If emergency working departments like fire departments and EMS organizations, are expected to help reduce the number of lives lost everyday due to physical illness, substance abuse, suicide, fire and criminal activity, then educating them and providing them with coping skills is the necessity of the hour. Training them to deal with traumatic and stress full situations is more important now than training to be good at what they do. Job induced stress disorders can no longer be "an expected reaction," it should be responsibility of every supervisor to make sure that the emotional wellness of his/her department. Without the help of community and society, stress and trauma can very easily take toll on emergency workers and not just them, but their families as well (Ursano & McCarroll. 1994)

Recommendations for Coping with Stress and Trauma:

We need to understand that emergency workers need to maintain and look after their health so that they can maintain the vigilance and alertness that is required of them. Workers are required to stay focused in their jobs that are dynamic and all the time changing. Workers need to recognize that they need to take care of themselves especially emotional self, this is particularly important if the recovery requires them to put in efforts for several weeks. The following suggestions for emergency workers so that alongside with external help, these workers can help themselves to stay alert and maintain themselves so that a minor incident does not affect then too hard (Markey. 1998)..