Pre-Hospital Post-Stress

Research has shown that prehospital medicine is a very stressful environment. Subsequently, emergency medical services personnel (EMSP) experience a high level of occupational stress. EMSP workers are exposed to both short- and long-term stress, which leads to a chronic stress condition. Chronic occupational stress correlates with burn-out, low job satisfaction, poor physical health, fatigue, and post-traumatic stress symptomatology. This is also true for multiple disciplines across the healthcare system. There are many symptoms associated with stress such as agitation, feeling of being overwhelmed, low self-esteem, depression, chest pain, clenched jaw, headaches, low energy, poor judgment, inability to focus, pessimism, and forgetfulness. I am certain almost everyone in 911 and critical care transport have felt some of these symptoms at one point in their career. Does this stress affect our clinical capacity to provide the best care to our patients? The answer, not surprisingly, is yes. There is a negative relationship between job performance and stress. Clinical performance is vulnerable to stress.  To be the best clinician you can be, you must take care of your mental health and stress levels. There is one stress relief program that is proven to reduce stress and physical pain. It has also been proven to improve cancer treatments. What am I talking about? I am referring to mindful-based stress reduction (MBSR).

MBSR was developed by Jon Kabat-Zinn in 1797 at the University of Massachusetts Medical Center. He developed the program to integrate mindful meditation practices into western medicine. Since its integration, thousands of studies have been done showing great improvements in stress, chronic pain, post-traumatic stress syndrome, social anxiety, chemotherapy success, sleep disturbance, and tinnitus. A Google scholar search for MBSR produces over 20,000 results. What is mindfulness? Kabat defines it as “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmental to the unfolding of experience moment by moment.” Mindful practice calms the mind and relaxes the body through self-directed practice of focusing on the present moment. MBSR programs teach participants to become more aware of body sensations, and how they relate differently to thoughts. MBSR is more than just some meditation. It utilizes various types of exercises that teach the conscious to be mindful. The mind is developed to be used as a tool to realize how the present moment affects our body and thoughts.  

The MBSR program is traditionally an 8-week course that serves as an educational tool for participants to assume a degree of responsibility for their own well-being. The course is evidence-based and utilizes patient-centered interventions that teach the participant mindfulness meditation, relaxation techniques, and some basic yoga. For busy individuals, it has been shown that practicing mindfulness techniques can reduce stress, anxiety and improves self-worth. Can you see yourself doing meditation? Or do you think mindfulness sounds silly? Are you too tough to do meditation and mindfulness exercises? That’s not the case for several fire departments and police departments across the U.S. who have started to add MBSR to their training programs. Tualatin Valley Fire & Rescue (TVF&R) is a large fire district that introduced a mindfulness-based eight-week resilience training (MBRT) for firefighters and day staff in 2014. It continues to be part of their agency behavioral health program. The graph below shows the mental improvement that the program has had on their firefighters: 

MRBT was designed to be a friendlier version of MBSR for emergency personnel that deal with acute stress and trauma. MBRT is also an eight-week course, but it is only 2 hours per week. The last day is a longer 4 to 6 hour class. Similar to MBSR,  it uses meditation, breathing techniques, and some martial arts. Police agencies across the country are bringing this course to their officers with outstanding results. Detective Jennifer Elliot from Falls Church, Virginia describes using mindfulness techniques in a stressful situation here:

Here are two mindful techniques you can use when responding to a call: One technique is tactical breathing. How do you do it? Take a deep breath over 4 seconds, hold it for 4 seconds, breath out over 4 seconds, hold the empty breath for 4 seconds, and then repeat. Try to do this at least 4 times. As you do, imagine each time that you are filling a balloon in your stomach and slowly letting that air out. Feel and focus on the air going in and out of you mouth, nose, and into your lungs. Imagine your heart rate slowing with each breath. I suggest practicing this several times a day during down time. Then, when responding to a stressful call, the breathing technique will become natural. Another breathing technique that can be done to reduce stress is done by placing your hand directly over you heart. Take deep, in and out breaths. When you do, imagine the air is flowing through your hand into your heart. At the same time, imagine the air flowing into the back, top, bottom, and side of the heart. This mimics air coming into the heart from all sides. When you breathe out, imagine that air going throughout your body; releasing from your toes, fingers, mouth, and nose.  

There is no doubt in my mind that MBSR and MBRT programs can improve your mental health and performance as a clinician. Is it time that pre-hospital air and ground transport agencies add MBSR or MBRT into their training program? A lot of you are reading blogs and listening to podcasts to improve your clinical skills. Look at yourself and your mental health as part of improving your clinical skills. The research is there. The program is there. You have the tools to help you reach your goals and become a better clinician. I have listed some resources for you to look at, but I recommend you doing your own research and taking responsibility for your own mental health.

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