Emergency Responder work is stressful, unpredictable, and requires that the First Responder cope with multiple factors - the situation itself, the public, victims’ families, the media, and how critical incidents affect co-workers. Throughout all of this, the Responder is expected to perform his or her duty in a professional manner, in spite of the ever-present threat of psychological and physical injury.
Critical incidents, work stress, cumulative stress, and Emergency Responder Exhaustion Syndrome (ERES) are common occurrences in police work, fire fighting, trauma and emergency medicine, and paramedic and emergency dispatch work. Risk factors for developing a more enduring a traumatic stress reaction include a tendency to isolate from supports, having no one to talk with about what is stressful, a sense that nothing is interesting or fun any more, and focusing all areas of one’s life, personal and professional, on the workplace.
Critical incidents and chronic stress can influence not only the First Responder, but also families, spouses, life partners and children, as the effects of chronic stress and traumatic stress often affect the Responder’s ability to effectively cope with daily life and work.
Typical events that may cause stress include:
- Any event where one’s personal safety is in peril
- Line of duty deaths and line of duty injuries - especially when the person is known to the First Responder(s)
- Injury or death of a child
- Skewed media attention
- Multiple injuries or fatality accidents
- Suicide of a First Responder co-worker
- Proximity and length of time the First Responder is exposed to a victim, especially if the victim is known to the responder. If the victim is a relative, exposure can be for only a few minutes
Stress Responses that Emergency Responders typically experience are:
A Brief Stress Reaction: Symptoms during and following a critical incident are common and normal. It is not unusual that stress symptoms are experienced immediately following a critical incident. Feelings of panic, freezing, disorientation, and agitation normally occur for most First Responders during and soon after a critical incident.
Acute Stress: Acute Stress is a more prolonged and intense stress reaction following a critical incident. Symptoms may include nightmares, difficulty concentrating, irritability, emotional mood swings, shock, somatic or physical symptoms, difficulty concentrating, feeling detached or not like oneself, difficulty sleeping, and use of alcohol or other substances to decrease the discomfort of the symptoms. These symptoms may last for up to a month after a major incident.
Chronic Stress: is a state of ongoing physical arousal. The human body experiences so many stressors that the body rarely has a chance to relax.
Cumulative Stress: Cumulative Stress is a result of multiple stressful events that happen over time and can be a combination of major and micro traumas. Common signs of cumulative Police stress and other Emergency Responder stress include emotional detachment, cynicism, suspiciousness, alcohol and substance abuse, as well as the Responder’s social isolation from family, friends, and co-workers.
Emergency Responder Exhaustion Syndrome (ERES): ERES occurs when a First Responder reaches significant levels of exhaustion and depletion. This can occur within months or years. The Emergency Responder Exhaustion Syndrome is often the result of cumulative stress experienced by First Responders. The key signs of ERES are depression, isolation, physical and emotional exhaustion, and can include alcohol and substance use in an attempt to cope. Past ability to cope with stress, even at an insignificant level, is compromised – the Responder’s coping skills aren’t as effective as in the past. Signs of ERES may include panic attacks, self-blame and guilt, depression, psychic exhaustion, global negative self-appraisal, and the job site becomes toxic, all of which result in a diminished ability to effectively cope with ordinary situations and life. ERES may also be accompanied by Post Traumatic Stress (PTSD).
Post Traumatic Stress: Post Traumatic Stress Disorder or PTSD is usually apparent if after three months from the critical incident, a person experiences symptoms that include nightmares, difficulty concentrating, irritability and/or angry outbursts, inability to feel a full range of emotions, no longer expecting to live a full or normal life span, difficulty concentrating, hypervigilance, an exaggerated startle response, and use of alcohol or other substances to decrease the discomfort of symptoms. After an incident, a person with PTSD will generally also re-experience the critical incident either through intrusive visual images, smells, sensations, or sounds that happened during the critical incident. The Responder may also be unable to remember parts of the incident. Other common symptoms of PTSD can include feeling heightened paranoia/suspicion, not feeling like oneself, not participating in previous interests, isolating and feeling detached and estranged from others - including loved ones. PTSD can be what is known as “late onset” if the symptoms appear at least six months after the stressor. This means that with enough chronic stress, and no intervention, PTSD symptoms can occur at any time, even years after the incident.
There is increased risk of developing PTSD if the critical incident or event was very severe and highly intense, feels personal, was unexpected, there was a feeling of helplessness or terror, the event was associated with high blood pressure and increased stress hormone releases (a high state of intensity), and the Responder had difficulty calming down in the hours and days after the event.