First Responders: A 3 Step Guide to Coping with Stress and Avoiding Burnout

First responders (fire fighters, police, EMTs, ER staff and others) are recognized as being at significant risk for developing Post Traumatic Stress Disorder. Our risks are increased not only by the potential for experiencing traumatic events but are also due to the extremely stressful and draining nature of our work. Career and personal burnout are often the precursors to these conditions but seem to be viewed as inevitable.

We’re held to higher standards than the general public. What we do can make the six o’clock news and then get reviewed under a microscope. The pressure of such scrutiny is intense. We learn to hide not only our emotions, but also our scars.

Our work is honorable. If we are to honor ourselves, our colleagues, and our loved ones then we must accept these responsibilities:

1. Taking steps to avoid burnout and lowering our risk of becoming overwhelmed on and off the job.
2. Recognizing the red flags that indicate we’re struggling and responding to them adaptively.
3. Identifying and utilizing resources and supports that can be accessed without potentially compromising our professional standing.

Avoiding Burnout

In all my years of clinical practice I’ve consistently found that it’s not generally what we do that causes burn out. It’s what we don’t do. We don’t find healthy releases for the stress we accumulate. Establishing certain daily and weekly routines makes us less susceptible to becoming overwhelmed and developing unhealthy forms of coping.

Daily Habits

• Learn how to leave work at work. Develop a ritual for concluding your workday. Put things in order routinely and with the awareness that work is ending for the day and going home means not continuing to anticipate or plan for the next emergency.
• Learn how to change hats at home. Literally put down the tools of your trade and initiate a routine for what you do when you get home.
  
• Invest in organization. Do mundane things methodically in order to reduce stress in your overall life (plugging in your cell phone).

Weekly Habits

• At least once per week, set aside time to talk with someone who not only gets you but also understands the work you do. We protect those we love from the details of what our work often demands of us.
• Implement at least one activity that provides release both physically and emotionally.
• Make time for the people who matter. Maintaining close ties through shared time and activities sustains you. After all, the biggest fear those of us on the front lines have is the fear of losing those whose love keeps us going.

Recognizing Red Flags

It’s always easier to explain away (rationalize) or ignore signs of cumulative stress. We’re acutely aware of what others need and not aware of ourselves beyond how we perform our duties.

At Risk Signs:

• Chronic fatigue, sleep disturbances, nightmares, frequent waking.
• Having to use excessive amounts of aspirin, antacids, nicotine or caffeine to get through the day.
• Mood instability, being quick to anger, lashing out, low frustration tolerance, impatience.
• Loss of perspective – small annoyances are infuriating, minor stressors seem overwhelming, financial stress or relational problems are at the forefront of our minds and interfere with focusing on the work at hand.
• Decline in quality and quantity of food intake, lowered sex drive, reduced interest in hobbies or pursuits you usually enjoy.
• Difficulty processing verbal or written instructions.
• Feeling overwhelmed by sensory input (sound, sight, smell).
• Hesitation during times of crisis.
• Increased use of drugs and alcohol, using earlier in the day, the feeling of “needing” a drink.
• Decline in self care, loss of interest in things we normally enjoy a great deal, withdrawing socially, isolating ourselves from loved ones.

Responding Adaptively

The importance of support systems cannot be overstated. Having people in our lives that are willing to challenge us and tell us what they’re noticing is vital. Having an eclectic group of colleagues, friends, and family who are supportive of not only our work, but of us as individuals, ensures that we go through no hardship alone.

Maintaining connections means having lifelines during times of need. Accountability is key. Being brutally honest with those we trust allows us to explore options. Two heads aren’t just better than one – they’re a million times better than one.

If Your Job’s on the Line

Unfortunately, the systems we serve often fail to provide the resources and supports we need to maintain the high standards demanded of us. Our “Human Resources” seems aptly named. Too often we’re seen as resources to be used up, not protected.

If reporting traumatic stress, addictions, or other mental health conditions will endanger your professional standing, then manipulating systems is warranted in order to get your needs met. The risks of not getting help are too great.

Support Options

Seek out professionals and paraprofessionals who are not required to report to your superiors:

• Recovery coaches and life coaches are solid options for treatment. Many of us have the same training as therapists and addictions counselors and some of us choose to be both licensed professionals and “coaches.” The importance here is that coaches are not required to maintain documentation of any kind nor are they required to report to any governing body.

Know your rights. If you choose to see a clinician you have the right to confidentiality (exceptions: reporting being homicidal, suicidal, or the abuse of children). Know that your diagnosis will be reported to your health insurance provider. If being diagnosed with PTSD or other serious condition could jeopardize your position, I recommend interviewing your clinician and saying something like this:

• “I cannot admit to having symptoms that would be consistent with PTSD or other significant mental illness. Are you willing to work with me and consider a diagnosis of an ‘adjustment disorder (benign diagnosis) due to my current job stress or would you be willing to refer me to someone who would?”

We must be willing to go to any lengths to protect ourselves and those we serve. Seek out brothers and sisters in your field who have been on similar journeys. Do not go through this alone.