Transcript When Opportunities Knock

When Opportunities Knock
Mike McEvoy, PhD, NRP, RN, CCRN
EMS Coordinator – Saratoga County, NY
EMS Editor – Fire Engineering Magazine
Paramedic Supervisor – Clifton Park & Halfmoon Ambulance
Chief Medical Officer – West Crescent Fire Dept.
Senior RN – Cardiothoracic Surgical ICU & Chair Hospital Resuscitation Committee –
Albany Medical Center
Opportunities
Resilience
1976 - 2016
Police, Fire, EMS
Front Seat
Rewards?
June 8, 1972 – South Vietnam
• 9 year old Kim Phuc tore off her burning clothes as
she fled from a napalm bombing attack
“Love, hope and forgiveness”
Big Party
Are we different?
One Word: Adrenaline
• 90% of population lack traits needed
to perform well as an emergency
responder
The “Adrenaline Junkie”
• Control oriented
The “Adrenaline Junkie”
• Attentive to detail
The “Adrenaline Junkie”
• Traditional
The “Adrenaline Junkie”
• Strong role identity
The “Adrenaline Junkie”
• Action oriented
The “Adrenaline Junkie”
• Risk takers
The “Adrenaline Junkie”
• Highly dedicated
The “Adrenaline Junkie”
• Family oriented
The “Adrenaline Junkie”
• High expectations
The “Adrenaline Junkie”
• Strongly rescue oriented
“Adrenaline Junkie” Issues
• Control oriented
• Attentive to detail
• Traditional
• Strong role identity
• Action oriented
• Risk takers
• Highly dedicated
• Family oriented
• High expectations
• Strongly rescue oriented
“Adrenaline Junkie” Issues
• Control oriented
• Attentive to detail
• Traditional
• Strong role identity
• Action oriented
• Risk takers
• Highly dedicated
• Family oriented
• High expectations
• Strongly rescue oriented
The most difficult
conversation ever.
Emergency Services
Stressful?
EMS
•Stressful
occupation
•Expect to see
others in trouble
•Routinely manage
crises
Impact of Major Stressors
Have you ever had any education on this?
Pathological Stress
• Acute Stress Disorder (ASD):
• Symptoms experienced during or immediately after the
trauma, last for at least 2 days, and resolve within 4
weeks.
• Post-Traumatic Stress Disorder (PTSD):
• Symptoms begin within 1 – 3 months after the event,
may last months to years.
• Lifetime incidence: 7.8%
• Population prevalence 0.8 – 4%
• Lower incidence in emergency responders
Javidi H, Yadollahie M. Post-traumatic stress disorder. Int J Occup Envir Med. 2012;3:2-9.
ASD and PTSD Revised 2014
1. Reliving the
event
2. Active avoidance
3. Emotional
anesthesia
4. Persistent
anxiety
Pathological Stress
• Acute Stress Disorder (ASD):
• Symptoms experienced during or immediately after the
trauma, last for at least 2 days, and resolve within 4
weeks.
• Post-Traumatic Stress Disorder (PTSD):
• Symptoms begin within the 1 – 3 months after the
event, may last months to years.
• Lifetime incidence: 7.8%
• Population prevalence 0.8 – 4%
• Lower incidence in emergency responders
Javidi H, Yadollahie M. Post-traumatic stress disorder. Int J Occup Envir Med. 2012;3:2-9.
Resilience: psych & behavioral lingo
• Resilience =
ability to withstand negative pressure
• Resilient people experience negative
circumstances associated with poor
psychological and social outcomes yet
despite odds, they end up healthy &
productive:
• Mentally ill or abusive parents
• Deprived social or economic conditions
• Major stressful events
Personal Resilience related to:
1. Biology
•
temperament, emotions, intelligence, creativity,
immune resistance, genetics and physical
condition
2. Attachment
•
capacity for bonding (forming significant
relationships with others), capacity for empathy
3. Control
•
mastery over one’s environment, social
competence, self-esteem, personal autonomy and
sense of purpose
Firefighter/EMS Stress
• FEMA funded 3year, 5-state study
of CISD, firefighters’
disposition, and
stress reactions.
• Included personnel
from Murrah
building bombing in
OKC.
Fire/EMS Service Stress
• Social support
structure of service is
protective
• FF/EMTs are quite
resilient
• Social support comes
first from family, then
from friends and
coworkers
Fire/EMS Service Stress
• The majority of responders would seek
support from clergy (40.9%) over
professional counselors (7.4%)
• FF and EMTs tend to have positive views
about the world despite continued
exposure to
traumatic events
Immune to Stress? NOT…
• You are human
• You are highly effective
on the job
• You also have a family, bills to pay, cars to
keep running, homes to maintain and
lives to live outside of EMS…
Compared to John Q Public, EMS 
• Substance use/abuse
• Alcohol, drugs, tobacco
• Sleep disorders
• Depression
• Suicide (?)
• Anger management, violent behavior
• Marital, family, relationship problems
Nature vs. Nurture
Taking Care of Each Other
• Chaplain
• Employee Assistance Program (EAP)
CISD Scientific Review
1. Value neutral to negative
2. Not effective when all forms of
debriefing compared to no debriefing
at all
3. While perceived as helpful, rescuer
satisfaction ≠ effectiveness
4. Some evidence of harm to certain
individuals, often iatrogenic
CISD – What Now?
What else should we
be doing?
PFA – Psychological First Aid
Three basics of psychic resilience are
hardwired into our biological makeup:
1. Sense of safety Protect
2. Meaningful social connections Direct
3. Sense of efficacy Connect
Recreate sense of safety
• Immediate physical needs (self-care)
• Bathroom, food, fluids, breaks, clothing
changes, sleep, time off…
• Protect from onlookers & media
• Walk-Around – supportive presence &
monitor well being
(chaplain, peer, etc)
Protect
Meaningful social connection
• Help connect with family, friends,
children, significant others
• Talking in homogenous groups (ie:
EMTs/Paramedics vs. heterogeneous strangers)
• Information/education on normal signs
and symptoms, what to do
• Exercise, rest, relaxation
• Educate significant others on how they
can help
Direct
Reestablish sense of efficacy
• Recognition for job well done
• Encourage normal routines & roles
• Encourage people to support and assist others
• Accurate, simple information about plans,
schedules, events
• MH follow-up assessment @ 3 months
Connect
PFA
• Protect
• Direct
• Connect
Do you know
a “Happy
Person”?
Happy People Choose to be Happy
Miserable People Choose
to be Miserable
Most of us are somewhere in
between
Many of us would like to be
happier
Opportunities
How Can I Be Happier?
• Less stress
• Improved outlook
• Better Health
• More success…
Be Happier in 21 Days…
• Jot down 3
good things
that happened
in the last 24
hours
• Rewires your
brain
Shawn Achor –
The Happiness Advantage
Stress Management
Tips for Responders
1. Condition your body and mind
Stress Management
Tips for Responders
2. Listen to your inner
voice
Stress Management
Tips for Responders
3. Never stop growing and learning
Stress Management
Tips for Responders
4. Be positive
Stress Management
Tips for Responders
5. Have a life outside your department
Opportunities
Every moment,
we have a choice
NEED PHOTO
Opportunities
Never Forget
Always Remember
Opportunities
How are you doing?
Fantastic! How about you?
Summary: EMS
• The best job in the world
• It takes a special (different) kind of person
• Courage and Compassion fuel our engines
• Every moment, we have a choice (opportunity)
• The road is not always easy
• Time is a great healer
• Look out for others while you look out for
yourself
www.mikemcevoy.com