First responders prioritize the safety and well-being of their communities, which can be stressful and traumatic for them. This can lead to burnout, depression, substance abuse, vicarious trauma and unhealthy coping mechanisms.
Fortunately, many resources exist for first responders to get help and treatment. Whether it’s one-on-one counseling, peer support or crisis hotlines, these options can be invaluable.
The impact of disasters on mental health is well known, and in rural communities, the challenges can be even greater. During normal times, access to mental healthcare can be difficult, but following a disaster it is essential to ensure that the services are trauma-informed and supportive.
Trauma-informed care is a person-centered approach that promotes physical, psychological, and emotional safety. It is based on knowledge of the effects of trauma and how it can affect a person’s ability to manage their own stress response, thoughts, emotions, behavior, and relationships. It is focused on providing a safe space to discuss past traumas, ongoing stressors, and concerns about future events. It also includes reframing history-taking patterns to ask “what happened to you?” rather than “what’s wrong with you,” and ensuring that clinicians are aware of possible triggers for patients.
Research suggests that emergency medical responders are at high risk for vicarious trauma, burnout, and work-life imbalance. In a study of ambulance personnel, it was found that they experienced high levels of psychological distress and were at increased risk for PTSD, depression, and anxiety. These symptoms, if left untreated, can have significant impacts on their personal and professional lives.
A key to reducing this risk is the development of an organisational culture that supports employees and prioritises their wellbeing. This involves training staff on how to recognise and support employees who may be experiencing difficulties in their workplace. This is often done through mentoring programs that link new staff with experienced and trained individuals who can offer support and help to develop coping skills.
Resilience is the capacity to overcome or cope with adversity, trauma, or loss. It’s an individual’s inner strength to deal with challenging situations and emotions, whether that be fear, sadness, or anger. Resilience is influenced by internal factors such as optimism and the ability to regulate emotions, and external factors such as a sense of safety and social support.
Increasing resilience in the EMS workforce is essential, but it can be a challenge for first responders to seek help when they experience problems due to their ongoing exposure to traumatic events and situations. This can lead to high rates of job-related burnout, substance abuse, relationship challenges, depression, PTSD, and compassion fatigue.
Behavioral Health Care
In addition to addressing the impact of a disaster on mental health, rural communities need access to treatment for behavioral healthcare conditions like depression, anxiety and substance abuse. These conditions, if untreated or ignored, can lead to a host of problems for those who suffer from them including lost productivity, job-related burnout, clinical depression, PTSD, relationship challenges and compassion fatigue, and suicide.
Resilience is the ability to adapt well in the face of adversity, as defined by the American Psychological Association (APA). It includes an individual’s abilities to cope with stress and trauma and to recover from adverse experiences. Those who are resilient tend to have a higher level of coping skills, self-confidence, positive life satisfaction and optimism. Individuals can develop their resiliency through both internal and external factors, including social support; healthy coping strategies (such as problem-solving); spirituality; and a sense of meaning.
Those who work in the field of emergency services can be particularly vulnerable to a loss of resilience. The nature of their work involves high intensity, time-critical tasks intermixed with routine and bureaucratic aspects of the job that may not stimulate a person’s emotional or psychological well-being. A recent study of ambulance workers found that their level of resiliency was closely linked to the work environment and sociodemographic characteristics.
The good news is that resiliency can be learned and reinforced through training. First responders can be taught to recognize the warning signs of depression and anxiety and encouraged to talk to a trusted colleague when they’re experiencing symptoms. They can also learn to engage in regular exercise, eat well, and get adequate rest, all of which are important factors in building resiliency.
EMS agencies should also consider developing relationships with local mental health providers to establish an ongoing care plan that will address the needs of those who are impacted by a crisis. In addition, they should be prepared to screen community members for a variety of behavioral health concerns as part of the post-disaster recovery process and refer those who screen positive for further evaluation and assistance.
As awareness of trauma and its impact has increased, so has interest in integrating TIC into public health curriculum. Search data reflect this trend; for example, “trauma informed care” has become one of the top terms used in online public health course searches.
TIC is an approach that recognizes the prevalence of trauma in human experience and seeks to promote environments, practices and services that support safety, healing and recovery rather than those that may inadvertently retraumatize. TIC principles are grounded in the fields of neuroscience, epigenetics, ACEs and resilience.
While TIC training is typically associated with medical, mental health and research/policy/advocacy professions, it can be applied to any setting that provides direct client services. For example, a public health department can be a community resource for families by offering educational and support programs for children who have been exposed to violence or loss. A police department can be a community partner by providing counseling and other supports for people experiencing trauma related to domestic violence, crime or addiction.
A variety of tools have been developed to implement TIC approaches in the workplace and other settings. These include surveys to assess for traumatic stress and other symptoms, coping skills (like belly breathing) and algorithms that determine if more serious action is needed, such as contacting child protective services or conducting further evaluation of suicidal symptoms.
Taking a trauma-informed approach in the field can help reduce burnout and PTSD among staff, improve outcomes for clients and contribute to more effective disaster response. To implement TIC, organizations should consider training for their entire workforce, from board members to administrative and non-clinical staff.
As the demand for a more resilient community continues to grow, rural residents need to be healthy enough to sustain opportunity and realize their full potential. In order to do that, we need to ensure that public health policies and programs are designed with their unique challenges in mind. By taking a trauma-informed approach, we can make sure that the residents we serve have access to all of the resources they need to thrive.
Peer support can be offered through a variety of different methods. It might involve meeting in a group, which is often called a self-help or support group, but it could also take the form of one-to-one peer support, or even telephone calls or text messages. Peer supporters are usually people who have experienced the same conditions as their clients, and they can share their own experiences and strategies with them. However, they should not give medical advice or make a diagnosis, and they should encourage their clients to see a health care provider if they have questions that a trained professional can answer.
The goal of peer support is to provide a safe space for participants to express their emotions. It is important for first responders to understand that they are not alone and that it is normal to have difficulties coping with the stress of their job. It is also important to recognize that asking for help is not a sign of weakness and that it can be a positive step in their recovery.
Peer supporters are trained to provide a supportive environment, and they may use techniques such as active listening and building friendships and camaraderie within the group. They can also offer assistance in identifying and managing symptoms of mental health issues. They can also guide peers in crisis and direct them to the right resources for help.
In addition to the training and services that are available through EMS agencies, peer support has been shown to be a valuable resource for first responders. It has been shown to reduce the need for formal treatment and can also improve a person’s ability to reintegrate into their community following a mental health episode or trauma.
While the work of emergency first responders can be incredibly rewarding, it is essential to ensure that they are able to maintain their mental and emotional health and are not at risk for developing symptoms of trauma-related disorders such as PTSD. Taking steps to identify and address these issues can reduce the number of emergency workers who are absent from work due to mental health concerns, decrease workplace accidents and injuries, and ultimately increase the efficiency and safety of EMS operations.