REDUCING OCCUPATIONAL MENTAL STRESS
FOR FIRE FIGHTER/PARAMEDICS
Captain, Taylor Fire Department
An applied research project submitted to the Department of Interdisciplinary
Technology as part of the School of Fire Staff and Command Program
This paper was researched and written to determine the causes of occupational
stress and burnout, related to the fire fighter/paramedic at the City of Taylor, Michigan
Fire Department and develop ways to reduce stress and prevent burnout. There are fire
fighter/paramedics that will remain in this position for a majority of their career, without
the possibility of advancement. The constant pressure of providing E.M.S. transport for
twenty or more years will eventually take its toll on these individuals, not only mentally
but physically. Recognizing the potential damage that could be sustained, a program
will be recommended to reduce stress and develop ways to cope. The need for a
program is reinforced by the growing statistics showing how occupational stress is
related to line of duty deaths and injuries.
TABLE OF CONTENTS
The traditional duties of a fire fighter were always thought of as being physical in
nature. Past statistics relating to occupational hazards and disability claims mainly
documented injuries and physical illnesses, and did not consider mental stress and
burnout an occupational hazard. Within the past 10 years, the fire service has changed
dramatically. Now considered as “emergency services” we perform many additional
roles relating to our jobs, with EMS becoming a major part. Many systems have
developed physical wellness programs that address the prevention of injuries and
illnesses such as sprains/strains and heart disease/high blood pressure. Very few have
developed programs to decrease occupational stress and reduce burnout. This paper
will study the causes of occupational stress and burnout relating to the fire
fighter/Paramedics and recommend ways to develop a program for prevention.
BACKGROUND AND SIGNIFICANCE
Fire fighting is listed as the fifth most dangerous occupation in North America,
with an overall job-mortality rate of 48.8 deaths per 100,000 workers. However, despite
the popular images and beliefs of the fire fighters themselves, only slightly more than
one third of these deaths are fire related (i.e., caused by burns or building collapse)
(Ottlinger 1997). Both acute stressors resulting from disasters and chronic stressors,
such as difficult working conditions, have been linked to various kinds of illnesses
among emergency service providers. Research on fire fighters has tended to focus on
biochemical or physiological indicators of stress: electrocardiograph findings, pulse rate,
blood pressure and working energy metabolism (Ottlinger 1997). This has been the
result of concerns over the high rates of cardiovascular disease and coronary heart
disease found among fire fighters. Fire fighters are a highly select population, both
physically and psychologically. New fire fighter recruits must pass rigorous medical
examinations, meet stringent fitness standards and pass extensive psychological
screening to gain employment. On the average, firefighters across all age groups are in
better physical condition than the rest of the population. Yet, Professional firefighting is
still considered one of the most life threatening of all U.S. occupations (IAFF 1992).
According to Mitchell and Bray (1990), the field of emergency services is one of
our society’s most challenging and potentially rewarding professions. Yet, many who
enter cannot withstand the persistent pressure of its occupational stress. There are few
stressors in life that can have the destructive power associated with the stress of caring
for the sick and injured. The fire fighter/paramedic and other emergency workers
experience tremendous stress as a result of their job duties (Ottlinger 1997).
Rates of injuries and occupational illness among fire fighters between 1990 and
1991 were the highest of any group of U.S. workers. The National Fire Protection
Association’s (1988) annual report on firefighter deaths reported that in 1987, stress-
related diseases accounted for 58.8% of on the job deaths among firefighters. The most
serious occupational hazard associated with firefighters is psycho physiologic stress.
Nearly one half of all line of duty deaths for firefighters have been found to be
caused by stress. Because the effects of stress on firefighters can be so far reaching, it
is important to recognize stress before it becomes disabling (Ottlinger 1997). One way
to do this is to identify those situations likely to produce stress and to intervene before
the effects of stress affect the physical and psychological well being of the firefighter
The Taylor Fire Department under went a major restructuring during the middle
of 1999, causing a majority of the senior members to retire. Additionally the City
discontinued a part time fire fighter program and hired all full-time fire fighters. The fire
personnel that were hired prior to this transition are now promoted to upper ranks in the
department, and will be in these positions for at least the next 13 years until they are
eligible to retire. Beginning January 2000, the department began ALS transporting; the
majority of the fire fighter/paramedics that were hired will spend most, if not all of their
career at the firefighter level, without the possibility of advancement. These fire fighters
will be assigned to the rescue/ambulances on a regular basis.
In the field of EMS, it is a known fact that the average paramedic will burn out in
approximately 5 years. The average Taylor fire fighter will spend at least 20 years
providing EMS transport. Constant exposure to sleep disturbances, reactions to alarm
bells, exposure to tragedy, organizational stress and overall mental demands of the job
are important determinants of stress levels among fire fighters. This is not including the
stress they may face in their personal life. If stress is not recognized or prevented it
could be disastrous for the fire fighter in regards to job performance as well as their
personal life. The occurrence of substance abuse, family/marital problems and divorce,
also the physical illnesses that could develop including but not limited to coronary heart
disease and high blood pressure.
The Taylor Fire Department must start looking at the causes of occupational
stress, and develop programs to decrease stress and prevent burnout. With the
implementation of a wellness and physical fitness program, which was partially funded
by a F.E.M.A. grant in the year 2001, the Taylor Fire Department in off to a good start
towards decreasing occupational stress for fire fighters. Also the department has
studied the effects that alarm bells have on the fire fighter, this triggered the research to
spec out a new alarm notification system, which will be installed in one station for a trial
period. If successful it will be installed in all stations. There has been an as needed
CISD program in place for many years; it probably should become an automatic
program depending on the type of incident. Another member of the department is
currently researching this. One program that is not currently available is an E.A.P.
employee assistance program. This incorporated with the wellness and physical fitness
program could prevent the common build up of stress that leads to burn out, also a
regular education about stress to all members on an annual basis. There are also
programs that could be implemented on a daily basis that could help decrease stress,
such as a regular rotation off of the ambulance and placed on the engine or on another
apparatus that has a low run volume.
With prevention programs in place, they could possibly create a supportive work
environment for the fire fighter. This will in turn save money in the future in the way of
sick leave, possible overtime, potential disability claims and increased insurance
premiums, not to mention the possible increase of productivity of employees.
Firefighting has been considered one of the worlds most honored but hazardous
occupations. Saving lives or reducing injuries and property loss is the primary duty of
every fire department. The fire fighters job is not comfortable or easy; it is a profession
that exposes an individual to a high level of personal stress and danger (Ottlinger 1997).
From the first time an emergency situation is encountered until the last day of service,
fire fighters are expected by the department and the public to perform heroically. Fire
fighters are not extraordinary or superhuman – they are ordinary people who often find
themselves in extraordinary situations. Like other people, fire fighters have their limits
(Ottlinger 1997). With the additional responsibilities of hazardous materials, confined
space rescue and the increasing aspects of E.M.S., much is expected of today’s fire
fighters, Meeting these expectations requires an above normal level of dedication. With
these demands comes stress and the toll stress takes on the fire fighter.
Stress is recognized as one of the most serious occupational hazards in the fire
service that can affect the health, well being, and career of a fire fighter. It is estimated
that nearly one half of all fire fighters deaths, in the line of duty, can be linked or
contributed to stress. Stress is a major cause of psychiatric, drug and alcohol problems.
Lower marital adjustment and higher divorce rates among male fire fighters can also be
contributed to job-related stress along with higher attrition rates (Hildebrand 1984).
Coping with their own emotional reactions to the very real horrors that they face on a
regular basis is one of the least understood tasks of fire fighters. Situations that may be
extremely disturbing to the public, the fire fighter/paramedic is expected to remain calm
when dealing with it, no matter how appalling the scene, performing every function with
machine-like accuracy. Is this realistic? Fire fighter/paramedics are human beings and
they have human reaction, emotions and feelings (Ottlinger 1997).
Stress is defined as the result of any demand, either internal, external or both,
that causes a person mentally and physically to readjust in order to maintain a sense of
balance (Fishkin 1989). Stress can be positive or negative. There are three stages of
stress, the alarm stage, the resistance stage and the exhaustion and burnout stage.
The alarm stage - A person becomes aware of a specific demand or signal
requiring a response.
The resistance stage - The mental and/or physical response to a specific
demand or signal.
The exhaustion and burnout stage - A total inability to maintain balance because
our responses (coping) are ineffective (Fishkin 1989).
Stress causes changes in our blood flow, heart rate, metabolism, breathing and
blood pressure. It is associated with emotion but, unlike emotion, we have little control
over it. We just perceive some kind of feeling that is taking place within us (Ottlinger
1997). Stress can be caused by any of the changing conditions of daily life. The change
may be as subtle as a car’s tires screeching that breaks your concentration as you read
the morning paper, or as severe as two cars colliding in the middle of an intersection.
The stress process goes something like this. An alarm is dispatched, causing the
neurons in the brain to send a signal to the hypothalamus, which in turn releases a
chemical messenger that runs to the pituitary and adrenal glands. They in turn release
their own chemical substance called steroid-glucocorticoid, the stress hormone. At
some point in the process, the sympathetic nervous system releases bioamines. With all
these chemicals interacting within our bodies, things quickly begin to happen. We
become alert and ready for action, every organ in our body starts to pulsate with energy.
Strength becomes mobilized; the pulse and breathing rates speed up. This is stress. It
happens every time fire fighters are dispatched to an emergency call. It also happens
every time a superior calls a person in or a person’s child yells for help. These events all
have one common thread: when they occur, they disrupt the routine or balance of the
moment (Ottlinger 1997).
The reaction that the body has during the release of these chemicals could cause
damage, especially under chronic circumstances. As the blood pressure increases
blood supply to the brain is increased, heart rate becomes rapid, as well as increased
cardiac output, skeletal muscle is stimulated. There is an increase of plasma free fatty
acids, triglycerides, cholesterol, decreased blood flow to the kidneys, gastrointestinal
system and skin. There is an increased risk of hypertension, thrombosis formation,
angina pectoris attacks, sudden death from lethal arrhythmia, myocardial ischemia,
ventricular fibrillation and myocardial infarction (Blum 01).
The changing conditions that trigger stress are called stressors. Stressors are
countless, varied and change over time. They are normally events or conditions that
introduce some functional change in the organism’s internal system or external
environment. When the stressor disrupts the existing homeostatic state, the stress
response is triggered to restore balance. Some examples of stressors include heartburn
one might get from spicy tacos, the flu that is going around, changes in temperature,
receiving an award or being surprised by a party. Everyone experiences stress at one
time or another. Many stressors are not unique to the fire service, but are part of
everyday civilian life. These stressors often involve some kind of change in living habits,
such as change in residence, marital status, financial resources and the like. Even a
positive change such as getting a new job or starting a new relationship can be a source
of stress. Everyday events such as a traffic jam or a long line at the bank also cause
stress. In addition to these sources of stress, however, fire service people face
additional stressors related to fire service work (Ottlinger 1997).
According to the Hildebrand study (1984), there are five stressors unique to fire
1. Level of uncertainty - When most people go to work, they have some idea of
what to expect. Salespeople know they will make sales calls, an order clerk expects to
process orders and a teacher follows a lesson plan for the day. Many people have some
degree of control over what the day’s work will involve. Fire fighters, on the other hand,
do not know what their day will bring, and they have very little control over these
2. Physical response to an alarm - When the alarm sounds, the fire fighters body
prepares itself for increased physical demands. If there is no fire or if a medical run
produces little physical activity, the increased adrenaline, blood sugar levels, blood
pressure and muscle tension remain. It may literally take several hours for these to drop
to normal levels.
3. Interpersonal tension - The crisis nature of fire fighting tends to magnify
tensions between people or organizational units – tensions that would be far less
serious in a non-fire fighting environment. Poor communications, faulty equipment or a
lack of coordinated effort may be serious in an office, but can be dangerous or fatal on
the fire ground.
4. Exposure to human tragedy - The fire service takes pride in “running into
buildings that everyone else runs out of.” The price for that pride, however, is being on
hand when people lose their homes, families or businesses.
5. Fear - Like most people, fire fighters do not often talk about their fears.
Nonetheless, fire fighters have legitimate concerns for their own safety, for the safety of
their peers and for the impact of a possible mistake on themselves and others.
Most high-stress professionals are subject, in varying degrees, to these
stressors. Start with the stress associated with normal adult life, add the physical and
emotional demands of the fire service, then further add the combination of the fire
stressors, the conclusion being that the fire service is an extremely high-stress
profession (Ottlinger 1997).
Hildebrand (1984) also identified environmental and psychological stressors
related to the fire service. The environmental stressors are: fire fighting, training,
temperatures (hot and cold), noise (alarm bell, air horn, siren, etc.), explosions, building
collapse, smoke, toxic fumes, bodily harm, staffing and scheduling policies, broken or
unsafe equipment. The psychological stressors are: encountering death, injury to self or
fellow fire fighters, danger of the job, peer pressure, false alarms, interactions with
supervisors and relatives of victims, department policies/procedures, boredom and
inactivity, perceived management practices, lack of encouragement for innovation, lack
of feed back or recognition for performance, lack of advancement opportunities/personal
development/respect, low pay (Ottlinger 1997). Most stimuli fire fighters encounter
become stressors because of interpretation. If the stimuli is interpreted as nonthreating,
the stimulus is merely dismissed. On the other hand, a threatening stimulus triggers
autonomic response via the neuroendocrine system. Regardless of the emotional
appraisal of the stressor (good or bad, pleasant or unpleasant, positive or negative), the
body reacts in the same manner (Ottlinger 1997).
In 1986, the study “Occupational Stress Within The Paramedic Profession”
(Hammer, Mathews, Lyons & Johnson 1986) was conducted at a major midwestern city.
The participation was voluntary. The research confirmed that there was a high level of
stress associated with employment as a paramedic. This stress appears to manifest
itself either through negative organizational attitudes or through patient care
In 1980 post traumatic stress disorder was recognized by the American
Psychiatric Association as a bona fide diagnosis, after large numbers of Vietnam
veterans began to display common symptoms indicative of the disorder. PTSD is
recognized as a long-standing and pervasive disorder caused by exposure to human
tragedy. The essential feature of PTSD in the development of characteristic symptoms
following the experience of a traumatic event that is “outside of the range of normal
human experience” One of the criteria for diagnosing PTSD is the presence of stressors
that would evoke symptoms of distress in almost anyone (Ottlinger 1997). Today, fire
fighter/paramedics face higher degrees of occupational and critical incident stress then
they did ten years ago (Ottlinger 1997). A well managed and accepted CISD program
will benefit the fire fighter/paramedic by mitigating the psychological impact of a
traumatic event, prevent the subsequent development of PTSD and serve as an early
identification mechanism for individuals who will require professional mental health
follow-up after a traumatic event. They also are intended to accelerate the recovery of
Burnout is the result of long term stress, and is defined as “unrelieved stress of
sufficient duration (6 months or more) leads to stress exhaustion or “burnout” (Fema
1988). The symptoms of burnout manifest themselves in the primary areas of a person’s
life, those being: psychological, physical, work and family (Fishkin 1989). The key is to
avoid the burnout syndrome that to treat it. Burnout did not occur rapidly, so treatment
may become a long-term process (Fishkin 1989).
All the literature that was used for this paper gave a wide range of common
causes of stress relating to the fire fighter/paramedic. With all of these in mind, a basic
stress-reducing program could be implemented. But, we must additionally look at what
the fire fighter/paramedics working at the Taylor Fire Department recognize and
perceive as stress. Once the leading stressors are identified, a more comprehensive
solution for reducing and or coping with stress can be rendered.
The department has already implemented a physical fitness and wellness
program this past year. Along with the purchase of top quality fitness equipment, which
are in place at all the stations, each employee will be medically evaluated to determine
what type of work out program they will benefit from the most. It is proven that a regular
physical fitness program reduces stress, but this alone is not sufficient.
To determine what the fire fighter/paramedic at the Taylor Fire Department
perceives as stress, a questionnaire will be administered on a volunteer basis. All
information will be confidential and non-punitive. Different categories of stress will be
evaluated in two distinct areas, what the department has control of and what the
department doesn’t have control of, questions will evaluate. What are the causes of
stress caused by the department’s management? What stress is caused by the city
administration? What stress is caused due to lack of interpersonal communication skills
between employees or between employees and management? What stress is caused
from outside of the organization (i.e. hospital, police department, medical control
authority)? What stress is caused by interactions with the general public? What stress is
caused by the day-to-day performance of the job? In addition to asking these questions,
the department will have to evaluate current policies, procedures and S.O.G.’s to
determine if any could be altered or updated to help relieve stress. Also, providing
education related to recognizing and coping with stress on a regular basis. Other
departments will be surveyed, regarding any programs they may have developed and
initiated or if they have an employee assistance program, and if so what it initials.
Since the questionnaire has not yet been conducted, there are no results to
report. All the literature regarding fire fighter/paramedic occupational stress points to a
common denominator, that stress is prevalent to this occupation and has been proven
to be damaging to individuals. Also, the need for programs to help decrease stress is
indicated. A stress-reducing program could begin using the common causes that were
found during the study. Once the questionnaires were completed and the causes of
stress related to the Taylor fire fighter/paramedics were determined, a more
comprehensive or tailored program could be developed.
Through out my career it has felt as if I have been on a roller coaster ride, at
times feeling good about myself, and my job performance, other times feeling extremely
inadequate, no matter how hard I tried to do my best. The high feeling that naturally
comes with success, and the lonely isolation that accompanies the perception of failure.
Sometimes coming to work was an exhausting task, other times I couldn’t wait for my
Kelly day to end, with anticipation of reporting for duty the night before a shift. There are
times that I’m at work wishing that I were somewhere else, and times that I have been
elsewhere craving the adrenal rush associated with an exciting incident or a dangerous
fire. I assume that these feelings were the results of occupational stress that I was
exposed to. How did I learn to cope? How did this affect my personal life and family?
How much damage did my body sustain?
There are many question that I may never have answers for regarding the past,
but I can attempt to control the effects of stress in the future as a result of the
knowledge gained through this study. Hopefully I will be able to help others decrease
stress associated with this job, or help start stress recognition and reducing programs
that will become apart of the daily routine of the fire fighter/paramedics with the Taylor
Fire Department. The “old school” mentality of “suck it up” and “be tough” are killing fire
fighters in the line of duty at an alarming rate, not to mention destroying families by
divorce, alcohol and substance abuse, as well as the effects of depression. The other
end is the high cost of disability claims, sick leave abuse and low productivity of
The average Taylor fire fighter/paramedic will most likely spend their entire
career at this level without the opportunity for advancement. This means they will be
responding to and transporting E.M.S. patients on a regular basis. The constant
exposure to tragedy, the responsibility of providing advanced life support, the regular
sleep disturbances and high paced routine associated with this position will begin to
take its toll. This is in addition to their responsibilities and duties as fire fighters, with the
mental and physical demands that are placed on them. Stress will become a daily
occurrence. These individual must have someway of controlling and reducing
There are sources of stress that are beyond any ones control that are adherent
to the fire fighter/paramedic such as the level of uncertainty of their daily events, the
response that an individual has to an alarm or loud noise, the exposure to human
tragedy and the fear they may feel for themselves or their co-workers safety. But even
though these situations are uncontrollable, they can be made more tolerable and the
ability to cope with the stress associated with them. New up dated alarm systems to
notify crews can be utilized, automatic C.I.S.D. activated for certain type incidents and
regular training exercises conducted under real fire conditions to build confidence.
There are sources of stress that the department management has some control
over as well as the individual fire fighter/paramedic. Updated policies, procedures and
S.O.G.’s so the employees know their responsibilities and duties, the employees need
to read and understand them, better management styles and tactics when dealing with
subordinates, management providing consistent recognition and feed back towards
employees, peer pressure should be supportive, not critical, open communication
should become a regular routine for management and all employees.
Individuals within the organization must also take responsibility for reducing
stress. Self-recognition that an individual is suffering from stress and asking for help is
the first step someone can take. Changing the peer pressure mentality that “if a person
needs help they are weak” to a peer support system through out the organization.
The implementation of a physical fitness program is the first step towards the
reduction of stress, especially heart disease, but this alone is not sufficient. An
employee assistance program must be developed to be successful in reducing
occupational stress. This program must be developed to meet the needs of emergency
workers, but also address personal issues as well as issues associated with
An employee is an organizations most valued asset, and they must be treated as
such. Just as you would provide preventive maintenance to a machine or a vehicle, the
fire fighter/paramedic also needs periodic maintenance on a regular basis, also when it
The study proves that occupational stress is a serious and damaging condition
associated with fire fighter/paramedics. All the previous information supports the
development and implementation of a program to reduce occupational stress. Growing
statistics are beginning to change the overall attitude towards stress. But this is only the
beginning; the recognition and coping with stress should begin earlier in a fire
fighter/paramedics career, possibly as early as the fire academy or paramedic school.
It will be impossible to totally alleviate all stress associated with this occupation,
here are my recommendations for reducing and coping with occupational stress for the
fire fighter/paramedics of the Taylor Fire Department.
Educate all employees of the recognition and causes of occupational stress
associated with their employment. Also methods to cope with stress.
Change the current type of alarm notification system to a less stressful type
system in all stations.
Begin a rotating schedule, so all fire fighters will ride on the engine on a regular
basis. Thus decreasing their run volume slightly.
Management training is currently being provided to all upper ranking officers, this
should continue for all officers.
Implement an automatic C.I.S.D. policy that will be conducted on certain type of
incidents. This will be mandatory for all personnel involve at that particular incident.
Improve the relationship between the union and the management. The union
must portray all information in an objective manner, and not give the perception that
management is against them.
Develop and implement an employee assistance program. This program must
provide the necessary resources to effectively relate to emergency workers. Must also
provide for personal issues such as, marital problems, alcohol and substance abuse,
debt management, etc. This must be confidential and anonymous, must be provided to
Continue the newly provided fitness program, possibly adding a nutritional
Conduct a questionnaire to all Taylor Fire Department personnel regarding what
they feel are the major causes of occupational stress. Make changes according to the
results if possible.
Ottlinger, James Michael (1997) Stress and fire fighters: Walden University
An Exploratory study Dissertation
Hildebrand, J.F. (1984). Stress Research. Fire Command, 55-58
Fishkin, Gerald Loren. (1989). Firefighter and paramedic burnout:
The survival guide – the role you play.
New York – Harcourt.
U.S. Fire Administration. (2002). USFA Releases preliminary fire fighter fatality
Statistics for 2001
F.E.M.A. (1988). Student Manual For The National Fire Academy Course
FIRE FIGHTER HEALTH AND SAFETY. (Pp 5-1 – 5-4)
Blum, Lawrence Dr. (2001) Stress and Survival in the Fire Service:
How they Live and Die
Report for S&C