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					          REDUCING OCCUPATIONAL MENTAL STRESS
              FOR FIRE FIGHTER/PARAMEDICS




                             Michael Brennan
                      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

                              August 23,2002
                                                                                               2


                                        ABSTRACT



       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.
                                                    3


                  TABLE OF CONTENTS




ABSTRACT……………………………………………………………………………………..2

INTRODUCTION……………………………………………………………………………….4

BACKGROUND &SIGNIFICANCE…………………………………………………………..4

LITERATUREREVIEW………………………………………………………………………..8

PROCEDURES………………………………………………………………………………..15

RESULTS………………………………………………………………………………………16

DISCUSSION…………………………………………………………………………………..17

RECOMMENDATIONS……………………………………………………………………….20

BIBLIOGRAPHY……………………………………………………………………………….22
                                                                                              4


                                     INTRODUCTION



       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
                                                                                               5


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.
                                                                                                6


       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

(Ottlinger 1997).



       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
                                                                                             7


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.
                                                                                                8


       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.




                                   LITERATURE REVIEW



       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
                                                                                            9


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
                                                                                           10


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,
                                                                                         11


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

service personnel:



       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
                                                                                           12


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

unpredictable events.

       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
                                                                                          13


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
                                                                                            14


stress associated with employment as a paramedic. This stress appears to manifest

itself either through negative organizational attitudes or through patient care

dimensions.



       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

traumatized people.



       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
                                                                                            15


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).




                                         PROCEDURES




       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
                                                                                          16


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.




                                         RESULTS




       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
                                                                                             17


stress related to the Taylor fire fighter/paramedics were determined, a more

comprehensive or tailored program could be developed.



                                        DISCUSSION



       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
                                                                                                18


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

employees.



       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

occupational stress.



       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.
                                                                                          19




       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

employment.



       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
                                                                                              20


fire fighter/paramedic also needs periodic maintenance on a regular basis, also when it

is indicated.




                                      RECOMMENDATIONS




       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.
                                                                                           21


       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

all employees.

       Continue the newly provided fitness program, possibly adding a nutritional

education segment.

       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.
                                                                                    22


                                    BIBLIOGRAPHY



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
                                   Emmetsburg, Md




F.E.M.A. (1988). Student Manual For The National Fire Academy Course
                 FIRE FIGHTER HEALTH AND SAFETY. (Pp 5-1 – 5-4)
                 Emmetsburg, Md




Blum, Lawrence Dr. (2001) Stress and Survival in the Fire Service:
                          How they Live and Die
                          Report for S&C

				
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