There’s having a bad day at work and then there’s having a bad day at work when someone’s life is on the line. First responders are under immense pressure every time they settep foot in the field but it’s only recently that researchers have begun to realize the toll this could take on their mental health.
For example, a study came out of Kitchener, Ont. recently that established a framework for addressing operational stress injuries in paramedicine. In this guide, the researchers stressed that “the term injury helps to recognize that these outcomes are as legitimate as physical injuries.”
Terminology is important when addressing stigmatized topics. Janaih Parsons, a Primary Care Practitioner in the Edmonton area, believes that the stigma around mental health can be a barrier for people seeking help.
“I think the hardest part is reaching out.”
Like many of her coworkers, Parsons has faced several of the stressful events that researchers say contribute to high operational stress injury rates.
There are many such events. For example, the death or serious injury of a coworker, serious work-related injuries and events resulting in mass casualty or with a high degree of threat can all have a substantial impact. Similarly, events involving children, with excessive media interest, or where the victim is known will also often leave a negative impact.
With high-pressure situations like these, paramedicine has gradually gained a reputation as a career with a high rate of burnout. Stress has only worsened in the face of the COVID-19 pandemic as paramedics have been dealing with supply scarcities, staffing shortages and altered standards of care.
“It’s frustrating when patients need care and there’s just no beds for them,” says Parsons. “Hospital wait times are so much longer that I’ll sometimes wait at the hospital for six hours before I can get back out on the road to another call, and that’s exhausting.”
Parsons has seen many of her coworkers struggle with this and with the added pressure since the start of the pandemic.
Nicola Cavanagh works at Alberta Health Services where she deals with policy, strategy and research in paramedicine. She has seen much of what Parsons spoke about in her own research.
“I think that one of the things it’s really done is exacerbate some of the things that were already stressful for people in their job,” says Cavanagh.
Cavanagh mentions that many health-care workers have to deal with this stress while worrying about personal health working in the pandemic and the wellbeing of their family. Her feelings are echoed in the operational stress injuries guidelines which state that “infectious public health crises bring on additional stressors that further increase the risks of OSI.”
As mentioned, these stressors can include fear of transmitting infection from work to loved ones. There is also the social stigma of being infected and logistics of quarantine and self-isolation to be considered. Additionally, health-care workers must quickly adapt to changing job requirements, dealing with uncertainty and overwhelming amounts of information.
It’s clear to Cavanagh that managing this level of stress can be a burden on many paramedics. That’s why she feels it’s important to have multiple types of mental health support services available. These can be emotional or practical, online or in-person, formal or informal and “can involve various personnel”.
“You need to learn how to compartmentalize and that takes practice,” says Parsons. “Different grounding techniques like box breathing is something I’ll do on calls when I feel overwhelmed.”
However, when a call is especially distressing, she’s learned to seek help outside of herself.
“If I have a tough call, I’ll book an appointment with my therapist and have a self-care day,” says Parsons. “To have access to somebody that I’ve been talking to now for a while, who knows some of my triggers, is really helpful.”
She adds that Alberta Health Services has some “pretty good critical incident stress management” strategies already in place. One example of this is AHS’ Critical Incident Stress Management. Critical Incident Stress Management aims to help EMS staff through difficult calls by implementing a provincial peer support program.
“There are certain things that will trigger this relay of action,” says Parsons, “They’ll check in on you just to make sure everybody that works the call is doing OK.”
Critical Incident Stress Management isn’t the only initiative of its kind. Cavanagh says AHS has several baseline initiatives for health-care workers like the Employees and Family Assistance Program which provides confidential counselling. There are also education and training programs for mental health with resources and connections, as well as extended benefits, many of these made available through the Alberta Health Services website.
“There’s definitely a formal acknowledgement that this is an issue that has to be responded to in a really comprehensive way. There’s no easy answer here,” says Cavanagh, “It doesn’t all happen at once.”