How Paramedics Can Prevent Compassion Fatigue
As an EMT or paramedic, you regularly encounter people on the worst day of their lives. Whatever the emergency, it's your job to get people to safety. The role takes extraordinary empathy and compassion.
But recent research shows that almost half (48%) of emergency medical services (EMS) professionals have experienced compassion fatigue, a wearing down or diminished ability to care, in the aftermath of traumatic events. The pandemic has pressurized the health care system and impacted those on the frontlines.
According to Eric Brenneman, a former lieutenant firefighter who works for non-profit YogaShield® Yoga for First Responders®, first responders have been isolated and unable to socialize with peers, which adds a layer of stress.
"Talking with my colleagues, they all say that it's been the hardest year of their careers," Brenneman said.
EMTs and paramedics can suffer emotionally, mentally, in their relationships, and at work without addressing compassion fatigue.
If you want to become an EMT or paramedic, keep reading to understand the signs of compassion fatigue and expert tips for coping.
What is compassion fatigue?
Compassion fatigue happens following long-term, continued exposure to suffering. After a while, this exposure results in feeling numb.
"Like sponges, EMS providers absorb trauma over time," licensed clinical social worker Lauren Young Work said. "And what happens when a sponge has taken in all it can? It doesn't soak anything in anymore. Or in this case, it becomes difficult to take in that trauma, and that can impact how we feel, both on the job and at home."
A systematic review of compassion fatigue listed symptoms, including:
- Exhaustion, anger, and irritability
- Harmful coping mechanisms, such as abusing drugs or alcohol
- Diminished ability to sympathize and empathize
- Lower job satisfaction
- Difficulty making decisions and caring for others
Compassion fatigue versus burnout
Burnout is a state of total exhaustion with your work, and it can happen in any field. According to research published in The Journal of Trauma Nursing, burnout may accompany a lower sense of achievement or taking on negative views of patients.
Compassion fatigue may include burnout, but it's also related to secondary — or vicarious — traumatic stress. People experiencing compassion fatigue may have similar symptoms as PTSD and need to process that stress.
6 tips to prevent compassion fatigue
Maybe you're not feeling your best or just beginning to notice slight changes in your mood or behavior. Now's a great time to build up your stores of wellness for when challenges inevitably arise.
Here are some tips for preventing compassion fatigue:
Paramedics and EMTs work very long shifts — sometimes up to 24 hours. So, it can be a challenge to get regular sleep. The American Sleep Association offers tips for how to fall asleep fast, including:
- Create a bedtime routine.
- Avoid caffeine, alcohol, and other substances that can keep you awake.
- Find a calming ritual to help you sleep, such as counting breaths, meditation, or progressive muscle relaxation.
Physical activity and nutrition can have loads of benefits in protecting your overall wellness. A workout routine might offer an outlet to relieve stress.
The First Responder Center of Excellence provides workout routines for EMS pros.
Jared Sharza, a third-year medical student at the University of Medical and Health Sciences St. Kitts returned to New York when the pandemic shut down his in-person classes. He worked on the frontlines as a paramedic while pursuing his education online.
Sharza referenced a mindfulness research study, where people who meditate experienced more compassionate responses to traumatic images and sounds with less anxiety. This means meditation can be a powerful tool for EMTs and paramedics who want to strengthen their defense against compassion fatigue.
Many EMS and law enforcement agencies have peer support teams. These individuals receive training to recognize emotional and behavioral issues, from depression to drug misuse, so they can guide their colleagues to a network of resources.
For example, the International Association of Fire Fighters' peer support training curriculum focuses on several elements of peer support, including:
- Active listening
- Crisis intervention
Speaking with a mental health professional isn't just for emergencies. Anyone can benefit from therapy. And today, many options are accessible online, over the phone, or on mobile devices. For example, the CrewCare app helps you confidentially track your daily mood and mental health and receive feedback from a professional.
Find more resources for frontline workers at the end of this article.
Young Work recommends creating your own coping skills plan. It goes along with the idea that everyone will have a different preferred way to cope, depending on the type of stressful situation they've experienced.
Creating a plan can help you pause, identify the level of stress you're feeling, and have some go-to coping strategies to try.
We created a downloadable coping plan template that you can customize:
Self-care and coping mechanisms
Rather than promoting a focus on "toughening up," Young Work encourages EMS professionals to anticipate challenges and proactively find ways to cope.
"When EMS culture encourages personnel to recognize signs of stress, trauma, and empathy fatigue, we help EMS workers gain insight into their mental health," she said. "We can learn what coping mechanisms work for us, when to use those coping tools, and how to access peer or professional support when we need it."
Here are a few ways you can cope with stress and compassion fatigue:
"It's not about touching your toes," Brenneman said. "We're really using yoga to perform optimally under high stress. We're training to get comfortable with the uncomfortable."
Brenneman served in the fire service for 13 years and was formerly a lieutenant in Des Moines, Iowa. He participated in his fire department's peer groups to help his colleagues find services for mental and behavioral health issues. When he encountered YFFR and realized people could proactively address these challenges through yoga, his "mind was blown."
If you work in EMS, you can get groups like YFFR to host a virtual training for your department or agency. Or experiment with mindful movement such as yoga or tai chi at a fitness studio or through online videos.
Counting your breath can help you put your mind at ease before you go to bed at night. It's also a technique you can use to pause and recollect your nerves when something happens to upset, distress, or anger you.
The 4-7-8 breathing technique can help you achieve a state of relaxation within minutes. It's simple to try:
- With your tongue resting behind your front teeth, breathe in for a count of four.
- Hold your breath for a count of seven.
- Exhale, making a whooshing noise, for a count of eight.
- Repeat this three more times.
Get Out in Nature
There's research behind the idea that natural environments impact our mental health.
A review of the research on nature and mental health suggests an association between exposure to nature and many aspects of mental health, including:
- A sense of purpose
- Positive social interactions
- Improved sleep
- Decreased distress
In fact, an American Journal of Critical Care study measured what happened when hospital nurses took their breaks in a garden versus in an indoor breakroom. Nurses who took breaks in the garden reported lower levels of emotional exhaustion.
Consider hiking, walking in a park, or even sitting in a green space for a bit to help you recuperate from stress.
Journaling might help you collect and organize your thoughts so you can make sense of triggering situations or even release them.
In a Journal of Nursing Education and Practice study, nurses who participated in a six-week journaling program reported higher levels of compassion satisfaction and lower compassion fatigue and burnout at the end of the program.
Plus, you don't have to just write in your journal. You could create a visual journal with drawings or photographs.
Mental health resources for paramedics and EMTs
If you or someone you know is facing a crisis, you can connect to a professional at the following helplines:
- The National Suicide Prevention Hotline, 1-800-273-8255: Call the hotline anytime, 24/7, to speak to a trained crisis worker.
- Frontline Responder Services Helpline, 1-866-676-7500: Speak with another frontline service provider to get help for PTSD, family issues, addiction, sleep deprivation, or other issues.
- Safe Call Now, 206-459-3020: This 24-hour hotline operates to help EMS professionals and their family members. The counselors on the line are first responders.
- Fire/EMS Helpline, 1-888-731-FIRE (3473): Call to get support with family conflict, substance abuse issues, and other mental and behavioral health concerns.
If you want to learn more about compassion fatigue and how to prevent it, check out some of the organizations below. In addition, your employer, city, or local health care system may have additional resources to support first responders' mental health.
The Code Green CampaignThis non-profit advocates for better mental health among EMS practitioners. Its resource page includes national mental health hotlines and services in your state.
Emotional PPEThis organization connects anyone working in a healthcare-related field to clinicians who can provide critical emotional support.
First Responder Center for Excellence (FRCE)Non-profit FRCE helps promote health and well-being among first responders through research and education. Its online Stress First Aid module aims to help you identify stress in yourself and your colleagues.
Share the LoadOperated by the National Volunteer Fire Council, Share the Load provides videos, explainers, and other resources related to promoting the mental health of EMS workers.
Asking for help ≠ Weakness
Our experts agreed that we need to debunk a myth if the professional EMS community is to overcome compassion fatigue. The myth is that mental health challenges — or asking for help — make you weak.
"In EMS, there's a real issue of ‘you have to be strong, you have to just deal with it all and be tough,' and it's just not true," said Young Work.
While the pandemic hasn't made things any easier, it has highlighted the importance of mental health in a way no one can ignore.
"The pandemic has brought healthcare worker mental health to the forefront. It's normalized something that in the past, providers were less open to recognizing and openly addressing," said Young Work. "We have a real opportunity with incoming first responders who are new to the field to change the conversation in regards to mental health."
If you are entering the field, you shouldn't have to ignore your well-being. Ask agencies what mental health tools and resources are available to you, and remember that needing help is a normal and natural part of the job.
Meet the Experts
Lauren Young Work is a licensed clinical social worker and the medical social work coordinator for a fire-based EMS agency in South Florida. Young Work's been in the field for 26 years and authored the chapter on mental health emergencies for the National Association of Emergency Medical Technicians (NAEMT) Advanced Medical Life Support course text. She also recently presented an NAEMT webinar on managing stress and anxiety during COVID-19.
Eric Brenneman, an advisor for Yoga For First Responders, has practiced yoga for two years, attending studios throughout the country. Brenneman is a former lieutenant with the West Des Moines Fire Department. Prior to the promotion, Eric spent many years in leadership positions with IAFF L-3586 and the Iowa Association of Professional Fire Fighters. Eric served in the fire service for 13 years.
A third-year medical student at the University of Medical and Health Sciences St. Kitts returned to New York when the pandemic interrupted his studies. He began working on the frontlines as a paramedic in upstate New York while pursuing his medical education online.
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