Quick Take: Building First Responder Resilience
A Pinnacle precursor webinar from the 911 Training Institute’s Jim Marshall offers strategies for preventing PTSD, decreasing suicides and increasing happiness in first responders
More and more first responders are lost to suicide, leaving public safety professionals searching for ways to help their colleagues before it’s too late. One promising approach is focused on increasing resilience, defined as the ability to advance despite adversity.
First responders handle an accumulation of daily stressors, traumatic events and major disasters. Resilient first responders are relaxed, engaged, flexible and happy, and able to tackle these stressors without suffering serious psychological damage.
As a precursor to the Pinnacle leadership conference, Jim Marshall, MA, the director of the 911 Training Institute; and Mike Taigman, improvement guide for FirstWatch, presented a webinar titled “Building Resilience to Prevent PTSD, Decrease Suicides, and Increase Happiness.”
Marshall and Taigman offered specific leadership strategies to build a resilient team of first responders.
Top quotes on building resilience to prevent PTSD
Here are some of the quotes that resonated from Taigman and Marshall’s presentation on mental health resilience.
“When leaders don’t acknowledge these events and they only delegate, that’s going to be a miss at the end of the day.” — Jim Marshall
“Post-event management strategy is a huge missing link in our professional industry.” — Mike Taigman
“Post-traumatic stress injury is what we need to see this as, as leaders and as front-line people, and embrace and provide support for it.” — Jim Marshall
Top Takeaways on how to build a resilient EMS team
People who suffer PTSD – which is likely underdiagnosed in first responders – have a significantly higher (six times higher) risk of suicide than the general population, according to the presenters. They shared how to prevent PTSD, treat PTSD and provide long-term support to first responders. Here are three takeaways from the webinar.
1. Why resilience helps prevent PTSD in first responders
Marshall uses the analogy of a battery to explain resilience. Think about your cell phone. That cell phone will hold a charge for only so long. The longer you use it, the weaker the capacity of the battery. “Each of us has mojo inside of us that is our battery to handle life, to weather adversity,” Marshall said. “We need to have the energy to face and manage, travel through and repair from difficult experiences.”
“What we have is a lot of medics and first responders who are living on caffeine and willpower and not enough sleep,” so their resilience is compromised. “We have to stay charged; we need to stay in the green as much as possible, because the less resilience we have, the more impacted we are psychologically by events and the more it plays out over the quality of our life,” he noted.
The idea is to prevent the most serious fallout from traumatic events. “We are far more likely to prevent PTSD and suicidality, depression, people bailing from their careers if we are building resilience strategically,” Marshall said.
2. How do you build resilience in first responders?
While some first responders come on the job day one more equipped than others, we can strategically build up the resilience of all our employees by teaching resilience skills that they can use in the moment the traumatic stress occurs, Marshall advised. “Cortisol is not our enemy and stress doesn’t kill us, it’s what we do or don’t do with the stress and how we manage the cortisol.”
He explained first responders have trained themselves to disregard their stress cues, their doubts and fears, because in the moment, their No. 1 job is to take care of others. Newer research, however, teaches us that stuffing these emotions down is not effective. While repressing emotions may help the responder to function in the moment, the cumulative impact of the stress will be greater.
Instead, Marshall advises recognizing choice points; those intersections in time when responders can choose how to react in the present to impact their futures.
Notice the cues instead of disregarding them – anger, a tightening in the chest or stomach, fear – and through heart-focused breathing, down-regulate, acknowledge what’s happening and travel through it. Manage the stress in the moment, before, during and after, to recharge the resilience battery.
Intervention after a traumatic event is just as important. Taigman shared research that the earlier and faster intervention is provided after a traumatic event, it decreases the first responder will experience PTSD, as well as the severity.
3. PTSD is like any other injury in the line of duty; it can be healed
The concept of resilience is framed by building yourself up; building strength. Just as EMS providers need to stay fit to handle the physical stressors of the job, building mental strength will allow them to take the hits and be less likely to experience the symptoms of PTSD.
“Post-traumatic stress disorder is also post-traumatic stress injury,” Marshall said. “The stigma for responders to call something a disorder is deep and fixed, and we need to recognize; look, what we’re talking about is an injury in the line of duty.”
Just as medics need to be conditioned for lifting patients, they need to be conditioned psychologically to handle the mental lift. “What happens when a medic puts their back out? They’ve got a work-related injury and now they’re out,” Marshall compared. “What happens when someone lifts psychologically, and they strain the brain?
Another important clarification in using injury, rather than disorder; you can heal PTSD. “Injury is usually something people think they can heal from, where a disorder is something they’re stuck with forever,” Taigman added.
“Most of your medics out there, 90% of your medics – this is my estimate – don’t believe you can heal PTSD. They believe you can only learn to manage the symptoms and therapy will help them cope with the symptoms,” Marshall noted. “This is not accurate. If people get help with EMDR or other evidence-based treatments, they can heal this.”
4. Traumatic events warrant a long-term continuum of care
PTSD, like a physical injury, can be healed. But like a deep tissue injury or sprain, it takes time and reconditioning. One problem common even in agencies that recognize the need for peer support, is that the response to a traumatic incident is immediate, but short lived.
“We have an incident, we bring in peer support and therapy dogs and psychologists and we do debriefings, and pay a lot of attention for a couple weeks, maybe three weeks, and then it’s back to business as usual,” Taigman summarized. But “the people most effected may not have completed their healing journey.”
In the first responder day-to-day world, you move on from these traumatic events because they are followed by another one, and another one, and you have to keep staying present, Marshall explained. “The problem is, the accumulation is not recognized with follow through.”
It’s important to recognize these high-impact events, whether it’s the death of a child, or the suicide of a fellow responder, and put in place a framework for managing things in the long term, Marshall advised. “There’s insidious, invisible pileup accumulation within our medics, within our other responders, that ends up taking this toll that we’re recognizing: increased suicidality, increased depression, increased self-medicating and relationship failures. So we need a systematic approach to be able to tend to and provide the care our responders need so that full continuum of care even beyond that first year.”
Marshall suggests a grid to manage how the person impacted is doing, not just that week, but the next week, the next month, the next 3 months, the next 6 months – a post-event personal care planner, which tracks the incident, and the resources being offered to the person in need, “whether it’s obvious people are struggling or whether they bury the struggle as we typically do, we want to lean into this.”
Strategically planning support elements and then reviewing the plan each week makes sure the ball doesn’t get dropped. “Somebody’s got to keep the pulse and let them know that it’s not forgotten,” Marshall said.
Additional resources on mental health resilience
Learn more about how to prevent suicide, identify when an EMS colleague is struggling with mental health issues and how to build mental health resilience with these articles from EMS1:
- Fit for duty: How to be a resilient responder
- What’s your department’s suicide prevention plan?
- Mental health in EMS and signs to look for in partners
- Study reveals roadblocks to mental health counseling in first responders
- How to speak up if you’re worried about a co-worker's mental health
- 5 things EMS providers should know about seeking mental health treatment
- Paramedics use peer support group to tackle PTSD
- Self-care tips to recover from a traumatic EMS incident
- Do you have PTSD or Complex-PTSD?
- PTSD quiz: Find out if your symptoms qualify
- Use the RESPOND method to assess EMS provider PTSD