Stress management for emergency services personnel: Exam Review

1.     Briefly describe the physical symptoms of stress in four physiological systems. (muscular, gastrointestinal, etc. )

GI: Since digestion is a complex system that is influenced by many interacting systems influenced by emotions and stress, multiple symptoms can rise following chronic stress exposure. In the presence of chronic stress, hypo or hypersalivation can occur as well as esophageal spasms that interrupt peristalsis. Anorexia, nausea and GER can also occur alongside peptic ulcers, colon spasms, diarrhea and constipation.

MUSCULAR: Stress can cause muscle tension/contraction that helps the body get ready for a stress response. Chronic stress however, can cause chronic muscle tension triggered by the extrapyramidal motor system. This stress induced muscle tension is usually nonspecific tonus. In the long run, these tensions can cause; headaches, esophagus/colon spasms, various eye problems, and other musculoskeletal  injuries. This occurs because chronic muscle tension causes blood vessels to constrict which interferes with blood flow causes pain.

CARDIOVASCULAR: Stress contributes significantly to the development of cardiovascular disease. Various physiological symptoms of stress add strain on the cardiovascular system overtime. It can overwork the heart causing hypertrophy leading to decreased cardiac output and function. It can lead to hypertension, atherosclerosis, arteriosclerosis leading to further damage and disease including infarctions.

SKIN: Stress contributes to a decrease in both skin conductance (it’s ability to pass current) and temperature (blood flow and coloration). Stress can also cause eczema and rashes on skin.

IMMUNE: Physiological symptoms of stress sometimes compromise and alter immune function. When the immune system is under active, cancer and infections can take over. Asthmatic symptoms can be caused by a hyperactive immune system. Autoimmune disorders such as MS and arthritis are often genetic and not caused by stress however, they can worsen or arise due to stress in affected individuals.

 

2.     Describe and give examples of Acute, cumulative and delayed stress.

CUMULATIVE: Cumulative stress is a build up of many types of stress from multiple sources. Individually, these stressors are manageable. Together their combined stress can be debilitating and overwhelming leading to burnouts and nervous breakdowns, also known as a Cumulative Stress Reaction.

Ex: Someone is rude to you, you fail a test, someone steals your car and you get fired in the same month.

ACUTE: A powerful emotional reaction to extremely stressful events. This type of stress will be overwhelming and can also overwhelm one’s ability to cope. Usually an acute stressor is described as a critical incident causing extreme stress. Reactions will differ across individuals.

Ex: On duty death of a co-worker, co-worker suicide, several dead patients in multi-casualty incident, child dies in traumatic incident.

DELAYED STRESS: Is a delayed response to a critical incident several years, months weeks after it happens. It is a consequence of emotional suppression. When the critical incident is not dealt with in a timely manner it may be more difficult to identify the source of stress, it may also distort the reaction. Reactions will be more extreme and professional help may be required in order to deal with the stressor.

Ex: You are called to a child pedestrian involved in a motor vehicle accident. When you arrive on scene there is nothing you can do, the child is horribly dismembered. You don’t deal with this call in a timely manner and you experience a delayed stress response a month later when you are called to another MVC with similar circumstances.

 

3.     Compare stress response and methods of coping for short and extended emergencies.

SHORT: Most emergency incidents are short term stressors which are performed on autopilot until the stressor is eliminated. Coping is based largely on prior training and experiences.

EXTENDED: Longer emergencies incidents will require a prolonged stress response that strain the ability to cope. Coping will require active steps during the incident, therefore they need to be dealt with in a timely manner and as soon as possible. Poor management in such situations may cause harm to you or your patient. The ability to cope in these situations is based on general coping skills and important relevant factors such as; health/diet/exercise, competent leadership, supportive mentoring and avoiding  blaming yourself. The CISD (Critical Incident Stress Debrief) can also help following the extended exposure to stress but must only be initiated if all relevant persons agree to talk about the incident in a therapeutic manner.  

 

4.     Briefly describe four considerations that help reduce the effects of an extended stress response.

Rest/Rotation: Rest periods allow the responder to perform at higher levels for greater periods of time.

      Withdrawing the responder from the scene for 30 minutes every 2 hours will allow the responder to rest in a calm environment where there are no visual, auditory or olfactory cues which may draw out the stress response.

    Time Orientation: Since it is easy to lose track of time during a large emergency which can cause increased fatigue as well as injuries, time reorientation is an excellent coping tool in order to increase monitoring of the physical, mental and emotional state of the responder.

Hydration: Stressful/demanding work requires constant hydration since it may lead to dehydration. Water or juices are a better choice to stay hydrated due to their sugar content providing a source of glucose for energy. Caffeine should be avoided within 4 hours after the extended stress response.

Nutrition: Keeping a good food intake increases metabolic efficacy and increases the ability to cope with an extended exposure to stressors. Carbohydrates are neatly superior to fats or protein in terms of usage for energy production.

 

5.     Identify and describe the effects of four food products that amplify the stress response.

CAFFEINE: Most popular sympathomimetic substance. Increases heart rate, blood pressure and the need for oxygen. Higher doses than 400mg per day can induce side effects such as headaches, diarrhea, tremors, heart palpitations, anxiety, irritability and insomnia that contribute to stress.

ALCOHOL: The consumption of alcohol can cause negative impacts physically, on memory, on performance, behaviour and judgement. It compromises the stress and immune response by interfering with the vitamin B and C which are important in the production of protein and Ab synthesis. The empty calories can also interfere with the liver, heart, brain, and pancreas. Together weakening stress coping mechanisms and therefore amplifying the stress response.

SUGAR: Sugar metabolism depletes stores of B vitamins, which compromises the stress, and immune responses, also interfering with protein and antibody synthesis. Too much of the refined substance may lead to obesity, diabetes and heart disease (Reactive issue). Too little of this substance can cause, hypoglycaemia which can cause extreme irritability lowering tolerance to stress also causing headaches, dizziness and anxiety (Functional issue).

SALT: Salt stimulates water retention and enhances the stress response because is causes vasoconstriction and subsequent hypertension. Salt also stimulates the sympathetic nervous response (Epinephrine, Constriction, Hypertension) by increasing pressure in the brain and spinal cord. It contributes to anxiety, irritability and a larger stress response.

CHOLESTEROL: Is present in high fat foods and is associated with a higher risk of heart disease and increased stress. Contributes to build-up on artery walls. Low density lipoproteins (LDL) are the problematic type of cholesterol and can be found in some foods such as; butter or full fat cheese. Two types of cholesterol are present in the human body, high-density and low-density lipoproteins. HDL is responsible for carrying LDL away from the arteries and back to the liver. While LDL simply deposit as fatty buildups within the arteries.  

 

6.     Describe Self-Efficacy and outline four factors that contribute to it.

SELF-EFFICACY: Self-efficacy is described as one’s own ability to complete tasks and achieve intended specific goals. When one judges their individual skill set as matched to a specific challenge it is a strong predictor of actual performance. It is to be noted that the individual must possess sufficient skill and motivation for the task. According to self-efficacy belief is sufficient to predict performance.

FOUR FACTORS: Four factors will contribute to self-efficacy.

1- Performance Accomplishments: Past successes and failures will be the strongest predictors of future self-efficacy across comparable challenges.

2- Vicarious Experience: The successes and failures of similar others will be an indicator of the individual’s capabilities as well as level of self-efficacy.

3- Verbal persuasion: The opinions of respected others can be used to influence self-efficacy. For example, they can help uncover skills or make an individual realize they have unrealistic expectations.

4- Emotional Arousal: Least influential of four factors, interpretation of level of emotional arousal influencing self-efficacy. For example, excitement helping performance.

 

7.     Describe the five types of physical activity and their effects on performance

ISOMETRIC: Contraction muscle groups against immovable objects, improves joint flexibility and may lower blood pressure. This type of exercise is great for strength, not endurance.  Ex. Plank, wall sit, yoga…

ISOTONIC: Expanding and contracting muscle groups with resistance mostly in one direction. This type of exercise is great for both strength and endurance. Increases bone density.

ISOKINETIC: It cannot be done without a dynamometer, it consists of muscle contractions using a constant speed throughout the full range of movement. Mainly used to measure muscular strength and in musculoskeletal rehabilitation.

AEROBIC: Type of low to high intensity exercise where the oxygen demand adequately meets energy demands of the body. Used to increase cardiovascular endurance

ANAEROBIC: Physical exercise that is intense enough to cause lactate to form. The oxygen demand surpasses availability. Used to build muscle mass.

 

8.     Describe the Set-Point theory and its relationship with genetics and challenges in weight

SET-POINT THEORY: Is a theory that the body works to maintain a genetically predetermined set weight. The body modulates energy output, fat stores, metabolism and food intake to maintain this set weight. Varies above/ below 10% in either direction, changes bigger than this are difficult to achieve. This theory is based on basal metabolic rate, a genetically influenced rate at which the body burns calories. Basal metabolic rate will decrease or increase depending on one’s caloric intake. The set-point theory does not adequately explain the epidemic of obesity plaguing modern civilization; genetics haven’t changed rapidly enough to explain increasing obesity and slow sustained changes to body weight can alter the set-point making this theory less reliable.

 

Reference

A. Paganopoulos (2016). Managing stress for emergency services personnel. Montreal, Quebec: Copiebec.