Stress and CSIM Flashcards
What is a demand?
Any threat, demand or challenge that requires the body to adapt
Anxiety and Stress
Stress results from the interaction of events (environmental stimuli) and the adjustive capabilities of the individual
– Usually seen as generaying negative affect (fear, depression, guilt, etc.)
– Also experienced with positive events
Stress
Anxiety is uneasiness or dread about future uncertainties
Eustress
– Good Stress
– response to positive stimuli
– i.e. Working Out, jogging
Distress
– Bad Stress is harmful
– a negative response to an environmental stimulus
Types of Stress (Environmental)
– Weather
– Confined space
– Lightning
Types of stress (Psychological)
– Family relationships
– Relationships with other personnel
– Intoxicated patients
Types of Stress (Personality)
– Guilt
– The need to be liked
The “Pile up Effect”
- Usually one stressor alone is not sufficient to create a major stress response
- Cumulative effect of many small stressors
The Comfort Zone
Stress caused by boredom
Phases of the stress response
– Alarm reaction
– Resistance
– Exhaustion
Alarm Reaction
“Fight or flight” phenomenon
– Occurs when any emergency situation threatens one’s safety or comfort
– Is considered positive (eustress)
– Prepares the individual to be alert and to defend himself or herself
Resistance
- Stress response raises the level of resistance to the agent that provokes it and others like it
- If the stress persists, a person’s reactions to the stress may change
- Example: As you become accustomed to emergency response with lights and sirens, the alarm reaction is no longer elicited to the same degree
Exhaustion
- As stress continues, coping mechanisms are exhausted
- Adaptive resources used
- Resistance to all stressors declines
- Increased susceptibility to physical and psychological ailments
- Rest and recovery are needed
Factors that Trigger the Stress Response
Many factors can trigger the stress response. Examples include: – Loss of something that is of value – Injury or threat of injury – Poor health or nutrition – Frustration – Ineffective coping skills
Stress Reactions
Catecholamine release…
– Heart rate, respiratory rate and BP increase
– Perfusion to Skin, GI, and Renal decrease
– Level of Awareness improves…
– Increase in sugar, fats, cholesterol (energy)
Physiological and Psychological Effects of Stress
- Normal anxiety
* Detrimental reactions to anxiety/stress
Physical Effects of Anxiety and Stress
• Person may be aware of:
– Heart palpitations – Difficult /rapid breathing – Dry mouth – Chest tightness or pain – Anorexia – Flushing, diaphoresis – Frequent urination – Dysmenorrhea – Aching muscles and joints – Backache, headache
Physical Effects of Anxiety and Stress
Person may be unaware of:
– Increased blood pressure and heart rate – Blood shunting to muscles – Increased blood glucose – Increased adrenalin – Reduced gastrointestinal peristalsis – Pupillary dilation
Warning Signs and Symptoms of Stress
- Physical
- Emotional
- Cognitive
- Behavioral
Stress Symptoms (Physical)
– Fatigue – Headache, stiff neck, muscle aches – Insomnia – Heart palpitations, chest pains, abdominal cramps – Cold extremities, flushing/sweating – Frequent colds.
Stress Symptoms (Emotional)
– Anxiety, depression
– Nervousness
– Anger, frustration, worry, fear, irritability, impatience, short temper
Stress Symptoms (Cognitive)
– Decreased concentration/memory
– Indecisiveness
– Mind racing/going blank
– Loss of Sense of humor
Stress Symptoms (Behavioural)
– Pacing, fidgeting, nervous habits
– Crying, yelling, swearing, blaming
– Throwing things, eating, smoking, drinking
Reactions to Stress
Individual reactions to stress are “customized” based on:
– Previous exposure to a specific type of stress
– Perception of the stressful event
– Personal coping skills
Dynamic, evolving process whereby one “learns” successful ways to deal with stressful situations
• This process:
– Usually begins with using defense mechanisms
– Then develops coping skills
– Continues with problem solving
– Culminating in mastery
Methods used to initially manage stress include:
– Reframing
– Controlled breathing
– Progressive relaxation
– Guided imagery
Other Stress Interventions
- Being aware of personal limitations
- Peer counseling and group discussions
- Proper diet, sleep, and rest
- Pursuit of positive activities outside of EMS to balance work and recreation
- Intervention programs that may be available through EMS agencies, hospitals, and other groups
Reducing Stress
• Meditation and Contemplation
Seong aside some “personal time” for meditation and contemplation can greatly enhance mental and perhaps even physical health
Reducing Stress
• Spirituality
– A unique characteristic of human existence
– Should not be overlooked as an effective means for some to achieve mental and physical well‐being
Family, Peer, and Community Connections
- Belonging to groups can affect a person’s motivation and performance in very positive ways
- People tend to associate with others most like themselves (e.g., family members, coworkers, members of community and religious organizations)
- These groups provide a “connection” with people who share similar values and interests
Freedom From Prejudice
• Accepting cultural differences allows individuals to:
– Learn about other cultures
– See cultural variations in a positive light
– Affirm the values of these differences
Stress Reduction (Lifestyle Change)
– Decrease caffeine (yeah whatever…) – Eat a well balanced diet, decrease junk food, eat slowly – Regular exercise, adequate sleep – Leisure time, spend time with family – defibrillate a frog at 360 joules
Stress Reduction (Stressful Situation Change)
– Time and money management
– Assertiveness, problem solving
– Leave a job or relationship if necessary
– Dance naked in front of your pets
Stress Reduction (Change your thinking)
– Look at things positively – See problems as opportunities – Refute negative thoughts – Keep a sense of humor – During a late night stage, when your partner is sleeping slowly park the ambulance right behind a semi-‐truck, lay on the horn and scream, “look out!”
Critical Incident Stress Management
• “Critical incidents” include tragedies, deaths, serious injuries, hostage situations, or threatening situations
• CISM is an organized, formal, peer and mental health support network and process
– Enables emergency personnel to vent feelings
– Facilitates understanding of stressful situations
What is Stress?
“A nonspecific response of the body to any demand made upon it”
Critical Incident Stress Management
CISM is designed to help emergency personnel understand their reactions and reassures them that what they are experiencing is normal and may be common to others involved in the incident
Components of CISM
- Pre-incident stress training
- On-scene support to distressed personnel
- Individual consultations
- Defusing services immediately after a large‐scale incident
- Mobilization services after large‐scale incident
- Critical incident stress debriefing 24 to 72 hours after an event
- Follow-up services
- Specialty debriefings to non-emergency groups in the community
- Support during routine discussions of an incident
- Advice to command staff during large scale incident
Defusing
• Usually takes place within 8 hours after an event
– Allows initial release of feelings
– Allows opportunity for people to share their experiences
• Occurs in an informal gathering of the people involved in the event and two-person CISM-trained teams who are also peers
• Usually lasts less than 1 hour
Debriefing
- More formal than a defusing
- Conducted in a confidential setting
- Usually takes place 24 to72 hours after the event
- Conducted by a specially trained CISM team of other emergency services personnel and mental health workers
- Only those present at the incident are allowed to attend a debriefing
Situations in which CISM should be considered:
– Line of duty injury or death
– Disaster
– Emergency worker suicide
– Infant/ child death
– Extreme threat to emergency worker
– Prolonged incident that ends in loss or success
– Victims known to operations personnel
– Death/ injury of civilian caused by operayions
– Other significant event
Reducing Crisis-induced Stress
- Rest
- Replace food and fluids
- Limit exposure to incident
- Change assignments
- Provide post-event defusing/ debriefing
- Other approaches to help manage stress
Behaviour Types
– Assertive
– Aggressive
– Passive Behaviour
Assertive Behaviour
Being assertive allows a person to express his/her feelings,preferences, needs or opinions while respecting others.
Aggressive Behaviour
Aggressive behaviour allows you to get what you want or force your
opinion on others, but usually without respect for others.
Passive Behaviour
When you do not express yourself (behave passively) you open
yourself up to being victimized and allow others to make decisions and
choices for you
Post Traumatic Stress Disorder
- A psychiatric disorder
- Can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape.
- People who suffer from PTSD oDen relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person’s daily life.
- PTSD is marked by clear biological changes as well as psychological symptoms.
PTSD is complicated by the fact that it frequently occurs in conjunction
with related disorders such as:
– depression, substance abuse, problems of memory and cognition, and other problems of physical and mental health.
– also associated with impairment of the person’s ability to function in social or family life, including occupational instability, marital problems and divorces, family discord, and difficulties in parenting.
How does PTSD develop?
– Most people who are exposed to a traumatic, stressful event
experience some of the symptoms of PTSD in the days and weeks
following exposure.
– Available data suggest that about 8% of men and 20% of women go on to develop PTSD, and roughly 30% of these individuals develop a
chronic form that persists throughout their lifetimes.
The course of chronic PTSD usually involves periods of symptom increase followed by remission or decrease
– although some individuals may experience symptoms that are
unremiong and severe.
– Some older veterans, who report a lifetime of only mild symptoms,
experience significant increases in symptoms following retirement,
severe medical illness in themselves or their spouses, or reminders of
their military service (such as reunions or media broadcasts of the
anniversaries of war events).
Who is most likely to develop PTSD?
– Those who experience greater stressor magnitude and intensity, unpredictability, uncontrollability, sexual (as opposed to nonsexual) victimization, real or perceived responsibility, and betrayal
– Those with prior vulnerability factors such as genetics, early age of onset and longer-‐lasting childhood trauma, lack of functional social support, and concurrent stressful life events
– Those who report greater perceived threat or danger, suffering, upset, terror, and horror or fear
– Those with a social environment that produces shame, guilt, stigmatization, or self-‐hatred
