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Stress and Emergency Healthcare Workers 1

Running Head: The Relationship between Stress and Emergency Healthcare Workers

Stress in Emergency Healthcare Workers

Tim Standon

University of La Verne

October 28, 2009

Senior Thesis Advisor – Kimberly Porter Martin


Everyone everywhere is affected to some degree by the stresses and strains of

daily life. However, there are some in society who work and live under extraordinarily

stressful conditions. Professions like the military, air traffic control, and emergency

services are innately high stress work environments. The people who do these jobs must

cope not only with the stresses that affect everyone in society on a day-to-day basis, but

also the pressure to accomplish miracles through their work, followed by the stress of

actually trying to doing it.

The actual numbers of emergency workers is difficult to pin down due to the size,

diversity, and overlapping nature of the field. In the United States there are several

agencies that represent different factions of emergency personnel. The National Registry

of Emergency of Emergency Medical Technicians (NREMT) claims that there are over

1,000,000 active paramedics and EMT’s (National Registry of Emergency Medical

Technicians, 2009). The US Department of Labor states that as of 2006 throughout the

United States there were approximately 361,000 paid firefighting jobs, about 201,000

paid EMT and paramedic positions, and nearly 861,000 paid police officers. They also

state that there are approximately 2,505,000 registered nurses and 633,000 doctors

(United States Department of Labor, 2009). These statistics do not include any of the

volunteer positions or other related paid jobs within the different areas of emergency

care.

Stress

Stress is a word that is commonly used but is often not well understood. Kagan,

Kagan , and Watson (1995) define stress as a basic reaction experienced by all living


organisms, that it is due to the tension that results from one’s basic vulnerability to the

surroundings, to one’s own circumstance, to one’s own impulses or needs, and to one’s

reliance on others. They further explain that stress is expressed emotionally, cognitively,

and behaviorally: and that one’s reaction to stress under different situations is determined

by one’s underlying personality, prior experience, and coping mechanisms. It is also

suggested that people may not be fully aware of their stressors under all conditions, and

that stress often is an out-of-awareness thing that happens (Kagan et al., 1995). Signs of

excessive levels of stress can often be noticed by observers before they are noticed by the

affected person. Stress, oddly enough, is different things to different people and even

different things to the same person at different times (Kagan et al., 1995).

A stressor can be defined as any stimulus that causes a stress response from an

individual which taxes their physiological or psychological resources and possibly elicits

a subjective physical or mental strain (Anisman & Merali, 1999). Stressors can be

physical and/or psychological. The response from stressors manifests in physical and

psychological ways. Some of the problems associated with being under stress are: a

higher incidence of alcohol and drug usage, increased risk for cardiovascular problems

like hypertension (high blood pressure) and myocardial infarction (heart attack),

increased risk of stroke, and insomnia as well as other sleep disorders (Anderson, 2009).

Physical Manifestations of Stress

According to Beaton, Murphy, Johnson, Pike, and Jarrett (1995), the International

Association of Firefighters (IAFF) claims that firefighting is one of the United State’s

most dangerous professions. The 1990 US Department of Labor statistics show that

firefighters are 9.2 times more likely to be injured and 4 times more likely to be killed on


the job compared to workers in private industry. In 1992 the IAFF revealed that the

single most relevant cause of line-of-duty death is cardiovascular disease that leads to

death by stroke and cardiac arrest. This is surprising when one takes into account how

cardiovascularly fit firefighters are (Beaton et al., 1995).

Police and other Public Safety Officers have shown an increase in cardiovascular

disease as compared to others in society. After a 22 year follow up in a longitudinal study

of 970 Helsinki police officers, there was an association found between hyperinsulinemia

and increased heart disease independent from other risk factors. A study of Buffalo, New

York police officers was done to see if there was a difference in cardiovascular disease

markers between mildly or sub-clinically stressed and highly stressed officers. The study

showed that there was a decrease in coronary blood flow as officers’ stress levels

increased from mild to moderate to severely stressed. The dilation of the vessels was

nearly half that in severely stressed officers compared to sub-clinically stressed officers.

The study suggests that failure to turn off the stress mediator chemicals of the body, such

as cortisol, will cause an individual to continue to have high levels of stress which will

eventually generate wear and tear on the body and lead to disease (Violanti et al., 2006).

Post Traumatic Stress Disorder

Post-traumatic stress disorder or PTSD, as defined by Anderson (2007), is an

anxiety disorder which can build from an exposure to a frightening event or ordeal in

which serious physical harm occurred or was threatened (Anderson, 2007). Robbers and

Jenkins (2005) state that PTSD is also known as shell shock or battle fatigue. They

continue on to state that this disorder can overpower an individual and become

incapacitating by inducing symptoms such as panic, defenselessness, and avoidance.


Frightening thoughts or memories of the critical stimuli can also invoke numbness,

fatigue, aggression, rage, or hyper vigilance (Robbers &Jenkins, 2005). According to

Anderson (2007), the National Institute of Mental Health has found that traumatic events

may trigger PTSD. Some of these events include violent personal assaults, natural or

human-caused disasters, accidents, or military combat. People with PTSD have persistent

frightening thoughts and memories of their traumatic event, they have an emotional void,

and are frequently unable to relate normally with others. This is especially true for

relationships with people to whom they were once close. Furthermore, they may

experience sleep problems such as insomnia or night terrors, and they can be easily

startled at any time (Anderson, 2007).

A study of women at a long-term treatment center in the USA, which was

reported by Brewerton (2008), shows a possible link between PTSD and eating disorders.

The strongest correlation between PTSD and eating disorders occurred in patients with

anorexia nervosa which is a binge-eating/purging type of disorder.

“It has been hypothesized that eating disordered behaviors, particularly

purging behaviors, serve to facilitate avoidance of traumatic material and to numb

the hyper-arousal and emotional pain associated with traumatic memories and

thoughts. Purging may also promote forgetting parts or all of a traumatic event,

for example: dissociative amnesia. Several studies have reported higher rates of

dissociative symptoms in bulimic patients than in controls, and in the National

Women's Study, 27% of patients with bulimia nervosa reported forgetting all or

part of traumatic memories compared with 11% of participants who did not have

an eating disorder. Thus, bulimia often serves as a maladaptive coping strategy in


the same way substance abuse does in relationship to trauma and PTSD”

(Brewerton, 2008:2-3).

A prime example of an incident that caused PTSD in EMS workers is from the

September 11, 2001 terrorist attack on the USA. There was a huge loss of innocent life,

along with the loss of life of colleagues and even family members of the EMS workers on

that fateful day, not to mention the loss of life and the chronic illness associated with

working at ground zero of the World Trade Center in New York. Many individuals in the

first responding teams who were not killed in the collapse have suffered long lasting

medical problems from breathing polluted air and being exposed to toxic substances

while at the scene. Some of their primary medical complaints are from upper and lower

airway problems as well as esophageal problems. They put in long, physically and

emotionally draining days digging out a few survivors, but mainly finding those who

were deceased. This led some workers to develop PTSD (Herbert et al., 2006).

Another example of emergency workers developing PTSD can be found in 2004.

Robbers and Jenkins did a study regarding PTSD symptoms on the Arlington County

police officers that responded to the September 11, 2001 terrorist attack of the Pentagon.

The all of the sample population had responded to the incident within 90 minutes of the

attack. The officers worked an average of 136 hours at the site. Some of the officers did

not return to their homes for several weeks, because they felt a need to stay on the site in

order to clean up and restore the Pentagon. Initially the officers assisted the fire

department in rescue operations and also controlled traffic in the immediate area of the

Pentagon. Later, the police officers became part of the teams that sifted through the

rubble, searching for body parts, personal effects, airplane parts, and top secret


information. Many of the officers came in contact with what they were looking for. One

experienced officer reported that after finding charred human remains, the thing that

troubled him the most was the unearthing of a small, pink child’s purse. Another officer

said that a burnt teddy bear was the most unforgettable picture left in his mind. The study

found that more than one third of these individuals had suffered from some symptoms of

PTSD over the three year time period. The research suggests that higher levels of PTSD

may be found in police officers due to the experience of disenfranchised grief after

exposure to traumatic events, because officers who experience emotional trauma are not

socially sanctioned to grieve. Furthermore, the increase in PTSD may also be related to

police organization and management. The police organization is para-militaristic; its

officers are required to be the helpers, not the helped. Basically the police are supposed to

be in control and they are held to higher moral standards by the community. And finally,

it is suggested that the police officers code of silence adds to the development of PTSD,

because many officers think that a cop who seeks mental health treatment is weak and not

reliable (Robbers & Jenkins, 2005).

Secondary Traumatic Stress

A related form of PTSD is referred to as secondary traumatic stress or STS for

short. It can be described as a healthcare worker being traumatized while trying to help

someone with PTSD by listening to their stories. This has occurred with mental health

professionals who work large incidents, like the September 11th tragedy. In the September

11th instance, social workers were exposed to the same event as those whom they were

trying to help. For many of the counselors, hearing the clients' stories interacted with

their own stress levels and concerns about the terrorist attacks, heightening the resultant


STS reaction beyond the simple additive effects of the two factors taken alone (Pulido,

2007).

Other professionals such as firefighters, paramedics, police officers, and 911

Dispatchers can also experience STS from helping and wanting to help people who are

victims of trauma. It is suggested that repetitive exposures to critical incidents can lead to

problems from the cumulative effects of those exposures. Exposure to duty-related

trauma or critical incidents usually involves overwhelming exposure to injured,

mutilated, or dead and dying victims (Beaton, Murphy, Pike, & Corneil, 1998).

Burnout

Burnout is another concept that goes hand in hand with stress and PTSD.

Committed professionals who start out their careers with energy, efficiency, and

dedication to what they are doing can end up exhausted, inefficient, and cynical. Burnout

is characterized as having feelings of failure, being worn out or becoming exhausted by

excessive demands of the job. Burnout manifests both physically and behaviorally

causing emotional and physical exhaustion, diminished caring, and a profound sense of

demoralization (Bush, 2009). Cannon (2006) states that the American College of

Emergency Physicians lists the symptoms of burnout as: withdrawal from family then

friends, denial, overwork, anxiety, dread, anger, isolation, martyrdom, risk taking, and

depression even leading to suicide (Cannon, 2006). As reported by Anderson (2008), a

study of 119 nurses in the Caribbean was done on work-related depression. They looked

at the nurses’ role, their work and social factors, stress, burnout, depression, absenteeism,

and turnover intention. The researchers found that burnout was the sole predictor of


depression, which directly predicted both absenteeism and turnover intention (Anderson,

2008).

A 2005 study of Taiwanese firefighters, suggests that major life stressors often

leads to depression and a decrease in the quality of life for an individual experiencing

them. The article goes on to propose that those individuals with a poor quality of life

often will not return to work. A finding of the study, done by the Taiwan Department of

Health, showed a connection between depression and suicide; and as a result of that

finding, high risk groups such as firefighters are being encouraged to receive mental

health screenings as an attempt to reduce suicides (Chen et al., 2007).

A survey study of nurses in Finland was done in 2001-2002 to see if there was an

association between nursing management behavior and burnout among nursing personnel

in health care. Six-hundred-twenty-seven nurses were randomly selected from a frame of

900 Finnish nurses, most of them women, in different patient contact practices. They

found small correlations between leadership styles in the organization and burnout in

nurses. Style of leadership is both positively and negatively associated with burnout

among nurses. A Nurse Manager who has an active and future-oriented transformational

leadership style will have fewer nurses working under him/her who experience burnout.

This management style tends to protect employees from emotional exhaustion,

depersonalization, and to increase feelings of personal accomplishment. On the other

hand, nurse managers who use a passive leadership style are setting the employees up for

burnout. Subordinates working under this kind of leader are particularly vulnerable to

emotional exhaustion and depersonalization. The information obtained from this study

suggests that the management team must be aware that their actions as well as their


omissions are powerful and can make the difference between an emotionally healthy

workforce and an emotionally unhealthy one (Kanste, 2008).

The Sacramento Medical Society studied 454 physicians and found that 40% of

those studied were depressed, had thought of leaving the profession at least once in the

previous 12 months, would not choose to go into medicine if they had it to do over again,

and would discourage others from becoming doctors . The study suggests that the level of

a physician’s professionalism or traditional professional stance, their attitudes, their self-

expectations, and especially their training has made doctors particularly vulnerable to

stress. Every year in medical schools across the country, the freshman class begins with a

sense of privilege and excitement about becoming doctors. Four years into medical

school, the excitement has changed to cynicism and numbness. By graduation, the

students have learned how to diagnose and treat patients but they have forgotten why they

wanted to (Remen, 2001).

A similar issue was raised by a longitudinal study from 1997–2000 in England.

The study of 800 British doctors in revealed that there may be a causal relationship

between stress and burnout in doctors. Mayor reported an increase in stress for doctors

who were emotionally exhausted, which leads into a vicious circle of being more

exhausted and then even more stressed. He also reports that an increased work load and

having to treat patients as individuals in order to reach higher personal goals is another

reason for the doctors increasing stress levels. Mayor then recommended that to reduce

stress, doctors should reduce their workload (Mayor, 2002).


Stress in EMS

Emergency Medical Personnel belong to a subset of the healthcare system. It is

comprised of many different factions of both public and private employees. The positions

involved in EMS are primarily, but not limited to: paramedics, emergency medical

technicians (EMT’s), firefighters, police officers, doctors, nurses and dispatchers. These

people are directly involved in the job of saving lives and trying to create some sort of

order out of chaos.

Field rescue personnel are put into harm’s way from the start of a call by driving

with lights and sirens (Code-3) quickly through traffic, sometimes running red lights or

going down the street on the wrong side against the flow of oncoming vehicles. Once

there the scene may be filled with violent people or laden with many kinds of chemicals

or bio-hazards that could harm or kill them. They must deal with patients and with the

situation at hand; many incidents are mundane and simple enough to deal with, but then

there are others that are not. Situations with multiple critical patients, large fires, active

shoot outs, pregnant patients having a complicated delivery, trapped and dying

individuals from accidents, or senseless acts of violence towards people make the job

much harder to do (Vettor & Kosinski., 2000). Working on injured and/or ill patients

places the emergency healthcare worker at risk for exposure to air-borne and blood-borne

pathogens that can transmit diseases like Tuberculosis, Hepatitis, and HIV (Beaton et al.,

2005). Besides taking care of the needs of the patient, the rescuers are dealing with

bystanders who can be not only a nuisance but can also pose a threat to the rescuers

safety. Many times the EMTs and paramedics then face dangers during the process of


transporting the victims to the hospital. At the hospital the stress may stop for some of the

EMS personnel but it is just starting for others, like the receiving hospital staff.

EMS workers are expected by the public to thrive in stressful situations and to

come through it unscathed (Carolan, 2007). This expectation is often contradictory to the

comments of people in society who say things like: “you could not pay me enough to do

your job”, “I could never deal with the things you see and do”, or “I don’t know how you

do what you do”.

Kanner (1991) points out that the physical stressors of the EMS work

environment can cause career limiting injuries for EMS workers. He continues in the

article to suggest that despite wellness classes for EMS workers to educate them on

proper lifting and safe work practices designed to reduce on-the-job injuries; they will be

expected to do their job under conditions that cannot be planned for or that set them up

for injury. Examples include police officers having to chase suspects over/ under/ through

many different obstacles and over dangerous terrain, paramedics who have to lift people

from a bath tubs, or firefighters who may have to carry patients through tight spaces and

down stairways while wearing heavy cumbersome equipment. He also states that back

injuries are the most common injury occurring in this line of work. Finally he suggests

that regular training and enforcement of good body mechanics does help reduce the

chance of EMS workers hurting themselves (Kanner, 1991).

A study of 101 volunteer French Firefighters was done and reported on by Lourel,

Abdellaoui, Chevaleyre, Paltrier, and Gana in 2008. The researchers looked into the

Firefighter’s workplace and its impact on their mental health. They stated the study

revealed that job demands predicted depersonalization and emotional exhaustion.


Personal achievement, on the other hand, was not linked to job organization. The

researchers also found that the duties of firefighting seem to be a strong source of stress

and mental strain. This occupation may create psychological trauma that could turn into

post-traumatic stress disorder (Lourel et al., 2008). Something else thing to take into

account regarding working conditions is that, besides military personnel, firefighters and

paramedics may be the only occupations that must respond to a potentially life-

threatening emergency from a state of sleep (Beaton et al., 1995).

A study of stress levels according to the beginning or end of shift was done on

200 Italian police officers. One hundred were traffic officers and 100 were based in the

office. It was found that with both groups there were more mal-adaptive responses to

stress such as anxiety and aggression at the end of a shift compared with the start of the

shift. However there was a significant increase in the traffic officers scores compared to

those of the office workers. Part of the explanation for the field officers scores might be

due in part to the chronic exposure to hazardous substances from automobiles and

industry. Chronic exposure to carbon monoxide appears to lead to chronic

poisoning which manifests as headaches, blurred vision, poor

concentration, confusion, and irritable or violent behavior. Also,

psychiatric symptoms can be found following exposure to carbon

monoxide, lead and mercury. Another interesting anomaly is in the

increased maladaptive coping at the end of the shift that single

mothers have over the rest of the population studied. Being a single

working mother seems to dramatically increase work-overload and

stress in general (Tomei et al., 2006).


Effects of stress on EMS Family Members

The effect of stress and PTSD on emergency workers can encompass more than

the individual; it can spill out onto the workers family. Emotional and psychological

issues arise from exposure to stressors; this often includes anger, irritability, depression,

and detachment from relationships. Work stress and negative mood negatively affect the

quality of family life, primarily causing problems within a marriage and in relationships

with children. This in turn leads to reduced family cohesion (Thompson, Kirk, & Brown,

2005).

Reported by Johnson, Todd, and Subramanian (2005), the stress of emergency

work is thought to cause some police officers to abuse their spouses or engage in other

types of family violence. The abuse is sometimes physical but more often is verbal and

psychological. There are several theories about what the cause is for family violence such

as: “isolationism (sociological theory), violence exposure (posttraumatic stress

syndrome), job burnout (occupational stress theory), authoritarianism/control (feminist

theory), and substance abuse (bio-psychological theory)” (Johnson, et al., 2005:3).

Johnson testified before congress in 1991 that she had done a study of 425 police officers

and the study revealed 40% of them had been involved in domestic violence of some sort,

ranging from pushing/shoving to the use of firearms on their loved ones (Johnson et al.,

2005).

According to Regehr (2005), paramedics and other emergency workers are

frequently exposed to high trauma incidences. Having family support through these


events significantly reduces the emotional and psychological traumas that the emergency

worker faces. Those individuals with a high level of family support are less likely to take

mental stress leave from work after a critical incident. Often the significant other of an

emergency worker has negative feelings toward the relationship caused by the negative

mood of the emergency responder. The skills needed to be an emergency worker, such as

making quick decisions, being in control, and emotional detachment are often the other

end of the spectrum of what it takes to be a good family member or spouse. Also,

opening up to the family members about the details of traumatic events that have been

experienced at work, it can cause STS in the family members. Another problem faced by

family members of an emergency worker is the impact that shift work has on the family.

Mandatory overtime is unpredictable and plans often need to be changed or discarded,

this leads to feelings of neglect and abandonment in addition to being unsure about the

loved ones safety (Regehr, 2005).

Children who are continually exposed to traumatized first responders to whom

they are emotionally linked may develop secondary traumatic stress symptomatology.

The psychological condition of the emergency responder is one of the predictors of their

children developing psychological and emotional problems after a traumatic event. A

study of 8,236 New York children, ages 9-21 that was done six months after the

September 11th terrorist attacks showed that the highest rate for the possible development

of PTSD came from children with EMT/paramedic family members. This was followed

by children with police officers as family members and lastly by children with

firefighters as family members, who scored the same as children with no family in

emergency service. The study suggests that the difference could be partially attributed to


the fact that EMT/paramedics are found to have higher levels of stress compared to

firefighters and police officers, as well as the children’s exposure to the 9/11 incident,

and possibly their demographics (Duarte et al., 2006).

Coping with Stress

There are some beliefs and feeling amongst emergency workers that stress comes

with the job and that it is a necessary evil that comes attached to the excitement and joy

of having a rewarding job, being able to save someone’s life. These professionals know

the destruction that stress can wreak upon life, but they are too often blind to the effects

that it has on them at the moment. Despite their knowledge of stresses destructive power,

they often wear it like a badge of honor and courage to show that they can handle

whatever is thrown at them (Heyworth, 2004).

It is widely known that many emergency personnel often use a negative coping

mechanism that is referred to as the "John Wayne" syndrome. It is characterized by a

worker who hides their feelings and emotions to cope with the hard reality of some of

their calls. They found that this is a strong predictor of burnout for Firefighters. It is then

suggested that individuals who exhibit this behavior should be monitored, given regular

debriefing sessions, and have access to a permanent system of social and psychological

support. There seems to be no difference as to age, sex, and level of experience of the

person who has a highly stressful job and their likely hood to reach burnout (Lourel et al.,

2008).

Another long held belief is that humor counteracts stress. Humor in emergency

workers is often crude, callous, and macabre. Often referred to as gallows humor, it is a

way in which emergency workers cope with the doom and gloom of their profession.


Humor is a proven beneficial and useful tool in fighting off stress, specifically it is a

cathartic mechanism that should not be underestimated in helping emergency personnel

cope with the work they do (Scott, 2007).

There are other coping mechanisms that may be good to look at for people dealing

with the stress of emergency care such as: on-site aroma therapy massage, critical

incident stress debriefings, and staff support systems. All of these seem to hold some sort

of benefit for most of the people who use them; however there is no generally agreed

upon treatment of choice for PTSD. The severity, prevalence, and lack of commonly

agreed on beneficial interventions is a strong argument for the development of a plan to

avoid PTSD, especially in high-risk populations (Everly et al., 1995).

Everly and Mitchell define Critical Incident Stress Debriefing (CISD) and

defusing processes as

“group meetings or discussions about a traumatic event or series

of traumatic events. Although they are not considered psychotherapy, the

CISD and defusing processes are designed to mitigate the psychological

impact of a traumatic event, prevent the subsequent development of

PTSD, and serve as an early identification mechanism for individuals who

will require professional mental health follow-up after a traumatic event.

CISD is intended to accelerate the recovery of traumatized people”(Everly

et al., 1995:176).

Lowery and Stokes wrote that paramedic students and police trainees may be particularly

susceptible to PTSD. And they suggest that debriefing and having a social network of

peers to discuss traumatic events with, as well as to get advice from, is quite effective for


dealing with stressors. The degree to which one is affected by PTSD is related to the

amount of emotional display or repression. Those individuals who suppress their

emotions in order to appear “tough” are not processing the emotions of the event and

therefore they increase the likelihood of developing deeper and stronger psychological

trauma to themselves. A study of seventy-four Australian ambulance paramedic students

showed that there were positive results when they could openly and securely talk over

incidents with others who had gone through similar things. However there was also a

presence of dysfunctional peer support; some paramedic students revealed on their

questionnaire that they felt they could not emotionally open up to their peers, because if

they did they would become social outcasts and/or be shunned for doing so (Lowery et

al., 2005).

Morrissey points out in her article that employers have a responsibility to protect

their employees from harm, both physical and mental. She goes on to state that

employers often make it difficult for the employees to get the help they need after dealing

with a traumatic event. She suggests that they make the effort to start debriefing sessions

as soon after the traumatic event as possible to make the best impact on the employees’

mental strain. She explains that in emergency settings the personnel involved often need

to go on to the next emergency before dealing with their stress from the first. Other

sections of medicine do not necessarily have the same type of constraints as emergency

care. For example in parts of the Royal Belfast Hospital for Sick Children the nursing

staff is allowed to work in non-direct patient care jobs after the exposure to a traumatic

incident with a patient, in order for them to deal with their mental strain from the stress

(Morrissey, 2005).


A 2007 study about the effects of on-site ‘aroma therapy massage with music’ on

the anxiety levels, caused by work-related stress, of Australian emergency nurses found

that there was a marked decrease in the anxiety levels of the nurses after receiving the

therapy. Thus it is suggested that since high levels of anxiety and stress can be harmful to

the physical and emotional condition of emergency nurses there should be a support

mechanism such as on-site massage as an effective a tool for coping with stress (Cooke,

Holzhauser, Jones, Davis, & Finucane, 2007).

Kimbrough-Robinson reported that the Dart Center for Journalism and Trauma

recommends several things to help reduce stress and the possibility of developing PTSD.

Take care physically by eating healthy foods, eating regularly, getting plenty of sleep,

and engaging in physical activities. Take care psychologically by writing in a journal,

decreasing the stress in your life, reading something unrelated to work. Take care

emotionally by seeking out the company of those you enjoy, playing with children, and

allowing yourself to cry. And take care spiritually by singing, meditation, giving to

causes you consider important, spending time in nature, and joining a spiritual

community. It is also strongly suggested that if the recommendations don't work then the

individual should seek professional help. The real sign of courage is getting help when

you need it. There is no shame in asking for help. However, it would be a misfortune if

the need for help was ignored, as we humans are not immune to tragedies of life

(Kimbrough-Robinson, 2005).

Stress and its effects are felt by everyone in all types of societies and cultures.

This is especially true for emergency healthcare workers. Stress has become one of the

largest mental health problems in the United States today. The manifestations of stress,


PTSD, STS, and burnout not only affect the person that is directly touched by the stressor

but also those who are close to that person. Marriages, friendships, and family ties are

often stretched to the breaking point and sometimes past it. This in turn can cause more

stress and possibly the loss of a support group making coping more difficult. So it is

important to recognize when there is a problem with stress and to have a game plan in

place to deal with it as it occurs.

Research Questions

RQ 1: What is stress like for emergency workers?

RQ 2: What kinds of stress do emergency workers face?

RQ 3: How do stressors affect emergency workers?

RQ 4: What do emergency workers do when they feel stress?


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