First Responders First - Physical, mental, & emotional toll of stress

Any disturbance of the human body, such as temperature changes, infections, emotional responses, or any of the situations described in other course modules can produce a stress response.

Regardless of the source of the disturbance, the body responds to different types of stressors similarly. In some cases, stress can be positive as it helps people overcome challenges.

These are often short-term stressors, like responding to sudden loud noises, that activate the fight-or-flight response through the sympathomedullary pathway or SAM.

A stress trigger causes the hypothalamus to send action potentials, or messages, to the adrenal medulla, stimulating the release of epinephrine and norepinephrine.

This causes a temporary increase in heart rate, blood pressure, and blood glucose as well as bronchiole dilation. Nutrients like blood, glucose, and oxygen get redirected to essential organs like the brain, heart, and skeletal muscles.

Usually, people experience a pounding heart, faster breathing, sweaty palms, and trembling hands. Though short-term stress is helpful, long-term stress can become detrimental.

Prolonged stress involves the interaction between the hypothalamus, pituitary, and adrenal glands, also called the hypothalamic-pituitary-adrenal or HPA axis, and initiates a cascading hormonal response.

The hypothalamus secretes corticotropin-releasing hormone, triggering the anterior pituitary gland to release adrenocorticotropic hormone, signaling the adrenal glands to release aldosterone and cortisol.

Aldosterone increases blood volume and blood pressure. Cortisol increases blood glucose, facilitates the breakdown of proteins and fats, and temporarily suppresses the body’s immune response.

Chronic exposure to stressors like financial difficulties, career concerns, relationship problems, and deadlines can lead to persistent elevations in heart rate, blood pressure, and blood glucose, eventually leading to health problems like heart disease and diabetes.

Continual diversion of blood circulation away from non-essential organs can cause problems in the skin and digestive systems.

People in this phase may experience difficulty concentrating, fatigue, depression, and anxiety. Although prolonged stress can have a marked physical effect on the body, studies have shown that chronic stress can inhibit the brain’s prefrontal cortex.

This creates difficulties in concentration and memory and also interferes with decision making, negatively affecting the ability to appropriately respond and recognize client status changes.

Eventually, unresolved chronic stress can also lead to the development of mental health disorders. One study showed that healthcare providers exposed to chronic stress during the COVID-19 pandemic reported heightened levels of depression, anxiety, insomnia, and distress.

Often, the first steps to promote mental well-being include incorporating stress management techniques and seeking mental health resources and services from employer programs, mental health professionals, support groups, and/or nonprofit organizations that specialize in mental health support for healthcare providers.

In times of stress, here are some interventions that may help. First, identify signals that may indicate impending burnout.

These may include increased heart rate, difficulty concentrating, negative emotions such as irritability, depersonalizing relationships or concerns, and social conflicts with friends, family, or coworkers.

Use these signs as guideposts to inform your physical, mental, and emotional breaks throughout the day. Second, take moments to unwind.

This can include stretching or elongating your spine at different points throughout the day, taking a walk outside during a break, practicing deep breathing techniques, or listening to a calming song during breaks or when a shift ends.

Third, take extra time to recover after particularly challenging moments. Recharge and reset before returning to your shift.

Fourth, focus on positive thoughts. When washing your hands, take the 20 seconds to recall three things you are grateful for.

When you are feeling stressed, remind yourself why you became a healthcare worker in the first place. Lastly, seek help when needed.

When stress is overwhelming, it is important to reach out to support systems like friends, family, or mental health professionals.

If help is needed right away, call, text, or visit the websites for the following hotlines, like the National Suicide Prevention Lifeline, SAMHSA National Helpline, SAMHSA Disaster Distress Helpline, and the Crisis Text Line.

Long-term mental health resources are also available to provide ongoing assistance. Recent surveys of healthcare employers show over half have built out or developed mental health resources for their employee base since the COVID-19 response began.

‘External’ or third-party support groups like the Frontline Nurses WikiWisdom Forum and Compassionate Listening Circles offer healthcare providers the opportunity to share experiences outside of their work environment.

Mental health services through organizations like the Emotional PPE Project offer no-cost mental health services to healthcare providers.

NAMI Frontline Wellness, an initiative launched by the National Alliance on Mental Illness in partnership with First Responders First, offers a suite of no-cost digital resources and community support services for frontline workers.

Childcare support from organizations such as Bright Horizons and YMCA Emergency Childcare Services can alleviate the burden of childcare, allowing healthcare workers to focus on their occupational needs.

##SummaryAs a quick recap, you will experience various sources and levels of stress. Short-term stressors can be beneficial and allow people to grow and eventually overcome challenges by activating the fight-or-flight response.

This stimulates the release of adrenaline hormones increasing heart rate, blood pressure, and blood glucose and causing symptoms like a rapid heartbeat, fast breathing, sweaty hands, and trembling.

Prolonged, long-term stress is harmful and triggers the release of aldosterone and cortisol. This increases blood pressure and blood glucose as well as fat and protein metabolism and immune system suppression.

Continual exposure to chronic stress can lead to physical health issues like heart disease, diabetes, digestive disorders, and mental health issues like anxiety, depression, and insomnia.

Some stress management techniques include identifying your individual signs of burnout, finding moments and practical ways to rest and recharge, focusing on positive thoughts, and seeking mental health services when possible.