Mental training can help firefighters and others cope with stressful jobs
February 4, 2013 10:00 AM
Engine House 17 firefighters Kevin Murphy, left, and Dan Reiser list the groceries they'll need for a lunch of Cuban sandwiches and a Greek chicken dinner. Early that morning firefighters went out on a call to help a woman going into labor.
After receiving the call about sparking wires, firefighter Dan Reiser puts on his gear in the parking lot. When the firefighters return later to the grocery store, their cart is still there.
Firefighter Dan Reiser, left, speaks with firefighter Bill Gilchrist after finishing up on a call for sparking power lines on Friday, Jan. 18, 2013.
Firefighter Dan Reiser prepares pork for the station's Cuban sandwiches on Friday, Jan. 18, 2013. Station 17 would receive and respond to three calls during the meal preparation, leaving the food unready each time.
Firefighter Dan Reiser, left, and Lieutenant John Gardell exit Fire Station 17 in Homewood in order to make a trip to the grocery store for lunch on Friday, Jan. 18, 2013.
From left, firefighters Kevin Murphy and Dan Reiser and Lt. John Gardell enter a Giant Eagle to buy items for the day's meals. Three minutes into shopping, the three receive a call for sparking wires near a residence and leave the store.
While responding to an early morning call for a pregnant woman going into labor, firefighter Bill Gilchrist runs through several checks on engine 17 on Friday, Jan. 18, 2013.
Lt. John Gardell uses his radio to talk to dispatch while examining power lines on a call on Friday, Jan. 18, 2013.
After finishing a first responder call at a senior independent living facility, Lt. John Gardell returns to the fire truck.
Firefighter Dan Reiser smokes a cigarette while engine 17 wraps up a call about sparking power lines on Friday, Jan. 18, 2013.
Lt. John Gardell, center, and firefighter Dan Reiser, return to Giant Eagle to find their cart exactly where they left it on Friday, Jan. 18, 2013.
By David Templeton Pittsburgh Post-Gazette
STRESSED OUT:One of an occasional series on managing stress
Settling in to sleep in Engine House 17 in Homewood, Ed Farley curls up with his two-way radio to catch every fire, medical or accident call citywide throughout the night despite a firefighter at the front desk and an alarm system that sounds whenever his unit must respond.
"I don't want to miss a run," said Capt. Farley, 51, of Beechview. "I'm a firefighter. That's what they pay me for."
Because of his vigilance, Capt. Farley doesn't sleep soundly, if at all, during his 24-hour and oftentimes 36-hour shift. When the alarm does sound, firefighters awaken wide-eyed with a surge of adrenalin and flash of stress hormones. Energy levels spike. The heart beat hammers. The mind whirls with anticipation. And what science now reports, such scenarios can affect health if the person has trouble returning to calmness.
"I have headaches and fluctuations in weight. On a stressful day I need to unwind," Capt. Farley said. "This is a stressful job. People's lives depend on us. A lot of times it's unknown what we're walking into."
Acute stress occurs suddenly and is unanticipated. The alarm, then the dash to the truck, followed by the high-speed rush to the fire, accident or medical call, with additional stress of entering burning buildings, saving lives by risking one's own and witnessing destruction -- they all can exact a toll on health.
Firefighting stress prompted Pittsburgh Firefighters Local No. 1 to enlist the help of Bruce S. Rabin, the University of Pittsburgh immunologist and stress-management expert often known by the misnomer, "Dr. Stress." He's been conducting two-hour sessions with the city's 570 firefighters in its 28 firehouses to instill skills to help them avoid the health effects of stress.
Based on pension board records, the union says the average retired firefighter doesn't reach the age of 71. Social Security and U.S. Census data state that a 40-year-old man today, on average, is expected to live to be almost 78.
CareerCast.com lists firefighters as the third most stressful job behind enlisted military personnel and military generals. Stress is known to cause a long list of physical and mental health problems, including heart disease, hypertension, type 2 diabetes, autoimmune diseases, depression and problems with brain function and memory.
During his first session in Engine House 17, Dr. Rabin recognized an unexpected health threat -- the noise of continuous radio chatter and the alarms citywide that firefighters were exposed to, even when they didn't involve the firehouse. He told John Gardell, a firehouse lieutenant and the union's recording secretary, that the persistent noise levels elevate stress hormones with negative effects on health.
In a resulting pilot project at three firehouses in the city including 17, Firehouse Automation is installing a computerized system that provides more information faster, to improve response times, with an alarm featuring a calming hum that gradually gets louder. Firefighters also hear only those calls and radio information pertinent to their firehouse.
Lt. Gardell, 35, of Banksville, said he now realizes the benefits.
"Any time the alarm goes off, the heart goes off, and it's more difficult in the middle of the night when you have to go from zero to full capacity within seconds," he said. "And at the same time you are processing what you are dealing with and whether there will be trouble."
Dr. Stress to the rescue
Dr. Rabin's program book, "Coping With Stress for Health and Wellness," says stress "disrupts the chemical and physiological balance of the body by activating stress-reactive areas of the brain" and releasing stress hormones into the bloodstream.
Coping mechanisms help blunt this flow of hormones and prevent stress-induced disruptions of important bodily functions. Each person should strive to keep stress levels below one's own trigger point, which is the level where health-altering stress hormones are released because of the difficulty of stopping their flow.
The human mind is the prime culprit in stress's assault and battery.
Reducing anger and temper outbursts can work to prevent stress-induced depression, high blood pressure, the risk of heart attack, and the need for pain medications. Better stress control coupled with lifestyle improvements and interactions with friends and family can enhance sleep, cognitive ability, immune function and health by reducing the inflammatory response stress causes, which can lead to chronic illness and a shorter duration of life.
"What determines the trigger-point is the individual's perception of the stressor, its intensity and its duration," Dr. Rabin's program says. "Coping mechanisms may be considered the anesthesia that reduces the response of the mind to stress."
The ultimate goal is to develop a conditioned response to stress. Dr. Rabin said he has trained his own mind to turn off stress hormones automatically.
His lifestyle program, which he recommends to reduce the influence of acute and chronic stress on health, is based on the acronym "RELAX," which means:
• Reflection. Enjoy participating in spiritual or religious activities or taking time to reflect on things that add meaning to life.
• Expectations. Practice being optimistic.
• Laughter. It's difficult to think negative thoughts when laughing or smiling.
• Acquaintances. Spend quality time with friends and family.
• eXercise. It is well documented that physical activity reduces stress and improves health.
Dr. Rabin's program also offers techniques to cope with acute and chronic stress. Those interested in reducing the effect of acute stress on health can consider the following techniques:
Deep breathing -- more specifically, abdominal breathing -- draws in six times the volume of air that chest breathing does. With a hand on the stomach, breathe in a way to make the belly rise an inch or two. Closing one's eyes improves the effect. Oxygen improves awareness and reduces the brain's beta waves that cause restlessness. To avoid feeling faint, take only three to five deep breaths per session.
Dr. Rabin advises people to tuck three to five funny thoughts into the mind, then recall those thoughts to extinguish the flames of stress. He said it's difficult to experience stress when recalling a happy or funny moment and smiling.
Chants of choice -- "I will be well," or "I am a good person," or some other comforting reminder -- can help a person withstand, or recover from, a stressful episode. Set the chant to a simple tune and chant quietly then silently. Chanting during calm moments trains the mind to return to that calm state whenever the technique is used.
Because the mind often isn't focused and even blurs during stressful episodes, Dr. Rabin recommends posting reminders to use the techniques and sharing them with others, forging an agreement to remind each other to use them during stressful times.
Managing chronic stress is a more advanced problem.
It can result from the effects of the mother's stress on the fetus, childhood abuse or trauma, or major traumatic events throughout life. In those cases, people no longer release enough cortisol, the hormone that suppresses stress hormones and returns the body to a calm state.
Managing chronic stress also requires the "RELAX" lifestyle, but it uses different techniques than those used to manage acute stress. They include expressive writing, meditation, guided imagery, body awareness and mindfulness.
Those methods will be discussed in more detail in the third installment of this series.
Colleague in the field
Dr. Rabin said Betsy Blazek-O'Neill, medical director of the Integrated Medicine Program at Allegheny General Hospital, is one of the few physicians in the area who readily recognizes the health impacts of stress, and uses that knowledge to help patients manage it.
Dr. Rabin's program, she said, is "sound and well designed" with many options for patients. Dr. Blazek-O'Neill also teaches the techniques so people can prevent stress from exacerbating their health problems.
"As with most things like this, you want to give people options, just like you do with exercise and eating. Not everyone will want to do the same thing," she said. "Dr. Rabin is great in explaining the physiology of stress and the stress response, with options that people like and can build into their lives."
People who are ill, she said, often also are dealing with family, financial or employment problems, or have suffered from abuse or traumatic events in life. The health impact of stress alone is difficult to isolate, but it's clear that it notably affects health. "When things are going well in life, people usually are healthier than when their lives are falling apart," Dr. Blazek-O'Neill said.
Allegheny General uses stress-management techniques to assist not only patients but also staff members showing difficulties in coping with stress. Studies definitively show that stress management and a positive attitude improve outcomes for those diagnosed with major illnesses, including breast cancer, she said.
For now, Dr. Blazek-O'Neill said, the health impacts of stress "are under-appreciated" by health insurance providers, medical providers and the general public.
"We are developing programs to build stress management into more of what we do," she said, including using aroma therapy and making relaxation techniques recorded on compact discs available in waiting rooms.
"People in the hospital need attention to their physical concerns but also to their psychological and spiritual concerns," Dr. Blazek-O'Neill said. "We can't treat them as machines. We have to treat all aspects of the person."
And with Dr. Rabin's help, city firefighters also say their awareness is raised about how stress might be affecting their professional and private lives.
"Is it a stressful job? Absolutely," Capt. Farley said. "Is it an exciting job? Absolutely and very rewarding. But is it a heartbreaking job? Yeah. The things we see, how people live, the destruction that fire does, or a person in an accident, or a person in pain, you take that home with you.
"You picture the ones you love in that situation, and when you go home you want to give your daughters a hug."
Moments later, a fire alarm sounds for Engine House 17. Information about the call scrolls across the new electronic signboard in the firehouse. All eight firefighters work to memorize the address, the crossing streets and the basics about the fire call. Within a minute they have scrambled aboard the two fire trucks and go flying down North Braddock Avenue with sirens wailing.