March 4, 2024

Mental Health in EMS

The topic of mental health in EMS has not been formalized for far too long. Previously, many have had informal processes in place for mental health interventions, but mainly for post-event occurrences and not prospective or preventative.

There was no set person assigned or trained at one department to address such concerns. The situation was usually referred to the local Employee Assistance Programs, with front-line personnel not really understanding the process or resources available. The goal of the Mental Health Resilience Officer, or any equivalent course/training available, is to fill this role. The assigned person, as well as the process, should be spelled out. 

Those in the Safety Forces experience a 200-fold increase in exposure to traumatic events, but do we have a 200-fold increased strength against such occurrences? Of course not. Then what can be done with this awareness to such stress? It is where formal mental health support is needed.

In the following discussion, and continuing medical education on mental health in EMS, we shall discuss the physiology of stress and its signs and symptoms. Also, you will be introduced to the concept of a “stress continuum.” Next, we shall discuss what can be done to address the different levels of stress with “resilience” techniques. Basically, a form of physical therapy for the mind.  

We will also explore what a mental health resilience officer is NOT. You will not be your department's psychologist or therapist, rather you will be the formally trained contact person versed in awareness and knowledge to monitor your personnel. If needed, guide them through the process and offer supportive techniques.  

Sincerely,



Dr. Campensa, M.D

March 11, 2024

In part 2 of our mental health in EMS series, we discuss the physiology of the stress reaction and define “normal” from “abnormal” response. 

The two main structures involved in the central nervous system’s response to stress are the amygdala and the cerebral cortex. 

• The amygdala is part of the limbic system or our primitive brain. It is where “fight or flight” reactions reside, important in our survival.

• The amygdala is autonomic, requiring no actual thinking. An example of this is our startle reflex. It is important for survival when a perceived threat does not allow much time to think and react. (But not all unanticipated loud noises are actual threats, such as a pan falling in the kitchen.)

• The impulse from the amygdala is sent to the cerebral cortex for the conscious thought process to occur. Was the loud noise just a pan falling, or was it something worse, like an active shooter? Your conscious mind then decides which it is and how to respond.  

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If the two structures “short out” in their processing, then this results in a person “freezing up” with an inability to respond. 

We all exhibit reactions to stress, but when do these reactions cross the line from “normal” to “abnormal”? It is a gray area, but if the stress response is less than one month long, is mild, and temporary, then it is considered “normal” and treated with our own self- care and the support of peers. 

If the stress response lasts more than one month or is severe, then it has crossed into the” abnormal,” which would require some level of intervention. One of the first signs of such in healthcare is compassion fatigue. We are in the business of caring for others; when we lose this empathy for others, we cross the line into an abnormal stress reaction, affecting the care we provide to our patients.    

Next week, we discuss the stress continuum. From definitions of thrive, survive, struggle and crisis, to signs and symptoms with recommended interventional levels of support.

Sincerely,



Dr. Campensa, MD

March 18, 2024

Today, we will discuss the categories related to the stress continuum and resilience techniques as they relate to each other.

Stress is thought to occur on a continuum or progression from thrive (healthy) to crisis (behavioral health pathology). The four categories considered are:

1. Thrive

2. Survive

3. Struggle

4. Crisis

Thrive is considered our baseline of good mental health, using regular coping skills and self-care to maintain optimal functioning.

Surviving is the next phase on the continuum. At this point, you have “just” crossed over into the “abnormal” response to stress, which is mild or temporary. Compassion fatigue may be an early sign with changes in sleep patterns, eating, mood, or focus. Besides self-care, your Mental Health Resilience Officer (MHRO) would offer techniques to relieve stress and peer support.

Struggling is next in the continuum, concerning in that if not treated, it would lead towards crisis. Here, we are in persistent distress and impairment. Not just sleep changes but exhaustion and apathy.   The Mental Health Resilience Officer would need “agency” support from command-level officers and Employee Assistance Programs (EAP) or similar professional assistance.

If not treated, the individual has crossed into the last level, “crisis.” At the crisis level, severe distress and impairment occurs. A behavioral health disorder is present, such as major depression or PTSD. Hopelessness and helplessness may lead to suicidal ideations. At this point, full professional clinical care is warranted. 

To maintain positive mental health, or recover from the different levels of the stress continuum, requires resilience techniques. Resilience is the ability to recover from or withstand adversity or difficulties. You can think of it as “physical therapy” for the mind. There are three areas related to resilience techniques. These include biological or physical health, psychological or emotional health, and social or interpersonal health and relationships.

Each level of the stress continuum (except crisis) has resilience techniques recommended. Biological processes are focused on physical well-being and health. To maintain or thrive, it is recommended to do at least some physical exercise daily. Alcohol and caffeine should be in moderation. Sleep should be as close to 8 hours as possible. Psychologically, you should be aware of the stressors you encounter and maintain social connections with family, friends, and co-workers. 

Once crossed over into the surviving stage of the stress continuum, the levels of resilience also increase. 

• Exercise should be a must.

• Alcohol and caffeine monitored.

• Sleep is now a priority.

• Minimize interruptions such as watching TV in the bedroom or reading your phone/tablet in bed.

• Reflect on the stressors you encountered during your shift.

• Reach out to family and friends and discuss your stressors and other reactions to stress.

               In the next stress level, the struggling phase stress has threatened enough to overwhelm.  

• Do physical exercises that also include the mind such as yoga or Tai-Chi.

• Limit alcohol and caffeine.

• Seek out support groups or consider a therapist to share your concerns.

• Let family and friends in as a true support network. 

The crisis phase, unfortunately, is past that which resilience can heal. An emergent referral for professional intervention is warranted.

Next week, we discuss the last installment of mental health in EMS and the actual role of the Mental Health Resilience Officer, as well as what concrete steps you can take at your agency.   

Till next week’s last installment.

Take care,



Dr. Campensa

March 25, 2024

This is the fourth and last installment of Mental Health in EMS. We will discuss the role of the Mental Health Resilience Officer (MHRO) and how this integrates into your agency.

First, in describing the role of the Mental Health Resilience Officer keep in mind what it is NOT including:

• Agencies

• Therapists

• Psychologists

They are agencies, resources formally trained in recognition of those in distress, educated in resilience techniques, and knowledgeable of professional resources available and how to access them. The MHRO will:

• ENGAGE peers in their understanding of mental health issues.

• RECOGNIZE those experiencing stressors to the point of adverse impacts.

• NAVIGATE peers to and through services available and break down barriers of concerns when accessing such.

• PROMOTE a culture of wellness and mental well-being at your agency. 

An organization committed to wellness and resilience shows that they are truly vested in their personnel. If you feel that your agency values you, you will value your work’s mission and caring for others. The goal then is to start a formalized process. It is not just an informal discussion of EMS mental health issues but a true standard operating procedure that all are in-service and can follow. There are other courses available through organizations related to the safety forces. Seek them out, take the course, and formalize the process. Be the one who writes the SOP to present to your agency. What IS your agency mission? What values will be emphasized, resilience techniques discussed, self and peer support processes learned, professional assistance available? Let’s make 2024 the year that all our agencies under our medical control start and fulfill the process!

Take care,



Dr. Campensa