By Karen F. Deppa, MAPP, and Michael A. Donahue, Ph.D., CFPS, PilotLight Resilience Resources, LLC

The COVID-19 pandemic presents unique challenges to you as an emergency responder.  Regardless of whether you ride apparatus or ride a desk as a senior leader, your job demands will sorely task you. You will be asked to deliver professional service in an environment of increasingly limited resources and unquantified risk.

Being on the front lines providing care to your community while taking every precaution to preserve your own well-being and the well-being of those around you compounds the stress of an already stressful job. You do what has to be done because that’s what you signed up for, that’s what you trained for. The CDC recommends maintaining social distance, but how do you treat a critically ill patient from six feet away? You don’t. You get up close and personal, putting hands on to deliver care and increasing the chance of your own contagion.

You know your community needs you during this medical surge, now more than ever. But these are exceptionally challenging times: longer hours, comrades missing due to infection, insufficient protective measures. All of these challenges are compounded by anxiety over personal exposure to disease. How do you avoid burning out?

Year after year, Careercast.com lists emergency responders (police and fire) among the top few most stressful jobs (along with military service). Individuals in high-demand, low-control jobs, such as emergency response, have a higher incidence of burnout.  In 2019, the World Health Organization (WHO) declared burnout an occupational syndrome “resulting from chronic workplace stress that has not been successfully managed.”

According to WHO, symptoms of burnout include mental and physical energy depletion or exhaustion; increased mental disconnectedness from one’s job, or feelings of negativity or cynicism related to the job; and perceived inefficacy on the job. Burnout is linked to a range of serious health problems, including depression, substance abuse, sleep disorders, and weakened immune response. Professionally, burnout can result in productivity declines and more mistakes on the job.

The Key: Control What You Can

The demand-control-support model of burnout states that in order to decrease the risk for job burnout, at least one of three things needs to happen: 1) Reduce the demands of the job; 2) Increase control over the job; and/or 3) Provide support for the worker.

The mantra of today’s emergency services is to manage risk. This is feasible in a world of sufficient resources, but in a world of dwindling resource availability and increased service demand, managing risk becomes elusive. When there are no more N95 masks, exam gloves, or gowns available, how do you manage risk? Since reduced job demands ain’t happening anytime soon, if ever, let’s consider the possibility of increased control. In some ways, this is also a dead end. It is true that you can’t control the number of calls that come in, which ones you respond to, or the resources at hand. And depending on the situation, you often don’t have control over the outcome, despite your best efforts.

However, let’s look more broadly at how you might influence and take control over other aspects of your life. You may have more control than you think.

First, please make sure you check the boxes that are obvious but crucial to help you remain at your physical and mental best, help your immune system to function optimally, and protect those around you. For example, arrange to eat nutritiously to keep your body fueled in the best possible way. Plan for an adequate amount of sleep, if at all possible. Build in time for regular physical exercise, a great stress reliever. And to that add the CDC’s recommendations for the use of personal protective equipment, handwashing, social distancing, patient interactions, and quarantine where feasible.

Next, consider the following strategies based on research for increasing what’s known as intrinsic motivation:  the motivation that encourages you to engage in a behavior because it is personally rewarding and inherently satisfying. Intrinsic motivation helps to boost your sense of autonomy, the feeling of being in control of your own behaviors and goals.

• Focus on the meaning of your work. Even if emergency response is your full-time job, you’re not in this for just a paycheck. Take time each day to reflect on the impact you have made in your emergency response role. Reconnect with the values and motivation that prompted you to invest in, train for, and practice emergency response in the first place. Helping others actually provides a buffer against burn-out; studies have found that emergency responders who have a sense of the good they are doing in the world (also known as perceived prosocial impact) have greater levels of positive emotion at the end of the day, focus less on the unpleasant aspects of the job, and feel more competent and valued.

• Live your personal values. Your character strengths are those personal values that you express most naturally. To find out what your top character strengths are, take the free Character Strengths survey from the VIA Institute on Character (https://www.viacharacter.org/character-strengths, or simply review the list of 24 VIA character strengths at https://www.viacharacter.org/character-strengths and choose one of them, or another personal value, that you express in your life. Now write (or type) for 10 minutes about why and how you express that character strength/value, and how it makes you feel to express it. This exercise works to build resilience and prevent burnout because it helps you understand the factors that give meaning to your life. When you can connect stressful situations with your ability to express values of personal importance, you’ll be able to cope better with the stress in your life.

• Seek out the good. An optimistic outlook is positively correlated with greater coping due to a perception of control over stress. Here is a research-based technique to help develop a more optimistic outlook. At the end of each day, choose a quiet time to reflect on and write down three good things that happened that day, no matter how insignificant they may seem. Then write down what you had to do with why each good thing happened. This simple exercise, practiced every day for at least a week, has been shown to foster positive emotions and prevent depression related to burnout, because it pulls your focus away from the things that go wrong and onto things that go well, which you otherwise might take for granted. This is by no means suggesting that you ignore the realities of the current situation. Rather, allowing yourself to notice the positive aspects of even the most dismal circumstances can give you the strength and the mental energy to feel in control and seek options and solutions.

Add these control-boosting techniques to your behavioral health toolbox and practice them, not only to get past the current crisis, but to increase your overall resilience to the demands of your emergency response role.

We’ll deal with the “support” factor in the demand-control-support model of job burnout in a future article. In the meantime, please accept our gratitude for your dedication and courage, and take care of yourself.

Karen F. Deppa and Michael A. Donahue are principals of PilotLight Resilience Resources, LLC, creators of the Respond with Resilience™ class in Psychological Wellness for Emergency Services First Responders.  Learn more about us and our class at www.pilotlightresilience.com

Sources:

Centers for Disease Control and Prevention (2020). Interim guidance for emergency medical services (EMS) systems and 911 public safety answering points (PSAPs) for COVID-19 in the United States. March 10, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html

Fontaine, K. R., Manstead, A. S., & Wagner, H. (1993). Optimism, perceived control over stress, and coping. European Journal of personality, 7(4), 267-281.

Grant, A. (2020). Burnout isn’t just in your head. It’s in your circumstances. New York Times, March 19, 2020. https://www.nytimes.com/2020/03/19/smarter-living/coronavirus-emotional-support.html

Grant, A. M., and Sonnentag, S. (2010). Doing good buffers against feeling bad: Prosocial impact compensates for negative task and self-evaluations. Organizational Behavior and Human Decision Processes, 111(1), 13-22.

McGonigal, K. (2015). The upside of stress: Why stress is good for you, and how to get good at it. New York, NY: Penguin Random House.

Reith, T. P. (2018). Burnout in United States healthcare professionals: a narrative review. Cureus, 10(12).

Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American psychologist, 55(1), 68.

Van der Doef, M., & Maes, S. (1999). The job demand-control (-support) model and psychological well-being: a review of 20 years of empirical research. Work & stress, 13(2), 87-114. DOI: 10.1080/026783799296084

VIA Institute on Character. www.viacharacter.org

World Health Organization (2019). Burn-out an "occupational phenomenon": International Classification of Diseases. May 28, 2019. https://www.who.int/mental_health/evidence/burn-out/en/