A Stress Management Tool for EMS Professionals - Health And Safety - @ JEMS.com

A Stress Management Tool for EMS Professionals



John Amtmann, EdD, NREMT-B | | Monday, July 27, 2009

That familiar tone rings out, and the dispatcher relays information of a true emergency: a rollover with multiple victims. You and your partner hop into your trusty rig and hope the injuries are minor, but are prepared for the worst. You can feel your heart pounding in your chest, part of the effects of the "fight or flight" syndrome. What should you do? Take a deep breath and relax.

There are many sources of stress for the EMS professional: patients suffering and in pain, life and death situations, and interpersonal conflict with other professionals in the field, just to name a few.(1) The only time we're completely free of stress is when we're dead. Even when we sleep we're vulnerable to stressful dreams.

Researchers have found that, over the long term, stress (e.g., anger, hostility, a sense of hurriedness) can lead to the development of cardiovascular disease at an accelerated pace.(2) Also, medical experts don't know exactly what causes most (90%) hypertension cases, but some believe the inability to manage stress in a healthy manner may have a significant role in the development of hypertension and other diseases.(4,5) And hypertension is a major risk factor in the development of heart disease.

More relevant to the short term is the fact that the ability to deal with stress is important to the success of EMS professionals. It's difficult to function effectively when anxious, angry or overly aroused.(3)

Take a Deep Breath

Most notable in this area of research are Drs. Herbert Benson and Dean Ornish. Dr. Benson found statistically significant decreases in resting blood pressure in patients who were taught how to elicit what he calls the "relaxation response" (i.e., meditation) by employing deep-breathing techniques.(5) Dr. Ornish documented significant decreases in atherosclerotic plaque using a program that focused on diet, exercise, group therapy and similar breathing exercises.(6) This is significant in light of the research conducted by Maguire and associates, which found that cardiovascular events were the second leading cause of deaths of EMS professionals, behind motor vehicle accidents.(7)

So, how do you effectively perform these deep-breathing exercises?:

1) Sit quietly in a comfortable position.

2) Close your eyes gently.

3) Breathe slowly and deeply. (Many beginners worry about whether they're actually meditating correctly and so their minds begin to wander off. Concentrate on your breathing and dismiss other thoughts that come into your mind.(5))

Go ahead and give it a shot. Done? You know what? You just meditated! Do this for 10Ï20 minutes, twice a day, and we promise your body and mind will feel better as a result.

Pretty simple, eh? I know what you're thinking,I can't just stop in the middle of a stressful call and do this whenever I feel like blowing a gasket!But the thing is you don't have to be seated cross-legged in a quiet room with your shoes off to receive the benefits of deep breathing. You can make use of deep-breathing techniques anytime, anywhere, before/after a call -- just breathe deeply.

You might also be thinking ÚI wouldn't have time to do it for 20 minutes!In this case, just do as many deep breaths as you can. In as little as three minutes, this simple technique can have a calming, revitalizing effect.

An option you may find helpful is to choose a word or phrase of significance to you. This word or phrase is often times referred to as a "mantra." During exhalation, repeat your mantra slowly in your head or out loud.

There are even different types of breathing, such as belly breathing, diaphragmatic breathing, and breath-holding techniques. Experiment with different techniques, but make sure to breathe fully and deeply during this practice.

The Physiology of Meditation

How does meditation work? Well, that requires a little review of the autonomic nervous system. This system is responsible for maintaining the body's internal environment. Although it's considered involuntary, the autonomic nervous system appears to be closely linked to emotion.

In general, there are two divisions of the system: the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system is responsible for releasing epinephrine, which has a stimulant effect on the body.(8) The well known "fight or flight" response is a product of the sympathetic nervous system and various emotions (fear or anger) and was originally designed to prepare our ancestors' bodies to deal with life-threatening situationsƒan attacking saber tooth tiger, for example.

Today's problems arise when we perceive non life-threatening situations to be life threatening, and our body initiates the fight or flight response. Examples are the impending deadline for a project or an emergency situation, like the ones you encounter as an EMS provider. Over time, the temporary increases in blood pressure may become permanent, leading to hypertension.(2)

The second part of the autonomic nervous system is the parasympathetic nervous system. When stimulated, this system has the opposite effect as the sympathetic nervous system.(8) Instead of a stimulating effect on the body, a slowing down of the body's processes occurs. The conscious deep breathing involved in meditation and yoga stimulate the parasympathetic nervous system, slowing heart rate and metabolic rate, lowering blood pressure, and reducing unneeded muscular tension. Deep breathing might also be a more efficient way of delivering oxygen to the body.(9,10)


The EMS professional is expected to provide exceptional care, despite how stressful the situation might be. Though the "fight or flight" response may be activated, EMS professionals cannot usually fight or flee from any of the stressors that are common place in our profession. In fact, we're expected to function efficiently and effectively in high-stress situations. The technique outlined in this article may prove useful during those times when your sympathetic nervous system is working overtime. But keep in mind that there are many different methods that can elicit the relaxation response. I recommend you look at the works in the reference list for a more expansive list of techniques or go towww.meditationcenter.com.

John Amtmann, EdD, NREMT-B, is a professor of Applied Health Science at Montana Tech of the University of Montana in Butte, Mont. He's an EMT with A-1 Ambulance in Butte, an ACSM certified preventive and rehabilitative exercise specialist, and an NSCA certified strength and conditioning specialist. Contact him at JAmtmann@mtech.edu.


  1. Huber D:Leadership and Nursing Care Management. Second Edition.Philadelphia: W.B. Saunders Company, 2000.
  2. Benjamin S, Benson H, Gordon J: "Mind-body medicine: Expanding the health model."Patient Care. 31(14):126Ï137, 1997.
  3. Anshel M:Sport Psychology: From Theory to Practice. Fourth edition.San Francisco: Benjamin Cummings, 2003.
  4. Powers S, Howley E:Exercise Physiology: Theory and application to fitness and performance. Fourth edition.New York: McGraw-Hill, 2001.
  5. Benson H, Klipper MThe Relaxation Response.New York: Avon Books, 1976.
  6. Ornish D, Scherwitz LW, Billings JH: "Intensive lifestyle changes for reversal of coronary heart disease."JAMA.. 280(23):2001Ï2007, 1998.
  7. Maguire BJ, Hunting KL, Smith GS: "Occupational fatalities in emergency medical services: A hidden crisis."Annals of Emergency Medicine.40(6):625Ï632, 2002.
  8. McArdle W, Katch F, Katch V:Exercise Physiology: Energy, nutrition, an human performance. Fourth edition. Baltimore, Md.: Lippincott Williams & Wilkins, 1996.
  9. Cox R:Sport Psychology: Concepts and Applications. Fifth edition.New York: McGraw-Hill, 2002.
  10. Williams J, Harris D:Relaxation and Energizing Techniques for Regulation of Arousal. In Applied Sport Psychology: Personal growth to peak performance.Calif.: Mayfield Publishing Company, 2001.


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Related Topics: Health And Safety, Provider Wellness and Safety, stress, meditation, John Amtmann


John Amtmann, EdD, NREMT-Bis a professor of Applied Health Science at Montana Tech of the University of Montana in Butte. He’s an EMT with A-1 Ambulance in Butte, an ACSM certified preventive and rehabilitative exercise specialist and an NSCA certified strength and conditioning specialist. Contact him at JAmtmann@mtech.edu.


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