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A “Paramedic-Athlete” Model for Improving Mental Wellness and Resilience in Canadian Paramedicine

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BY ALYSSA KOHL AND AMAN HUSSAIN

Like athletes, paramedics are required to perform at their best, regardless of the circumstances. In a sense, they are always expected to be ready to utilize their knowledge and skills at a moment’s notice. Collectively, paramedics (and other First Responders) face heavy work demands which often involve routine and/or prolonged exposure to various physical and psychological stressors.1,2 Unlike athletes, however, some of this routine work could often involve traumatic stressors, such as having to attend to a call where the patient involved reminds the responder of a close personal connection. It is these traumatic stressors, or occupational stress injuries (OSI), that distinguish the work of paramedics and other First Responders from almost any other occupation. A large body of research has found that consistent exposure to OSI takes a toll on and can increase the potential for paramedics to experience burnout.3,4 If steps are not taken to manage OSI and burnout, the cumulative effects can lead to the development of post-traumatic stress disorder (PTSD). In order to manage the effects of stress, we can look to other performance contexts (e.g., sports) that utilise evidence-based psychological skills to prepare their personnel for these heavy work demands.5,4,6,7 This is because human performance is human performance, regardless of context.8,9,10 Consider the following case as an illustrative vignette:

My last race at the Canadian Sprint Canoe-Kayak Championships did not go as planned. My mind is ruminating over where I went wrong, but there is no time to dwell on any disappointment and negative emotions. In the moment, I have to re-set and re-focus on the next race, starting with my pre-race routine and trust in my preparation. All I can control in the next few moments are my first few paddle strokes.

Table 1

Life Skills Learned From Sport
  • To perform under pressure
  • To communicate with others
  • To handle both success and failure
  • To be patient
  • To respect others
  • To recognize your limitations
  • To accept responsibility for your behaviour
  • To accept criticism and feedback
  • To evaluate yourself
  • To be able to learn
Note: Adapted from Danish et al. (1993)

The parallels of this example and the re-setting between calls as a paramedic are clear. The skills that can be developed participating in sport and/or physical activity represent an accessible way for paramedics to start reflecting on their own mindset as they approach work (or their own performance context). In the early 1990s, a research team documented several life skills that can be developed whilst participating in sport and physical activity contexts (see Table 1).11 From an exhaustive list, these ten skills were found to have the most utility for paramedics, and this article will highlight three specific areas of relevance.

One only needs to look at the literature for similarities between paramedics and athletes. Research on paramedics, for instance, highlights desirable attributes including braveness, leadership, feeling in control, being disciplined (task-focus oriented), remaining calm under pressure, and being internally motivated, self-aware, resilient, and physically fit.12,13,14 Anecdotal stories from practicing paramedics parallel the desirable attributes of paramedics previously mentioned by researchers.12 Effective communication, for instance, is often viewed as a foundational skill for paramedics. An awareness of one’s strengths/limitations, moreover, can be combined with respect for others (particularly with patients) and the ability to perform under pressure is also perceived to be valuable. The following vignette provides an instructive example:

As a high-performance kayaker and now as a paramedic, I manage my emotions and maintain calm under pressure. In these moments I utilise skills developed as an athlete and put them into practice as a paramedic. I also ensure that I devote time after the race or the call for self-reflection and feedback from my teammates or coworkers. It is from these interactions where there is opportunity to learn, improve for the next task and enhance my resilience.

Another important parallel between paramedicine and sport is the stigma associated with attempting to access and use psychological skills training or related health and wellness programming. Individuals, regardless of context, who attempt to access psychological services often must navigate and manage this stigma or risk being labelled as weak.15,16 This stigma is often rooted in outdated conceptualisations of how a paramedic (or athlete) is supposed to behave.17,16 Fear of failure and/or showing emotion within the workplace is perceived as unprofessional and inhibits the ability to voice concerns or fears as it relates to their work.18 Yet, the life-skills developed as an athlete can also provide an opportunity to transfer and enhance skills from one context to another. For instance:

Growing up an athlete has provided a solid foundation for performance. For instance, I had to maintain my physical fitness to compete, but it now allows me to lift patients and equipment. I must also maintain a sustained level of motivation to stick with a daily training regimen—discipline that keeps me current with medicine. The confidence I must project in sport and paramedicine is fragile, as any display of insecurity or doubt manifests as weakness and fear of failure. The very thought of people thinking I am not strong or competent is as pervasive now as it was in my paddling career. Holding myself to a high standard keeps me accountable for my actions.

Perhaps it is not that athletes have better mental health or are less susceptible to mental illness, rather, it could be that their mental health support systems are superior (particularly at the high performance and elite levels). One researcher contends that the entire field of sport psychology was developed to provide athletes with tools to combat psychological issues so that their performance is not compromised.15Research demonstrates consistently that utilizing simple psychological skills allows for athletes to get out of their own way.6,7,15 The inability to get out of their own way has been described as a choke or under-performance, given what one is actually capable of.19 Targeted programming for athletes can help prepare for intense moments and to perform under pressure. Sport psychology can benefit a troubled mind that is inextricably connected to the quality of thinking, mood, and physical health of an athlete.14 Programs such as Road 2 Mental Readiness (now known as The Working Mind First Responders) offer a potential solution, focusing on the Big 4 psychological skills including tactical (diaphragmatic) breathing, self-talk, visualisation, and goal setting.6,7,20 Additionally, athletes have expressed that accessing traditional treatment lacks the flexibility in accommodation to erratic schedules or to a service provider who understood the nature of their performance context.14 These same barriers are experienced by paramedics, especially considering that a majority are often involved with shiftwork. We believe that targeted programming for early-career paramedics should be delivered during initial training. Conversations about psychological skills and the potential for stigma must be continually managed and reduced for those attempting to access such programming.20

Lastly, both athlete and paramedic performance are often heavily scrutinised by the public (e.g., during/after games or emergency calls) or even their own peers. This can be constructive, particularly if lessons learned are incorporated into practice. Yet, this same scrutiny often lacks the necessary background or context to be able to make an informed judgment on performances. The risk associated with this is that performers may often stop voicing their concerns or mistakes for fear of being ‘called out’ or humiliated, or may even engage in inappropriate coping strategies. The ability to manage oneself and anticipate dealing with occupational stress is increasingly important.

As an athlete, I had to prioritize 11-16 practices per week, year-round. Sustaining performance required sacrificing time with friends and trips with family, and self-directing my education. I have realized that there are similar struggles managing shift work as a paramedic. Prioritising time for friends, family, and hobbies is increasingly difficult, especially due to the guaranteed physical, mental and emotional exhaustion of the job. However, I can transfer the skills I learned in high performance sport and prepare myself for intense moments on the job as a paramedic.

The parallels between sport and paramedicine are clear. We propose that further attention be paid to a “paramedic-athlete” model with emergency medical services. We also encourage looking outside paramedicine to incorporate best practices in order to make work more sustainable. Finally, we can encourage further investigation into sustainable, evidence-based sport or performance psychology strategies to work against OSI, burnout and the potential of PTSD.

Radio EMS

References

  1. Canadian Institute for Public Safety Research and Treatment. (2016). Peer support and crisis-focused psychological intervention programs in Canadian first responders: Blue paper. Regina: The University of Regina Press.
  2. Parliament, Senate, Standing Committee on Public Safety and National Security. Healthy minds and safe communities: Supporting our public safety officers through a national strategy for operational stress injuries. 42nd Parl., 1st Session.
  3. P. T., Evces, M., & Weiss, D. S. (2012). Treating post-traumatic stress disorder in first responders: A systematic review. Clinical Psychology Review, 32, 370-380.
  4. Benedek, D. M., Fullerton, C., &Ursano, R. J. (2007). First responders: Mental health consequences of natural and human-made disasters for public health and public safety workers. Annual Review of Public Health, 28, 55-68.
  5. Andersson, A., Carlstrom, E. D., Ahgren, B., & Berlin, J. M. (2014). Managing boundaries at the accident scene – a qualitative study of collaboration exercises.International Journal of Emergency Services, 3(1), 77-94.
  6. Lauria, M. J., Rush, S., Weingart, S. D., Brooks, J., & Gallo, I. A. (2016). Potential role for psychological skills training in emergency medicine: Part 1 – Introduction and background.Emergency Medicine Australas, 28(5), 607-610.
  7. Lauria, M. J., Gallo, I. A., Rush, S., Brooks, J., Spiegel, R., &Weingart, S. D. (2017). Psychological skills to improve emergency care providers’ performance under stress.Annals of Emergency Medicine, 70(6), 884-890.
  8. Taber, N., Plumb, D., &Jolemore, S. (2008). “Grey” areas and “organized chaos” in emergency response. Journal of Workplace Learning, 20(4), 272-285.
  9. Goldman, E., Plack, M., Roche, C., Smith, J., & Turley, C. (2009). Learning in a chaotic environment. Journal of Workplace Learning, 21(7), 555-574.
  10. Botterill, C., Brooks, J., &Hussain, A. (2014). Sustainable high performance. Winnipeg, MB: Life Skills Publishing.
  11. Danish, S. J., Petitpas, A. J., & Hale, B. D. (1993). Life development intervention for athletes: Life skills through sports. The Counselling Psychologist, 21(3), 352-385.
  12. Killner, T. (2004). Desirable attributes of the ambulance technician, paramedic, and clinical supervisor: Findings from a Delphi study. Emerg Med J, 21, 374-378.
  13. Kajtna, T., Tušak, M., Baric, R., &Burnik, S. (2004). Personality in high-risk sports athletes. Kinesiology, 36(1), 24-34.
  14. Glick I. D., Stillman, M. A., Reardon, C. L., &Ritvo, E. C. (2012). Managing psychiatric issues in elite athletes. J Clin Psychiatry, 73,(5), 640-644.
  15. Gee, C. J. (2010). How does sport psychology actually improve athletic performance? A framework to facilitate athletes’ and coaches’ understanding. Behaviour Modification, 34(5), 386-402.
  16. Glick, I. D., & Horsfall, J. L. (2005). Diagnosis and psychiatric treatment of athletes. Clin Sports Med, 24, 771-781.
  17. Jurišova, E., &Sarmány-Schuller, I. (2013). Structure of basal psychical self-regulation and personality integration in relation to coping strategies in decision-making paramedics. Studia Psychologica, 55, 3-17.
  18. Regehr, C., Goldberg, G., & Hughes, J. (2002). Exposure to human tragedy, empathy, and trauma in ambulance paramedics. American Journal of Orthopsychiatry, 72(4), 505-513.
  19. Beilock, S. (2010). Choke: What the Secrets of the Brain Reveal About Getting It Right When You Have To. New York, NY: Free Press.
  20. Canadian Institute for Public Safety Research and Treatment. (2019). R2MR 2019 review.https://www.cipsrt-icrtsp.ca/en/policy-brief/r2mr-2019-review
Alyssa Kohl

Alyssa Kohl

Alyssa Kohl, Bachelor of Health Studies, soon to be an Advanced Care Paramedic in Regina, SK. I am a retired high performance athlete and a 5-time national medallist in sprint canoe-kayak. I love books, wine, cheese and the outdoors. Exercise is my medicine.

Aman Hussain

Aman Hussain

Dr. Aman Hussain is an early career academic and Assistant Professor in the Faculty of Kinesiology and Applied Health in the Department of Kinesiology at the University of Winnipeg. He is a trained social scientist who has utilized qualitative methodologies for his research.

Women in Paramedicine

Women in Paramedicine

Women in Paramedicine is compromised of dozens of women in the paramedical field across Canada. Since 2019, they have been sharing their research, point of view, thoughts, and strength to Canadian Paramedicine through their voice and words.

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