Stress Injury Risk for Patrollers

Helping to keep people safe in the outdoors is what we do.
Keeping ourselves safe – physically, mentally and emotionally – is what we must do.
The Risk for Stress Injury
Patrollers and all First Responders have occupational hazards by nature of their profession. In addition to musculoskeletal injuries and the risk for cold exposure, stress injuries – our reaction to taking care of injured people – can affect our physical, mental and emotional well-being. We have all heard the term PTSD, or post- traumatic stress disorder. PTSD is an exaggeration and prolongation of a person’s inability to cope with traumatic stress. Stress injury, if left unchecked, could evolve into a PTSD condition. Examples of situations that could cause stress injury include: the traumatic death of adult or child; traumatic injury of a fellow patroller; or a difficult incident where the outcome was poor. These types of traumatic events can cause real physical, mental and emotional stress. Exposure from our job is an important piece; but it’s not the whole story. Most of us are volunteer patrollers. Many of us have other jobs that have their own occupational risk for stress injury, such as law enforcement, firefighters, EMS or healthcare. Stress injuries from all aspects of our lives can stack or pile up until we find ourselves physically and emotionally drained.
The Result of Stress Injury
Stress can lead to physical changes in the body. Stress causes an increase in cortisol secretion. Chronically elevated cortisol can lead to increased inflammation, sleep disruption, weight gain, pathological fractures, hypertension, hyperlipidemia, cardiac injuries, diabetes and chronic pain.

Stress injury exposure affects our body, our brain function, our hormonal balance and our organs. Chronic stress tricks us into thinking that we are constantly under attack. Our bodies sense danger, putting us in survival mode every day, 24/7. This stress injury can build up over time affecting us physically, mentally and emotionally.
Physical, Mental and Emotional Changes from Stress
Prolonged stress can lead to sleep disturbances, irritable behavior, angry outbursts, difficulty concentrating, reckless self-destructive behavior, depression and even thoughts of suicide. Those who are affected can feel that no place is a safe place. Negative thoughts can make a person isolate themselves from others. It is common for them to avoid memories, thoughts or feelings of the original experience and to avoid external reminders of the event. Patrollers may try to cope by avoiding treating certain groups of patients (like children), stop running the scene, or just quit. Physical changes can include increased heart rate and blood pressure. We may overeat and stop exercising. These physiological changes can put us at risk for cardiovascular disease and obesity.

Cumulative stress puts us on a continuum from well-being to major depression. This continuum was originally developed for the U.S. Military Combat and Operational Stress First Aid (COSFA) Caregiver Training Manual and ranges in color from Green to Red.
Green - READY = emotionally healthy, good to go
Yellow - REACTING = early changes
Orange - INJURED = start of late changes including fatigue and burnout
Red - ILL = late changes including thoughts of suicide
Stress Injury Continuum Model - Reacting to Stressor (traumatic incident or situation)
READY REACTING INJURED ILL
  • I love ski patrolling
  • Stoked to ski with friends
  • Healthy sleep
  • Joy & vitality, having fun
  • Emotionally healthy
  • Motivated, calm & steady
  • Let's shred the hill
  • I don't like the cold
  • Regretting patrol duty
  • Distancing from others
  • Sleep disturbance
  • Cutting corners
  • Short fuse/Irritable
  • Fatigue/Weariness
  • Drinking to forge
  • Burnout/Trapped
  • Skipping or late for shifts
  • Guilt, blame or shame
  • Nightmares
  • Eating too much junk
  • Dodging injury calls
  • Depression, anxiety
  • Avoiding patient care
  • Dreams about that call
  • Avoiding patient care
  • Substance abuse
  • Suicide thoughts
  • Hiding/broken relations
  • Scared to ski
TO STAY READY TO RECOVERY & BUILD RESILIENCE TO BEGIN HEALING TO GET HELP
  • Keep fit
  • eat right
  • learn to let go
  • Get adequate sleep
  • talk to someone you trust
  • Schedule fun activities
  • Talk to a counselor
  • Talk to a medical provider
  • Talk to a CISM resource
  • Seek medical treatment
  • Do not delay, call today
  • Stay close to someone
Patrol Leader, Individual & Family Responsibility Caregiver Responsibility
Immediate Steps to Heal and Return to Green
These are the first steps to mitigate the stress injury cascade; to reduce the initial distress; to foster adaptive functioning and coping.​
  • Create a sense of safety
  • Create calm
  • Create self & collective efficacy
  • Create connection
  • Create hope
​The goal is to move toward the Green section of the Stress Injury Continuum.
Goals for Staying Green and getting to Green
  • I’m sleeping 8 hours per day without nightmares
  • I’m not dreading going to work or patrol shift
  • I’m not using alcohol or drugs to numb out what hurts
  • I’m laughing with my children, partner, spouse
  • I can take pleasure in the small things
  • My body feels strong; it doesn’t hurt
  • I can listen to my body’s cues
  • I wake up looking forward to the day
  • I am meditating or praying
  • I have time and desire to help others
  • I like myself
  • I have enough left over to care for my family
  • My friend’s tell me I’m back
  • I head to the mountains regularly
Melinda Mingus, MD - ED Safety Program Supervisor, Senior Nordic Patroller, MTR Instructor, CT Medical Advisor, Mohawk Mountain, CT Region
Dallas W. Coffman, OEC Instructor, Nashoba Valley, EMARI Region
​Laura McGladrey, RN, FNP, PMHNP, FAWM, Eldora Ski Patrol, Colorado
Copyright © 2021 Patroller Stress Awareness Team (PSAT)