What first responders can do to reduce their risk for operational stress injury

By: Bill Howatt, Glenn Cullen, Lara Sigurdson, Megan McElheran

This op-ed was originally published in OHS Canada Magazine on June 30, 2020. It was written by Dr. Bill Howatt, Chief of Research at the Conference Board of Canada.

Understanding the term operational stress injury (OSI)

Duties of first responders and military personnel put them at increased risk for exposure to potentially traumatic events. Though post-traumatic stress disorder (PTSD) is a real possibility for some first responders who experience traumatic exposure when doing their jobs, it’s not the only kind of mental health issue that may occur. They also risk onset of other operational stress injuries (OSI’s).

Before we can prevent an OSI, it’s helpful to have a clear frame of reference as to what it is.

Veterans Affairs Canada defines an OSI as “any persistent psychological difficulty resulting from operational duties performed while serving in the Canadian military”. The term is a concept rather than a specific medical term or diagnosis. It represents an umbrella of the kinds of mental injuries that can occur because of direct traumatic exposure to human tragedy (e.g., death through accidents, violence, suicide), moral conflict and vicarious trauma. OSIs can also be a result of fatigue from chronic injuries, compassion fatigue or the loss of people we care about on the job. In other words, when stress on the job becomes a psychological issue.

OSI injuries can include things beyond PTSD, such as symptoms of anxiety, panic attacks, depression and addictive behaviours, to name a few.

How to reduce your risk for an OSI

To begin, think of preventing an OSI much the same as you would a heart attack. To reduce your risk for a heart attack you’d engage in healthy exercise and diet, get proper sleep, and make healthy lifestyle choices such as no tobacco and minimum to low alcohol consumption. Doing these with intention can reduce risk but won’t guarantee a heart attack won’t happen.

Three factors that can influence a first responder’s vulnerability for OSI:

  • Daily intentional behaviours—Daily lifestyle choices such as the degree a first responder engages in physical health activities (i.e., exercise, diet, rest and lifestyle choices), mental fitness programs (e.g., practicing deep breathing when stressed, mindfulness, resiliency) and quality of social connections all play a role in charging their battery each day. In order to approach life with intention, we need to be self-aware. Understanding our unique style of responding to the world, people and indeed ourselves allows us to make healthy changes. Self-awareness requires introspection, humility, and openness to considering other viewpoints.
  • Workplace experiences—Quality of interactions with peers and community, ability to match personal values to work, and degree of job satisfaction all play a role in the degree of stress and fulfillment a first responder will have. The relationship a first responder has with their supervisor has been shown to be particularly important. In addition, the nature of traumatic events first responders are exposed to is important. These can include things specific to the incident (what happened, who was involved, who was there to assist you), and personal variables (childhood experience, personality style, and how you make sense of what happened).
  • Perception of employer supports—The perceived benefit of programs in place to support first responders to learn, deal with stress, and get access to psychological support services when needed. The perception of positive employer supports has been correlated with a greater sense of organizational belonging and being taken care of by one’s employer. This contributes greatly to feeling as though one’s contribution to the organization is valued.

The sum of these three factors can help predict a first responder’s vulnerability to OSI. In addition, it’s worthy to note that past exposure to trauma that has resulted in post-traumatic growth, may increase resilience. Post traumatic growth (PTG) was a term developed in the mid-1990’s by Richard Tedeschi, PhD, and Lawrence Calhoun, PhD. They held that people who endure psychological struggle following adversity can often see positive growth afterward.

For example, compare the following two first responders:

  • First Responder A—Doesn’t pay any attention to physical health, is obese, and when stressed typically drinks alcohol after shift to turn off. Does minimal to promote their mental health proactively and is known to be cynical and critical of others. Has been on the job for 15 years; has seen a lot of traumatic events. Doesn’t really engage in any programs, like mandatory critical incident debriefings, unless ordered. Presents to the outside world that all is well but inside is struggling daily with unhappiness. They don’t share for fear of judgment. Doesn’t enjoy work, needs a paycheque, has gaps with meaningful social connections outside of work, feels alone, lives alone, and has nightmares that are never talked about. Works in an organization that limits opportunities for debriefing and maintains attitudes that exposure to traumatic events is what the member “signed up for” and thus shames members who struggle emotionally with the demands of the job.
  • First Responder B—Is in a loving marriage, active in community as a baseball coach, takes physical and mental health seriously, is disciplined, and follows both physical and mental health fitness programs. Positive in the workplace, gets along well with peers, loves work, and when needs support seeks proactive psychological services—doesn’t want to let things accumulate. Very aware that anyone can develop an OSI, and takes mental health seriously. Wants to have a quality life with spouse and kids. Employer offers peer support and conversations about mental health have become increasingly commonplace within the workplace.

As you compare the two first responders, it’s clear they’re on two different trains. Though both could be exposed to an event that could result in a mental injury, from a vulnerability level, First Responder A would have more risk with respect to behaviour, experience and supports.

The most distinct difference is degree of awareness. First Responder B is more aware and in tune with their mental health. They also don’t believe that they are invincible – it can happen to them. This doesn’t eliminate their risk, but it does mitigate it. Their level of vulnerability is lower.

One way to help first responders is to measure their degree of vulnerability for an OSI injury based on their daily behaviours, perceived experiences in the workplace and employer supports.

This is why Public Services Health and Safety Association (PSHSA) has created the Early Recognition for OSI Risk screening tool that will be tested to evaluate its ability to predict OSI risk. It has been designed not as a diagnostic tool but as an early detection, educational tool that a first responder can use to get feedback on their vulnerability for OSI. Its purpose is to increase awareness, so first responders can take accountability for their mental health by taking actions that can be helpful. The data from this screening tool can also provide employers with insights as to the kinds of perceived workplace experiences and supports that inform policies and program decisions.