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Fighting the fire of stress

It’s 3:46 a.m. – you’re comfortable, warm – it’s quiet, dark, relaxed. You may even be swept away in a dream somewhere. Suddenly, you’re awakened to the tones of an alarm, a sound so familiar, yet just as startling as the last one that invaded your tranquil slumber. Fearing the worst, but hoping – even praying – for the best,  you put yourselves aside for the sake of others.

Enter the firefighter
Forgoing their own needs, firefighters dedicate themselves to the sound of that alarm. It could mean anything, or it could mean nothing at all – at least, not this time. Putting their focus, energy and hearts into that sound, they respond with lights flashing and engines roaring. Fixated on what’s to come, they have little if no time to consider what’s going on inside of them.

But what is happening inside the firefighter when he or she is responding to an emergency call? A mini-lesson on the stress response might shed some light on this. The body is designed to adapt and cope with periods of stress; the key word here being “periods.” When stress is perceived, we immediately begin the “fight or flight” process. Only in the case of firefighters, “flight” is not an option.  They run into the very places most of us run screaming from.

Stress produces a very real process in the body. People can experience stress and not even realize it. Many bodily systems are affected when we are under stress including the brain, hormones, organs and the immune system.
 
The adrenal glands produce several hormones, including adrenaline and cortisol. Adrenaline gives us the “push” that we need to respond to the stress, and cortisol modifies how our body uses fuel sources while we are experiencing stress. Cortisol is a steroid hormone secreted by the adrenal glands. When we experience stress, there is a “trigger” in the brain to release a hormone called corticotrophin, thereby releasing hormone CRH (think of this hormone as a messenger to alert the body that trouble is coming). CRH then stimulates the adrenal glands (down near the kidneys) to release adrenalin and the stress hormone cortisol.

Cortisol is the primary stress hormone and is needed by our bodies to function. We require some cortisol to help us manage our body’s systems during times of stress. It functions in our brain with something called circadian rhythm - the clock in our brain that controls our sleep-wake pattern. Not exactly good news for firefighters who face constant sleep disturbances and daily variations in their sleep cycles.

Cortisol stimulates protein conversion to energy, suppresses inflammation and temporarily shuts down the immune system so that our body can handle the stress. Chronic high levels of this stress hormone can have serious metabolic effects including increased blood sugar levels (along with an increase in appetite and cravings for carbohydrates and rich foods), loss of muscle mass and an increase in body fat.

After a stressful period, cortisol levels should go down and return to normal. So, we are very much designed to deal with episodes of stress.

What we are not designed to do is experience chronic stress. If the stress does not go down, neither does the cortisol. For firefighters, responding to the potential of multiple alarms or simply waiting around in anticipation of the next call, means stress levels don’t often get the chance to return to normal. Research has concluded that stress is the main cause of almost 80 per cent of illnesses, serious diseases like heart disease, psychological disorders, cancer and hormonal dysfunctions. Because the damage caused by stress is not something that is easily measured, it is somewhat of a paradox in that the physiological response of the body to stress is two-fold; it protects and restores, yet the same systems have the ability to destroy.

Unlike acute (temporary) stress, which usually invokes a response and then subsides, chronic stress is more cumulative, negative and unrelenting – being defined with feelings of tiredness, fatigue, anger, irritability and lack of energy.

The brain reacts the same way, whether we are in acute stress or chronic stress, because it cannot distinguish between the two. Constant stress can cause free-radical damage (free-radicals are highly reactive, unstable molecules that cause cellular damage and cell death) and nutritional deficiencies that can have serious consequences, even in someone who appears fit and healthy and consciously tries to keep a clean diet. High levels of cortisol can lead to muscle wasting. Reduced muscle mass is not exactly beneficial to someone who might need to carry another person down a flight of stairs, or hump a heavy hoseline clad in turnout gear! It can also lead to reduced levels of the brain neurotransmitters serotonin and dopamine – both of which are calming to the body.

Conditions that reduce the levels of these neurotransmitters can develop into depression and mood/behavioural disorders. 

Each time the firefighter responds, their body’s stress response also responds, and even if it’s only a false alarm, the stress response of the body is still activated. You as a firefighter know what that is like, doing it several times a day or in the middle of the night.

It is of absolute importance that firefighters and their authorities educate themselves about stress and its potential negative effects. Understanding their individual needs, requesting proper medical tests (stress tests, cardiovascular, hormone and cortisol tests) as well as paying close attention to their nutritional and fitness needs should be at the forefront of training and education in modern firefighting. 

References:

1. Maté, G., When the Body Says No, The Costs of Hidden Stress, Knopf, 2003.
2. Talbott, S, The Cortisol Connection, Hunter House, 2002.
3. Selye, H., Stress Without Distress, Harper & Row, 1974.
4. Talbott, S., The Cortisol Connection, Hunter House, 2002.
5. Hancock, M., Young and Stressed, Alive, 251, September 2003.
6. McEwen, B.S., Protective and Damaging Effects of Stress Mediators, Seminars in Medicine of the Beth Israel Deaconess Medical Centre, New England Journal of Medicine, 171, 1998.
7. ibid, p. 172.
8. Stefano, M., www.firefightersworkout.com
9. Scala, W.R., Research Features www.paramedic.com


Erin Bell is a researcher and writer currently studying to become a registered nutritionist. She is married to a full-time firefighter in southern Ontario.

December 13, 2007
By ERIN BELL

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