Features, Health & Safety

The Stress Tetrahedron: A New Way To Visualize First Responder Stress

Stress tetrahedron
By Mark Goodman

By Mark Goodman

In the course of encountering many first responders in my role as fire chaplain in the initial weeks of the COVID-19 pandemic, I noticed a common theme of distress. On-duty and off-duty, the conversation would always come back to the concern over contracting the coronavirus. Firefighters were not so much concerned for themselves as they were about the potential of contracting the disease and then transmitting it to their family, friends and co-workers. This is the typical firefighter rescue personality. Discussion about the potential consequences of contracting the virus and the “new normal” dominated many conversations at every level of the departments I serve. As the weeks turned into months and the risk of contracting the virus only increased, so did the precautions to minimize the threat of being contaminated. As the daily graphs tracking the death toll in the U.S. and around the globe continued to trend upward, the anxiety levels in the first responder community rose as well. As I thought on this recurring conversation with firefighters, law enforcement, and EMS personnel, I began to consider the additional stress that was being carried by first responders due to the current pandemic.

The threat of possibly becoming an asymptomatic carrier of the coronavirus caused me to reevaluate my fire chaplain operations. Several of my immediate family members are in the high-risk category, so I was concerned about their well-being. As a first responder myself, I was experiencing the additional stress as well. Additionally, I did not want to potentially carry the virus from station to station, possibly infecting entire crews, so I temporarily suspended station visits. To maintain close relationships, I made many phone calls to let those I serve know I was still available and able to serve in a peer support role or fire chaplain role. As the anxiety levels increased, I was eventually asked to resume station visits with appropriate personal protective equipment (PPE), physical distancing, and temperature checks. I was glad to be back in action, despite the risk.

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Concerning the subject of firefighter stress, we generally teach about three types of stress: Life, job, and critical incident. I’ve heard some instructors refer to these as the “triple whammy”. First, life stress generally includes those daily pressures of life associated with providing for and raising a family, financial issues, or health issues. Relations with a spouse or significant other, children, or in-laws would also be included. Life stress is just part of the human condition. If we receive a diagnosis of cancer, the phone rings alerting us that a friend or family member has been involved in an accident, or the air conditioner at the house is failing, we immediately feel the effects of life stress. The terminal illness or death of a loved one may be the ultimate life stress.

Second, job stress generally falls into one of two categories: intrapersonal or interpersonal. Intrapersonal job stress for a first responder, especially in the fire service, has to do with one’s self-assessment of issues such as:

  • “Am I fitting in?”
  • “Am I measuring up?”
  • “Did I perform my best on that last call?”

We experience anxiety if we feel that we’ve let down our crew. If the outcome of a call results in the death of a patient (even when all the interventions and actions were performed timely and flawlessly), first responders play the “should have, would have, could have” game in their minds. No doubt these are very real stress points for a probationary firefighter.

Interpersonal job stress on the other hand deals more with the actual interaction with other crew members or administration. Relational questions may include such concerns as “Is everyone getting along?” or “Are there bad feelings between crew members?” Performance, new policy implementation, union contract disputes, politics, snoring in a bunk room, etc. would cover a broad range of interpersonal stress issues. Competition for advancement is another source of tension within the department and even within a particular station. At the end of the day, we all know a firehouse family can be just as dysfunctional as any biological family unit.

The third type, critical incident stress, is, as the name implies, generated from a specific call or arises from the accumulation of those calls that are particularly horrific or have the potential to overwhelm normal coping skills.

Although the general public would consider just about every emergency the fire department runs on a “bad call,” our fire service and other first responders know otherwise. There is a difference between a motor vehicle crash with three deceased persons inside, the motor vehicle crash (MVC) with ejections and decapitations, or the necessity of an extended period cutting out deceased victims in a recovery operation. The death or serious injury of a child would definitely be a potentially traumatic event. The serious injury or line-of-duty death of a first responder may be the ultimate critical incident stress. This article does not address the various interventions available for first responders who are affected by these calls, but they do include critical incident stress management (CISM), peer support, the chaplaincy, employee assistance programs (EAPs), and mental health professionals.

Imminent Stress

As I thought about these three, I recognized the additional stress that was being caused by the threat of the COVID-19 virus represented a fourth type of stress that needed to be identified and included in first responder training on stress. It’s a type of stress that has always existed, but just hasn’t been specifically defined and specifically taught in the context of firefighter stress; it may have just been lumped into life stress.

I was on the back patio at my house one day self-distancing a number of weeks ago as the pandemic was unfolding, and several terms came to mind as a way to identify and teach about this type of stress. I’ve coined the term “imminent stress” to identify this type of stress brought about by the threat of contracting the coronavirus and transmitting it to a family member, friend, or crew member.

There are several general definitions of imminent. Webster’s defines imminent as “ready to take place: happening soon.” Another definition of imminent is “about to happen.” One definition of an imminent danger found on the Internet is “an anticipated danger that is likely to happen, is impending, and is separated by time or space.” These definitions do not imply that the threat will actually transpire but acknowledge that it is ever-present. Of particular interest is the archaic definition and sense of the word imminent, which is “overhanging”.

This especially captures the essence of “imminent stress” as a threat/stressor that is continually overhanging an individual. To initially define the term, I would propose: “Imminent stress is the stress associated with a threat that may or may not happen, but that threat is real and ever-present and generally spans an extended period of time.” I realize that “extended period of time” is subjective, and may require further definition. I include it to differentiate it from the stress of operations on a fireground or MVC scene or a law enforcement officer facing a “shots fired” call, both of which would better be characterized as critical incident stress.

As applied to the current pandemic, a first responder may or may not contract the virus, but the threat is ever-present. Even at the time of the writing of this article, the current threat is still “overhanging” the first responder, and most likely will continue until a vaccine and treatment are developed. There are still areas of the country that have not yet reached their peak number of infections and deaths. It has been more than three months and first responder agencies are still grappling with issues concerning PPE usage, masking, station and equipment sanitizing, decontaminating gear, and physical distancing of crews. As areas of the country are beginning to relax restrictions on stay-at-home orders due to successfully “flattening the curve,” there are concerns that a second wave may be in the future.

Other examples of imminent stress would include the threat of developing firefighting related cancer over the course of a career. A firefighter may or may not develop a cancer, but the threat is ever-present and overhanging. It is a very real threat as well that spans a period of time. Imminent stress would also encompass the stress a fire chief experiences knowing that everyday their personnel are in harm’s way, subject to potential serious injury and death. Those things may or may not ever happen, but the threat is ever-present and overhanging a chief officer or even a company officer. Those concerns are obviously real and span a career. Another example may have been the anxiety we experienced doing our jobs immediately following 9/11, not knowing if, when, or where there might be another terrorist attack. The threat was overhanging, for sure.

I’m sure as this concept of imminent stress is studied and researched; a better, more comprehensive definition will be developed. This type of stress I have identified and preliminarily defined is actually a subset of a more general type of stress known as “anticipatory stress” (Albrecht, 2020). This category of stress is very broad, including any stress associated with some event in the future.

Anticipatory stress could be the stress associated with having to give a speech in front of five co-workers the following day (low risk), to the hyper-vigilance a law enforcement officer experiences responding to a “shots fired” call (high risk), to a husband and wife expecting the birth of a child in nine months. Anticipatory stress therefore can be short or long term, low or high risk, real or imagined. It could be comprised of life, job, critical incident stress, or imminent stress. For this reason, it is appropriate to identify imminent stress as a fourth type of stress firefighters and other first responders may experience that are a real threat. The definition would not include parents awaiting the birth of a child. It is absolutely an anticipatory stress, but would more appropriately be classified as a life stress. Imminent stress would extend to the spouse or family of a first responder, knowing that their loved ones are in a hazardous occupation. 

On the same day I began considering the term “imminent stress” I also began thinking about a framework to use to teach on these four types of stress. As the components necessary for fire (heat, fuel, oxygen, and uninhibited chain reaction) comprise the “fire tetrahedron,” so the four types of first responder stress (life, job, critical incident and imminent) may be referred to as the “stress tetrahedron.” The tetrahedron is a foundational term in the fire service lexicon and will be easily relatable to the discussion of types of stress in the realm of interventions including peer support, chaplaincy, CISM, EAP, and mental health.

With the recognition and identification of imminent stress, we may now have a more thorough discussion with firefighters and other first responders about stress and the need for self-care to stay healthy.

We will also be better equipped to recognize stress and offer interventions when normal coping skills are overwhelmed. The “stress tetrahedron” completes the picture or visual representation of stress in the fire service and other first responder agencies.

REFERENCE

Ahlbrecht, 2020. https://www.mindtools.com/pages/article/albrecht-stress.htm

NOTE: To facilitate the use of the terms Imminent Stress and Stress Tetrahedron, I would suggest using the following hashtags on social media #ImminentStress #StressTetrahedron.

Mark GoodmanMark Goodman currently serves as fire chaplain for five Southwest Florida fire departments and a fire peer on the Tri-County CISM Team. He has enjoyed a career as a firefighter, fire inspector, and fire marshal for more than 35 years. He is certified as a Fire Instructor III in the state of Florida and a Master Chaplain and Instructor III for the Federation of Fire Chaplains. He is the president and executive director of the 501 (c)(3), FD Chaplain Services, Inc., an organization that trains fire chaplains. He also pastors a church in Estero, Florida.