fireEMS ❘ By Bryan Fass
Suicide claims more lives than line-of-duty fatalities. This headline statistic is both shocking and concerning. Are we approaching the issue with only half of the perspective needed? Simultaneously with our mental health and suicide problem has been a decline in provider health and wellness. Couple that with an almost rampant occupational inability to sleep, and we have the making of an epidemic in our profession.
A Decline in Physical Wellness
Personally, I point to one major and predictable issue, food—or, in this case, the lack of healthy food in our diet. Our diet has become so overly processed, fast-food based, and chemically laden that it’s entirely possible that you may go days without eating something that has not been processed. A vast majority of emergency medical technicians (EMTs) rely on the vending machine, fast foods, and convenience stores for their “nutrition.” Add to that hormone- and antibiotic-laden meats and the endless supply of sugary drinks (both natural and artificial), especially energy drinks, and we have a major wellness issue on our hands.
We have forgotten, or perhaps we just never learned, how to eat to heal. Frankly, in half the classes I teach, the majority of responders have no clue about what their diet is doing to their bodies. All these processed and chemically laden foods, coupled with antibiotic use, have effectively killed off one of the key balances in the body, that between the brain and the gut. Three studies that clearly link gut health to mental health have recently been released:
- “Gut Bacteria Linked to Depression Identified in Landmark Study.”1
- “Role of gut microbiota in posttraumatic stress disorder: More than a gut feeling.”2
- “Posttraumatic Stress Disorder: Does the Gut Microbiome Hold the Key?”3
The “fix” is relatively simple: Cut out the sugars (real and fake). Cut out the boxed/packaged foods with ingredient lists full of chemicals. Add natural foods like lean meats, meat substitutes (Impossible Burgers™ anyone?), green veggies, dark fruits, and nuts.
Then, get yourself on a strong probiotic supplement. By strong, I mean 50 billion+ microorganisms per pill. You get what you pay for here, so don’t skimp, and switch brands frequently since they all have different formulations.
At bedtime take ZMA. It’s an over-the-counter supplement of zinc and magnesium that promotes not only sleep but also cardiac, brain, and muscle health. When you sleep better, eat better, and stay hydrated, your gut microbiome will naturally start to rebalance itself.
Resiliency Specific Exercise
As your body continues to wear down from stress, fatigue, and lack of healing foods, so does your cardiovascular health. In fact, after a 24-hour shift or multiple bouts of insufficient sleep, your heart rate response is drastically altered for up to two days.4 So, it would seem prudent to do some more cardio to help right the ship, but with shift work in mind, that’s actually the opposite thing you should do. With shift work, our cortisol response and HPA (hypothalamus, pituitary, adrenal) response is essentially messed up. High-intensity (cross-fit type/HIIT training) or long-duration cardio (running) is, in fact, the wrong thing to do.
To boost your physical resiliency and help balance your HPA axis, do primal lifts. That’s right—deadlift, squat, leg press, barbell row, and pull ups. Not only will heavy weight with low reps and longer rest periods balance you out, but all of these exercises will help to prevent line-of-duty soft tissue injuries. Plus, primal lifting helps to boost testosterone levels, and they happen to be job specific. On almost every call, you deadlift, squat, step, and pull; so, these types of exercises are also key to preventing injury and serving as a career longevity program at the same time.
Lack of Accountability
Is part of the problem simply a lack of a standard? If we hold employees to a physical abilities standard with an annual physical abilities test (PAT) and we require annual medical physicals with bloodwork, we could very easily right the ship on physical wellness. The job is 100 percent physical, and a validated job-specific PAT is the perfect vehicle to keep employees accountable for their wellness. Annual bloodwork, which you should do anyway, can and will save your life. Early detection is the key; by being married to a physical standard, we can take a big and relatively easy step forward to improving employee health.
A consistent habit that has been handed down in emergency medical services and, to some extent, in firefighting is to conserve any and all energy just in case you need it for the big call. So, we have generations of EMTs who have been taught to sit in a dark room or lounge in the truck for the duration of the shift.
Unfortunately, this is the opposite of what your body needs. As humans, we are creatures of movement; we were not designed to be still and sedentary. Your body craves movement to keep your muscles strong. Activity keeps you alert and will help to balance your brain. In fact, simple walks in the sun are a key component in posttraumatic stress disorder rehabilitation.
So, get off your butt and do something. Walk, do some body weight exercises, throw a frisbee—do something to burn a calorie.
As you can see, the impact of physical wellness on all the facets of mental wellness; physical health; injury prevention; sleep; and, yes, suicide is complex. However, when we step back and look at the issue from a wholistic perspective, many of the issues we are facing are easy to address, and you should be doing that on a daily basis anyway.
1. Can J Psychiatry. 2016 Apr; 61(4): 204–213. Published online 2016 Feb 24. doi: 10.1177/0706743716635535.
2. Stellenbosch University. “Role of gut microbiome in posttraumatic stress disorder: More than a gut feeling.” ScienceDaily. 25 October 2017. <www.sciencedaily.com/releases/2017/10/171025103140.htm/.
4. Int J Occup Med Environ Health 2017;30(3):433-444.
BRYAN FASS, ATC, LAT, CSCS, EMT-P (ret.), has dedicated the past 10 years to changing the culture of fireEMS from one of pain, injury, and disease to one of ergonomic excellence and provider wellness. He has leveraged his 15-year career in sports medicine, athletic training, spine rehabilitation, and strength and conditioning and as a paramedic to become an expert on prehospital patient handling/equipment handling and fireEMS fitness. His company, Fit Responder, works nationally with departments to reduce injuries and improve fitness for first responders.