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Northern Ohio Trauma System, 10th Annual Trauma Symposium.Cleveland Ohio 5 November 2020.SUMMARY of PRESENTATIONTaking charge: an individualized, real-world approach to help prevent burnout and vicarious trauma in today’s risk-intolerant and demanding workplace.Dr Christian Heim HYPERLINK "" 315741624442700TAKE HOME MESSAGETo help prevent burnout, take care of your emotions,The WASH your WEB tool can help.THE PROBLEM 1 SUICIDE EMS profession: 2? times more likely to suicide than general populationVigil, Neil H., et al. "Death by Suicide—The EMS Profession Compared to the General Public."?Prehospital emergency care?23.3 (2019): 340-345.Doctor suicides: double rate of population.Stockburger, SJ. “Physician Suicide: a problem of distressing severity.”The Broader View of Suicide?(2020): 166.Nurse suicides: 1.5 gen pop; female nurses are 4 times the female rateSelf-sacrifice, bullying, long and erratic shifts, workplace violencePeterson C, Stone DM, Marsh SM, Schumacher PK, Tiesman HM, McIntosh WL, Lokey CN, Trudeau AT, Bartholow B, Luo F. Suicide rates by major occupational group - 17 States, 2012 and 2015. MMWR Morb Mortal Wkly Rep. 2018;67(45):1253-1260. & police more likely to die by suicide than in line of dutyHeyman, Miriam, Jeff Dill, and Robert Douglas.?The Ruderman white paper on mental health and suicide of first responders. Ruderman Family Foundation, 2018.The Firefighter Behavioral Health Alliance estimates that only 40 percent of firefighter suicides are reported and that the actual number of 2017 suicides would equal more than twice the number of those who died in the line of duty. PROBLEM 2 BURNOUTBurnout in physicians 42% (F>M; 1/3 little impact, 1/3 moderate, 1/3 severe)Why? Workplace culture & organizationAdministrative burden, paperwork, computerization, Lack of respect, long hours.Impact? close relationships, substance use, depression (17%), Ideation (23%)Cope? Isolate 45%, exercise gym, talk, sleep, Eat junk food 30%, music, Alcohol 24%, binge eat 20%.Treatment? 75% no plan; 42% wouldn’t use provided MH servicesDon’t trust MH prof 9%, Don’t disclose 22%, I’ll deal with it 45%, too busy 45%, not severe enough 50%Kane, L. "Medscape National Physician Burnout & Suicide Report 2020: The Generational Divide. January 15, 2020." (2020). SURVEY OF 15,000 PHYSICIANSTHE PROBLEM 3: COVID“The coronavirus crisis means 20lbs more anxiety for all of us.” (C Heim)ACEP survey of 862 members Oct 2020:87% more stress, 72% experienced burnout, 73% stigma was a major concern in the workplace, 57% were concerned for their job if they sought help (particularly older, rural).Why avoid mental health treatment? Loss of job, loss of future, stigma.45% said I’d seek no MH input. CAN BE DONE CORPORATELY? 1 INITIATIVESHERO act Helping Emergency Responders Overcome 2019: For police officers, firefighters, ambulance crew & health care providers. (1) a public-safety officer suicide-reporting system at the CDC and Prevention. (2) a grant program for peer-support behavioral health and wellness programs.Coronavirus Health Care Worker Wellness Act June 2020: Grants to promote health, mental wellness & launch additional researchLorna Breen Health Care Provider Protection Act July 2020: Fund a study to assess professionals’ mental health & encourage them to get careBut these do not overcome the problems associated with stigma, cultural clashes (cultural of thanks for the caring you provide and we are accountable) Mental Health Service will need to be anonymous and outsourced.Management’s bind: wanting to people like people but money are resource allocation are the bottom lines in a corporate culture.IMPORTANCE OF EMOTIONSThe experience of music, a language of the emotions still not understoodSince the time of Descartes’ I think therefore I am we have de-emphasized and even devalued the importance of emotions.At conference, we believe more knowledge is the answer and this is only partially the case. We need to look after our emotions as we make decisions based on our emotions not our rationale (examples of buying a car & completing suicide)Damasio, Antonio R. "Descartes’ error: Emotion, rationality and the human brain." (1994).Bottom line: we make decisions based on emotions and body sensations.I think and Feel, therefore I am.Brooks, David. “The Social Animal.” (2011) (An easier to digest best-seller based on Damasio’s ideas.)WHAT CAN BE DONE INDIVIDUALLY? 1Know your trauma cup.Were you born with a large or a small trauma cup?How full is it now?WHAT CAN BE DONE INDIVIDUALLY? 2: RESILIENCE FACTORS1. Network factors – external support. Close attachment, family, friends, community.2. Personal skills – internal support. Skills, abilities, character, intelligence.3. Meaning, values and faith – existential support. Values, faith, coherence, fellowship.Gunnestad, Arve. "Resilience in a cross-cultural perspective: How resilience is generated in different cultures." (2006).RESILIENCE AS PROCESS 1. Networks, ameliorate RF Grandma cared while my parents drank2. Skills give a strong sense of self I am good at … gym3. Existentially maintain hope with opportunities I can still …Rutter, M (1990). Psychosocial resilience and protective mechanisms. In Rolf, J. Masten, A.S et al.: Risk and Protective Factors in the Development of Psychopathology. Cambridge: Cambridge University Press.RESILIENCE IN APPLICATION1. Put People First. You are swimming in a sea of emotional trauma, each person in your life is a rope to keep you secure. How many ropes do you have? Have you cut ropes by losing touch with important people? (C Heim)2. Find your serenity. Find something just for yourself that makes you feel capable and worthwhile: a sport, exercise, walking, gardening, music, anything. (C Heim)3. Have faith; take time for mind, body & spirit. Religious affiliation or faith in science gives meaning, purpose and hope.(Farias, Miguel, et al. "Scientific faith: Belief in science increases in the face of stress and existential anxiety."?Journal of experimental social psychology?49.6 (2013): 1210-1213.)THE PSYCHOLOGICAL TOOL: WASH your WEBA psychological tool is a reminder to get your brain to do something that is helpful to you. When driving, you will “turn left” only if you remind yourself to, intend it, choose it and understand the difference between “left” and “right.” You will then travel down that road. Likewise, you will develop the use of, say, “compassion” over “empathy” if you remind yourself to, intend it, choose it and understand the difference between “compassion” and “empathy.” Your mental processes will then travel down the compassion road and build that neural pathway.The WASH your WEB psychological tool is:Pre-shift and on shift:Wall off empathyAnticipate traumaShelf Strong emotionsHold HopePost-shift:Walk through your dayExperience & Express strong emotionsBilateral Stimulation TechniqueDetails of the tool are on the specialist page at References:Heim, C. (2020). Preventing vicarious trauma: a private psychological tool for health care workers. International Journal of Emergency Mental Health and Human resilience, 22(2), 6-10.Use of compassion over empathy:Singer, T., & Klimecki, O. M. (2014). Empathy and compassion.?Current Biology,?24(18), R875-R878.Use of mature defense mechanisms anticipation & “shelving:”Vaillant, G. E. (1985). An empirically derived hierarchy of adaptive mechanisms and its usefulness as a potential diagnostic axis.?Acta Psych. Scandinavica,?71(S319), 171-180.Use of exposure therapy:Rauch, S., & Foa, E. (2006). Emotional processing theory (EPT) and exposure therapy for PTSD.?Journal of Contemporary Psychotherapy,?36(2), 61.Keenan, P., & Royle, L. (2007). Vicarious trauma and first responders: a case study utilizing eye movement desensitization and reprocessing (EMDR) as the primary treatment modality.?International Journal Emergency Mental Health,?9(4), 291-298.Use of a bilateral stimulation technique:Amano, T., & Toichi, M. (2016). The role of alternating bilateral stimulation in establishing positive cognition in emdr therapy: a multi-channel near-infrared spectroscopy study.?PloS one,?11(10).Artigas, L., & Jarero, I. (2014). The butterfly hug.?Implementing EMDR early mental health interventions for man-made and natural disasters, 127-130.REFERENCES IN C. HEIM PAPERAmano, T., & Toichi, M. 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