10/24/2017

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Rescuing our Responders-

Resiliency & Risk in EMS

By Bryan Fass, ATC, LAT, CSCS, EMT-P(ret.)

President Fit Responder

@fitresponder

Perspective

An Unplanned Entry into the Public Safety World

Down the Path we Go

10/24/2017

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STOP the CHURN

Lessons Learned aka. “The Injury Free Effect”

• Mobility• Depth• Friction• Tools• Fitness

• What skill gaps get in the way of doing

the vital safety behaviors (physical skills,

knowledge, understanding, social skills)?

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“Man”, sacrifices his health in order to make money.

Then he sacrifices money to recuperate his health.

– Dalai Lama

Invest

Are we Part of the Problem?

+ +

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· Do they exercise Properly…..?

· Do they eat well?· Do they get their blood work annually?

· Are they mentally sound?

· Are they tactically sound?

· Do they have physical PAIN?

What Is a Healthy Resilient First Responder?

Dehydration

Food Like Products

Poor Sleep Hygiene & Interrupted/Insufficient sleep

Chronic Circadian Rhythm Disruption

Adrenal Axis Dysfunction

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Poor Sleep

Poor Lung Function/Obesity/Dis-Ease

Physically Demanding

Chronic Inflammation

Revolving Door Of Risk

Adrenal Axis Dysfunction

AldosteroneCortisolEpinephrineAdrenocorticotropic-hormoneNorepinephrine

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The Secret Dis-Ease in Public Safety

· Chronic Stress from:

· Natural ‘Steroid Hormones’ decrease due to cortisol escape = low cortisol levels = adrenals become overstressed.

Adrenal Axis Dysfunction

Job Family

ETOH/Tobacco Finances

Chronic Illness Poor Intestinal health

EXCESSIVE Caffeine

Aka: HPA Axis Dysfunction

HypothalamusPituitaryAdrenal

· Cortisol = 911 stress HORMONE

– Insulin + Cortisol + high calorie diets = Belly fat

· Short term stress = Burns Fats

· Chronic Stress = Fat Storage

Long Term Effect is Metabolic Syndrome

Hormonal

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Diabetes/Obesity/Metabolic Syndrome

· Obesity & Stress pack a double punch

– Overweight & Obesity have increased levels of stress induced inflammation & Joint Dysfunction.

· Each BMI unit increase had 5% chance of disabled First Responder.

•Greater obesity Greater Risk of Increase of WCClaims Jahnke, Poston, Haddock, 2013

WHY

Fatigue + Chronic Stress = Adrenal Fatigue

What you crave Why You Crave It What you Should Eat

Candy

Sweets

French Fries, Chips

Sugary cereal

Doughnuts, muffins,

breads

Cortisol: the ‘stress

hormone.

Triggers insulin

release in oyur body.

Causes cravings for

refined carbs and

sugars. Constant

cycle if crave-eat-feel

better-need more.

Bran muffin, Brown

rice

Dark green leafy

veggies

Fresh (dark colored)

fruit

Whole wheat pasta

Sweet potatoes

Stress Eating

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Fatigue Eating

What you Crave Why you crave it What you should

Eat

Buttered popcorn

Coffee or cola

Fast food

Fried foods

Frozen foods

Ice cream

Mayo and or

cheese

Galantin is a

chemical released

by the brain when

you are tired. The

more fatigued and

stressed you get

the more you want

fat.

Grilled or broiled

fish/chicken

Oatmeal

Trail mix

Raw veggies

Protein bar

Smoothie with

protein

·Diabetes Care 2003 June: Vol. 36. No. 6:20-30Pilz, S., Frisch, S., et al. (2011

Low Testosterone levels are associated with an increased risk of diabetes, heart disease, carotid atherosclerosis, depression, metabolic syndrome, & Poor overall vitality.

Lack of Sleep + Lack of Ex + Stress + Poor Diet + improper exercise = Belly Fat & Low T

-Good diet and exercise = T + insulin = counter to cortisol’s catabolic effects.

T

·Diabetes Care 2003 June: Vol. 36. No. 6:20-30Pilz, S., Frisch, S., et al. (2011

Vitamin & Minerals Zinc

· Improved sleep patterns

· Lowers systemic inflammation

· Protects the heart

· Deficiencies = low testosterone

· Can be toxic in high dosages

· Generally low with those suffering from depression

· Oral Zinc can influence the effectiveness of anti

depression therapy

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Magnesium

• Lost thru sweating

• Improved cardiovascular health

• Reduces levels of oxidative stress *****125-300mg with each meal at bedtime led to rapid recovery

from major depression in <7 days

Mag (500) Calcium (300) + D = great sleep

• Deficiencies increase CRP (inflammation)

• Aluminum is antagonist to magnesium and reduces the Absorption and utilization of it (antiperspirant)

Vitamin D

Associated with depression & a markedly higher risk of heart attack, diabetes, pain & fatigue.

2-6k mg.

Omega 3 & 6 Fish Oils/Flax/Chia has shown to help with depression (1.5 – 2g) & cholesterol levels.

· Magnesium: ZMA = a First Responder’s best friend.

· Power Off

· Melatonin

· 5-HTP:serotonin producer = sleep

Sleep Hygiene

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· Promote an Environment for sleep

· Napping

Sleep Hygiene

· B complex

· Vit. C 2-3k mg. day

· At bedtime Mag-Cal. 300/500

· Pro-biotic= High potency and quality

· PRIMAL Lifts

Adrenal Axis Dysfunction

Fit but Fatigued first responders will still outperform unfit and rested first responders.

Fitness and Resiliency

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Teach a first responder to self treat and eliminate their pain and ANYTHING is possible

Pain

If you do not have a valid, scientifically accurate system of Patient handling…..

Patient Handling

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If you do not have an externally validated, job task simulation, non-biased PAT…….YOU ARE HIRING YOUR NEXT INJURY!

Physical Abilities Testing

The Cost of Injury & Low Resiliency

WC / OJI + Insurance costs + Turnover + On Boarding

Lost Work Days + OT + Morale + call volume/Shift Time

Absenteeism + Presenteeism + crew Utilization

Injury Occurs From Injury Prevention Strategy

Seated Work Posture Get out of the truck, off the couch

Frequent Lifting, Pulling & Pushing Better equipment, stronger

Frequent Torso Motion Teach spine sparing techniques

Repeated Lumbar Flexion Change lift height and torso flexion

Lower torso muscle Endurance Fit for Duty

Poor Motor Patterns Fit for Duty

Abdominal/Torso Girth Fit for Duty

Low Back Disorders, McGill. P. 124

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PUTTING IT TOGETHER

•MOVES•WELL

•POOR•HEALTH

•MOVES•WELL

•GOOD•HEALTH Fitness Wellness

•MOVES•POORLY

•POOR•HEALTH

•MOVES•POORLY

•GOOD•HEALTH

•DR. MCGILL: BUILDING THE ULTIMATE •BACK

Movement Competency

Injury / Disease

Conclusion

Sleep & Resiliency are multi-faceted issues in public safety

There is no single fix = Educate Constantly

It takes a true wellness approach-both personal and operational

12 hr. shifts are bad, 24’s are horrible and 48’s can be deadly

Conclusion-New Research

Recovery of rescuers from a 24-h shift and its association with aerobic fitness

-The Heart Rate Variability findings show that recovery after a long work shift (+24 hours) takes several days.

-Cortisol Response is poor = Adrenal Axis Dysfunction

-2+ days for a return to base line HRV

Int J Occup Med Environ Health 2017;30(3):433-444.

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Success Trains

Failure Complains…& there is a LOT

of Complaining going on

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bfass@fitresponder.com

www.fitresponder.com

Injury Free UniversityA true Blended Learning

Platform to Reduce Loss & Cut Costs while Improving

Crew Wellness