Top Tips for Blue Light Team Members

This set of tips for blue light team members are intended to help:

build healthy, mutual support between colleagues
manage one’s own stress
manage the stress of your colleagues
reduce risk of burn-out

Things to know:

Stress: occurs when the demands made on us exceed the resources we have available to manage them

When we feel stressed there are likely to be good reasons for this
Good colleagues in strong teams, within psychologically smart organisations, help so much
Be aware: stress once experienced as stimulating and exciting, may become unpleasant if repeated time and again
Emergencies tend to create stress in themselves (e.g. pandemics)
Emergencies accelerate the impact of existing vulnerability/stress
Stress can also occur in anticipation of events

Traumatic stress: this refers to events that are often sudden and shocking

These events have been described as like puncturing a ‘mental skin’
We need time and sensible support to recover after such events; this should be anticipated in blue light teams
Most of the time, the majority of people do recover if things are supportive and stable over the following weeks: look out for colleagues not recovering after 4 weeks

Repetitive stress: ‘the straw that broke the camel’s back’

Events coped with successfully, sometimes for years, may still have had a cumulative effect
This is hard to notice, gradually reducing psychosocial resilience and bringing us close to a tipping point
In this state, any additional stress may suddenly prove too much, such that our coping ability collapses

Thinking patterns

Growing our minds and learning, including post trauma growth, is protective
Post traumatic growth is when, following a trauma, we discover and learn new things that build our psychosocial resilience, and we feel psychologically stronger
Our minds need time and care to rebalance, rest and recover

Psychosocial resilience:

It is dynamic; it can increase, for example through gaining new skills, learning and adding tools to the kit. It can also decrease through loss of confidence, feeling under skilled or overwhelmed
Remember some days we are more resilient than others; mind and body fluctuate day-to-day regardless of external events

Key Psychology of Stress and Trauma

Stress and Trauma: what do they look like?

Things to do:

Think of body, mind, relationships and networks

Keep your body in good shape, with healthy living habits, including enough regular sleep
Preserve leisure time, even short times out can make big differences
In the thick of events, when you need to keep going, make a mental note of the need to recover when it’s safe and sensible to do so
After a traumatic event take extra care when driving or doing anything potentially dangerous; put off difficult and demanding tasks temporarily
After events, have regular check-ups, “Did I look after myself”, “My colleagues”, “How did we do as a team”?

Be sensitive to existing difficulties

A colleague may have vulnerabilities that flare up when a new work stress occurs

Every interaction matters; ‘Social Connectedness’

Nurture hope: it helps us cope

Support from each other gives hope, and hopefulness is very important for psychosocial resilience and wellbeing
Learn new skills - growing together as a team promotes optimism
See the glass ‘half full’ and acknowledge what we have to be grateful for
Remember ‘tomorrow is another day’ and ‘this too will pass’

Get trauma-informed to help prevent it

Learn what might be expected after a traumatic incident
How you can support yourself and each other:
- Find out whether your service has a formalised trauma prevention protocol
- Learn about expectable responses to trauma
- Remember that post-traumatic type symptoms are not indicative of a disorder until at least a month after an encounter with trauma
- Keep a careful eye out for each other

Pillars of supporting each other well: trauma-informed approaches

Use the strategies highlighted here:
- Social connection - value relationships
- We are in it together: collaboration versus isolation and often blaming, even bullying
- Self/peer compassion and self-care, body, mind, family, friends, networks
- Through team learning, the whole becomes greater than the sum of the parts, this gives the team strength and cohesion - nurture it
- Effective, psychologically-informed working and leadership: be trustworthy, look out for the team, be fair-minded, be kind where needed, be firm, be consistent, look for clarity of purpose and meaning of the job
- Organisational support - seek out ways to support everyone to feel safe physically and psychologically with transparency and trust
- Empowerment through voice, choice, knowledge and skills
- Stigma comes from ignorance and prejudice: counter stigma and isolation with education and challenge

Team culture

It’s about each team member, and especially leaders, knowing what’s needed and when. Sometimes the team needs to deliver rapid action. Then there are times for reflection. Team structures need to deliver both

Decompression and post-event team reviews

These are supportive ways to relieve the build-up of stress during a shift by sharing at its end and learning from each other
Information may need to be obtained for legal and risk management purposes. If this is the case, be careful to protect the worker from unnecessary rumination on trauma

Be honest and prepare together

Be honest about what each other will face in a work emergency task
There may be personal psychological risks, and everyone should know the range of support available
Pay attention to how we make meaning - ‘why we do this job’. Reinforce the value of the role as individuals and team members. Remember we need to look after ourselves too

Learn what stress is, and what clinical depression and anxiety look like

Stress, anxiety and depression are usually the biggest causes of sickness in services
- Monitor your own and others’ stress
- Work out what works as ‘stress buster’ for you - it’s very individual
- Have your strategies ready and available, don’t assume you’ll find them when you need to
- Know what help is available both from your organisation and externally. There should be clear pathways and resources available in all organisations
- Confront the fear of the unknown by finding out what local HR policies say. Allay anxieties about help-seeking

Listening skills

Listen very carefully
Summarise
Reflect back what you think you heard
Check you have it right
Defer judgement
Repeat with open questions for example “Is there anything else you want to talk about?”
Respond appropriately – beware of leaping into premature action, be open to working out a collaborative plan
Develop the ability to empathically tune in without emotional contagion
Relevant skills can be developed via mindfulness-based approaches, further learning is available on mindfulness here

Knowing who to speak with

Be shrewd in identifying support both in and out of work and who you can share your feelings with safely

It's ok not to be ok

It’s important that supervisors give the space for this to be true, for themselves and team members
For supervisors to know how to handle team member’s distress
Like layers of PPE, get your psychological (oxygen) mask on first before trying to help others

Resources and references

Internally:
- Occupational Health

External resources that may offer help:
- GP
- Improving Access to Psychological Therapies (IAPT)

References:
- Jones, N, Fear N.T., Wessely, S., Thandi, G. and Greenberg, N. (2017) Forward psychiatry – early intervention for mental health problems among UK armed forces in Afghanistan European Psychiatry 39, 66-72
- Solomon Z, Mikulincer M. Trajectories of PTSD : A 20-year longitudinal study. American Journal of Psychiatry 2003 ; 1 63 : 659–666
- Stevenson D, Farmer P. Thriving at Work: The Stevenson/ Farmer Review of Mental Health and Employers. Department for Work and Pensions and Department of Health and Social Care; 2017
- Milligan-Saville JS, Tan L, Gayed A, Barnes C, Dobson M, Bryant RA, Christensen H, Mykletun A, Harvey SB. Workplace mental health training for managers and its effect on sick leave in employees: a cluster randomised control trial. Lancet Psychiatry 2017; 4: 850-85

Other resources

Web resources:
- NHS People
- NHS Practitioner Health
- Psychological First Aid
- Mind: Blue Light Programme Research Summary 2016-18. London: Mind; 2018.
- March on Stress TRiM
- The Oscar Kilo Programme
- HeadFit - aimed at the military but trying to appeal to others too
- Critical incident stress management: Merseyside FRS
- MindEd Mindfulness e-learning session
Other support groups and caring organisations you may find helpful include:
- The Samaritans – offers a 24- hour helpline for those in crisis. Tel: 116 123
- Cruse – Bereavement Care – Offers counselling, advice and support throughout the UK. Tel: 0808 808 1677
- Assist Trauma Care – Offers telephone counselling and support to individuals and families in the aftermath of trauma. Tel: 01788 551919.
- Drinkaware – offers facts, advice and support to manage drinking. Tel: 020 7766 9900
- Relate – offers relationship support for couples and families. Tel: 0300 0030396
- Stonewall – offers information, advice and support for gay, lesbian, bi, and trans communities. Tel: FREEPHONE 0800 0502020.
- Domestic Violence Intervention Project – offers advice and support to individuals and families who have experienced domestic violence as well as to individuals who want to change their behaviour. Tel: 020 7633 9181.
- The Ambulance Staff Charity (TASC)
- Our Frontline
- Just B
- Shout – Mental Health At Work
- College of Paramedics
- The Fire Fighters Charity - offers a range of mental and physical health support, as well as residential stays.
- Assist Trauma Care - provides information and help for people with PTSD and anyone supporting them
- PTSD999 - support and training for serving and retired emergency services personnel

Acknowledgements

The content for these tips draws upon four more detailed elearning sessions launched in 2021 for Blue Light Services Staff “Building Staff Psychosocial Resilience and Wellbeing”. We are grateful to the authoring teams for all their input and support, upon which these tips are built.

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Disclaimer

This document provides general information and discussions about health and related subjects. The information and other content provided in this document, or in any linked materials, are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment.

If you or any other person has a medical concern, you should consult with your healthcare provider or seek other professional medical treatment. Never disregard professional medical advice or delay in seeking it because of something that you have read in this document or in any linked materials. If you think you may have an emergency, call an appropriate source of help and support such as your doctor or emergency services immediately.

MindEd is created by a group of organisations and is funded by NHS England, the Department of Health and Social Care and the Department for Education.