How will I know if I’m not OK?

Recognising your warning signs

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Recognising hazards at work

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Risky jobs, roles and stages of your career

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Your warning signs

In the section on Coping and Self-care we used a car metaphor to explain the importance of having enough fuel in your tank. Now we’re going to think about the warning lights on your dashboard and the hazard signs that might appear along the roadside. These things let us know when we need to do some maintenance and help us prepare for difficult conditions ahead. 

Let’s start with your dashboard. Do you understand your warning signs? Do you pay attention to them? And is there one that you’re never quite sure what it means?

In Understanding our response to trauma and stress we explained how our minds and bodies react when we’re under threat and the things that affect our ability to bounce back. It can be hard to recover our balance after some traumatic events and difficult to maintain it when we’re under constant pressure. When this happens, things can get out of kilter. 

Below are some common warning signs which, if you can recognise and understand, you’ll have a good chance of fixing them. If you need a bit more help, please have a look at the tips on the What can I do if I’m not OK? page. 

A car dashboard showing empty fuel

Common warning signs...

Sleep difficulties
Most of us have nights where we don't sleep well. Sleep is a sensitive thing, easily disrupted by too much food or alcohol, excitement or worry, time zones or shift work, and it's a common warning sign that things aren’t OK.  

When we’re stressed the survival parts of our brain are active and alert to potential danger. This means we may have difficulty getting to sleep or wake during the night with a head full of worries. Once our sleep routine is disturbed it can become a vicious circle; we may nap during the day and so be less tired at bedtime, or our worry about not being able to sleep, can add to the stress that keeps us awake.

For more information on improving your sleep, visit the NHS website or watch these videos by the Sleep Council and NHS24 on how to improve your sleep. 

If you’ve had problems with insomnia for a while, please try the Sleepio app. It’s an evidence-based sleep improvement programme (based on CBT) that is free to Scotland’s emergency responder community.

Sleep disturbance is common after we’ve experienced a traumatic event. During the days and weeks that follow the event, our brain is “processing” this experience and so we may dream about it at night as well as thinking about it when awake. It’s important to know that if we avoid thinking about the traumatic event when we’re awake, then we are almost certain to dream about it. The best thing to do is to let yourself think (and talk) about it during waking hours. If nightmares and sleep difficulties persist then you may need some extra help to manage these. Have a look at the tips in the What can I do if I'm not OK? pages
Headaches and other muscle pain
When our hyperarousal response is triggered, we tense our muscles ready for fight or flight. If we use them for action, the tension is released. If we don’t, then the muscle tension stays in our body and turns into aches and pains. Lots of the things that stress us don’t require a physical response and so our muscles get tight and sore.  We need to move our bodies to release the tension.

Any movement helps so try a stretch at your desk or getting out for a walk. We commonly hold lots of tension across our neck and shoulders (hence the headaches) so try a shoulder roll – breathe in as you bring your shoulders up towards your ears and out as you roll them back and down.

Have a look at Coping and Self Care for some more tips on releasing tension in your body.
Changes in appetite /upset stomachs
When our bodies are in fight or flight mode all resources are geared towards being able to survive the here and now. This includes diverting energy away from our digestive system to our muscles, and emptying our bowels and bladders to make us faster and lighter. It explains why athletes need to go to the toilet just before a race and why, when we’re stressed, we often experience changes in our appetites, have upset stomachs, acid reflux, or need to use the toilet more.

Sometimes these changes bring their own problems. Because we don’t feel hungry, we don’t eat or because we’re tired, we may crave high energy foods or increase our caffeine intake.

Things that will help
When we’re stressed our body needs us to eat well even if we don’t feel like it, so try to maintain or re-establish regular eating habits. Eat as healthily as you can, stay hydrated and watch out for alcohol and caffeine. It might be helpful to plan out your meals in advance and stick to regular mealtimes.  

Please look at Coping and Self Care to get tips on switching off your stress response when it’s not needed. You can find more tips on eating healthily on this NHS website.
Feeling on edge or irritable
Our stress response prepares us for action, physically and mentally. This means when we’re stressed, we find it hard to settle and often feel jittery and restless. When it goes on for a while it’s exhausting, we're "wired but tired".

This explains why irritability (also known as being more crabbit than usual..) is a classic warning sign. Our body is primed to react and we’re on a shorter fuse which means we’re more likely to startle if someone bangs a door, or to lose our temper over small things.

This is a sign our family and friends often notice before we do. You can get your stress response under control through exercise and relaxation. Have a look at the Coping and Self Care page for some tips
Feeling anxious and worried
Because you work for an emergency service, you know that random bad things happen. You probably worry more than the average person about switching off electrical appliances and teenagers learning to drive. Let’s think of this as your risk-o-meter. When we’re stressed, that risk-o-meter can get further out of kilter and feelings of anxiety are a classic warning sign to look out for.   Our stress response prepares us for action, physically and mentally.

If it doesn’t switch off, then this affects how we think and feel. Because our body is tense and ready to respond to threat, our mind may think there is a threat to respond to. This can become self-fulfilling: the more anxious we feel, the more adrenalin our body produces, so we feel more anxious and may overestimate the challenges and risks we face. This can spiral until we feel panicky and out of control.

When we’re feeling anxious and worried it can help to recognise that our risk-o-meter is overheating. Try using exercise and relaxation to get your stress response under control and do things that keep your mind focused on the present moment. We want to avoid getting anxious about feeling anxious. Distract yourself from worries by doing something else, for example exercising, cooking, watching a film or talking with family and friends. Remind yourself that if you can calm your stress response down your anxiety levels should reduce too.

If anxiety doesn’t settle, have a look at the advice on the What can I do if I'm not OK? page. You can also try the Daylight app -It’s an evidence-based anxiety management program free to Scotland’s emergency responder community.
Feeling exhausted and down
It is exhausting being ready for action for extended periods of time. The stressor we face may require us to be physically active (e.g. a prolonged response to a rail crash) or not (e.g. the challenges of working from home during COVID19) but either way it is normal to feel fatigue and exhaustion after a while.

Sometimes if our brain decides that being on high alert is not something that is going to resolve the stressor, it can drive us to “shut down” to save energy. This might impact our mood and make us feel low or numb. We might feel slowed down and unmotivated.

We call this fatigue being “wired but tired”; our body has run out of energy for the stress response and needs time to recover and recuperate. It is important to listen to this warning sign and rest. Don’t misinterpret these feelings as weakness and push yourself harder!

Be aware that if you’ve been working full tilt for a long period, you may not realise how physically and emotionally exhausted you are until you stop. Be gentle with yourself.  

Living Life to the Full is a free online course that will help you deal with low mood and stress. You can find other tips on how to recharge on the Coping and Self Care page and the What can I do if I'm not OK? page for advice on low mood and depression
Difficulty concentrating and making decisions
When we experience situations that are highly stressful the survival parts of our brain come "online". When these parts are in charge, the part of our brain that allows us to concentrate and make decisions doesn't work so well and can become “sluggish”. The longer the survival parts are online the more sluggish it can get. This can also happen when we’re worried, tired or angry.

If you're having trouble with concentrations, recognise it as warning sign that you need to rest and recover. Find tips on what can help on the Coping and Self Care page
Feeling numb and detached
The ability to detach emotionally, when we’re involved in potentially traumatic situations, is a helpful part of our Protective Armour.  It is our brain’s way of coping with extremes of stress and allows us to focus on our professional role without getting distracted or overwhelmed.  However, if we stay disconnected from our emotions then this is a warning sign of too much stress.

Try to do things that give you pleasure and connect you with the people who are important to you. As much as possible, try to maintain a balance between your work and home life.  Have a look at the Coping and Self Care pages for more suggestions on coping with these feelings
Intrusive memories or bad dreams
The memories we make during frightening or distressing experiences are different to our other memories; they are more vivid and often jumbled or fragmented. Our brains are information processing machines and their job is to “process” these memories; they get a time code, so we know they’re in the past, and we learn from what happened, so we can stay safe in the future. To do this our brain will bring the raw data (smells, sounds, images) into our awareness during the day and while we’re asleep. This isn’t very pleasant because until the processing is complete, the memories are vivid, and it can feel like we’re right back in the frightening experience.

This is a light on your dashboard that you don’t need to worry about too much if it comes on in the days and weeks after a traumatic experience. It’s a sign that things are working normally and if we can allow the memories to come and go, then our brain will do its work and they’ll get filed away. They’ll always be more vivid than non-trauma memories, but they won’t pop up unless we choose to think about them. When the stressful situation goes on for a long time, our brain may not start to make sense of it until it’s over so don’t be surprised if the “processing” happens sometime after the experience.

However, if the bad dreams and daytime intrusions are happening so often that it is hard to sleep or function during the day, or if they’re not reducing after a month then they’re a warning light we need to pay attention to.  

One thing that can make intrusions worse is trying not to think about them. We need to trust our brains and allow the processing to happen. We can do this by talking with someone we trust or perhaps writing things down. Have a look at the What can I do if I'm not OK? page for more advice on dealing with trauma memories
Avoiding reminders
When we experience something that is highly stressful or distressing we don’t want to be reminded of it, so we may avoid reminders, such as the place where it happened or the people connected with it.  This is OK for a short while and can help us manage our distress. However it becomes a problem if we need to keep avoiding things, places, thoughts and feelings in order to cope. It’s a warning sign that we may be developing a post traumatic stress reaction.

Where possible, try not to avoid. Remember that the event has passed. You can do this by focusing on differences between then and now and keeping yourself grounded in the present moment. It can be helpful to speak to others about these experiences if you feel ready to do so.

Please look at the What can I do if I'm not OK? page for more advice on managing avoidance and post traumatic stress.
Drinking more alcohol
This is a warning light that you need to check out. Are you drinking more alcohol than usual? Are you drinking to reduce stress or to numb difficult emotions such as sadness, anxiety or fear? Are you drinking more to get to sleep or to block unpleasant memories?

It’s human nature to try to find a way to reduce emotional or physical pain but drinking too much alcohol makes us feel more anxious, lowers our mood and disrupts our sleep cycle. If you’ve answered yes to any of the questions above, please use this website to find other suggestions on Coping and self-care and What can I do if I'm not OK?

If you are worried about your alcohol use, you can find tips on how to reduce your intake on the NHS Inform website or get more information on our Find Help page.
Changes in pre-existing mental health conditions
We all have mental health and so some of us may have a history of (or be living currently with) illnesses like depression, bipolar disorder, substance misuse or an eating disorder.

You may have recovered or be managing these conditions well, but that can be affected by exposure to stress and trauma. Watch out for any changes in your mood and ability to cope and please access help if you need it.  

Recognising hazards at work

Let’s think now about how we can anticipate times when you may be more vulnerable to psychological injury. These risks may be related to the incident you’re responding to or perhaps to your career role or stage.

You can read more about these in the Protective Armour section and watch  Iain and Jules describing some of the difficult jobs they’ve faced.

Risky jobs

Incidents involving large loss of life or multiple victims with serious injuries
Incidents involving known victims
Incidents involving children
Incidents involving colleagues
When you can’t detach and identify with the people or community involved in a traumatic incident
When things go wrong, or mistakes are made
When you’re isolated or unsupported
When normal coping isn’t possible
When physical resilience is overwhelmed

Risky roles and career stages

As well as the hazardous incidents listed above, there will be other times when your Protective armour might be challenged.
At the start of your career
It takes a little time to build confidence and a sense of competence. We need to establish trusting relationships with colleagues and learn to detach from the human suffering we encounter. Until this happens, you are at greater risk of psychological injury from potentially traumatic jobs.

We used to think it was helpful to show new fire fighters the bodies of those who had died in fires or accidents, a way of helping them get used to dealing with death and serious injury. This attempt at inoculation was well-intentioned but based on flawed logic. Science tells us that we’re protected by being active and purposeful in the face of trauma; so passive viewing increases rather than reduces the risk of injury.

Creating teams where colleagues can discuss difficult jobs reinforces everyone’s armour.
Working in the retained duty system
There are some specific hazards for those of you working in the retained. You’re more likely to know the people involved and, because you have to go back to work or bed after a shout, may have less time to decompress with colleagues after a difficult job.

If your station is short-staffed you may feel the need to be on call most of the time, so you don’t get a break or protected time with your family and friends. Especially if you’re the crew or watch manager, or work in the wholetime service as well.

However, there will be positives too, and the retained fire fighter’s armour has some extra protective features. You are likely to have a strong sense of pride in providing a service to your own community and may enjoy the extra solidarity of working with close friends or family members.
When you’re promoted
We know that change can be stressful and that even positive changes can compromise our protective armour.

Promotion usually brings additional challenges which can be both rewarding and stressful. We may find that we’re working alone and miss the camaraderie of colleagues or find that we’re now their manager and no longer enjoy the same peer support. Moving into a senior role may mean we lose the flexibility of shift work and instead need to adjust to being on call.

Don’t underestimate these hazards and make sure you adapt your Protective Armour to suit your new role.
When you move into a specialist role
The expertise and status that often accompany a specialist role is likely to form a new section of your Protective Armour. Whether you’re working in a station that does water line rescue or joining the fire investigation team, you will get additional training and develop new skills. But there may be hazards too, both physical and psychological.

For example, those of you working in fire investigation can find it harder to detach because your job is to understand the back story, you are mentally rather than physically active in the face of potentially traumatic material and often working alone.

It is not inevitable that you will be injured by these fresh challenges, but it is important to understand the hazards and to do what we can to mitigate them. That’s why we have Lifelines Essential # 3 “Health and Safety assessments should include psychological risk”.

Taking Fire Survival Calls in Control
There are several role-specific hazards for those of you who work in Control and you will have modified your Protective Armour to deal with these. You learn how to juggle multiple competing demands on resources and how to detach as you deal with distressed callers or hear worrying the information across the airwaves.

Fire Survival Calls are a specific hazard faced by you and your colleagues. If the person dies when you’re on the phone with them this increases your risk of psychological injury significantly. Even if the outcome is positive, these are stressful calls, so keep a check on yourself and your colleagues and make use of the information and advice on this website.
At the end of your career
This is so important we’ve given it a whole section on this site. However much you’re looking forward to retirement, there are losses involved, from your colleagues, your daily routine, to your sense of identity. This is further complicated if you’re retiring early on physical or mental health grounds. Have a look at the I’m leaving or have left the service section to find out more.
Stressful times outside work
As well as all these work-related stressors, you will also be dealing with the challenges of everyday life. These may be positive changes, like moving to a new house, starting a new relationship, becoming a parent, or children leaving home. Others will involve losses and heartbreak such as bereavement, ill health, relationship breakdown and practical stressors like debt or difficulties linked to discrimination and harassment.

You may have experienced traumatic events outside work that are affecting your wellbeing and mental health. Perhaps you are a veteran of the armed forces, experienced adversity in childhood or abuse within a relationship.

All of these things can affect your ability to stay well and can trigger the warning signs listed above. Please make use of the support available, both nationally and through your service to get the help you need to get through difficult times.