17 2019
WAGES AGREEMENT REACHED FOR QGAIR RESCUE
Australian & New Zealand Disaster & Emergency Management Conference Wednesday12 - Thursday13 June | RACV ROYAL PINES resort GOLD COAST, QLD
2019 conference www.anzdmc.com.au
THE PLACE LEADERS COME TO MEET EARLY BIRD REGISTRATION CLOSES
8 May 2019 Brought to you by:
VOLUME 9 ISSUE 1 2019 Cover photo: QGAir, photo courtesy of United Voice QLD.
06
Paramedics, are you ready to stomp for mental health?
09
Queensland News: QGAIR reaches in-principle agreement
Queensland News: Industrial update
Riding across America for Beyond Blue
AUSTRALIAN CAPITAL TERRITORY Steve Mitchell E: TWUAmbulance@act.twu.com.au P: 02 6280 9353
NORTHERN TERRITORY Erina Early E: erina.early@unitedvoice.org.au P: 0400 030 834
NEW SOUTH WALES Greg Bruce E: GBruce@ambulance.nsw.gov.au P: 0408 020 609
QUEENSLAND Debbie Gillott E: debbie.gillott@unitedvoice.org.au
Ambulance Active Official Publication of National Council of Ambulance Unions
08 17
PUBLISHER Ambulance Active is published by Countrywide Austral. Countrywide Austral adheres to stringent ethical advertising practices and any advertising inquiries should be directed to:
Level 2, 310 King Street, Melbourne • GPO Box 2466, Melbourne 3001 Ph: (03) 9937 0200 Fax: (03) 9937 0201 • Email: admin@cwaustral.com.au
REGULARS From the President 05
FEATURES are you ready to 06 Paramedics, stomp for mental health? unions tired of ramping 07 SA “talkfests” 08 Queensland News 10 WA Country Ambulance Services 12
Eye Movement Desensitisation and Reprocessing (EMDR) Therapy
16 Health and wellbeing 18 WA bargaining concludes 20 Things paramedics understand
SOUTH AUSTRALIA Phil Palmer E: info@aeasa.com.au P: 08 8340 3511
VICTORIA Danny Hill E: Danny.Hill@unitedvoice.org.au P: 0419 383 152
TASMANIA Tim Jacobson E: tim@hacsutas.net.au P: 1300 880 032
WESTERN AUSTRALIA Pat O’Donnell E: wa@unitedvoice.org.au P: 08 9388 5400
Disclaimer: Countrywide Austral (“Publisher”) advises that the contents of this publication are at the sole discretion of the National Council of Ambulance Unions and the publication is offered for background information purposes only. The publication has been formulated in good faith and the Publisher believes its contents to be accurate, however, the contents do not amount to a recommendation (either expressly or by implication) and should not be relied upon in lieu of specific professional advice. The Publisher disclaims all responsibility for any loss or damage which may be incurred by any reader relying upon the information contained in the publication whether that loss or damage is caused by any fault or negligence on the part of the publisher, its directors and employees. Copyright: All advertisements appearing in this publication are subject to copyright and may not be reproduced except with the consent of the owner of the copyright. Advertising: Advertisements in this journal are solicited from organisations and businesses on the understanding that no special considerations other than those normally accepted in respect of commercial dealings, will be given to any advertiser.
Super advice. Super easy. At ESSSuper we want to make it easy for you to get the information and advice you need, to make good decisions about your future. You have free access to our Member Education Consultants, who understand the type of work you do. Or for more wide-ranging, personal financial advice, we have Financial Planners* who are the experts in your fund.
To make an appointment with a Member Education Consultant or Financial Planner, call 1300 350 161 or simply visit esssuper.com.au/Advice
* ESSSuper Financial Planners are authorised representatives of Adviser Network Pty Ltd (Adviser Network). Adviser Network holds a current Australian Financial Services Licence No. 232729 and is responsible for the financial services provided to you. ESSSuper has an arrangement with Adviser Network Pty Ltd to provide financial advice to ESSSuper members. ESSSuper pays Adviser Network a fee for this service. Neither the Board, nor the Victorian Government, guarantee or endorse any recommendations made by Adviser Network, or are responsible for the advice and actions of Adviser Network. © Emergency Services Superannuation Board (ESSB) ABN 28 161 296 741. Issued by Emergency Services Superannuation Board ABN 28 161 296 741 (ESSB), the Trustee of the Emergency Services Superannuation Scheme ABN 85 894 637 037 (ESSSuper). Before making a decision about an ESSSuper product or service please consider our Product Disclosure Statement (PDS) that is available at esssuper.com.au or by calling us on 1300 650 161.
ESS17563_PUBLICATION_AMBO_MECFP_190x131mm_V4.indd 1
23/3/18 4:22 pm
Living with PTSD? We Can Help Moving Beyond Trauma is a 5-day residential program at the Quest for Life Centre in Bundanoon, NSW designed to assist people with PTSD reclaim their lives. The program draws on an understanding of trauma, its effect on the brain and teaches practical skills and tools which bring relief to the troubled body, mind and spirit. Based on the latest research on health, healing and neuroscience, our nationally acclaimed programs are delivered by a highly qualified professional team in a safe and confidential environment. 2019 Programs 3-7 June 15-19 July 19-23 August 14-18 October 2-6 December
Call 1300 941 488 or visit www.questforlife.com.au
NDIS Provider. Subsidies available. Speak to us if you’re covered by worker’s compensation. Special Offer for Ambulance Active readers
$200 off
the program fee if you mention ‘Ambulance’ when booking
PRESIDENT
the PRESIDENT
DANNY HILL, PRESIDENT, NCAU WELCOME TO THE SECOND EDITION of our digital format of Ambulance Active. The mental health of first responders continues to be a major focus for NCAU. In March I represented NCAU at the Mental Health Forum in Melbourne. Speakers included representatives from Emergency Management Victoria, Fire and Emergency New Zealand, Ambulance Victoria, and Beyondblue. It was an excellent chance to share knowledge and listen to strategies being adopted by other organisations. This forum came after the recent National Survey on Mental Health and Wellbeing of Police and Emergency Service Personnel – Answering the call. Forums such as this ensure that through working together and sharing knowledge we are better positioned to devise a national mental health strategy for our members that works. Recently I gave personal testimony at the Senate hearing into mental health. The Education and Employment References Committee published its findings a few weeks ago and is available at parlinfo.aph.gov.au/. Overall the report recommended a more coordinated approach between State and AMBULANCE ACTIVE
Federal governments to help emergency responders. Interestingly it recommended that all levels of government increase oversight of privately owned first responder organisations. Fortunately in Victoria we have a State Government that has recognised the gaps, and has committed to tighter regulation. Hopefully this level of recognition will lead to positive change for our comrades around the country. Another significant recommendation to emerge from the report was that there needs to be greater design in a national action plan that specifically benefits emergency responders. With a cohort of approximately 80,000 full-time emergency workers spread across Australia, states and territories really do need to work together to address mental health. Strategies should not be shaped along partisan lines. Repeated exposure to traumatic and critical incidents has in the past been seen as part of the job. But now we are becoming increasingly aware that repeated exposure can lead to significant mental health problems in the medium to long term. Education is therefore seen as a key ingredient to a national strategy, with awareness training and safety plans in every first responder organisation across Australia being advocated for in the report. The workers compensation claims process has been identified as a key area of concern, with submitters reporting that due to a variance in workers compensation laws in both state and federal jurisdictions, not one single system is easy to navigate. The committee made four recommendations relating to this area. They include improvements to the use of independent medical examiners, the consistency of medical referrals, the need for early intervention within organisations, and the establishment of a register of health professionals who specialise in first responder mental health. While the legislative process may frustratingly take some time to catch up with any of
these recommendations, parliamentary recognition of the inherent flaws in the system is an important first step. This is why it is critical that NCAU continue to work together to ensure that the mental health of first responders continues to remain in the public mind. On a lighter note, it is with great pleasure that we congratulate former NCAU President Steve McGhie on his election to the Victorian State Parliament. After a 15 year career in the ambulance service, Steve joined Ambulance Employees Association Victoria (AEAV) in 1993 when he became a Regional Shop steward. He went on to become AEAV General Secretary in 2005. After a brief period of retirement he was lured into State politics- when Daniel Andrews convinced him to stand in the seat of Melton, in Melbourne’s fastest growing corridor. He won convincingly, with 54.3 per cent of the vote. He delivered his maiden speech in March. It can be viewed through his Facebook page. Congratulations Steve!
Welcome Savannah White as the new editor of Ambulance Active. Savannah is studying a double major in Creative Writing and Literature and Professional Writing and Editing, with a minor in Public Relations, at Swinburne University. Working with the Swinburne journals Backstory and Other Terrain editing pieces, writing book reviews and conducting interviews. Savannah is excited to be working with the NCAU in producing the Ambulance Active publication.
05
PARAMEDICS, ARE YOU READY TO STOMP FOR MENTAL HEALTH? Have you ever sat in a stadium watching a game of AFL or cricket, musing over the number of stairs it takes to build a 40,000-100,000 seat venue? THE ANNUAL STADIUM STOMP EVENT gives you the chance to put your feet on each and every stair, and it is happening around the country again this year, starting in Sydney on 2 June and finishing at Brisbane’s GABBA in late July. The most stairs to tackle will come from arguably Australia’s most iconic sporting venues, the MCG, with up to 7,600 stairs for the most daring emergency services personnel to stomp. Paramedics are signing up alongside colleague, stair climber and mental health advocate Rain Histen from Ambulance Victoria as she leads a team at this year’s Stadium Stomp Emergency Services challenge at The ‘G’ on 30 June. Rain has teamed up with Emergency Services Foundation (ESF) as her charity partner, an organisation dedicated to providing a service to emergency services officers. “The great thing about Stadium Stomp is we choose our own charity to fundraise for, and I am completely aligned with the work ESF does for emergency services,” Rain said. “The Stadium Stomp is much much more than a race, it is a coming together of all emergency services stomping our iconic MCG to show the camaraderie that exists between us, and raise money for a foundation we back whole-heartedly.” The Emergency Services Foundation was established after Victoria’s 1983 Ash Wednesday fires to provide relief to affected families. CEO Siusan MacKenzie said ESF brings together people, organisations and expertise from across and beyond the sector to further knowledge, drive innovation and continuous improvement in the area of mental health and wellbeing. “There is much evidence which points to the fact that this needs attention and is critical to overall capability of the sector.,” Ms MacKenzie said. “The Emergency Services challenge component of this year’s Stadium Stomp
06
will include people working with the agencies Ambulance Victoria, MFB, CFA, SES and VicPol. “It will be a team effort to raise funds to help the ESF help the sector address the mental health challenges faced by its people.” Rain said mental health is not an issue individual emergency services agencies can tackle individually. “We can’t find solutions to mental health just by ourselves,” she said, “We need allies. When a paramedic or a police officer, a member of the SES or a firey is in the room talking about PTSD, we can all relate. “This event will bring us together and connect us, building camaraderie and will be a solid reminder that we need each other and are there for each other as we face similar issues and problems. “We are very proud to have the Emergency Services Foundation onboard and will look to raise money that will be funneled back into programs that aim to keep us well.” Paramedics from all over Australia are encouraged to join the Emergency Services challenge at this year’s The Stadium Stomp at the MCG! Or, check out a Stadium Stomp in your capital city and get onboard.
ABOUT THE COURSE The Stadium Stomp is a challenge not a race, not a timed event. You can match a course to your level of fitness. Full course: Number of stairs: 7,600 up and down Expected time to complete: 45 minutes – 2 hours Short course: Number of stairs: 2,200 up and down Expected time to complete: approx 25 minutes
THE STADIUM STOMP 2019 EVENTS: Sydney ES, Sydney, 2 June Adelaide Oval, Adelaide, 16 June Melbourne, MCG, 30 June GABBA, Brisbane, 28 July
For more information about The Stadium Stomp Melbourne contact Rain Histen at rainparamedic@gmail.com The Stadium Stomp visit www.stadiumstomp.com Emergency Services Foundation visit esf.com.au
AMBULANCE ACTIVE
SA UNIONS TIRED OF RAMPING “TALKFESTS”
THE SA AMBULANCE EMPLOYEES Association joined forces with the SA Salaried Medical Officers Association and the Australian Nursing and Midwifery Union recently, calling on the State Government to take immediate action to reduce ramping. The state’s three biggest unions representing health workers held crisis talks with the State Government in early February in an effort to improve patient flow and reduce pressure on emergency departments. The unions followed up with a joint letter to the South Australian Government, telling them the time for “talkfests” was over. "Despite promises of consultation and briefings, the unions and our members have yet to receive any plans arising from those planning forums," the letter said. "The time for talkfests is over. Please act now to issue and implement AMBULANCE ACTIVE
the change that we have all agreed is required." The unions called on SA Health Minister Stephen Wade to release SA Health's plans within a week of receiving the letter (end of February) with "clear timeframes for implementation". The pressure from the unions came at the same time a review of patient safety incidents in South Australia’s ambulance system was released. The review looked into 17 incidents (including nine deaths) and showed 14 where people suffered preventable harm. It also reported that paramedics and patients were being let down by years of ambulance ramping. The State Government announced shortly after that more staff, including nurses, midwives and junior medical staff would be authorised to discharge patients, reducing the reliance on doctors to undertake this task, which is one of the biggest causes of ambulance ramping.
MORE STILL NEEDS TO BE DONE! AEA Secretary Phil Palmer said that on some nights, up to 18 ambulances could be ramped outside the Royal Adelaide Hospital. In November last year, Mr Palmer told the ABC that some patients were moved into the hospital but were still in the care of paramedics waiting for a bed in an attempt to make it look like there were few ambulances ramping. “You might call it ‘corridoring’, we still call it ‘ramping’,” he told ABC state political reporter Leah MacLennan. “It doesn’t matter what you call it, it’s a delayed transfer of care. It’s tying up an ambulance instead of freeing it up to go into the community.” Soon after this night, which Mr Palmer described as “an absolute shocker”, paramedics took to writing messages like ‘I can’t save your life if I’m ramped’ and ‘I can’t save your mate’s life while I’m ramped’, in liquid chalk on the side of ambulance to raise public awareness.
07
QUEENSLAND NEWS Industrial update THE QUEENSLAND AMBULANCE Sector continues to grow in density with membership now exceeding 3000. We have also seen an increase in members wanting to perform a more active role in their union with over 35 new delegates elected to represent their workplace.
PROFESSIONAL REGISTRATION Registration has now become a reality. Due to the concentrated efforts of United Voice Qld delegates and the ambulance team in supporting and assisting members through the application process we were pleased to report that less than 1 per cent of QAS employed paramedics did not apply for registration. Available to current employees applying by 1 December 2018, members were able to secure from QAS a commitment to pay the one-off application fee. United Voice also brokered a prime Professional Indemnity product for members with a cover of 20 million dollars. In the event of a claim the excess of $2000 will be covered United Voice. This product made available to members without any increase to current membership fees. We also have a specialist team of industrial advocates who are familiar with the National Law for the professional registration of paramedics and who will be able to provide support and assistance for any member who is required to have dealings with the regulator, AHPRA, in the course of their career. Especially important to seek this specialised advice in order to ensure obligations are met around mandatory reporting and correct response if a member is in receipt of a notification.
INDUSTRIAL We continue to have some good wins and member activism in local and broader issues such as: • Consistent application of pressure on the health service in addressing ramping issues. Delegates taking their stories to media and community forums which has resulted in some interim fixes such as Rapid Offload. The ground work, reporting, collecting of data and campaigning by members continue so we can keep up the fight around Ramping until a solution has been reached.
08
Photos supplied by United Voice QLD.
• Securing full time positions for long term casual patient transport officers. • Representing graduate placements with issues of rostering, underpayment of wages, transfers. • Flexible working arrangements for return to work parents. Particularly around the very expensive child care arrangements that our shift-working members have to deal with. • Dispute around pay point progression, which resulted in a six-month salary continuance and back pay.
• Positive outcomes for compassionate and voluntary transfers. • Resolutions to work place bullying and sexual harassment issues. • Commitment from QAS not to use arrangements such as agency, contract or private paramedics in order to meet peak demands. Utilisation of casual pool. • Committed by the State Government, an increase of 100 extra paramedics across Queensland. AMBULANCE ACTIVE
QGAIR reaches in-principle agreement AFTER MANY MONTHS OF negotiations with their employer, members of QGAir Rescue from Cairns, Townsville and Archerfield sites have reached agreement around wages and conditions for their next certified agreement.
KEY WINS INCLUDED: • 42-hour weekly roster to be paid at 38-hour ordinary time and four hours overtime putting an extra $1500 - $3000 per annum into the pockets of staff • Agreement on the calculation of relevant loadings and consequential adjustment to salaries to apply from 1 September but prior to EB salary adjustment • Increase to NVG allowance $1000 for the first year then as per wages adjustment for the remaining two years • Increase to casual rates for ACOs and RCOs. • Increase to training allowance for training crew. Agreement has also been reached to amend the current Award to
Photos supplied by United Voice QLD.
introduce coverage of aircrew into the General Employees (Qld Government Departments) and Other Employees Award – State 2015. An application has been lodged with the Queensland Industiral Relations Commission. All staff participated in voting on the proposed agreement with 94 per cent voting “YES” and 6 per cent voting “NO”.
Congratulations to all staff on the outcome. These results would not been achieved without the hard work of your negotiating team Greg Gill, Greg Huppatz and Rod Edwards. On behalf of United Voice members we thank you for your dedication and professionalism to these negotiations.
ERINDALE KEBAB AND CAFE 2/50 Denigan St Wanniassa ACT 2903 Ph: 02 6296 3582 Please call Adam on Mob: 0475 435 397 “Find us on Facebook”
Proudly Supporting the Ambulance and Paramedic Members
AMBULANCE ACTIVE
09
WA COUNTRY AMBULANCE SERVICES By United Voice WA THE PROVISION OF AMBULANCE Services in Western Australia is managed by way of contract between the State Government and St John Ambulance (‘Contract’)1. Whilst there are key performance indicators contained within the contract (albeit relatively few) in relation to the standard of service in the metropolitan area, for approximately 99 per cent of the state’s geography, ‘there are no contractual requirements for an ambulance service to respond to calls, meet minimum standards of response availability or maintain constant coverage of emergency transportation’2. To date, the minimum standard of service provision in the country is one described in the Contract as ‘best endeavours’ – that is the provider, St John, is to use their ‘best endeavours’ to meet the pre-hospital care needs of people in country WA, which has resulted in communities being entirely reliant on the good will and dedication of local volunteers. This represents a significant inequity between country and metropolitan areas in the provision of ambulance services. United Voice Paramedic members and Delegates understand this inequity, particularly in how it translates to inadequate staffing levels in career locations, and a heavy burden on the mental health and wellbeing of Community Paramedics who work in isolation with volunteers in remote locations. Delegates, to this end, have continued to lobby the State Government for improvements in relation to country staffing levels, and an increased Government oversight into the provision of ambulance services both in rural and metropolitan areas. Commencing February 2017, the Western Australian government, in conjunction with the WA Country Health Service (WACHS) began work on the development of a Country Ambulance Strategy for Western Australia (Strategy). This process involved an examination of previous reviews conducted into St John Ambulance, analysis of Australian and international rural/remote ambulance practices, a comprehensive literature
10
review, and significant community consultation. In September of 2018, WACHS released for public comment the final draft Strategy, which was welcomed by United Voice, Delegates and members. United Voice subsequently provided a submission to WACHS in response to the Strategy and the 19 key recommendations that were generated from the extensive review. United Voice Paramedic Delegates also met with the Chief Executive of WACHS, Jeff Moffat, to further discuss the Strategy and United Voice’s submission in response to the Strategy. There was particular discussion in regards to CP roles, where United Voice Delegates emphasised the need to not only increase staffing in the country but to also ensure that existing CP roles are sufficiently staffed to provide ongoing relief. (See Recommendation 17, below) WACHS have committed to continue consultation with United Voice in regards to the Country Ambulance Strategy. The recommendations are listed below, along with a synopsis of UV Western Australia’s submission in response to the key outcome areas. The full final draft Strategy can be accessed at: http://www.wacountry. health.wa.gov.au/index.php?id=986. To request an electronic copy of the United Voice submission, please email: ambulanceunionwa@unitedvoice.org.au
POLICY AND SYSTEM: Recommendation 1: Establish clear statewide policy on ambulance services as a minimum and consider enacting legislation in line with other states and territories. Recommendation 2: Define the level of ambulance service (both IHPT and Primary Response) provided to country communities in line with the state-wide policy…and include this within the Clinical Services Framework Recommendation 3: Plan state-wide service delivery using demand modelling then work with providers to design appropriate service delivery models in all locations (existing and new) and include measurable performance indicators in contracts.
Recommendation 4: Form an engagement forum comprising WACHS, country volunteers, community representatives and paramedics to discuss ongoing service design and service improvement. Recommendation 5: Transfer responsibility for the contract management of country ambulance services to WACHS. United Voice prefers that any contract offered should be underpinned by legislation or policy standards to ensure minimum standards and consistency. Further, United Voice asserted that the current best endeavors standard is inadequate, and that we support the development of consistent service standards across ambulance service providers, the introduction of stringent KPI’s across a range of factors - in particular for mental health and crew safety, and advocates for transparency and oversight in relation to compliance with these standards.
TIMELY ACCESS: Recommendation 8: Introduce contemporary contracts for ambulance services that define IHPT and Primary response as two distinct services which have their own scope of services and key performance targets as a minimum. United Voice strongly believes that this recommendation is essential in providing country areas with an appropriate ambulance service. Any contemporary AMBULANCE ACTIVE
contract would need to stipulate Key Performance Indicators that would distinguish primary response calls and inter hospital patient transfers; response times broken down by priority, and require regular reporting on the ability of the country ambulance service to respond to incidents under contracted time limits.
PATIENT SAFETY: Recommendation 9: Mandate consistent clinical governance principles in all patients transport contracts and report jointly on progress and collaborative initiatives to improve patient outcomes and clinical performance. Recommendation 10: Ensure every ambulance - regardless of location - can communicate reliably with all necessary parties at all times. United Voice supports improved communication systems that allow crews to reliably contact relevant parties such as the police and clinical support within the metropolitan region can only enhance crew and patient safety.
SYSTEM COORDINATION: Recommendation 11: Implement a clinical prioritisation system to inform safe, effective and transparent coordination of inter-hospital patient transfers across WACHS. Recommendation 12: Implement formal escalation mechanisms to ensure safe transfer of inter hospital patients in line with clinically indicated timeframes. Recommendation 13: Commission WACHS to lead the development and coordination of state-wide inter-hospital patient flow. AMBULANCE ACTIVE
The lack of co-ordination between WACHS and, where relevant, metropolitan hospitals and St John can be a source of frustration for staff in country areas, or staff travelling to country areas. United Voice is generally supportive of these recommendations, pending further detail becoming available.
SUSTAINABLE AND SKILLED WORKFORCE: Recommendation 14: Provide sufficient administrative and corporate support direct to country ambulance sub-centres in order to free up volunteers to focus on service delivery. Recommendation 15: Provide the volunteer ambulance workforce with the opportunity to obtain qualifications through an articulated structured training pathway, which aligns with the Australian Qualification Framework and supports career progression Recommendation 16: Research, trial and implement alternate workforce and training models (including the use of shared staffing and virtual support) and prioritise this at locations, which have difficulty maintaining a sustainable workforce. Recommendation 17: Expand the Community Paramedic model in FY18/19 as a priority in order to relieve pressures in those locations currently having the most difficulty in recruiting, supporting and retaining volunteers. Recommendation 18: Mandate transparent reporting on allocation of funds and costs of ambulance service delivery in ambulance contracts, detailing allocations between service locations and between IHPT and Primary Response services. Recommendation 19: Ensure contract periods align with contemporary best practice
and are long enough to enable providers to invest for effective service delivery. Recommendation 17 is a significant outcome for United Voice Paramedic Delegates, as our members have continued to identify the risks to the health and wellbeing of individuals working as Community Paramedics, over and above those that are normally attributed to the role of paramedic itself. Whilst United Voice ambulance service members strongly agreed that more Community Paramedics being able to serve local communities is a positive step forward, they also believe that any expansion should relieve pressure on already overworked, under supported Community Paramedics, who are often working in isolation as the only qualified paramedic within hundreds of kilometres, rather than to expand the reach of the CP model. There is still a lot of work to be done in this space, and United Voice Delegates and members are committed to ensuring improved outcomes for paramedics in the country.
1 State Solicitor’s Office (Commercial), 2015, ‘Services Agreement between State of Western Australia and St John Ambulance Western Australia Limited’, available at: http://www.parliament. wa.gov.au/publications/tabledpapers. nsf/displaypaper/3913225cb0a1e46 cb24a298748257ebb0005d5a6/$file/ tp-3225.pdf 2 Ernst & Young Global Limited, 2018, ‘The Country Ambulance Strategy Driving Equity for Country WA – Final Draft September 2018’, page 4
11
EYE MOVEMENT DESENSITISATION AND REPROCESSING (EMDR) THERAPY: UNDERSTANDING ITS USE FOR THE PREVENTION OF POST TRAUMATIC STRESS DISORDER (PTSD) By Dr Karen Klockner Department of Transport, Emergency and Safety Sciences, School of Medical, Health and Allied Services, Central Queensland University, Brisbane, Australia
This peer reviewed paper was presented at the Australian and New Zealand Disaster and Emergency Management Conference Broadbeach, Gold Coast (QLD), 21 – 23 May 2018 and is published with permission from the author and event organisers.
IT IS WELL UNDERSTOOD THAT critical incidents and first responders go hand in hand. First responders are those individuals who go into and towards danger when others move away. Whilst there is often a lot of discussion about the aftermath effects of major events on the community, individuals and businesses in the wake of such events (disasters, crisis, emergencies, everyday negative events), rarely recognised or discussed are the short term and longer term effects on the front-line workers who are deployed to deal with these events, sometimes on a daily basis. It is well recognised however that ‘first responders are the ones who move forward, they step up and override the basic fear mechanism that warns them of danger, they are simply extraordinary in their intention to go in and fight battles, recover the wounded, calm the masses, save the dying, and take care of their own’ (Luber 2015, p.1). This paper provides an overview of the trauma focussed therapy called
12
Eye Movement Desensitisation and Reprocessing (EMDR) with a view to educating and espousing the value of offering this therapy regularly in order to reduce the accumulative effect of exposure to traumatic events for first responders and as a preventative measure to Post Traumatic Stress Disorder (PTSD). Whilst it does not distil data-driven results from empirical research it does deliver on the notion of knowledge transfer and delivering what the pillars of academic scholarship are advocated to be, including distilling discovery and bridging theory and practice (Boyer 1990). More relevant perhaps for this paper is the sharing of evidence-informed practice to the emergency and disaster management community. It is intended to provide both organisations and individuals with a snap-shot of what known about trauma exposure mental health risks for frontline workers and how the application of a therapy based solution is assisting this community. In the practical application respect, it offers what can be deemed ‘a mental health clinician’s experienced opinion’ and sets out evidence-based recommendations from someone who has worked with trauma and PTSD at the front-line of these mental health issues and psychopathology for many years. It is hoped that this paper both educates and instil knowledge of what can and should be provided to first responders well before serious mental health issues arise.
PROFESSIONAL TRAUMA Luber (2015) in defining treatment for workers who respond to man-made and natural disasters recognises that they may experience daily career exposure to both acute stress and trauma and acknowledges that this population may be much wider than first thought, as it includes personnel in:-law enforcement, fire services, emergency medical dispatchers, emergency room staff (doctors and nurses), child welfare workers and psychotherapists, who all experience direct or secondary trauma from the work environment. The work of caring for the emotional and physical needs of others takes its toll on those in the trenches ... with exposure leading to direct and/or vicarious trauma for the professional in a first responder role. Organisations have generally begun to recognise that they need to address the mental health of workers and have started putting efforts into dealing with these mental health issues as they arise. Many organisation now have in place Employee Assistance Programs (EAP) where staff can access sessions of support if required and Psychological First Aid where support is provided immediately after the event. Where psychological harm is recognised and PTSD is diagnosed workers can also get assistance to psychotherapy through Workers’ Compensation schemes. However, by the time that workers reach out for help the opportunity to prevent AMBULANCE ACTIVE
more serious issues arising has been missed and this timing issue is at the crux of the discussion presented here. Earlier rather than later mental health intervention is absolutely advocated. What needs to be recognised is that ongoing preventative measures should be taken to ensure that front-line workers are assisted, as an early intervention strategy, after events to ensure maintenance of mental health and with a view to reducing the likelihood of more severe symptoms developing through the accumulative effects of experiences, particular traumatic events. Professional trauma has been defined as ‘responding to and witnessing an actual or perceived threat to the safety/integrity of self or others that may result in intense fear or helplessness in response to an event’ (Luber 2015, p. 7). There are also traumas unique to the types of field work and agencies including:1. Line-Of-Duty Traumas – those experienced during work that includes witnessing death or near death experiences of individuals in the community, other professions, or risk to self; 2. Line-of-Duty Death (LODD) – deaths that occur when professionals die in the line of duty. When a LODD occurs all other professionals responding to the call are now in an even more stressful position of trying to rescue and treat a comrade; 3. Post-shooting / Arson Trauma in Law Enforcement (PSTLE) – includes the events that professionals must endure following a shooting, arson or another criminal event; and; 4. Betrayal / Injustice Trauma – the experience that some professionals face when not feeling supported by departments or commands, and dealing with media, public perceptions and family issues (Luber 2015; AdlerTapia 2012). Whilst several definitions of the types of professional trauma can be established the effect on individuals cannot per se be determined. Many factors influence the effects to individuals including their past adverse childhood history (Adverse Childhood Experiences (ACE) Study), current personal and work circumstances, personal resilience and the amount and/ or intensity of exposure to traumatic events. No two people are the same and what is traumatic to one person may not necessarily be traumatic for another person. What is known however is that the daily wear and tear of the job take a toll and first responders not only experience Acute Stress Disorders (ASD), Post Traumatic Stress Disorders (PTSD), Dissociative Identity Disorders AMBULANCE ACTIVE
(DID) and Dissociative Disorders Not Otherwise Specified (DDNOS) (American Psychiatric Association 2013) but have an increased risk of chronic health issues and injuries (Kales et al 2007; European Agency for Safety and Health at Work 2011). The recommended solution to the prevention of trauma symptoms lies with providing a therapy called Eye Movement Desensitisation and Reprocessing (EMDR) therapy rather than waiting till trauma symptoms have taken hold and can no longer only be ignored, which is when first responders most often report or seek help, well after the fact.
EMDR THERAPY EXPLAINED EMDR therapy was introduced in 1989 by Francine Shapiro (Shapiro 1989a, 1989b) and is an eight-phase therapy which works via an understanding that the brain processes daily memories through normal rapid eye movements whilst asleep (REM sleep). Most daily memories can be processing and filed away into short and then long-term memory, however sometimes when a traumatic event occurs, that event can get stored maladaptively (charged with emotion, sensation and negative cognitions) and the brain is not able to process the event during normal REM sleep. The brain will, therefore, continue to try and process the event/s, often via bringing up nightmares or flashbacks but the event is ‘blocked’ and unable to be stored away like most other memories. The key to resolving this blockage is to assist the brain to move the negatively stored material into a more positively and adaptively stored resolution. This is achieved by working with a trained EMDR therapist who assists the client to
process the memory using eye movements mimicking REM whilst the client is awake. In therapy the client is asked to bring up the memory of the past event which is still having an effect on them, along with the associated emotions, body sensations and negative cognitions, and via the rapid eye movements, enables the client to processes the memory. With each set of eye movements, disturbing information is moved, often at an accelerated rate, further along, the appropriate neurophysiological pathways until it is adaptively resolved and stored. The eye movements tend to activate the brain’s information processing system and rebalance it. Clients do not lose the memory, they know it happened to them, but the memory becomes adaptively stored without the negative emotions, body sensations and cognitions that it once had (Van den Hout & Engelhard 2012). The therapy is explained further by understanding that often when something traumatic happens, it seems to get locked in the nervous system with the original picture, sounds, thoughts, feelings, and so on. Since the experience is locked there, it continues to be triggered whenever a reminder comes up. This can be the basis for both physical disturbance and negative emotions, such as fear and helplessness that people can't seem to control. These are really the emotions connected with the old experience/s being triggered in the present. The eye movements used in EMDR therapy seem to unlock the nervous system and allow the brain to process disturbing events stored in the brain in isolated memory networks which continued on page 14
13
continued from page 13 are preventing learning from taking place. Old material (negative life events, big and small traumas) just keep getting triggered over and over again. In another part of the brain, in a separate network, is most of the information the brain needs to resolve it, it is just prevented from linking up. Once processing (eye movements) begin with EMDR therapy, the two networks can link up. Where eye movements cannot be used therapists can use any form of bilateral stimulation to assist in memory reconsolidation, however, eye movements are recognised as the ‘superhighway’ to the brain. EMDR, therefore, is an accelerated information processing technique. Trained therapists consistently report that during EMDR treatment their clients' negative images, affect and cognitions become more diffused and less valid while positive images, affect, and cognitions become more vivid and more valid. A good metaphor is that of a train travelling along its route. Initially, the information starts off in a dysfunctional form. When the information processing is stimulated, it moves like a train down the tracks. During the accelerated processing that takes place with each set of eye movements, the train travels one more stop along the line. At each plateau, or stop, some dysfunctional information drops off and some adaptive information is added, just as some passengers disembark and others get on a train at each stop. At the end of the EMDR treatment, the target information is fully processed and the client reaches an adaptive resolution. Metaphorically speaking the train has arrived at the end of the line. EMDR therapy does not re-traumatise people, requires no homework and is not regarded as exposure therapy. Clients do not have to tell the therapist the trauma story for processing to work and so it is considered more private than traditional talk therapy. The therapist acts in a support role to allow the client to process the information and move to a more positive state of being.
THE EMDR THERAPY APPROACH EMDR uses an eight-phased approach and works on the three levels of physical (body), emotional (feelings) and cognitive (thoughts) to resolve traumatic experiences. The eight staged approach includes: 1 history taking 2 client preparation including resourcing 3 trauma event/s assessment and treatment planning 4 desensitisation of negatively stored material (using eye movements)
14
“ The work of caring for the emotional and
physical needs of others takes its toll on those in the trenches ... with exposure leading to direct and/or vicarious trauma for the professional in a first responder role.
”
5 installation of positive memory network linkages (using eye movements) 6 body scanning/somatic release 7 closure 8 re-evaluation of memory processing (usually on next follow up session). EMDR therapy, in essence, uses a bilateral stimulation process either through eye movements, physical tapping or audible clicking to allow traumatic events to be adaptively processed rather than staying blocked and being experienced as reoccurring negative thoughts, feelings and emotions. In EMDR therapy the eye movements are similar to those experienced during REM sleep (or slow wave sleep) allowing them to be adaptively stored for later retrieval (Pagani et al, 2017).
EMDR EVIDENCE OF EFFICACY Psychotherapies have long been espoused as a preferred treatment for PTSD and ‘the most recent US Department of Veterans Affairs (VA) and the Department of Defence (DoD) clinical practice guides for the management of PTSD recommends trauma focussed psychotherapies as a first-line treatment ahead of medications’ (Hoge & Chard 2018, p. 343). EMDR therapy is recognised as one of only two treatments recommended for children, adolescents and adults with PTSD by the World Health Organisation, these being EMDR therapy and Trauma-Focused CBT. Many other organisation recognise EMDR therapy as an effective treatment including the American Psychiatric Association, Departments of Defence and Veterans Affairs, the International Society for Traumatic Stress Studies, The National Health and Medical Research Council, The Australian Psychological Society, the Australian Phoenix Centre for Posttraumatic Mental Health, UK Guidelines for Mental Health Care, the Dutch Guidelines for Mental Health Care, the American Psychological Association and numerous other international agencies. It has its own Australian and American associations (EMDR Australian Association; EMDR International Association) as well
as associations in Europe and Asia. More than a dozen studies support the use of EMDR therapy for trauma resulting from natural disaster and treatment of war- and terrorism-related trauma. With little modification, EMDR therapy has been used successfully in response to a variety of mass-casualty events such as community homicides and terrorist attacks (Kutz, Resnik & Dekel 2008; Guedalia & Yoeli 2009). EMDR therapy has a positive impact on intrusive imagery (such as nightmares and flashbacks) (Aurora et al. 2010), numbing, and hyperarousal symptoms of PTSD (McGuire, Lee & Drummond 2014), as well as on associated grief and depression (Solomon & Rando 2007). In extensive direct comparison research between the effectiveness of EMDR therapy with Cognitive-Behavioural Therapy (CBT), EMDR was found to be slightly superior to CBT and was better for decreasing intrusion and arousal severity (Chen, Zhang, Hu & Liang 2015). The EMDR Association of Australia advises that it offers equivalent effects more quickly with fewer sessions and/or no homework and process analyses indicate less distress for individuals undergoing treatment (EMDR Association of Australia). EMDR has been around since the late 1980’s as a trauma treatment and many studies support its seniority as a preferred method for resolving traumatic and negative life events. It has its own dedicated Journal (Journal of EMDR Practice and Research) and it is also used for the treatment of numerous issues including addictions, psychosis, OCD, anxiety, stress, grief and performance issues. It has applications and protocols for critical incidents, recent traumatic events and is widely used in disaster management for combating the effects of trauma on communities (Jayatunge, 2008; Natha & Daiches, 2014; Shapiro & Laub, 2015). In America and other countries, it has its own humanitarian assistance program, which mobilises resources to actively respond to both community environmental disasters and mass violence events (EMDR Humanitarian Assistance Programs). AMBULANCE ACTIVE
RECOMMENDATIONS FOR EMDR AS A PREVENTATIVE MEASURE Research conducted by Shapiro in 2014 identified that at that time that:Twenty-four randomized controlled trials supported the positive effects of EMDR therapy in the treatment of emotional trauma and other adverse life experiences relevant to clinical practice … seven of ten studies reported EMDR therapy to be more rapid and/or more effective than trauma-focused cognitive behaviour therapy … and twelve randomized studies of the eye movement component noted rapid decreases in negative emotions and/or vividness of disturbing images, with an additional 8 reporting a variety of other memory effects. Numerous other evaluations document that EMDR therapy provides relief from a variety of somatic complaints (Shapiro 2014, p.71). A later systematic literature review by Valiente-Gomez et al (2017, p.1) has demonstrated its ongoing clinical support and that EMDR therapy is a useful psychotherapy well beyond PTSD treatment, as it had been used to treat trauma-associated symptoms in patients
with comorbid psychiatric disorders, was useful in improving psychotic or affective symptoms and was an effective add-on treatment in chronic pain conditions (Van den Berg et al. 2013; Grant & Threlfo 2002). In 2015 Marilyn Luber released her book on EMDR Therapy with First Responders with a view to educating people as to the benefits of ‘adapting the mental health response to the particular phase of disaster recovery, and to the need for special attention to the first responders and local human service workers confronting vicarious traumatisation’ (Luber 2015, p. xiii). Organisations wishing to support front-line workers need to recognise that they need to take action to thwart the accumulation effect or single incident effect of the daily exposure to professional trauma that these workers face. Only by recognising that assistance should provide up front and not when major symptoms appear will inroads be made to combating the mental and other health effects of trauma. The offering of EMDR therapy to first responders as part of upfront preventative measures to combat the onslaught of PTSD is, therefore,
higher recommended. First responders are unlikely to seek help early enough on their own volition and whilst therapy cannot be imposed the benefits of dealing early with traumatic events as they arise rather than waiting till they can no longer be ignored or tolerated cannot be stressed enough. Generally, people undertake maintenance of their physical health (dentist, gym, doctor) but fail to recognise that mental health also needs maintenance and ongoing care in order to ensure that responders can retain their resilience and wellbeing. Where events are dealt with on an ongoing basis the therapeutic work is much easier than waiting to work on multiple long-term events which have accumulated and consolidated over time. It is now time to recognise that all organisations should be working on providing preventative measures as part of mental health wellbeing endeavours. In this respect, EMDR therapy is an effective and evidence-based psychotherapy suitable for front-line responders which can assist them in avoiding professional trauma and PTSD. Do not let the trauma bin accumulate to overflowing, empty it regularly and often!
References Adler-Tapia, A 2012 Child psychotherapy: Integrating developmental theory into clinical practice, Springer Publishing, NY. Adverse Childhood Experiences (ACE) Study, Centres for Disease and Control Prevention, https://www.cdc.gov/violenceprevention/acestudy/about.html. American Psychiatric Association 2013 DSM-5, American Psychiatric Press, Arlington, VA. Aurora, RN, Zak, RS, Auerbach, SH, Casey, KR, Chowdhuri, S, Karippot, A, Maganti, RK, Ramar, K, Kristo, DA, Bista, SR, Lamm, CI & Morgenthaler, TI 2010 ‘The Best Practice Guide for the Treatment of Nightmare Disorder in Adults’ Journal of Clinical Sleep Medicine, vol. 64, no. 4, pp. 389-401. Boyer, EL 1990 Scholarship reconsidered: Priorities of the professoriate. Princeton, NJ: Carnegie Foundation for the Advancement of Teaching. Chen, L, Zhang, G, Hu, M & Liang, X 2015 ‘Eye movement desensitization and reprocessing versus cognitive-behavioural therapy for adult posttraumatic stress disorder: systematic review and meta-analysis’ the Journal of Nervous and Mental Disease, vol. 203, no. 6, pp. 443-451. EMDR Association Australia (EMDRAA), see www.emdraa.org. EMDR International Association (EMDRIA), see www.emdria.org. EMDR Humanitarian Assistance Programs: Trauma Recovery, see https://www.emdrhap.org/ Grant, M & Threlfo, C 2002 ‘EMDR in the Treatment of Chronic Pain’ Journal of Clinical Psychology, vol. 58, no. 12, pp. 1505-1520. Guedalia, JB, & Yoeli, F 2009 ‘EMDR emergency room and wards protocol (EMDR-ER)’ in M Luber (Ed.), Eye movement desensitization and reprocessing (EMDR) scripted protocols: Basics and special situations, pp. 241-250, New York, NY: Springer Publishing Co Hoge, CW & Chard, KM 2018 ‘A Window Into the Evolution of Trauma-Focused Psychotherapies for Posttraumatic Stress Disorder’, Journal of the American Medical Association, vol. 319, no. 4, pp. 343-344. Jayatunge, RM 2008 ‘Combating Tsunami Disaster Through EMDR’. Journal of EMDR Practice and Research, vol 2, no. 2, pp. 140-145. Kales, SN, Soteriades, ES, Christophi, CA & Christiani, DC 2007 ‘Emergency Duties and Deaths from Heart Disease among Firefighters in the United States, The New England Journal of Medicine, vol 356, no. 12, pp. 1207-1215. Kutz, I, Resnik, V, Dekel, R 2008 ‘The Effect of Single-Session Modified EMDR on Acute Stress Syndroms’ Journal of EMDR Practice and Research, vol. 2, no. 3, pp. 190-200. McGuire, TM, Lee, CW & Drummond, PD 2014 ‘Potential of eye movement desensitization and reprocessing therapy in the treatment of post-traumatic stress disorder’ Psychological Research and Behavior Management, vol. 7, pp. 273-283. Natha, F & Daiches, A (2014) ‘The effectiveness of EMDR in Reducing Psychological Distress in Survivors of Natural Disasters: A Review’. Journal of EMDR Practice and Research, vol. 8, no. 3, pp. 157-170. Luber, M 2015 ‘EMDR Therapy with First Responders: Models, scripted protocols, and summary sheets for mental health interventions’, Springer Publishing, NY. Pagani, M, Amann, BL, Landin-Romero, R & Carletto, S (2017) ‘Eye Movement Desensitization and Reprocessing and Slow Wave Sleep: A Putative Mechanism of Action’. Frontiers in Psychology, vol. 8, pp. 1-7. Shapiro, F 1989a ‘Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories, Journal of Traumatic Stress Studies, vol. 2, pp. 199-223. Shapiro, F 1989b ‘Eye movement desensitization: A new treatment for post-traumatic stress disorder, Journal of Behavior Therapy and Experimental Psychiatry, vol. 20, pp. 211-217. Shapiro, F 2014 ‘The Role of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in Medicine: Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experiences’ The Permanente Journal, vol. 18, no. 1, pp. 71-77. Shapiro, E & Laub, B 2015 ‘Early EMDR Intervention Following a Community Critical Incident: A randomized clinical trial’. Journal of EMDR Practice and Research, vol. 9, no. 1, pp. 17-27. Solomon, R & Rando, T 2007 ‘Utilization of EMDR in the Treatment of Grief and Mourning’ Journal of EMDR Practice and Research, vol. 1, no. 2, pp. 109-117. European Agency for Safety and Health at Work 2011 Emergency Services: A Literature Review on Occupational Safety and Health Risks, Luxembourg Publications Office of the European Union. Valiente-Gómez, A, Morano-Alcázar, A, Treen, D, Cedrón, C, Colom, F, Pérez, V & Amann, BL, (2017) ‘EMDR Beyond PTSD: A systematic literature review’, Frontiers in Psychology, vol. 8, article 1668. Van den Berg, D, Van der Vleugel, B, Staring, A, De Bont, P & De Jong, A 2013 ‘EMDR in Psychosis: Guidelines for Conceptualization and Treatment’ Journal of EMDR Practice and Research, vol. 7, no. 4., pp. 208-224. Van den Hout, MA & Engelhard, IM 2012 ‘How does EMDR work?’, Journal of Experimental Psychology, vol. 3, no. 5, pp. 724-738.
AMBULANCE ACTIVE
15
HEALTH AND WELLBEING Yes, mindfulness is really a thing By Dr Grant Blashki GP and Clinical Adviser at Beyond Blue. Source: www.beyondblue.org.au/personal-best/pillar/wellbeing/yes-mindfulness-is-really-a-thing MINDFULNESS HAS CERTAINLY become flavour of the month. Many workplaces now offer it to their employees and we are seeing more and more schools and universities providing mindfulness training to their students. The research tells us that practising mindfulness does have some benefits for mental health wellbeing and for managing depression and anxiety. It is also helpful when it comes to managing some long-term physical conditions, helping the patient to better deal with pain or discomfort. Many people who practise mindfulness report a number of tangible benefits, such as: • Improved memory • Better concentration • More flexibility in their thinking • Greater ability to focus • Less rumination (when the mind gets over chatty!) • Better stress management • Higher satisfaction with relationships and quality of life But what exactly is mindfulness? Essentially, it is the practice of being in the present moment, knowing where your mind’s attention is and learning to keep your attention where you want it to be. It also often involves stepping back from one’s own strong emotional reactions to life’s challenges, and seeing things more objectively, without getting entangled and swept up in the feelings. Typically, mindfulness involves practising meditation exercises on a daily basis. This usually involves sitting in a quiet place, turning your mind’s attention to your body and your breathing, and focussing on the sounds and sensations around you. With practice, you gradually learn to tame that constant chatter we all have in our minds. The guiding voice of a teacher or on an app is really helpful if you are new to meditation exercises. You might consider joining a local mindfulness class, or even just downloading one of the excellent mindfulness apps on your phone such as Smiling Mind. This is very convenient as
16
you can practice the mindfulness exercises with headphones at a time and place that best suits you. As a GP, I have found that this approach has been most helpful for my patients, especially those who are coping with mental health or physical health issues. There is a lot of secondary worry and stress and this can exacerbate symptoms, so developing some skills in mindfulness exercises can be a great way to calm the mind and provide some time out from worry and stress. For all of us, our minds often tend to get caught up thinking about the past or worrying about the future. Mindfulness helps you to keep your thoughts in the present moment. As you practice, you tend to get better at calming the mind and keeping things in perspective. As with any psychological approach there is always some risk, though it’s fair to say for most people learning mindfulness meditation, the risk is very low. As a caution, people who are experiencing serious mental illness ought to discuss if it’s a good idea for them with their mental health professional.
Social icon
Rounded square Only use blue and/or white.
Follow Dr Blashki on @GrantBlashki For more about Beyond Blue visit https://www.beyondblue.org.au For more details check out our Brand Guidelines.
AMBULANCE ACTIVE
Stress-busting activities to help you relax Source: www.beyondblue.org.au/personal-best/pillar/wellbeing/15-stress-busting-activities-to-help-you-relax
BLOCK OUT AN HOUR IN YOUR calendar and try one of these stressbusting activities to manage your mental health.
DO SOME GENTLE EXERCISE Walking, stretching and wading water are gentle exercises you can do to help get your endorphins flowing.
SPEND TIME WITH A FURRY FRIEND Yes, you have permission to hug all the dogs, cats and bunnies you wish. Petting and cuddling a fluffy friend gives you warm ‘n’ fuzzies, quite literally.
TUNE INTO (INSTRUMENTAL) MUSIC Create a playlist of the instrumental versions of songs that make you feel calm. When you’re listening, try to tune into one of instruments being played and focus your attention on it for 20 – 30 seconds. Repeat by tuning into another instrument and continue this until the song finishes. This is a type of meditative technique. You could try doing this to help ease you into sleep.
SALUTE THE SUN
CREATE SOMETHING
Find a sunny spot, close your eyes and lift your face towards the sun. Take slow deep breaths. Sit calmly for 10 to 15 minutes (remember to be sun-smart if you’re doing this in the warmer months).
Draw, colour-in, paint, knit, write, cook – do any activity that helps you express your creative flair.
BE GRATEFUL Write down all the things in life that you’re grateful for. Perhaps consider doing this each day. It can help keep you mind focused on being positive so that you have a better outlook when you face a difficulty.
LOOK AT PHOTOS OF EVENTS THAT YOU REMEMBER FONDLY
RIDING ACROSS AMERICA FOR BEYOND BLUE
That’s right; take a big whiff of your morning coffee or tea before you drink it. The scent of the drinks can be enough to help reduce your stress levels.
SPEND TIME IN A GARDEN
TRY ACUPRESSURE
Solve a puzzle, crossword or sudoku. The focus you devote to these brain-teasing activities can take your mind off your worries and give your brain a problem that has a clearer solution.
If you’re feeling overwhelmed and need immediate relief, try acupressure. It’s a self-massage therapy that helps to balance your body’s circulation of fluids and energies. Use your thumb and index finger of your right hand to massage the soft area between the thumb and index finger of your left hand. After two-to-three minutes, switch and repeat. It can also help you use calming essential oils such as lavender.
SING OR DANCE
GET WET
Whether you have a solo singing session in your lounge room or join a dance class, singing or dancing (or both!) to music you enjoy is a good way to unwind and boost your mood.
Have a warm bath, take a shower, dive into a pool or take a dip in the ocean; getting into water can help you to feel refreshed and relaxed (bonus points if that pool or beach is at a holiday destination!).
COMPLETE A BRAINTEASER
AMBULANCE ACTIVE
Sometimes when you’re feeling stressed, the thing you need most is sleep. If your mind is still going 100 kilometres an hour after you’ve hopped into bed, put on some calming tunes and put your phone on aeroplane mode. Then slowly tense and release one muscle in your body at a time. You should soon be able to drift off.
Dust off that old photo album to flick through or pull up your favourite snaps on your tablet. Looking at old photos from a day you enjoyed is sure to bring you joy. Better still; call someone who was at that event so you can reminisce together.
SMELL A CUPPA
Various studies speak to the benefits of being in a garden without even needing to have a green thumb. Surrounding yourself with plants has been linked to physical and mental health benefits, including slowing heart rates, improving memory and reducing symptoms of anxiety and depression.
TAKE A NAP
QGAir Ambulance Officer Crewman and United Voice member Allan Jefferson is on his bike for a good cause. Allan is an accomplished endurance cyclist who will be competing in this year’s Race Across America (RAAM) while raising money for Beyond Blue. As a first responder, Allan says he’s seen first-hand how the challenging environment emergency workers face can be an underlying cause of PTSD, depression, anxiety and suicide. “I’m asking for your help in raising funds to promote the awareness of the benefits of good mental health,” he said. “It’s important we all join together to help take care of our frontline emergency service workers.” The RAAM is 30 per cent longer than the Tour De France and attracts amateur and professional athletes alike from across the world. To support Allan’s RAAM race for Beyond Blue visit Facebook @teamjeffersonraam2019.
17
WA BARGAINING CONCLUDES UNITED VOICE CONCLUDED bargaining with St John Ambulance in late 2018, after six months of intensive bargaining. The proposed agreement was voted up by paramedics and is currently awaiting approval from the Fair Work Commission. The proposed new agreement includes several new improvements including: • Wage increases of 1.5%, 1.5% and 1.75% over 3 years • Back pay to 1 July 2018 upon approval • Allowances (excluding travel) to increase by 1.25% each year • Night shift payment increase by 5% in the 1st year and 1.25% in the 2nd and 3rd years • CCP officers be paid the same rate as CSP officers but required to perform additional roles when not working on the helicopter • Special Leave- ability to exchange shifts and utilise Special Leave credit to pay the other employee overtime rates
• Long Service Leave available for pro rata access after 7 years of service • 4 paid days of military leave per year • Parental Leave- 12 weeks of paid parental leave • Country Station Managers to be paid at SM3 rate, including all periods of relief • Unpaid Family and Domestic Violence Leave • Transition to Retirement new clause allowing officers options to reduce workload for those making a transition to retirement. St John Ambulance proposed to greatly reduce the North-West Duties Allowance that officers in the north-west have been getting for many years for their hard work and time in that region. After much discussion, St John Ambulance agreed to grandfather this allowance for three years. While this is not the outcome United Voice members hoped for, securing another three years pay security is a good outcome for all those currently in the north-west region.
St John Ambulance currently provides Salary Continuance Insurance (up to a maximum of 1.7% of the total wages) for all paramedics. At the bargaining table, St John Ambulance informed United Voice that they cannot continue to provide Salary Continuance Insurance due to the heavy increase in premiums over the last few years. They proposed to buy it out at 1.7%. Parties at the bargaining table came to an agreement for the buy out to be at 2.0%, given to each officer has a pay increase in the second year of the agreement. This is a permanent increase to each officer’s base wage to enable the officer to obtain their own Salary Continuance Insurance policy. The overall proposed three-year agreement is a strong one that United Voice members have fought hard for and are looking forward to the approval of the agreement by the Fair Work Commission.
Mint 360 Property
Contact Craig On 0418 464 465 Or Email - craig@mint360property.com.au 75 Belmore Road, Randwick NSW Proudly Supporting The Local Ambulance Services
18
AMBULANCE ACTIVE
EZIREG PTY LTD
Please Call Sam on
Mob: 0438 260 427 www.completeonsitegroup.com.au Find us on Facebook
www.ezireg.com.au
Please Call Steven on
Mob: 0433 852 152 Proudly Supporting the Ambulance and Paramedic Members
Find us on Facebook 8 Foundry Rd Seven Hills NSW 2147 Proudly Supporting our Ambulance & Paramedic members
Chloe Legal and Matthews Lawyers Mob: 0432 498 254 • Crowd Control • Unarmed guard loss prevention
Ph: 03 9663 1922 45 Domain Drive Berwick VIC 3806
Email: chloe@chloelegal.com.au
Email: alan@cisecurity.com.au
10 Gawler St Mount Barker SA 5251 Proudly supporting the local Paramedics.
Proudly Supporting Ambulance Active
THINGS PARAMEDICS UNDERSTAND
STEEL FIXING SOLUTIONS YOU CAN COUNT ON AJP Workforce prides itself in providing superior quality and reliable steel fixing and labour solutions. Our service enables our clients to achieve growth, finish projects on or before deadline and streamline processes -saving you time and money. With over 20 years’ experience in the industry, our professional steel fixers, labourers, supervisors and office support teams will work together to ensure that your project is seamlessly managed and receives the attention it deserves. We aim to carry out all work projects in a safe working manner, while delivering quality and excellence that will exceed your expectations.
“AJP Workforce gets the job done on time on budget. I wouldn’t hesitate to recommend them” – DOM, Mas concrete 32 Westbrook St Beverly Hills NSW 2209 website: ajpworkforce.com.au Email: contact@ajpworkforce.com.au
Mob: 0434 580 848 20
AMBULANCE ACTIVE
Zoned Painting For All Your Painting Needs! Commercial & Domestic
ambulance officers
Call: 0411 336 125
Ambulance Service
Website: www.zonedpainting.com.au Email: zonedpainting@gmail.com ambulance officers
Victoria Park WA Proudly Supporting our Local Ambulance & Paramedics
Ph: 02-8627 3314
Proudly Supporting the Ambulance & Paramedic Members
Tom Andrews Mackay
Ph: 03 9421 6697
Member of The QRPA Mackay Member of the REIQ
28 Gwynne Street Cremorne VIC 3121 www.facebook.com/pages/Smedleys-Engineers
Specialising in All Residential & Rural Property Sales Call: Tom - Mob: 0412 372 403 Email: tandrews@eldersmackay.com.au
www.twitter.com/SmedleysEng www.smedleys.net.au •Crash / Incident Investigation & Reconstruction •Heavy Vehicle & Operations Safety Auditing •Regulation / Policy Review & Advice •Technology Review & Advice
Drawing on eight generations of engineering expertise, Smedley’s Engineers are dedicated to providing innovative engineering solutions for the road transport industry.
Servicing All of Mackay Region Proudly Supporting our Ambo’s
www.itp.com.au
Poudly supporting the paramedics