What if the Rescuers Need Rescuing? New Study Highlights Stress and Burnout among Colorado's Back Country Search and Rescue Workers

In a recent post, I talked about the long-term effects that stress and secondary exposure to trauma can produce in nursing students. In a new study, my colleagues and I also looked at the consequences of stress exposure on back country search and rescue (BSAR) workers. 

Here in Colorado, outdoor recreation is a $11.6 billion industry. Much of our state is public land, and people can hike, jeep, float, or ski wherever their interest takes them. It's possible to get into remote areas, far from any other human being, with relatively basic gear and limited experience. People therefore sometimes get in over their heads or get hurt out in the wilderness, and need to be rescued. Interestingly, the people who perform those rescues (at least outside of large ski resorts that have their own specialized patrols) are mostly volunteers. They are outdoor enthusiasts who like to help others and to work with specialized gear, but performing rescues is a side activity done in their free time, competing for their attention with regular paid employment and family life. BSAR volunteers' activities are coordinated through local nonprofit groups and/or through local sheriffs' offices. This is a surprisingly fragile system to provide all of the needed support for a major slice of Colorado's economy.

In November 2021, we conducted a statewide survey of all BSAR workers in the state, to determine what types of stressors they were facing in their work. The survey was initiated by the Colorado Parks and Wildlife Department (CPW) based on stories they were hearing from the field -- stories of BSAR workers who got injured, who were traumatized by things they had seen, or whom their colleagues considered too impaired to continue the work. Because it takes time to train new volunteers, and there is a finite number of people who are willing and able to do the work for no pay, CPW had concerns about the sustainability of the BSAR system. Furthermore, the existing BSAR resources reported increased need during the COVID-19 pandemic, as many new people started to explore Colorado's back country once they no longer needed to be at the office. And the average age of BSAR workers also seemed to be increasing, raising concerns about whether an experienced workforce would be available in the future. Like the nature of the stressors encountered in BSAR work, many of these global forces parallel those seen among healthcare workers in recent years.

We worked with county-level BSAR agencies and county sheriffs to obtain lists of BSAR workers, sent an electronic survey link, and ultimately obtained responses from 657 BSAR workers who were part of 47 different teams across the state. This total represents somewhere between 26% and 41% of all BSAR workers in the state -- the lack of a precise number reflects the fact that there is no master list of all the people doing this type of work, and the range is based on varying estimates of the total size of the BSAR workforce provided by different experts in the field. 

One major methodological challenge in this study was the suspicion that BSAR workers might be unwilling to admit to problems that they were experiencing, in part because of a concern that problems might lead to them being considered "unfit for duty" and denied the opportunity to do the work, but also in part because the general culture of BSAR work emphasizes toughness in the face of extreme challenges. We worked around this problem by administering some pairs of questions that asked not only "to what extent have you experienced this problem?" but also "to what extent have you noticed your teammates being bothered by this same problem?" BSAR workers were generally more willing to endorse problems among their teammates than to acknowledge having those same experiences themselves. The discrepancy between the two versions of these questions helped us to form an overall estimate -- about 18% -- for the amount of under-reporting that was probably going on in this population. We then used that estimate as a correction factor to get a more accurate guess as to how prevalent psychological problems really are among Colorado's BSAR workers.

We found that although BSAR workers are unsurprisingly a group with good physical health, about 24% of them reported potential chronic health problems. A much higher percentage -- up to 79% -- had one or more risk factors for burnout, such as low satisfaction in their work, high current work-related stress, or a sense of depersonalization that makes them feel unconnected to others. We also administered a questionnaire that measures three types of symptoms connected to post-traumatic stress disorder (PTSD): About 40% reported exaggerated startle responses or difficulty calming down due to stress, 26% said that they avoid some people or situations that remind them of stressful events, and 36% reported intrusive thoughts, dreams, or flashbacks. Although only 7% were likely to meet formal diagnostic criteria for PTSD based on their responses, the stress-related experiences that BSAR workers reported were severe enough that they were likely to have effects on people's work performance or interpersonal relationships. Only about 5% of BSAR workers reported current symptoms of depression, which was an unexpectedly low result; however, about 11% were at risk for suicide based on a measure of hopelessness about the future. Finally, 56% of BSAR workers reported problematic levels of alcohol use based on binge drinking 1 or more times per year (4+ drinks at a single sitting). Other drugs or prescription painkillers were much less likely to be used. The overall pattern of results suggests that BSAR workers might be using alcohol to cope with distressing psychological experiences, with about half of 11% who reported any mental health problem also reporting substance use, in addition to the 17% who reported substance use alone. The overlap between medical and psychological problems was also significant, with about a quarter of the 23% with physical problems also reporting mental health issues, and about a third of those with physical health problems reporting comorbid substance use.

Based on physical health problems alone (leaving aside the question of mental health issues and/or substance use), we estimated that about 4% of current BSAR workers might become unable to continue their work in any given year. If new BSAR workers were to also develop problems at the same rate, the BSAR system as it currently exists in Colorado would not be sustainable. Heavy alcohol use also predisposes people to health problems involving the liver, heart, and kidneys; the level of excessive drinking in our BSAR sample was even higher than the greater-than-normal rates found in other published studies of firefighters, police, and emergency medical workers. High rates of substance use in the current study might be in part due to its timing, with data collection occurring after nearly 2 years of unique stressors created by the COVID-19 pandemic, and right at the start of the Omicron wave.

To address the identified problems, we are currently working on programs to help BSAR workers anticipate and respond to stress. As in our work with nursing students, we have taken an overall approach that emphasizes building resilience through healthy lifestyles and interpersonal relationships, identifying stressors early, having a language to talk honestly about stress, and making healthy choices to reduce stress before it begins to seriously impair performance. Focusing on physical health can be appealing approach to addressing problems among BSAR workers, given their demonstrated reluctance to acknowledge mental health concerns. Team-based and participatory interventions are also a promising approach for BSAR workers, given the strong relationships that people forge with their team members and the general esprit de corps that is an important motivator for doing this type of work. In a second new paper this month, we published preliminary results showing that this approach also helps BSAR workers to reduce their symptoms of stress and burnout. We have recommended that the state provide additional physical and mental health resources to support BSAR workers, who volunteer their own time and often spend their own money in efforts to help others who are lost and hurt in the wilderness.