the strength of - draeger

6 DRÄGER REVIEW 111 | 2 / 2015

Work-related stress, private problems, or other worries: everyone finds themselves in a stressful situation at some point in their lives. Resilient people MASTER CRISES MORE EASILY. Some people are born with such abilities, while others acquire them – people, companies, or even entire cities.

Text: Isabell Spilker

The Strength of

Resilient due to the job? Three people died and many others were injured in a multiple pileup on the A31 in North Rhine-Westphalia. Emergency workers shielded the accident from those who perhaps wouldn’t have been able to cope with it – and ultimately needed to muster a lot of strength themselves to come to terms with what had happened

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7DRÄGER REVIEW 111 | 2 / 2015

MENTAL STRENGTH FOCUSP

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FOCUS MENTAL STRENGTH

The emergency call was received by the call center at 9:33 a.m. What happened in the hours that followed would re-quire thousands of workers and drive them to the limit of human tolerance. In March 2009 a former student of a school in the small town of Winnenden in Baden-Württemberg shot dead 15 people – and ultimately himself. Martin Luitjens was also on the scene. As a leading emergency pastoral care worker he took care of the survivors and emer-gency crews by being there to talk to them. By the time evening came, the man who usually helps oth-ers to cope with traumatic experiences noticed that even his strength was waning. Emergency crews who have to recover children’s bodies, police officers who witness their colleagues being gunned down – they all work in these inhuman situations. Once everything has calmed down, stress takes its toll. However, those who do not possess the mechanism that psychologists call “resilience” will have big problems coping with

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their everyday lives. “People who come home after such a day at work are not initially in a position to come to terms with what has happened,” says Luitjens, who also works as a resilience coach. “They are disoriented at first, because the psyche needs time.” Some people pull themselves together within a few days, while others need months, sometimes even years – or an entire lifetime.

Tolerance to disruptionsResilience describes the psychological ability to cope with and recover from difficulties. The concept can be assigned to sys-tems, organizations, infrastructures, materials, and entire socie-ties. Across a number of different disciplines it describes people’s tolerance to disruptions – and the ability to take the measures needed to ensure that the serious situation doesn’t even occur in the first place or at the very least mitigate its impact. This works in a hospital as much as within other complex systems. An exam-ple: in recent years the impact of climate change on cities has been analyzed. The focus of the analysis was on how the cities



els of physical exertion, many people are under enormous pres-sure both at work and at home. If you are unable to keep up, you lose – at least that’s how it seems to many people. General stud-ies of the mental health of employees in medical careers reveal, for instance, that at least 20 percent of doctors suffer from burn-out syndrome. Work-related stress is one of the biggest challeng-es of the present age. Resilience is the flip side of it all and the thing that can protect people – like a callus.

“What doesn’t kill me only makes me stronger”Yet how is this protection mechanism formed? Systems can be made more resilient, but people? Resilience can protect the mind and prevent illness after intensive negative experiences. And just like an immune system it is more pronounced and effective in some people than in others. So why are some people more re-silient than others? Is it genetic, is it acquired during childhood, or does it develop during the transition to adulthood? Or can resilience evolve at any of these stages? The formula could be simple. An essen tially optimistic child is not wrapped in cotton wool by its parents, but is exposed to the oc casional crisis. He or she goes through life as a mentally strong adult and faces any adversity with an inner robust-ness. Stephen Joseph carries out research in precisely this area. He coordinates the psycho-therapeutic and practical psychology course at the School of Education at the Universi-ty of Nottingham and was head of the Cen-tre for Trauma, Resilience and Growth there until 2013 as professor of psychology: “Many of the skills that adults possess are the result of training during childhood. We must learn how to cope with difficult situations. Those who are confronted with adversity and catas-trophe will show a higher degree of resilience

TOUGH SHELL

The American

Psychological Association

has developed a

ten-point plan which

can pave the way

to greater resilience:

1. Make connections.

2. Avoid seeing

crises as insurmountable

problems.

3. Accept that change

is a part of living.

4. Move toward

your goals.

5. Take decisive actions.

6. Look for opportunities

for “self-discovery.”

7. Nurture a positive

view of yourself.

8. Keep things in

perspective.

9. Maintain a hopeful

outlook.

10. Take care

of yourself.

The noise was alarming, the scene incomprehensible: on June 3, 1998 the high-speed ICE train “Wilhelm Conrad Röntgen” derailed in Eschede near Celle. The train accident was the first major catastrophe in Germany in which the emergency crews received systematic follow-up care. A total of 700 of around 2,000 workers took advantage of the assistance over a period of three years; 100 had long-term problems – they suffered from internal unrest and could barely sleep

Resilience can protect the mind – like an immune system

manage to brave the extreme weather and return to normality as quickly as possible afterward. An aptitude for learning is a fur-ther dimension of this robustness and capacity to cope. A resil-ient system is in a position to learn and adapt to changing condi-tions. “In relation to people, resilience describes the mechanisms which ensure that they emerge stronger from stressful and de-manding situations,” explains Michèle Wessa, professor of clini-cal psychology and neuropsychology at the Johannes Gutenberg University in Mainz. Europe’s first center for resilience research opened here in the summer of 2014 with the aim of understand-ing the principles of resilience on a molecular and neuroscientific level and by conducting animal experiments. The idea is to devel-op new prevention methods on the basis of the findings.

The demand for effective concepts is rising. The psycholog-ical constitution of man has become a popular subject. Despite increased prosperity and (compared to bygone days) lower lev-

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10 DRÄGER REVIEW 111 | 2 / 2015

if they have learned from early experiences.” Accord-ingly, he also essentially sees the positive side of cri-ses and concurs with Friedrich Nietzsche’s Twilight of the Idols: “What doesn’t kill me only makes me stron-ger.” Stephen Joseph borrowed from Nietzsche for the title of his book (What Doesn’t Kill Us) and tells sto-ries of people who have managed to emerge stron-ger from setbacks. “Post- traumatic growth also means learning from trauma: setting new priorities and find-ing out what is really important.” However, those who have no positive experience of coping with crises, that is to say those who have been unable to come to terms with previous ex-periences, will be more vulnerable. This has also been shown by a study in which Joseph was involved in 1987 following the ferry disaster near the Belgian port of Zeebrugge in which 193 peo-ple died. Survivors who had to deal with further crises (such as a severe illness or the loss of a relative) in the three years after-ward proved to be even more vulnerable than a reference group.

“Those who are as cool as a cucumber are by no means resilient”Something else became clear from the study: people who were unable to show their feelings and who lacked social support fared especially badly. A finding also shared by resilience coach Luitjens: “Social support is a driving factor. Resilience has a great deal to do with the personal environment – as in the case of emergen-cy crews, for instance. The culture within the organization will also determine how resilient they are.” Is it not possible to sim-

ply talk to one another after a callout and just say that some-thing didn’t go so perfectly? “Structures which live by the myth of being invulnerable and in all probability being able to remain as cool as a cucumber make it difficult to deal with demanding situations. In such an environment hardly anyone has the cour-age to admit to a supposed weakness.” In his opinion and expe-rience, social resources – in other words, the support within the group – are the crucial factors which lead to greater resilience. The researcher Michèle Wessa goes one step further here: “The link is not as strong as people thought. Although these attributes and factors (optimism, social support, and early experiences) do have a significant influence, they are not sufficient to predict how resilient an individual will be in a situation.” Resilience is proba-bly a combination of different factors and mechanisms. “If it were merely attributes that made us resilient, then somebody would re-main resilient throughout their entire life. But that isn’t the case. An example: many emergency workers go through their profes-sional lives without suffering any damage – and then something suddenly knocks them off their feet. This seems to confirm that there are resources which are somehow built up over time, but can also be exhausted at some point.

Inherent feature of many training coursesThe German Resilience Center is trying to catch this moment with a specially established outpatient clinic. It is not aimed at people who are in the middle of a crisis and are in desperate need of resilience; it is more for stressed people and institutions be-fore the first serious situation occurs so that it can be countered

“The culture within the organi-zation will also determine how resilient emergency workers are”

Entering the water with the hope of find-ing survivors,

only to recover bodies:

the Costa Concordia mari-

time accident off the Italian coast

demanded mental strength from

the diving team



Five years ago Dräger set up a division which tests medical-technical equipment in more practice-based settings, making it more resilient to adverse environmental influences. Dirk Zumtobel is head of the product reliability division.

Mr. Zumtobel, quality assurance is taken for granted these days. What do you do to go further? Zumtobel: The conventional standards applied to functional testing in the area of quality assurance were no longer sufficient for us. We also test system stability over a longer period of time – and under “clinical conditions.” Flawless components do not necessarily produce a perfect system. This is precisely what we work on: we make sure that our components are free from defects and function within the overall system in everyday use.

Have you built a small hospital for this purpose?Zumtobel: Yes, kind of. In our quality lab we are technically in a position to simulate everyday clinical situations. We subject 25 or more devices of a certain type to stress under various conditions, record the results, and evaluate them statistically. This makes it possible to give statements about the robustness and reliability of our systems in the field.What conditions do you subject the equipment to?Zumtobel: As many predictable ones as possible – severely obese patients, premature babies (who need to be gently ventilated), regular disinfection measures (with various detergents and methods), temperature and pressure changes, power supply fluctuation,and many more besides.What were the initial findings?Zumtobel: After the first test runs with prototypes we were surprised at how many events were actually recorded. Not everything is immediately

noticed by the user. It revealed to use the areas where the system architecture is still “shaky” – in a similar way to a PC system which can also occasionally hang during an application.So the equipment is made resilient against itself in the first instance. What kind of external influences must it also be protected from?Zumtobel: The biggest challenge confronting technology is actually the user. Everything is generally OK as long as the equipment is used in accordance with the operating instructions, if there were no “foresee-able misuse.” To this end, we regu-larly let people with clinical and technical knowledge operate our new techno-logies without formal product training. In addition, we subject the equipment to further unpredictable situations: the use of unsuitable accessories, switch-ing it off suddenly, incorrect cleaning, and much more besides. This gives us more insight which helps us to make the equipment even more resilient during the development phase.

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12 DRÄGER REVIEW 111 | 2 / 2015

accordingly with stress management and relaxation techniques as well as a social network which offers assistance. Measures that promote resilience are often an inherent feature of training courses for firefighters, police officers, and pilots. It is important to realize the following: “There is no such thing as resilient or not resilient! Every individual has a certain limit which is sometimes sufficient for the challenges they face – but sometimes they go beyond this limit,” says Martin Luitjens. It took three days for him to regain his com-posure after his experiences in Winnenden. “Naturally I know about the coping process and what I need to do to get back on my feet.” Luitjens is well equipped. However, he also knows that even though an individ-ual reacted resiliently to a certain situation last year, it doesn’t necessarily mean that they will do so again on the next occasion. Nothing can be predicted, but everyone can arm themselves against it.

“There is no such thing as resilient or not resilient!”

LITERATURE AND LINKS

Stephen Joseph: What Doesn’t Kill Us. 288 pages, Jackson/TN, USA, Basic Books, 2013

Karen Reivich, Andrew Shatte: The Resilience Factor: 7 Keys to Finding Your Inner Strength and Overcoming Life’s Hurdles. 352 pages, Harmony Publishers, New York, 2013

American Psychological Association: www.apa.org/helpcenter/road-resilience.aspx

Resilence Training Institute (Branches throughout the USA)www.resiliencetraininginstitute.com



Even though the job requires a certain robustness, the image of the tough firefighter has changed in recent years. Nowadays, emergency workers can admit that callouts lasting several hours, such as this major fire, can really get to them

HOW STRONG IS YOUR MENTAL IMMUNE SYSTEM?People react very differently to demanding experiences. This is primarily due to their individual mental resilience. Take this test to determine how resilient you are. Mark the box which

generally indicates the extent to which the following state-ments apply to you. Add up all the points at the end – you can check your score below.

1. When I have plans, I see them through.

1 2 3 4 5 6 7

2. I usually manage to do everything somehow.

1 2 3 4 5 6 7

3. I am not thrown off

course that easily.

1 2 3 4 5 6 7

4. I like me.

1 2 3 4 5 6 7

5. I can multitask.

1 2 3 4 5 6 7

6. I am decisive.

1 2 3 4 5 6 7

7. I take things as they come.

1 2 3 4 5 6 7

8. I take an interest in many different things.

1 2 3 4 5 6 7

9. I can usually see a situation from more

than one perspective.

1 2 3 4 5 6 7

10. I can also force myself to do things that

I don’t really want to do.

1 2 3 4 5 6 7

11. When I am in a diffi cult situation, I usually

fi nd a way out.

1 2 3 4 5 6 7

12. I have enough energy to do all the things

I have to do.

1 2 3 4 5 6 7

13. I can accept the fact that not everybody

likes me.

1 2 3 4 5 6 7

Based on: Karena Leppert et al, Klinische Diagnostik und Evaluation magazine, 2008, pp. 226–243; with permission.

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SCORE58 points or less: You are not very

resilient. However, this does not

mean that you are at the mercy of

life’s diffi cult situations, but you

are more likely to need help working

through a challenging situation

than others who are confronted with

the same diffi culties.

59 to 82 points: You have average

resilience. You can normally

deal with diffi cult situations and get

back on your feet after a little while.

83 points or more: Nothing throws

you off course easily. You have

the ability to react fl exibly to adversity

and fi nd a strategy appropriate

to the situation. If you are unable to

change a diffi cult situation,

you are generally able to accept it.


the strength of - draeger

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