Chapter 3 of 5
Here I am again, Lord, asking your help fooooorrrrr a sinner…..oh, wait, not that one, or is it? Last week we looked at some of our brothers and sisters who made the unfortunate decision to end their lives. This week, I want you to take a long, hard look at your organization, your colleagues, and, especially (and probably the hardest), at yourself. At how we respond to this crisis.
In 2015, I attended the Ambulance Service Managers’ program. This is a two week course, eight weeks apart. In the first week, everyone is separated into groups. In the intervening week, each group does a research project to present the second week. My group did “Community Outreach on a Budget”.
But, another group decided to tackle the subject of mental health in EMS. They sent out a survey to interested EMS providers across the United States. The group figured they would get a few hundred responses, submit their data, and call it a day. They received over 4,000 responses from every state in the union, and several US territories. All credentialed EMS providers. This group has formed themselves into the Reviving Responders, and their research can be found at www.RevivingResponders.com. I absolutely implore you to review it.
They found that 85% of respondents had experienced critical stress on the job. No surprise there. They also found that 37% of those who replied had contemplated suicide. In 2012, the national average among all US citizens was 3.7%. More distressing, 6.6% had attempted suicide, where the national average was 0.5%.
Even more disturbing? Many of the respondents reported they had access to an Employee Assistance Program, however, a sizable percentage was AFRAID TO USE IT. Some were afraid they would be labeled with the stigma, others feared for their jobs. THEY. FEARED. FOR. THEIR. JOBS!
How in the hell did we let this happen? And I say “we”, as I fell into the same trap. “Suck it up, buttercup,” “If you can’t hack it, you don’t belong in this business,” and, of course, “I’m gonna write a manual: Suicide, Doing it Right!”
Several years ago, I attended a lecture by Randolph Mantooth. Yes, Johnny Gage himself. He spoke of a ride along in a major city where he responded to a “jumper down” call. The paramedic went to the patient, who had jumped from a second story window, and said “Hey, that won’t kill you. No, if you want to do it, you need to jump from at least the sixth floor. Hey, you know who dis is?”
Are you kidding me? These are the people who do not belong in this business. It’s one thing if you can get through this job and not be bothered by the bad, the worse, and the disgusting we see. Of course, we see some wonderful things, and, let’s face it, some funny sh#@, too.
I’m going to let you in on a little secret: EMS providers, cops, firefighters, dispatchers, etc are human, too. There are scenes, patients, situations, that will get to you. And, you know what? That’s ok. I mean, this job does take a certain amount of intestinal fortitude, and if you pass out at the sight of blood, perhaps this job really isn’t for you. But to show compassion, to show sorrow, to truly care about the people you are there to serve, that’s all ok.
And the reality it, it’s not just the calls that get to us. Post Traumatic Stress, or Cumulative Stress can both affect us, for sure. Add to it the long hours, sometimes 24 to 48 to even 72 hour shifts. The time away from family. Bills. Low pay. Poor management. Bills. Shoddy equipment. Having to work multiple jobs. Bills. Poor diet. Lack of exercise. Did I mention Bills? It all adds up.
And how do we prepare our newbies for all of this? No, really, how?
We lure them in saying “Come be a hero.”, “Come make a difference.” And we do heroic things. And every call is a chance to make a difference in someone’s life.
But they see the things on TV and in the movies with accident scenes with helicopters crashing and the overturned bus of hemophiliac nuns. And, well, they’re not exactly beating down the doors, but there are a number of wide-eyed kids who come through the door and get let down when they are on their third dialysis transfer of the day, after the stubbed toe call.
So they come. And we teach them how to take a blood pressure. We teach them how much oxygen to give this week. We teach them words like “Diabetic Ketoacidosis”.
But we don’t tell them what it will be like, when they are doing CPR on the 85-year-old woman, while her husband of 60 years stands there in his underwear, begging you to save her. And you know it’s not going to happen.
And we don’t tell them what it will be like, when the heroin overdose they woke up with Narcan not only won’t thank you, but will probably attack you for killing their high. On a side note, this is not, of course, unique to the US. In Australia, assaults against EMS providers have become so frequent, there is a nationwide ad campaign with the tag line “I can’t fight for your mate’s life if I’m fighting for mine.” And the suicide rate among Australian Paramedics is 20 times the national average.
And we don’t tell them what it will be like, when the mother of a 9-year-old child looks you in the eye, and adamantly insists her son just woke up with a spiral fracture of his femur. When the child screams for his father any time the mother comes near.
And the probies/rookies see these things and want to talk about it or ask questions. But they see some of the saltier folks who just say, “Suck it up!” And they go to their supervisors for help, but some of them say, “If you can’t hack it, find another job!” Management shies away from them because they don’t want to deal with it (not typical, but it’s out there, we know this). And the probie is afraid to go to EAP for fear of being labeled, or of losing their job. And they can’t afford outside counseling. And they keep it inside. And it festers. And it explodes. And then they are gone. And it’s not just new people. Seasoned veterans with 10, 20, 30 years on the job are killing themselves.
And then we have the nerve to say, “We never saw it coming.” “Why didn’t they talk to us?” Well, why would they when the environment we’ve created frowns upon it? Sure, it is changing. Many agencies have amazing EAP programs and take their employees mental health very seriously. But not all. This crap is still out there.
And then we get told “But it’s your job!” Well, to a point, yes, it is our job to deal with these things. But I have researched many jobs over the years, and here are a few things I have not found in job descriptions:
Responding to a call, and, while treating the patient, being stabbed by another individual, which happened in San Diego several years ago, and, more recently, in Jacksonville, NOT in the job description.
Having your ambulance shot at, which happens all too frequently around the world, not in the job description.
Having your ambulance stolen, and then being run over and killed by your own ambulance, as happened in the Bronx several years ago, not in the job description. (Bless you, Yari!)
And, of course, having 220 stories worth of skyscraper fall on you, as happened on 9/11/01, definitely NOT in the job description.
But such is the new reality. These are the things in our minds. Growing up in Queens, my mother’s uncle was the Chauffeur of Engine 288, first due where we lived. I grew up around this firehouse. It’s where I got the emergency services bug. On 9/11, this house suffered the largest loss of life of any firehouse in New York City. Then Squad 288, and the Hazardous Materials Company responded from Maspeth to the World Trade Center with 19 firefighters. None of them returned.
The bottom line is, for way too long we have been our own worst enemy. “We eat our young.”Sometimes it seems like it should be our motto. We cast our probies and rookies out into the streets with great knowledge of how to protect themselves physically (Scene safety, BSI, Scene Safety, BSI). But we DO NOT prepare them mentally and emotionally for what they will see.
And it’s not a bad thing. There are those out there who believe we aren’t worthy of PTSI (Post Traumatic Stress Injuries ) and CS (Cumulative Stress). They are entitled to their opinion. But they are, as I like to call them, wrong (ok, yeah, my opinion). But the fact is this: Our brothers and sisters are killing themselves. And we have to put a stop to it.
How do we do this? You know.
You know it in your heart and in your head. I hate cliffhangers, trust me. But I’ve gone a bit long again. We’ll discuss that next week. In the meantime, many of you have probably recognized the opening line and the accompanying picture. If you don’t, that’s ok, it is from the film Bringing Out the Dead
The movie is based on the book of the same name, written by former New York City Paramedic Joe Connelly. It is a disturbing look into the PTSI that EMS providers can develop. And it is all true. I had the occasion to do some of my Paramedic field training at St. Clair’s Hospital EMS in Manhattan, where Joe worked and the hospital that is portrayed in the book and movie. ED and EMS staff told me the stories that were represented in print and film. Oh, not all of it happened on one call like they show, but it all happened. Yes, even the IB Bangin scene.
Your homework this week (grumble…groan…no one said anything about blog homework!) is to take some time to watch this movie. And know that Joe, and other medics and EMTs at St. Clair’s, have gone through what many of you may be going through. Be warned, it’s pretty warped and there will be some triggers for some of you. And when you get some time, read the book, too.
Please come back again, we still have a lot to talk about.