I have not been to an EMS conference in the last two years where EMS provider suicide, stress management or mental health was not on the program. It seems nearly everyone understands we need to improve resilience, recovery and how we take care of our own.
Our challenge is that while we appreciate the problem, the path to making real and meaningful improvements is not clear. We hope that peer support teams, employee assistance programs, Just Culture and stress management education will help, yet the evidence for any single approach is thin.
Many, if not most, EMS systems have a plan in place for obvious traumatic situations, like the multiple fatality school shooting, mudslides with people buried alive in their homes or hurricanes that wipe out entire communities. They have resources and some kind of process to support employees who ask for help.
One of the big challenges is recognizing an opportunity to help a teammate who might need support but haven’t displayed obvious cues (e.g., called you asking for the peer counselor phone list or the EAP brochure, or have just run a multi-fatality school shooting).
Many EMS organizations are beginning to use their data systems to track the kinds of individual or cluster of calls that might put someone at risk for stress or emotional problems. They have the computer system identify situations that included potential triggers like:
- Burns.
- Suicide.
- Assault.
- Pediatric cardiac arrest.
- Violence directed at crew.
- Multiple-casualty incident.
- Severe trauma (e.g., brain matter, ejection, mauling, decapitation).
Chances are, you’ve got your own theories about what should be on the list. There’s not a lot of scientific evidence about this strategy yet, but we can probably agree that some situations have a higher probability of causing problems for some providers under certain circumstances.
Once the potentially highly troubling scenarios are identified, the computer reaches out and notifies a human, usually a supervisor, dispatcher, counselor or chaplain.
At that point, there’s a situation where a frontline provider or providers may or may not need emotional support and a leader who has been alerted to the possibility of an opportunity to support. Many of the leaders I’ve talked with don’t really know what to do next.
To address that question, we reached out to someone who has been responding to these kinds of alerts in hospital and EMS settings for 25 years; Russ Myers, chaplain for Allina EMS, for his expertise and perspective. In his current position, he builds relationships by riding along with medics, EMTs and wheelchair van drivers, sitting along with dispatchers, and following up with employees after stressful events. In addition to his chaplaincy practice, Russ is adjunct faculty in the Interreligious Chaplaincy program at United Theological Seminary in New Brighton, Minn. He shared the following perspective.
EMS1: Russ, how would you describe the role or goal of the person who is reaching out to check in with someone who has not asked for help?
Russ Myers: One of the hallmarks of EMS is our care and concern for each other. We have each other’s backs. On a person-to-person, human level, we care. So as far as the role of the person doing the outreach, it can be any of us – peer, supervisor, manager, friend. Like the CISM model, we leave rank and position at the door.
The goal of the outreach starts from the same place. Why do we reach out to someone who has had a tough call? Because we care. Because we know they would do the same for us. The goal is to let our colleagues know that we care. Not to fix them, not to take care of them, but simply to stand with them. Open the door.
How do you decide if you’re going to call them on the phone, send them a text, meet them at the hospital, or pull them out of service to come chat with you?
The “how to” will depend on the relationship and how you usually communicate. Friends might make a phone call or send a text. Field supervisors might meet them at the hospital. Dispatch leaders might be immediately available in the same room.
In my case, I’ve found it most effective to start with a text message. I never know if someone might be available, working or sleeping, so I hesitate to make phone calls. Plus, with text messages, I can send a brief message of support and leave it up to the recipient if or how they want to respond.
How would you suggest that leaders begin this kind of a conversation?
One of the simplest and most effective things any of us can do to support our coworkers is to acknowledge their experiences. Don’t assume that they’re doing OK, traumatized or anything in between. Sometimes, the best thing a supervisor can do is to take them out of service, even for a short time, without asking if they wanted it. “Take a half hour, get something to eat if you’d like.” Asking crews if they want a break is a set-up. What are they supposed to say? “Yes, I’m traumatized,” “no, I’m not,” “yes, I’d like a break, but I don’t want my coworkers to have to take on extra work just so I can have a half hour to myself”?
What might you say in a text message?
A common text message that I use is: “Checking in with you after the (pediatric cardiac arrest) incident. Sounds like it had the potential to be stressful. I want you to know I’m aware of it and am available if I can be of support.”
What kind of responses have you gotten from EMS folks that you’ve reached out to?
Responses to my outreach varies. Often, I don’t hear anything in reply. Sometimes, it’s a short, “Thanks, I really am doing OK.” Sometimes, it goes like this: “I’m all right, but am concerned about my partner. It seemed to hit him pretty hard.”
Occasionally, I get a long reply, detailing why the call was hard, putting it in the context of the medic’s current situation, assuring me that they’re OK. In effect, they are unloading the story, and the emotional weight that goes with it, in writing.
Sometimes, I get a text back: “That one was hard. I’d be interested in attending a CISD if one is held.” That’s a clue. I reply by offering to talk further – by phone, at a coffee shop, wherever and whenever they wish.
One thing I’ve learned is not to send a text message stating that I’m available unless I truly am available, right then. It’s happened where my text went out, and within 10 minutes, the medic was calling my phone.
Many leaders worry about causing harm to their teammate by making a mistake. Are there some things that you should never do, or at least avoid?
Our first impulse may be to ask, “how are you?” but I’ve found it to be more helpful not to ask anything. Just tell them you’re aware of the incident, express your concern and support, and keep your mouth shut. If they are visibly shaken, don’t try to fix it. Everyone deserves the right to interpret their own experiences in their own way.
For one thing, they may not know how they’re doing. They may be numb and not feeling much of anything. In the first hours after an incident, they’re still loaded with the stuff our bodies give us to get through a crisis – adrenaline, cortisol, norepinephrine – and truly unable to feel anything.
So asking them how they’re doing can be pointless, or even harmful, as it may lead to the impression that everything is fine. In fact, we often hear an initial response of “I’m fine,” “I’m OK.” By waiting until the next day, after we’ve had some sleep, those chemicals have worn off and we’re more aware of the emotional weight of the event.
If you’ve reached out and they accept your offer of support, what do you do next?
We sometimes tend to pathologize stress reactions, but we go into this business because we care about people, and coming face to face with human suffering does impact us. I don’t want to be a robot. I need to know that I’m human, and sometimes that leads to tears. Stress is a normal response to an abnormal event.
So when you do have that follow-up conversation, start out with education. Give them your brochure or handout. Tell them, “as hard as this is, it tells me that you’re normal.”
Common Reactions to Stress Handout by Ed Praetorian on Scribd
Then let them talk. They may recount the incident in detail. They may focus on the clinical aspects of the call and not go anywhere near the emotional impact. It doesn’t matter. You’ve done your job.
