By Susan D. Scott, PhD, RN, FAAN; and Shelby Cox, BS, NREMT-P
Billy, a 24-year veteran medic, was counting down the number of shifts until retirement. Only 15 24-hour shifts left until his long-awaited “last call!” His silent reflection was interrupted by the emergency dispatch system. A two-vehicle collision was just reported on the interstate with multiple casualties. Several ambulances were requested to respond. A wrong-way driver, entering the northbound lanes of the interstate traveling in a southerly direction, hit an SUV head-on. It was a call all too familiar to Billy. He had witnessed many accidents involving multiple vehicles on the interstate, but accidents involving impaired drivers were always more troubling.
Responding to the frantic scene, he noted the demolished SUV. The mother and a small toddler were dead at the scene. Billy started stabilizing the seriously injured father, who begged for medical attention to be given to his family and not him. Billy focused on stabilizing the young father for transport.
Even after he handed the patient off to ED personnel, he continued his thoughts about that unfortunate family. He was hoping that having the next four days off would help, but the case troubled him deeply. He was having trouble sleeping; and when he could rest, he dreamed of the gruesome scene. It was like a video that just kept replaying repeatedly. This call just hit too close to home. The young child was the same age as Billy’s first grandchild. Ironically, they also shared the same name – Matthew. He felt like he just wasn’t as tough as he used to be! He faced the grim reality that maybe he wasn’t cut out for this type of work anymore. He couldn’t shake one recurrent thought – perhaps he should call it quits now.
First responder support
This type of scenario is experienced regularly by first responders: yet, they continue to make a difference and save countless lives daily. Some calls are definite saves; some, unfortunately, are not. Emotionally challenging cases can frequently occur in this line of work. Most of the time, one can emotionally distance themself from the call, they are strong and resilient and capable of just getting the job done.
Regardless of their years of experience, gender and personal resiliency, virtually every first responder can easily recall the immediate and ongoing impact of at least one specific emotionally challenging call. Those who choose to become first responders are likely to be exposed to numerous challenging calls throughout their careers. We have learned that responses to stressful events are relatively predictable. Billy’s reaction was a normal human reaction and should have been anticipated.
This acute occupational stress is known as the second victim phenomenon (SVP). Research on the topic has demonstrated that the challenges of delivering care in any setting can take a toll on the physical, mental and emotional wellbeing of the individual rendering the care and support. EMS leaders need to understand SVP to help put the experience in perspective and offer the support required for healthy healing. First responder support, regardless of service location, should become a predictable part of the departmental operational response to any emotionally challenging run.
Recovering from emotionally challenging calls
Every day, first responders working in compromising environmental conditions face the harsh reality of unanticipated and sometimes tragic outcomes. Awareness of the second victim experience is the early intervention that can be deployed and should be incorporated during initial training courses.
Openly discussing previous cases and their impact on providers helps novice first responders understand that it is entirely reasonable to experience disturbing reactions to emotionally challenging calls. These tips of the trade from experienced first responders on how they have handled tough calls can be quite helpful. Peer supporters, trained explicitly on providing emotional first aid, have been proven to be a successful approach. Leaders should consider ways to formally integrate a peer support process within their teams. Awareness of the second victim phenomenon and a departmental response plan are critical steps in minimizing the potential suffering of first responders.
Three potential professional and personal outcomes of the second victim experience have been identified as thriving, surviving, and dropping out. Evidence suggests that a lack of departmental and peer support will negatively impact how the individual copes, leading to increased distress and suboptimal recovery. Researchers are just beginning to understand the link between second victimization and significant burnout.
A formal peer support network promotes a sense of safety and instills hope for recovery. Peer support delivered by trained, experienced colleagues is one of the most critical, evidence-based interventions to reduce distress and build resilience after stressful calls. The focus of supportive peer interaction is not on “fixing” the suffering but instead on allowing the individual to recognize how they are doing, realize they are not alone, and identify that their responses are normal. To follow best practices, peer supporters should identify and normalize the many reactions experienced in the aftermath of a challenging call.
First responders around the globe perform lifesaving and heroic work in unusually stressful environments due to the challenges and associated risks of their chosen professions. Providing such care poses unique threats to the individual care team members that include physical, mental, spiritual and emotional wellbeing. The potential personal and professional toll of rendering assistance and care are substantial. The development of a formal peer support infrastructure is a foundational element of a robust patient safety culture. Peer support should become a predictable part of the department’s response to potentially emotionally challenging runs.
CPS “Road to Reliability” Webinar Series
As part of its Road to Reliability Webinar series, the Center for Patient Safety is offering a webinar on Oct. 21, 2020, at 1:00 pm CST. The session will provide an overview of the second victim phenomenon as it pertains to the EMS community and offers tips on developing a successful peer support process.
Visit the CPS’s “The Road to High Reliability” for additional information and to register.
About the speakers
Susan D. Scott, PhD, RN, CPPS, FAAN
Dr. Scott is a patient safety consultant for the Center for Patient Safety. She also practices as a nurse scientist at the University of Missouri Health Care, where she continues her studies on the potential personal and professional impact of emotionally challenging cases. She has practiced the art and science of nursing in a variety of clinical settings that include nNeonatal ICU, neonatal/pediatric transport, ambulatory pediatrics, patient safety and legal nurse consulting. Her research interest involves the development of effective institutional support networks to address clinician support in the aftermath of unanticipated clinical outcomes and events. Her research has defined the second victim phenomenon allowing for the design and deployment of the first of its kind peer support network, the forYOU Team. She has authored numerous articles and textbook chapters related to the topic of the second victim phenomenon and healthcare workforce wellbeing. Dr. Scott has partnered with agencies such as the Agency for Healthcare Research and Quality, American Hospital Association, The Joint Commission, and the Institute for Healthcare Improvement to ensure comprehensive clinician support interventions are accessible to healthcare institutions around the globe.
Shelby Cox, BS, NREMT-P
Shelby is the patient safety project coordinator for the Center for Patient Safety. She is also a paramedic with more than 20 years of experience in EMS.
Additional resources on emotional resiliency
Learn more about recovering from challenging calls and emotional resiliency with these resources from EMS1:
- EMS resiliency, readiness relies on combating fatigue
- Building First Responder Resilience
- Planning for trauma: How to protect EMS providers’ mental health
- How one EMS agency launched a Peer Support Program
- Fit for duty: How to be a resilient responder
- Mental health in EMS and signs to look for in partners
- Study reveals roadblocks to mental health counseling in first responders
- How to speak up if you’re worried about a co-worker’s mental health
- Paramedics use peer support group to tackle PTSD
- Self-care tips to recover from a traumatic EMS incident
