We simply don’t expect it – plan for it – anticipate that it will happen. We often keep our blinders up, hoping that we’ll never encounter it. But, when it does happen – when we need to care for one of our own – keeping our blinders up is one of the most detrimental things that we can do.
Reflecting back over my career, I’m reminded how a few events stand out, and how even a single day has changed the trajectory of my career path. These days don’t stick into my mind because they were pediatric codes, multi-system traumas or even austere rescue situations. They’re embedded because either I, or my direct colleagues, had to care for someone close to us ... one of our own.
Objectively, we care for people every day in our line of work, and arguably with the same level of care, compassion and competence for each patient. Subjectively, however, different situations pull at our coat tails a little bit more than others, and those can result in outcomes of blinding ignorance or narrowed distraction. Each of these situations and outcomes can be exacerbated when the patient is one of our own.
Here’s my reflection and evaluation of some of these personal situations and encounters throughout my own career.
Mayday, RIT and LODD
Aug. 13, 2006 – it was supposed to by my first day riding as the number-two person and as a brand-new paramedic on Ambulance-451. Some internal processes couldn’t be completed in time, so instead, I was assigned to an engine company across town. Only a few hours into the beginning of our shift, some of our east-side crews were dispatched to a working structure fire in a newer residential home. Minutes after fire attack, crews entered the home, and a following search crew – Ambulance-451 – declared a mayday.
Both crew members had fallen through the main level floor and into the basement. On one side of the rubble was an open space that allowed for the firefighter to eventually exit; on the other side was the seat of the fire, and no exit. One of my colleagues – the one who should have been my first partner on the ambulance – died in the line of duty.
As with any situation where a mayday is declared, our fireground rapid intervention team (RIT) was deployed. Being assigned to RIT was typically an undesirable task, as you pretty much stood outside of a building while others were pulling hose, breaking windows and cutting holes in roofs. Aside from deploying a few ground ladders, it was a pretty gravy task, until you were actually needed. Then, it was a high-stress, high-stakes, and time-sensitive assignment, often with the safety – or even life – of a colleague on the line. Being prepared for these time-sensitive rescues – those requiring rapid intervention – are a necessity in the fire service.
I never made it to the fire scene that day, but I did get re-assigned to an ambulance (for my first time as a paramedic), and I did hear the first-hand accounts of what it was like to be a part of the rescue efforts to try to save – and later retrieve – one of our own. My career was changed as a result of that day, as were the careers of my 180 plus colleagues. Our brother called for help – “mayday!” – but none of us could reach him. Moving forward, my department was never the same.
Learning from tragedy
In my nearly two-decade career in EMS, I’ve experienced the loss of two direct colleagues as a result of an on-duty line-of-duty-death (LODD), the loss of few more neighboring community colleagues as the result of both on-duty and chronic disease LODDs and two colleagues who died by suicide, as well as the injury of a small handful of other colleagues. This is both inevitable and unfortunate, and offers its own set of lessons.
Responding to treat one of our own always seems to increase the stakes. I recall responding to a call where another vehicle collided with a police cruiser, and ordering my driver to slow down as he raced over 75 mph down a city street. I remember hearing the street address of homes that belonged to family members as I was being paged to respond to a call as a volunteer EMT in my local community (although not our own, they were my own). I remember twisting my ankle on a fire scene and hearing of the news broadcasting that “one firefighter was injured and transported to a local hospital” – later learning that my wife was watching at home (then finding out that it was me – just with a twisted ankle). Regardless of the situation, the stakes always seem higher when it’s one of us that is hurt. Why is that?
Bad things shouldn’t happen to the people that are trying to help others. Bad things shouldn’t happen to our brothers and sisters in red, blue or white. The reality, however, is that bad things can and do happen to us – to our own. Through my own tragedies – however close or distant – I’ve been able to reflect and learn from each of these situations. Now, as an EMS chief, I’m able to bring these lessons to the forefront in the form of pre-planning and policy.
Address emotions before they happen
In the midst of tragedy is not the time to start thinking about a plan, instead, it’s the time to start implementing the plan. Just like when you first hear cardiac arrest dispatched over the speaker, your mind automatically shifts toward protocols, algorithms, monitor strips, medications and immediate actions. What to do has been engrained into your mindset.
Responding to situations involving one of our own should be no different. Subjectivity and emotions aside, we need to formulate objective plans addressing how to handle these situations – and how to address the ensuing emotions – before they happen, not as they happen.
Maintain your poise – your command presence – and respond with a clear mind. Don’t cloud it with what ifs as you respond; prepare it with “step 1, step 2 ....”
After a call involving one of your own, maintain your sense of calm and afford everyone the opportunity to debrief and activate their own mechanisms to maintain resiliency.
Most importantly of all, don’t think; do! Thinking allows your mind to wander, to inflate reality, and to interject subjectivity into an already unfortunate situation. Doing enforces best practices and preparation, and promotes clear thinking (so long as you have a checklist or process to follow – to do).
7 steps to pre-planning a call involving a colleague
Here are 7 helpful tips and actions to pre-plan for situations where you encounter the need to care for one of your own. Download a copy of these tips to print and keep with you.
- Prepare like a RIT. Prepare your crews to identify and monitor potential hazards, prepare for immediate rescue needs, and respond to situations where one of their own may be in danger, whether it’s physical, mental or emotional danger.
- Pre-plan with checklists. Develop policies and procedures on what to do when you respond to one of your own, and how supervisors should act when tasked with handling the operations, logistics and initial emotions of a “down” crew member.
- Never face your troops alone. Always pair the most objective person with the most subjective person, allowing for facts and emotions to come together cohesively, rather than divisively.
- Embrace resiliency. Everyone is resilient in their own way. After a call involving a fellow public safety member, encourage everyone to rest, re-charge and return to work when their mind and body are ready (not rushed).
- Maintain poise. Call it command presence, stoicism or poise, it’s important that – during the heat of the fire – you remain calm, cool and collected in order to make sound decisions.
- Plan for out-of-service. Whether it’s a vehicle being placed OOS after an accident, or a crew needing some time to rehab and debrief after a stressful call, develop a process where it’s acceptable to go OOS for a bit to recover.
- Focus on safety. Pre-planning and prevention are all about a focus on safety before an incident occurs, so it’s important to remember safety practices during an difficult call, because this is the time where you and your crews are often most vulnerable.
Read next: Enduring grief: Coping with first responder loss
Have you been called to treat one of your own? Share your story with editor@ems1.com.
