Efforts to proactively address PTSD in the EMS community?

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Permalink Reply by Lisa Bell on March 31, 2009 at 3:15pm

Effectively coping with stress is critical to maintaining a long-term career as an emergency responder. Here's a few related sources I know of:

Posttraumatic Stress Disorder in Urban EMS Workers (NYC, 1997)

Killing Vampires (CISM, Dr. Bryan Bledsoe, 2008)

Trying to Reason with Hurricane Season (CISM, Dr. Bryan Bledsoe, 2005)

A Pocket Full of Kryptonite (stress levels, "EMS Mythbusters," March 2007 JEMS)

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Permalink Reply by Frederick Georges on March 31, 2009 at 5:42pm

Dave,

I can only suggest you confide in any friends you may know that have been in military service. They will certainly hook you up with your local Veterans Administration Hospital representative for guidence.

My generation of Veterans was forgotten mostly but I know that has changed so this would, in my opinion, be a good place to start.

Lisa Bell has offered some really interesting leads that I will now follow up as I too have many issues that I have managed alone for over 37 years.

Be well and stay safe.

Respectfully,

Fritz

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Permalink Reply by Eric D. Liddy Sr. on March 31, 2009 at 6:51pm

Many EMS systems offer an EAP program that can help with this, however, many systems don't properly address PTSD with EMS. Here in Detroit, it's just business as usual.

So sorry that you just had a scene where 7 people were shot or you had a houseful of burned children, but you've been at the hospital 20 minutes, get your unit back in service now.

Because we aren't afforded much in the lines of down time in the larger systems, we aren't given much thought when it comes to PTSD counseling.

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Permalink Reply by B Meckley on April 3, 2009 at 2:02am

I think Eric brings up some great points. I too believe that PTSD and burnout from an EMS lifestyle is way under-played among our profession. I had attended the Provider Trauma session at EMS Today. It a was good session and I learned some things. I also relearnd some things. PTSD is something that is a horrible thing to go through as a provider. It takes a toll on the provider, personnel within an organization, families, and then can effect patient care as vicious cycle of madness grows within ones head. I have seen some providers get chewed up and spit out from PTSD. Whats worse is that these are great people who hadn't recognized the signs. Moreover, their partners or coworkers DID see some red flags but didn't know how to help or knew that it was PTSD. In EMS, we do see some pretty ugly things at times. Not just blood and death, but also getting a real rude look at our society under the most unfortunate circumstances. Stress itself is all over us, if it had an odor we all would smell like a body thats been rotting in a bedroom in the 3 week of July. One thing I often think about seeing 3 kids who weren't going to have Christmas this past year because thier mother and father had lost thier jobs. Hearing those stories as you visit some patients on calls stay with you and often times wear on your own mind. Think that is a stressor to personnel? Damn right it is !!!

I would be interested to see a valid study or poll taken to assess signs for PTSD in EMS workers and assess the progression of signs as they develop among EMS providers. I think that the results would be shocking. I would be willing to bet that 60%-70% will show significant signs. Maybe Im a little off but I think we arent as aware of signs as we should be.

~BAM~
Eric D. Liddy Sr. said:

Many EMS systems offer an EAP program that can help with this, however, many systems don't properly address PTSD with EMS. Here in Detroit, it's just business as usual.

So sorry that you just had a scene where 7 people were shot or you had a houseful of burned children, but you've been at the hospital 20 minutes, get your unit back in service now.

Because we aren't afforded much in the lines of down time in the larger systems, we aren't given much thought when it comes to PTSD counseling.

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Permalink Reply by Laurie Fisher on April 4, 2009 at 1:48pm

Dave,

MY CISM team is currently researching and trying to put together a program to present throughout our County to new respnders to help them adjust and deal with the stresses of the field. We are researching, but having some difficulty with the topic. I think this is a new emphasis for EMS in general.

Too bad you're done. Hate to lose people, espeically to stress. However, East Bay of SanFran is world's away from rurall Northern NY, six miles from the Canadian border. My department runs about 1300 calls a year, about 1000 EMS and we're volunteer. What kind of numbers were you doing before you retired? We're trying to come up with all kinds of coverage solutions so we don't burn out...how do the cities do it?

Laurie Fisher, Firefighter/EMT-B
Malone Callfiremen

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Permalink Reply by asysin2leads on April 6, 2009 at 3:58am

Personally I think the "bad call + PTSD = burnout" equation is overplayed in EMS. Sure, we all have calls that really get to us, but pretty much, after your first year of work, you either learn to deal with bad calls or you don't. Even "burnout" is a pretty loaded term. I think a better term is "I've had enough of this crap and I'm going to move on." Here is my list of non-PTSD items that might contribute to an EMS provider calling it quits.

1. Spending half of the really good years of your life doing education, training, and CME so you can beg for a job that will end up paying you less than your average garbageman.
2. Being unfavorably compared to a fireman constantly, in every aspect, day in and day out, even by writers of JEMS.
3. Having to work overtime, every week, just to make ends meet.
4. Risking back injury, needlesticks, and MVA's for people who abuse the 911 system.
5. Having to be harassed by incompetent EMS managers who think that an ambulance service and Burger King should have the same managerial structure.
6. Having to put your life and career in the hands of a 19 year old with less training than your average forklift operator.
7. Being barely able to pay your bills and still be looked down upon by people who do your job for free.
8. Working for years and years and years at a career and still being told your opinion and said 19 year old brand new EMT's opinions both should matter.

I could go on and on and on but I think you get the picture. I hate to tell all you PTSD psychology heroes out there that despite that romantic aspect of it, by in large, its not PTSD that "burns people out", what burns people out is the petty little irritations and frustrations of day to day career EMS until people get fed up. So instead of writing yet another think piece on PTSD, how about you work on some of the stuff I mentioned above? Or is there just no glory in tackling non-PTSD EMS burnout issues?

B Meckley said:

I think Eric brings up some great points. I too believe that PTSD and burnout from an EMS lifestyle is way under-played among our profession. I had attended the Provider Trauma session at EMS Today. It a was good session and I learned some things. I also relearnd some things. PTSD is something that is a horrible thing to go through as a provider. It takes a toll on the provider, personnel within an organization, families, and then can effect patient care as vicious cycle of madness grows within ones head. I have seen some providers get chewed up and spit out from PTSD. Whats worse is that these are great people who hadn't recognized the signs. Moreover, their partners or coworkers DID see some red flags but didn't know how to help or knew that it was PTSD. In EMS, we do see some pretty ugly things at times. Not just blood and death, but also getting a real rude look at our society under the most unfortunate circumstances. Stress itself is all over us, if it had an odor we all would smell like a body thats been rotting in a bedroom in the 3 week of July. One thing I often think about seeing 3 kids who weren't going to have Christmas this past year because thier mother and father had lost thier jobs. Hearing those stories as you visit some patients on calls stay with you and often times wear on your own mind. Think that is a stressor to personnel? Damn right it is !!!

I would be interested to see a valid study or poll taken to assess signs for PTSD in EMS workers and assess the progression of signs as they develop among EMS providers. I think that the results would be shocking. I would be willing to bet that 60%-70% will show significant signs. Maybe Im a little off but I think we arent as aware of signs as we should be.

~BAM~
Eric D. Liddy Sr. said:

Many EMS systems offer an EAP program that can help with this, however, many systems don't properly address PTSD with EMS. Here in Detroit, it's just business as usual.

So sorry that you just had a scene where 7 people were shot or you had a houseful of burned children, but you've been at the hospital 20 minutes, get your unit back in service now.

Because we aren't afforded much in the lines of down time in the larger systems, we aren't given much thought when it comes to PTSD counseling.

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Permalink Reply by Jodi on April 6, 2009 at 4:35am

I can do my job.

It has always been the office BS.

The PT is on a nitro drip. Can't you transport as an EMT? A nurse Paramedic would cost more. You do it and I will say I call a nurse.

EMTs are a dime a dozen.

You want how much to work here? I will start you out as a paramedic a dollar over minimum wage and if you last 6 months you might get a raise. By the way don't touch the BMW.

You must be the new person. Ever driven code 3? Good here’s the keys and address. Heart attack. 5 th story. Go that way the ambulance is around the bar.

Drive up to an MVA first on scene, You jump out and your partner states they will call in the address. Few moments go by and you look back at the rig , 12 family members deep in injured pts, to see your partner still sitting. "Get me equipment" I yell. "No" they said "I was only taught to call 911."

" Honey" I yelled "today you are 911." I was fired for fighting with my partner. Bosses 18 year old Boyfriend.

Bounced pay checks and taxes never paid. Contracts broken and 5 kids to feed.

Ex calls the Ambulance office to find you and the standard answer is "Can't make visitation Fire Department wants him to go to Vegas for a convention. Sorry No Child Support this month too."

This goes on. This is why I left. I came back only to work Search and Rescue. They are grateful for someone who is willing to help.

But again it is the Brass pushing the EMS unit around. One is a wanna be EMT and has decided he is going to dictate protocol and equipment

I do it for free but you cannot buy the respect I am shown here from the crew members. First Job I have ever had where I don't look for knives sticking out of my back. By not so gentle fellow employees.

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Permalink Reply by V-fibber on April 6, 2009 at 8:44am

Hi Dave-

My take on this subject is very plain. I have been in EMS for 20 years, all on the street.Been a medic for the past 10 years. I personally have been thru a partner being killed in an ambulance roll over in 2001 , a 10 y/o girl being run over by a dump truck ( exact age as my oldest), a few SIDS ,1 Incinerated body, and a couple of miscarriages where the fetus has been expelled. Thats just some of the stuff that comes to mind right away. Never mind the sleepless nights , frequent flyers,BS calls. Thats just the stuff on the street. Never mind bad trucks , micromanaging station supervisors with no experience nit picking everything you do , incompitent partners, kids comming up with no experience and no respect for others who have done it longer,management who has forgotten what its like to be on the streeet.

Now I dont have a degree in psychology or management. Just a degree on the street. It's hard for me to hear people who havent been there,done that and experienced what street people have experienced first hand. I know I have PTSD , anxiety and yes a touch of depression. I have come to accept that people die,shit happens. But this is my career and I wouldnt change it for anything. I love my career. I enjoy helping people who need my skills . I think thats why I still do this.There are good days and bad calls. I talk to my partners and use humor as a relief. That is what works for me.

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Permalink Reply by Stu on April 7, 2009 at 1:00am

I did a project in college on EMS stress and I have a bunch of sources. I sent you a friend request. Send me an email, and I'll send all the sources I used. It may be easier than me putting them in the discussion and then you having to copy them again.

Stu

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Permalink Reply by B Meckley on April 9, 2009 at 2:00pm

Wow LEADS, you woulda thought I struck a nerve!!!! I think you have some very valid points to every item you had listed. I also think that I could add to that list. My feelings are like this, I feel that PTSD is a very real thing. HOWEVER, the circumstance like lack of leadership/organization, poor morale, increased hours with decreased pay, and so on that are added in to the equation multiply the "burnout" **"bad call + PTSD = burnout"**
I guess my equation would go a little something like this.

**(bad calls + PTSD) X Circumstance #1 X Circumstance #2 X Circumstance #3 = BURNOUT **


asysin2leads said:

Personally I think the "bad call + PTSD = burnout" equation is overplayed in EMS. Sure, we all have calls that really get to us, but pretty much, after your first year of work, you either learn to deal with bad calls or you don't. Even "burnout" is a pretty loaded term. I think a better term is "I've had enough of this crap and I'm going to move on." Here is my list of non-PTSD items that might contribute to an EMS provider calling it quits.

1. Spending half of the really good years of your life doing education, training, and CME so you can beg for a job that will end up paying you less than your average garbageman.
2. Being unfavorably compared to a fireman constantly, in every aspect, day in and day out, even by writers of JEMS.
3. Having to work overtime, every week, just to make ends meet.
4. Risking back injury, needlesticks, and MVA's for people who abuse the 911 system.
5. Having to be harassed by incompetent EMS managers who think that an ambulance service and Burger King should have the same managerial structure.
6. Having to put your life and career in the hands of a 19 year old with less training than your average forklift operator.
7. Being barely able to pay your bills and still be looked down upon by people who do your job for free.
8. Working for years and years and years at a career and still being told your opinion and said 19 year old brand new EMT's opinions both should matter.

I could go on and on and on but I think you get the picture. I hate to tell all you PTSD psychology heroes out there that despite that romantic aspect of it, by in large, its not PTSD that "burns people out", what burns people out is the petty little irritations and frustrations of day to day career EMS until people get fed up. So instead of writing yet another think piece on PTSD, how about you work on some of the stuff I mentioned above? Or is there just no glory in tackling non-PTSD EMS burnout issues?

B Meckley said:

I think Eric brings up some great points. I too believe that PTSD and burnout from an EMS lifestyle is way under-played among our profession. I had attended the Provider Trauma session at EMS Today. It a was good session and I learned some things. I also relearnd some things. PTSD is something that is a horrible thing to go through as a provider. It takes a toll on the provider, personnel within an organization, families, and then can effect patient care as vicious cycle of madness grows within ones head. I have seen some providers get chewed up and spit out from PTSD. Whats worse is that these are great people who hadn't recognized the signs. Moreover, their partners or coworkers DID see some red flags but didn't know how to help or knew that it was PTSD. In EMS, we do see some pretty ugly things at times. Not just blood and death, but also getting a real rude look at our society under the most unfortunate circumstances. Stress itself is all over us, if it had an odor we all would smell like a body thats been rotting in a bedroom in the 3 week of July. One thing I often think about seeing 3 kids who weren't going to have Christmas this past year because thier mother and father had lost thier jobs. Hearing those stories as you visit some patients on calls stay with you and often times wear on your own mind. Think that is a stressor to personnel? Damn right it is !!!

I would be interested to see a valid study or poll taken to assess signs for PTSD in EMS workers and assess the progression of signs as they develop among EMS providers. I think that the results would be shocking. I would be willing to bet that 60%-70% will show significant signs. Maybe Im a little off but I think we arent as aware of signs as we should be.

~BAM~
Eric D. Liddy Sr. said:

Many EMS systems offer an EAP program that can help with this, however, many systems don't properly address PTSD with EMS. Here in Detroit, it's just business as usual.

So sorry that you just had a scene where 7 people were shot or you had a houseful of burned children, but you've been at the hospital 20 minutes, get your unit back in service now.

Because we aren't afforded much in the lines of down time in the larger systems, we aren't given much thought when it comes to PTSD counseling.

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Permalink Reply by Eric D. Liddy Sr. on April 9, 2009 at 6:46pm

I will say that I am probably one of the lucky ones out here. One of my past departments that I worked for recognized that we are all only human and that we can be subject to PTSD.

Certain life stressors can contribute to PTSD and lead to burnout very quickly. My department at the time asked several of us to take CSID training and I was one of the chosen. Because Linda Living-Holly RN (North Oakland Medical Center, Pontiac, MI) had taught the course to us, it help me see what potential stressors could lead to and aggrevate PTSD. The course also taught me a lot on how to deal with and help others deal with things on the job that can push one over the edge.

I highly encourage ANYONE that has had a bad day, a bad call or some other critical incident to first: Talk with your partner, 2nd, if that isn't helping, contact your employer. They may have a CISD team in place to handle things and may be able to direct you towards an employee assistance program should you need additional help.

I have been working in EMS and fire services for almost 21 years now and some of these things have given me an extended lease on my career. I have a mere 16 years left until my retirement and I intend on making it there....sane.

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Permalink Reply by Greg Collaco on April 9, 2009 at 11:32pm

Dave,

I attended a first responder retreat called WEST COAST POST-TRAUMA RETREAT (WCPR)

It saved my life, marriage, and job!

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