Tag: EMS

Article: How One Paramedic is Recovering from PTSD

The Journal of Emergency Medical Services has published the PTSD recovery story of Benjamin Vernon, a paramedic/firefighter in San Diego. Vernon and his partner who was knifed by a bystander during an ordinary call. He describes the attack, recovery and the nightmares – a word he says isn’t strong enough – that followed. Unfortunately, the therapist he saw had never treated a firefighter or a victim of workplace violence.

“On the fifth day, I finally understood suicide,” Vernon writes.

The story ends well – he finds a competent therapist (whom he’s still seeing weekly) and receives EMDR (Eye Movement Desensitization and Reprocessing), which he describes as “the coolest Voodoo.” (It’s also sometimes called “FM” for “F%&#ing Magic.”

The danger of “nobody else can understand”

If you are in public safety or the military, as well as some other fields, you know that some people insist that there it is pointless to talk about work to any “outsider.” Often, big agencies have this attitude toward smaller, less busy, ones –  “We are the only REAL firefighters, police, medics, etc., around here.” So they close themselves off from  support by people who otherwise might be peers.

The walls even go up within agencies – specialized, elite teams form a “tribe” mentality that says if you haven’t been part of a similar unit, there’s no point in talking to you about stresses and challenges, even if do the same kind of job.

No doubt, there is some truth to this. Working at a big, busy, urban agency certainly is different from smaller ones. Combat experience absolutely has unique aspects. Being part of an elite or specialized team really is different. People who haven’t walked the walk truly cannot understand. Experience is the only instructor – words quickly fail if we were to try to fully communicate it, especially the emotions around high-stress events (which can directly impact the brain’s speech center).

For a number of years, I have suspected that organizational isolation – that’s this is about – could be as toxic as individual isolation. We know that social support is the most important factor in resilience under stress or recovery from trauma; isolation aggravates stress. In fact, almost any trauma expert will agree that people will continue to suffer as long as they remain isolated –  connections with others give us strength and healing.

I recently began reading Ellen Kirschman’s book, I Love a Fire Fighter: What the Family Needs to Know, which has been sitting on my nightstand for a while. Dr. Kirschman, a well-regarded therapist in public safety, is also regularly involved in the West Coast Post-Trauma Retreat, where I have volunteered and learned.

Here’s the light bulb that went off as I read Kirshman’s introduction – the “nobody else can understand” attitude cuts us off from our friends and family. If you are certain that even a co-worker who isn’t part of your elite unit can’t support you because “they don’t understand,” then how can your friends and family who are civilians, possibly support you?

Here’s one of Kirschman’s observations about going through a fire academy (emphasis mine).

No one acknowledged how the emotional courage fire fighter families need or the independence that is forced on them contributes to the fire service mission. This is extremely puzzling in light of the many studies that confirm how family and friends are the heart of a fire fighter’s emotional support system.

Her books (she wrote a similar one for law enforcement) are for families, but the message to public safety is just as important. Your social support outside of work is also critical to your strength and resilience in the face of occupational stresses, and recovery from critical incidents and other injuries that aren’t physical.

The following words are why it does not matter that outsiders can’t understand the job.

Empathy does not require understanding.

It’s true – if you are an outsider, you will not understand. If you’ve never been there, I can’t explain what it was like to talk to a patient one minute and then do CPR on him, unsuccessfully, the next. You won’t understand how difficult it was to walk past his wife in the ER waiting room, seeing her comforting another wife, not knowing her own husband was just pronounced dead. If you’ve never done anything like helping a family bury their dogs who couldn’t escape a wildfire, nothing I can say will make you understand. If you haven’t been part of a rescue that went all wrong and killed the victim, I don’t have words for the emotions. If you haven’t done shift work, you don’t know the toll it can take.

Even if you cannot understand, that doesn’t have to stop you from supporting a responder if you are a trusted friend – because empathy does not require understanding. They may spare you details. They probably won’t repeat the sick jokes that helps many get through the day. But if you are willing to simply walk beside them, your presence can be healing.

You don’t need to understand responder experiences to know that they are painful. You don’t have to work shifts to that it is hard to be exhausted and miss family events. Everyone has experienced pain and frustration, he stress of an event or life going out of control. Co-workers can appreciate it more than outsiders, so co-workers are an essential part of any responder’s network of social support. So are spouses, friends with completely different careers, pastors and may others.

Camaraderie is powerful. Every agency – and groups within them – benefits from friendships, mutual support and teamwork. However, the idea that only our co-workers or people like them can support us is a misguided obstacle to wellness. We should not want anyone, from new recruits to  seasoned veterans, to believe that their friends and family have little to contribute. As Ellen Kirschman says, that idea cuts t them off from the heart of their social support system.

Paramedics with social support sleep better

An article in the Journal of Occupational Health Psychology earlier this year described a one-week study of paramedics’ sleep and their social support. Those who saw themselves as having more social support reported better sleep. The researchers also observed that the sleep quality of paramedics who perceive more support isn’t as impacted by job stress.  On the other hand, they reported “Those with low levels of support displayed poor sleep quality in the face of high occupational stress.”

In recent years, it has become quite clear that good, deep sleep is vital for coping with stress – poor sleep is associated with increased risk of developing PTSD.  The correlation between social support and coping with stress has also been observed repeatedly in studies. It’s unsurprising to find a link between social support and sleep quality – this reinforces the importance of both.

Paper: Psychological First Aid training helps EMS workers

Star of LIfe

A dissertation , Community-based psychological first aid for emergency medical service providers: Mental health stigma, resilience, and social support, published at the University of South Dakota took a look at the effect of Psychological First Aid (PFA) training on EMS workers. Although the study did not confirm the researcher’s hypotheses about why there is stigma in EMS around asking for psychological help, there were two positive findings. Knowledge of PFA gave EMS workers a greater sense that they are supported and a decrease in the self-stigma of getting help.

Results are supportive of PFA as a practical and effective psychosocial support method for EMS providers. The present study contributes to the limited literature on psychological support for EMS providers and invites further research on the topic.

 

How to protect sleep-deprived EMS personnel

EMS1 published an article yesterday, “How to protect sleep-deprived EMS personnel,” in which the main point is the danger of driving home while sleep deprived.

Sleep is also essential for processing traumatic incidents. REM (rapid eye movement) sleep is when our brains put them to rest. Anything that interferes – lack of sleep, alcohol, some medications, sleep apnea – makes it harder to process the day’s emotions. Poor sleep sets you up for post-traumatic stress disorder.