COMING BACK FROM THE ABYSS
February 26, 2013
By Michael Swainson
For the first 18 years of my career as an EMT/primary care paramedic in the Yukon Territory in Northern Canada, I could not wait to get to work. I loved what I did and I was good at it. If I was not working my regular shift, I was working overtime, volunteering for the Canadian Ski Patrol, or teaching EMT classes, disaster management, or auto extrication. I became my job and never turned off “Michael the Medic.”
As an EMT with Yukon EMS, it was part of the job to take a regular turn as the EMS dispatcher. As with street work, I thrived on the adrenaline of 9-1-1. I was “being given the ball” to manage the caller’s emergency.
In the end, the ball nearly knocked me out.
After 21 years in emergency care, I was diagnosed with post-traumatic stress disorder or PTSD.
Even in a small service provider like Yukon EMS, critical incident stress is present. Critical incident stress can come in large doses (e.g., the death of a child) and small doses (e.g., a car accident with a fatality, or giving CPR instructions to someone who refuses to listen). No matter the intensity, every bad call adds a rock to your emotional backpack. Some rocks are small, some are mid-size, and some are downright huge.
Most of us don’t pay attention to the small rocks. While people outside the field of medical emergency response might consider a fatality something more than a small rock, it’s an all too common part of our profession; everyone in the field has responded to the scene or dispatched a unit to a fatality. During my 21 years of combined work on the street and in dispatch, I probably dealt with about 150 to 200 fatalities. The majority—95%—was people with no link to my life, although each call would add another small rock to my emotional backpack.
Let’s think about this emotional backpack.
If I put a small rock in my emotional backpack can I still jump up and down? Yes, I can. What happens though when I put 150 small rocks in my backpack? Can I jump up and down? No, I can’t. Now what happens when I put those 5 or 10 big rocks in my backpack from the dead children or dead friends that I saw in my career? Or worse, I add those 5 or 10 really big rocks to the 150 little rocks already in my backpack. What happens then?
Some might not fall down. They’re the ones taking care of themselves, listening to cues, and paying attention to the signs of stress. Others, like me, who never put the job away, aren’t so lucky. Eventually, we keel over under the weight.
My advice: “Do not let this happen to you!”
Dispatching first response is an incredibly stressful profession: lousy hours, too much caffeine, junk food instead of healthy selections, and taking abuse from callers complaining about “all of your stupid questions.” Throw in a management team that never shows their appreciation for their communications officers and where do you think you will end up?
During my EMS career, I had what I like to refer to as “The Big 3”: three very traumatic calls to me personally without my seeking critical incident stress management (CISM)for any of them. I was not a big believer in “sitting around, holding hands, and singing Kumbaya.” This was my very wrong impression of critical incident stress management. The big three were:
1.The death of an infant from sudden infant death syndrome was unbelievably traumatizing to me, the responder on the call. I did not sleep for a week after this incident and found myself wanting to hug my infant son constantly.
2.I still remember quite vividly trying to ventilate a patient with a bag valve mask and seeing blood, saliva, and air coming out of two holes in his forehead after an industrial accident. About 20 minutes after arriving at the hospital with him, I discovered he was a friend of mine. This was the only time in 21 years that I had to sit down after a call.
3.The most traumatizing call in my career is a failed rescue. I responded to a car accident that involved a minivan in a head on collision. We tried for over an hour to extricate her from the vehicle. We pushed, we pulled, we pried, and we twisted but nothing worked. She died right in front of us. I knew her. Her son and my son were in the fifth grade at their school and I had seen her in the school only a couple of days before. The call happened late in the afternoon and I just knew that her family was thinking, “How come mom is late for dinner?”
These three calls—the big rocks—added heavily to the weight of the many other smaller rocks accumulating in my backpack. I had never emptied any of them and suffered the consequences. I couldn’t turn off the stress and it was getting progressively worse.
I understood why so many first responders turned to addictive behaviors—alcohol, over-the-counter medications, gambling, shopping, computer gaming, and sex. Addictions take away from the pain, at least temporarily. And when they stop working? Your mind tries to turn off the pain permanently. Suicide is the last act of somebody so incredibly desperate to turn off the pain. I wasn’t there, but almost. I came to view PTSD as a workplace injury. It is not a mental illness. PTSD is a normal human response from repeated exposure to horrific trauma either experienced over the phone or in person on the scene of the emergency.
The Yukon Workers Compensation Board (WCB) and I fought over compensation for 13 months, and in the end I won. For me it was not about the money or getting my sick time back. I wanted the board to acknowledge PTSD as a workplace injury. Apparently, the board did. Six months ago I lost a staff member to repeated traumatic exposures from his time as an EMD and a street medic. The Yukon WCB approved his claim in two weeks.
My advice to you
You need to look after yourself. When you have a bad call, tell someone about it. If you have had a run of bad calls go see your employee assistance program (EAP) provider or a counselor. If your agency provides a Peer Support Team, go and see them. If you don’t have a Peer Support Team, talk to your supervisor or chief about establishing one. Talk to a peer, go to a debriefing after a critical incident, eat right, get exercise, and, most importantly, take time away from the job to do something relaxing just for you. It will help get your head back in the right place.
If you plan to survive as an EMD, find that escape. I live in a small city surrounded by mountains covered with snow six months of the year. When I put on my helmet and hop on my snowmobile, I leave the EMS Communications Centre that I supervise a million miles behind me. Find something! Don’t let the rocks crush the life out of you!