Pressure Makes Diamonds

Jonny McMullan

Guest Writer

Is it possible to focus too much on health and well-being? Does shining the spotlight on the harsh reality of dispatch stress and the pressure of an EMS job role always result in the intended consequences?

Having worked within an EMS setting for 15 years there can be no question that the past five years have witnessed a change in direction in relation to the narrative of the work we do. Dispatch stress and mental health have moved from the periphery of our discussions to the center ground. The issues of increasing call volume, patients with more complex needs, media attention, and not to mention the pandemic, have focused our attention on the struggle involved with operational service delivery and the impact it has on our staff.

This change in focus has largely been welcomed, and we have witnessed real progress in burgeoning staff welfare programs where previously there was a void; however, has the conversation turned to only focusing on the negative? Are we creating a culture where the positive aspects of the job are forgotten, and an unintended consequence is the very burnout and compassion fatigue we sought to avoid by highlighting the issues in the first place?

Diamonds in the rough

When I look around the control center there is always a sense of wonder and pride at the level of dedication and skill on display from our workforce. Yes, the pressure involved with the work we do will always have an impact—but not always negatively. Look at what our team can deliver and how they flourish; pressure makes diamonds.

The nature of the service we deliver provides us with challenges and opportunities to develop skills that are critical not only to our current job roles, but also to progress and flourish in any professional environment. The day-to-day experiences we encounter hone and tailor a range of qualities that are highly sought-after within and without an EMS setting, and none more so than those below:

  • Customer service
  • Decision-making/problem-solving
  • Risk assessment

Customer service
Our EMDs regularly face the dilemma of providing empathy and understanding, while delivering life-saving instructions, to a group of callers who are angry, scared, frantic, or any combination of the spectrum of human reaction (as illustrated by the examples included).

“Why are you asking all these questions?”
“Just hurry up.”
“If anything happens to my friend it is going to be your fault.”

The manner in which we maintain our composure while balancing assertiveness and empathy is a talent that is the envy of many public and private sector employers. Our ability to switch from talking to a panicked and distressed parent on one call to an intoxicated, aggressive 1st-party caller on the next call—with mere seconds between—is astonishing. Our EMDs can adapt to a myriad of scenarios immediately sensing tone, background noise, and urgency of clinical need all without seeing the caller or patient. It is difficult to imagine another setting where such a wide range of customer service and caller management techniques are tested so frequently and with such diversity.

In an environment so rigidly driven by policy, protocol, and procedure it is understandable if we sometimes overlook the experience we develop in thinking outside the box and solving complex problems. How often are we faced with a split-second decision while processing an emergency call or dispatching a vehicle that falls outside of normal practice but requires that “EMS common sense” we seem to acquire within our control center? We maintain a consistent balance between working within a rigid framework and making isolated decisions to benefit the patient and produce a positive outcome, and it’s a tightrope we walk with consistent success. There is irony in the fact that the same elements of the job that drive the discussion on dispatch stress provide us with a unique capability to consistently make good decisions under pressure. Control center staff face a range of challenges and circumstances that are constantly changing and dynamic in nature, and yet remain composed, alert, and determined to act in the best interests of our patients. 

Risk assessment
Increased call volume and limited resources are often cited as the most constant sources of pressure on the control center role and yet they drive our staff group to become extremely efficient at dynamically assessing risk. Whether it be applying urgent disconnect criteria on a call or weighing up the allocation of our final resource, our EMS teams are constantly measuring the risk involved in the immediate call at hand alongside the impact our decisions may have on the overall picture within the control center. 

We often see staff develop an in-built sensor for reasonableness—the EMS “X Factor” as to what discretion or logic can be applied in a certain situation but may not be appropriate for another. Think of those scenarios when we hear an EMD remain on the line for a call that 99 times out of 100 they would clear the line?  What were the drivers for that decision: active listening, previous call-type experience, or that EMD “hunch”? We develop skills and reactions that are difficult to describe or quantify and yet they become vital for our daily work. This sixth sense is critical to our role and is adaptable to so many job roles within the EMS setting.

Shine bright like a diamond
A focus on dispatch stress and the impact of control center pressure on EMS workers is critical. It is imperative we continue the ongoing discussion to ensure support and recognition are always available to our teams. We need to progress the health and well-being workstreams that are actively delivering real assistance to our EMDs and embed and normalize them within our agencies for years to come. However, we may need to reframe the discussion slightly and apply the consideration of “and yet.” We face so many challenges … and yet our teams continue to deliver an incredible standard of care. The expectations on our services are higher than they’ve ever been … and yet our people still strive to serve without any demand for recognition. 

Yes, the EMS environment is a tough one, and yes, we need to acknowledge this fact is a reality. It is important to remember that pressure makes diamonds—and they shine brightest when under the spotlight. Let us all shine a spotlight on the qualities and skills our EMS colleagues demonstrate every day and celebrate the impact they have and the opportunities that stand before us.