Last month’s Dashboard was by far the most engaged post we’ve had since we started this project. EMS provider mental health issues may be the single biggest issue facing our profession right now. This month, we have another submission from a provider who, despite being early in their career, is already carrying some of the weight of bad calls:

“The stigma of mental health and wellness in EMS needs to be crushed. I’m a 24 year old Paramedic working well over 90 hours a week and not once has anyone asked ‘Are you okay’ after a bad call. If only you’d ask I’d tell you – No, I’m not okay.

I just told a mother that I did everything I possibly could to save her daughter (nearly my age) but unfortunately she passed away. I just worked tirelessly on a 6 month old baby who choked on a piece of clay. The mom kept saying over and over again “I just left him for a few seconds.. a few seconds!” Listening to those heartbroken cries turn into fits of rage. They say never take work home with you, but this baggage hands over you, everyday and every night when you get off shift and take off that uniform.

Ask the questions… it’s okay to not be okay.. I know I’m not.”

Christen Kishel, Ph.D. commented on last month’s submission, and given the response that we received, I’ve asked her to give us her thoughts again this month:

I want to start by offering a sincere thank you to paramedic who has shouldered more trauma and tragedy early in his career than many people will experience in their lifetimes, and for making the clear and true statement that our culture HAS to change. Emails like his help to move the culture in the right direction.
When I read this email, I immediately thought of the 2015 article in JEMS Magazine that provided many in the field with a wakeup call long before we began seeing daily posts on social media reminding us that we lose more medics and other emergency responders to suicide than to line of duty deaths. The following is taken directly from the article:

The results showed that 3,447 (86%) of the 4,022 respondents experienced critical stress [defined as “the stress we undergo either as a result of a single critical incident that had a significant impact upon you, or the accumulation of stress over a period of time. This stress has a strong emotional impact on providers, regardless of their years of service”], but the shocking discovery was that 1,383 (37%) of the respondents had contemplated suicide and 225 (6.6%) had actually tried to take their own life.

The rates of suicide contemplation and suicide attempts significantly decrease when a field provider has the support of their peers and is encouraged to utilize the formal support institutions in place: A supportive and encouraging environment cut suicide contemplation rates in half and attempt rates by 66%.

There were two critiques prevalent in the responses, regardless of what type of support they utilized: the support was either not accessible or the provider felt discouraged from using the support. Some comments from the survey that illustrate these critiques include:

• “Fear of being fired. We’re not allowed CISM at our service.”
• “I asked for help and ended up losing my 22-year career.”
• “Asked for help and was laughed at.”
• “Was told to get back to work. Was told I signed up for it so deal with it.”
• “It wasn’t offered even though we all thought it should be. One co-worker stated it didn’t even bother him. A different co-worker who heard about it made comments about me being ‘mentally fit enough to be on a truck’ because the kid’s death bothered me.”

The survey results revealed that 1,592 (40%) of the respondents had access to support but didn’t seek help.

“Survey Reveals Alarming Rates of EMS Provider Stress and Thoughts of Suicide”, Barber, Newland, Young, Rose, JEMS Magazine, September 28, 2015.

Suicide is of course only one of the many possible outcomes for medics who do are not offered and accept mental health support. Post-Traumatic Stress Disorder, Depression, Substance Abuse, serious health conditions, and family problems (including divorce and domestic violence) are only some of the other consequences. When organizations and the people who work within them respond to requests for help with shaming, feigned ignorance, complete lack of response, and/or disciplinary action rather than support, the field loses their most valuable providers, and I have indeed seen all of these responses in my work. I often think to myself, who would I want working for me or responding to a call for a member of my family? I would want a provider who is supported by their peers and supports their peers, takes sick leave when needed to obtain mental health treatment, or uses coverage to get more intensive inpatient treatment services, maybe takes an antidepressant to enhance their brain’s ability to practice healthy coping skills and maintain stability in times of stress. I would much prefer that over a provider who has been discouraged from doing these things, afraid of stigma, afraid to lose their job, afraid they will lose respect or a promotion and instead suffers from sleepless nights, hangovers, illness, anger, and general malaise.

In the right set of supportive conditions, I have seen the difference it can make, especially when the people working to change a culture are persistent and consistent over time. It takes around 5-7 years to really change a culture, and it always starts with one person. That one person (or small group) will almost always feel like they are pushing a boulder uphill, and having personally helped to start peer support teams, I know just how taxing it can be. Most support systems start from the bottom up, and those grassroots movements often take time to gain momentum. For those reading this who are part of one of those movements, know that there are thousands of others all over the country who are doing the same. They are your invisible supports, and if you start to feel discouraged, make sure to attend conferences through the ICISF, the IAFF, the Rosecrance Florian program, the First Responder Network, or others. You’ll meet others who have been where you are and revive your passion for mental wellness programs and peer support.

So where to start? Support from leadership to provide education to their crews about trauma, burnout, and resilience. Leaders need to know where to refer people who identify themselves as struggling and make it easy to access mental health services by getting HR to start the medical leave process, getting coverage for appointment times, and making connections with the mental health providers to make it easy for a person to get an evaluation and referral to inpatient treatment if necessary. Disciplinary action or stigmatizing should never occur as a result of someone seeking help to prevent any harm to themselves, their team, or the community. Disciplinary action may be needed for actual actionable offenses, but if in the process of investigation, a mental health concern is identified, consider offering treatment resources as part of the process to assist in preventing future offenses rather than losing a valuable asset. When both labor and management show strong and public support for peer support programs, those programs flourish. And most importantly, even when leadership fails to provide formal supports, peers need to support each other. And it starts with the simplest of gestures, as the medic who submitted the email said – just ask! Even if the person does not say, “terrible, thanks for asking”, they will always remember that you asked, and that makes all the difference. Be well out there and take good care of each other!

Not every EMS Dashboard Confessional will be related to provider mental health issues, but we are happy to provide a forum for getting these issues off your chest, and providing constructive resources on how to handle them.

Use the link here to tell us about a decision or action that you wish you had handled differently. 

This Dashboard Confessional one of the shortest we have received, but one of the deepest.

“Just read your blog. I’m a paramedic – I’m not supposed to feel. I’m not feeling while operating on a bad MVC. I tell the family of a loved ones death and continue to go on to the next call. Although that is at work, I find myself doing the same at home.”

Personally, I have always worried about how we deal with the desensitization of EMS – how do you turn it off at work, but turn it on again back home. I know that I’m not the only person who has this concern.

I’ve asked a colleague work specializes in mental health issues in emergency services to comment on the topic. Christen Kishel, Ph.D., is a licensed Psychologist in Washington with an extensive background in this area. Her comments are long, but profound. Please take a moment and read to the end:

Emotional numbing is a survival skill in emergency response. If we cried with every distressed patient or family member, or screamed and flinched at the sight of bodily fluids, we would be completely unable to do the job. Like gymnasts who need to build calluses on their hands, those in EMS need to build calluses on their hearts. There is a difference, though, between having calluses and being callused. The process of building shields around the heart to be able to do the work can have the common but unfortunate side effect of generalizing to every situation and every relationship. It’s not hard to understand that when you see things like abuse, neglect, chronic illness, and acute traumas all day long, the things that distress the people in our lives who don’t work in the field can seem trivial. If anyone asked you what you value most in life, it would be your family and your job (not necessarily in that order), but the way you feel and act at home and at work is light years away from reflecting those values. Instead, you feel irritable, frustrated, fatigued, and worst yet, nothing at all. This is most frequently due to burnout and trauma. A core symptom of post-traumatic stress injuries/disorder is emotional numbing, and cynicism and apathy are common features of burnout. In fact, cynicism is so common that I consider it a job hazard. Most people experience their first episode of burnout about 5-7 years into the profession, and can move in and out of burnout throughout the course of their careers.

So, what can you do about it? Let’s start with some simple things that can help prevent, or bring you out of burnout. First is mindfulness. It’s not as “woo” as it sounds – it’s simply a matter of asking yourself, “Where am I now?” Are you in the present, in the past, still on a call in your head, checked out, or present? If you need to ground yourself to the present, take note of what you can see, hear, touch, smell, and taste. Take note of who is there with you and what is important to both them and you. If you are with a loved one, be there doing that. Easier said than done, but with practice, it gets better. If you have had a rough day or a rough call, you might not want to share all of the details. But your partner still needs to know how you are doing with the calls and situations of the day. They need to know who and how you are, even if the gore is better left unsaid so that they aren’t vicariously traumatized and you don’t have to re-live the situation before you’ve had a chance to sleep and process. They key is communication. From the very beginning, start talking about what you can say when you “aren’t ready to talk”, and discuss how much detail your loved ones can handle. Develop phrases or scripts that let that person know that you might need some alone time, a hug, distractions, humor, silent presence, or whatever best fits that relationship. If your loved ones can’t handle much of what you have to say, find peer supports or others on the job or at least familiar with the job to talk to when you need to. Find the kind of people who will listen, hear, and maybe even check on you the next day just to see how you are holding up.

It can be really helpful to create a work-to-home routine. Especially helpful is getting exercise – specifically cardio – to get the stress toxins (cortisol especially) out of the system. Follow that with water or Gatorade or something like it, and you’ll be literally flushing the system, like changing the oil to keep the gunk from building up and bogging down the engine. The work-to-home routine might involve listening to music or to a podcast, or maybe some comedy to change the channel in the brain. It might mean hugging your kids when you get home before setting a timer for 15-30 minutes during which you get to lie down and nap (research says we should all nap every day!) or otherwise “check out” for a bit before reconnecting to the family in a more fully present way.

Remember your big “Why” – why do you do this work? Do you work to live or live to work? (It’s ok if it’s both, but if the scale tips too far in the work direction it’s time to reassess!) Do you have hobbies and interests and friends? Or is it work-eat-sleep-repeat? If you can’t say that sleep is an actuality, time to get that looked at. If you can’t remember the last time you felt rested when you woke, talk to your doctor! Sleep apnea is approximately four times more common in emergency responders. And if anxiety/depression/trauma are keeping you awake, ask about a beta blocker like propranolol to help with sleep (stay away from things like Ambien or Ativan – they can increase nightmares and flashbacks, and can make things worse!). 

Drink less alcohol and more tea, hot chocolate, water, etc. Alcohol is your frenemy – it might make you tired, but you’ll disrupt the brain’s deep sleep, which is the part of sleep where stressors and traumas are processed in an adaptive way. And if the numbing and callousness has been around for a while, and it’s getting in the way of fully connecting with the people that you care about most, it’s time to think about seeing a psychologist or therapist who understands the culture of emergency response and can help you find your way back to being who you really are. I have personally been working with trauma for about 20 years, developed a specialty in working with emergency responders about six years ago, and a few years ago finally decided to learn about EMDR. What I am finding is that EMDR is extraordinarily helpful in moving the traumas that get someone stuck into more adaptive parts of the brain and bringing life back into balance. CPT and CBT also help. There are options and there is hope. You don’t have to live in that numb, disconnected place. You can come back to a place where you can detach enough to do the job but not so much that you no longer feel like a part of this world. You and your loved ones deserve for you to be fully present in your own life.

Use the link here to tell us about a decision or action that you wish you had handled differently. 

This Dashboard Confessional is a short story about a leader who regrets how they managed an interim leader and a significant project.

Due to a transition in leadership, I recently had to make an existing employee an acting manager. I had a feeling from the outset the they would not necessarily end up in the role permanently, both because of their talents and the fact that I had already identified an outside candidate that was a better fit for the role. During this interim period, I asked the acting manager to resolve a global scheduling issue that we had.

Unfortunately, this did not work out well. First, there were issues with the final scheduling program with unanticipated results. This was probably my fault for asking them to take on this role when it was not in their wheelhouse, and I did not have the bandwidth to closely manage the project.

My lesson here is not to make major system changes when you have an acting leader in an organization who you don’t anticipate will be the permanent leader. The biggest problem I created was for the new manager, as they came in and had to fix the problem I created. It was extra work for them, and it created an environment where multiple major schedule changes made it harder for them to develop trust with the team.

This is a great introspection on transition leadership. We often want to “fire and forget” with projects, at least as much as we can. This pressure is even more acute when we are understaffed after key personnel leave. Despite our impulse to move fast, this is when we should actually slow down and pay more attention.

There are a few other great lessons here to take home. Be careful about asking someone to fill an interim role when you have doubts at the outset of their capabilities. You risk the bad outcome, but you risk hurting their long-term longevity by burning out their trust in the organization. It’s easy for them to end up a scapegoat. Also, now the new leader has so much more work to do in order to build trust with employees, and by correcting the initial mistakes, it further risks undermining the original interim leader.

Use the link here to tell us about a decision or action that you wish you had handled differently. 

The EMS Dashboard Confessional is proud to announce that we have been awarded the Trademark for our logo and name!

This next Confessional story illustrates issues of delegation, and of taking personal responsibility.

I remember a time when I was first promoted to a supervisor in my agency when, of course, I received the lack of appropriate managerial training. I was in charge of the daily shift, as well as supplies for the department. I delegated the task of taking inventory in the supply closet to one of the people on my team, and gave them full reign to decide how much needed to be ordered and what our par levels should be. They had to give me the orders for processing, but they were able to decide what to order.

There was a week that the inventory was done, and I was given the order sheet, but the order didn’t make it past me, so we started running low on supplies. Of course, the Assistant Chief came down on me for the low inventory, and not knowing what else to do, I passed the blame further down the chain. As you can expect, this caused a rift on my shift, and a lack of trust from my team. It was well deserved.

I can’t help but feel that the first level of management training should be a class called “The Buck Stops Here”. I learned a valuable lesson in accountability, and integrity very early on, and with my first mistake as a manager.

This story illustrates two common mistakes we make in leadership. First is “fire and forget” – we are happy to delegate responsibility for tasks to other people, especially undesirable tasks! But once it’s off our proverbial plate, we often forget to follow up. The buck does stop with the person who ultimately owns the job, and you should not forget that. Personally, I find that a task manager program helps me stay on point for following up with assignments to make sure things are being done, and meeting deadlines.

Second, and perhaps more importantly, is the issue of passing on blame. One of the hardest things that a leader can do is admit publicly that he or she was wrong, and it’s very common unfortunately to avoid doing that by deflecting. In the end, not only does this not get the job done, and hinder your personal growth as a leader, but it destroys your relationship with the person who got the blame pushed onto them. Sure, they failed to do the assigned task, but this is not their failure to shoulder alone.

You can stand next to that person and take personal responsibility for your lack of diligence, and together own what happened and find a solution. Or you can push it off on them, and see what happens. Not only will you develop a reputation as a boss who does not have their people’s backs, but the next time something goes wrong, you can be sure that they will be there to push you under the proverbial bus!

Use the link here to tell us about a decision or action that you wish you had handled differently. 

After taking the summer off, except for the incredibly successful Pinnacle pre-conference workshop that we conducted, we are back with a new EMS Dashboard Confessional! This story illustrates some of the hazards of not doing the right thing at the time, and how they can impact people many years down the line.

One of the more regretful management decisions I made was several years ago but I didn’t realize it until recently. I was speaking with a past coworker who had been in charge of our outside training and regularly conducted educational sessions for the local fire departments. She was teaching a course one morning to a group who were incredibly disrespectful to her. The behavior was such that it most definitely harassing and something that we had both a legal and ethical obligation to address. I contacted the Fire Chief to inform him of the inappropriate behavior and asked him to assist us in investigating the incident. A few days later, he informed me that the firefighters acknowledged some inappropriate behavior but denied it was as severe as was reported by the employee. I told him that the accusations were sufficiently detailed to make them unlikely to be fabricated or exaggerated and asked for a written report that included the steps of his investigation and what remedial measures were being taken. He told me that he was not going to do this because it would end up a grievance from the union and that it would draw negative attention to his department. He told me that his hands were tied and that he could not do anything.

I went to my company owner and expressed my outrage and dissatisfaction of the Fire Chief’s position, and that we had to stand behind our employee, both from a legal but also a morale and ethical perspective. The owner told me that I should not push things too far as we wouldn’t want to jeopardize or position as the privately contracted ambulance provider in the community. I expressed my disagreement with this position and said that I felt we should contact the City Council. The owner told me that we were not going to do this and that I should just “let it go”. I knew that this was the wrong decision but I failed to stand up for this employee and do the right thing.

Recently, I reconnected with this employee. We chatted for a while about the “old days”. She recalled that story and got emotional telling me that it really had caused her great emotional stress over these last seven years. I had forgotten about the incident until she recalled it. I explained and relayed this entire story to her, and she told me that I had never followed up with her at that time. I had completely blocked that from my memory that I failed to get back to her. I had believed I was a relatively evolved leader until that day, one who stood up for their people and did what was right. I now know that I have a long way to go.

As I reflect on that incident and how I handled it, I am embarrassed. I am ashamed that I let her down and further, that I erased my failure from my memory. By doing so, I likely allowed this behavior to repeat itself with some other unsuspecting, undeserving person. For nearly 7 years, she was left in limbo. On top of that, we worked together for another year or so and she continued to work her backside off for me and that company. To further my embarrassment, the reason we had reconnected after 7 years was because I asked her to help with a project. She didn’t even hesitate to say yes. She was a true professional. More so that I could ever hope to be. This type of behavior happens nearly every day in EMS and in other industries. So much so that it is overlooked by almost everyone. It will continue until we all take responsibility for our actions, that includes me.

Finally, the self-awareness that the author shows here is incredible from a place of personal growth. Not only in finally identifying the problems that he created, but in the insight he shows in admitting that he completely put this out of his mind. I think we have all made a decision like this sometime and forgotten about it as a defense mechanism. We are all human. But remember that, even if you’ve moved past it, the other person probably has not.

If you’ve gotten to this point in the story, please take a moment and tell us your own. Use the link here to tell us about a decision or action that you wish you had handled differently.