This month’s EMS Dashboard Confessional is powerful and moving, and I will leave it here without comment. The issue of EMS provider wellness, mental health, and suicide prevention is going to be a primary issue, if not THE primary issue, that we will fight together for the next 20 years.

Recently, a full-time paramedic with my department took his own life. He was young and fairly new to EMS, and I had known him since he started his EMS career, and I considered him a friend.

Although we had been working with EAP,  and this individual was going to counseling, he still took his own life.  That was probably the most frustrating part of this process.  We recognized the signs, hell, he even came to management with some personal concerns.  We did what we thought was the right thing and it still didn’t prevent the worst possible outcome.

As for what I would do differently as an EMS Leader, I think it is important to realize that when something of this magnitude happens you must learn to take time for yourself and your team.  I didn’t do that.  You see, this happened in the middle of a very busy stretch for our department with community activities. We still had to “put on a face” and provide the top notch service that the community had come to expect.  All the while, the pain, guilt, and frustration were eating me from the inside.

I was so busy taking care of the community, and our folks, that I didn’t take any time for myself and my management team.  That proved to be a mistake later in the year as we then experienced a second suicide from within our agency.  So, I hadn’t taken care of myself from the first suicide and now here we are, months later and having to deal with this again.  It was very surreal, and at the same time provided a significant “gut check” about what I was doing as an EMS Manager.

This month’s EMS Dashboard Confessional was submitted anonymously, with no other information:

“The mistake I made was believing that by allowing employees to have a say in decision-making, through surveys and voting, that I would achieve acceptance of decisions and “peace in the valley.” What I learned was that, no matter the decision, those who don’t get exactly what they want will feel no obligation to accept the wishes of others, and the fact that “the boss” went along with the majority opinion buys the boss nothing. Lesson learned!”

“Leadership is multi-faceted,” says Raphael Barishansky. “We have to look at this issue in the context of the greater relationship between management and employees. It’s important to ensure that all voices are heard, but this is not the only way that we obtain buy-in from staff.”

Michelle Kobayashi agrees. “Buy-in is more than offering ‘fair’ methods like surveys and voting.  Team members buy in when they trust their leaders and the decisions that are being made.  One way to build this trust is to take the time to speak to team members one-on-one and listen to what they have to say.  Even if there’s only time to meet with informal leaders, they’re the ones that have their finger on the pulse and will either support the decision or stand in its way.”

Michelle and Ray are completely on-point here. I often recommend Simon Sinek’s book ’Start With Why’ because of how important it is to explain why we are doing things to obtain collective support. I also want to know if this leader set the lane markers for the surveys and voting, to make sure that the majority made decisions that were keeping with the organization’s goals and values? What were the topics being decided by the committee? Were these topics that were appropriately delegated to a committee, or should those decisions have been made more collaboratively?

The greater question remains about what else did he or she do outside surveys and voting to obtain support from the greater group. Relying on simple majority rule will always leave the minority feeling disenfranchised, so that can never be the only answer to establishing a shared organizational commitment. Good managers are consistent, competent, and have integrity. Leaders have a vision, and communicate that vision to the group.

Today’s EMS Dashboard Confessional is an introspective story about reflecting on your personal failures and how to self-improve:

“I was a middle manager at an EMS agency passed over for promotion. I had been in my role for about four years, and I was looking for a bump up in the same division. I was very confident in my role, people liked me, and I thought I was effective at my job. Of course, when the time came, not only didn’t I get the job, but a close friend got it instead.

I was incredibly angry, resentful, and shocked at not getting the promotion. My self-esteem tanked, and I wallowed in self-pity for a month. Then I took stock of myself. I realized that I could take one of two paths: either I could run away from the issue, or I could look at why they picked my friend over me. I decided to really analyze why they didn’t choose me for the job.

When I thought about it, I easily identified a few areas of my work performance that I could focus on. In the past, I was hesitant to put my ideas forward, so I decided to be bolder in advocating my ideas and for myself. I got better at making sure that people saw my ideas, and better at taking ownership of them. A major part of this growth was asking for feedback from peers on projects, and taking the criticism constructively instead of personally.”

I commend this leader for having the self-awareness to look at their failure at promotion and look for ways to get better. A huge part of this is the “Personal Board of Directors” that Ray Barishanksy suggests is an absolute essential to professional growth and navigation. This leader clearly took the harder path, but much of their growth was guided by the feedback from peers. It’s difficult to be this introspective, and turn away from the ‘dark side’ when your career path doesn’t go the way you envision. Having a small, trusted group of people to guide you, inside your organization, outside your organization, and outside your industry is essential to getting through these tough times.

I also think that we rely too much on email in today’s work environment. One peer of mine, an experienced attorney who was senior to me, was petrified of going down the hall to the boss’ office for fear of being ripped apart. Honestly, that fear was justified, as the partner we worked for was well-known for being very critical of our work, and he didn’t sugar coat things. Rather than walk down the hall, my colleague sent an email. In the end, my peer’s reluctance to go down the hall, and that lack of visibility, ended up being his demise. The partner saw him as ineffective, and didn’t see sufficient professional growth, so he was replaced with a new attorney. Walk down the hall and talk to someone face to face. Read their non-verbal cues and learn from them. If you can’t walk down the hall, pick up the phone and talk to them. Email is convenient, but it’s best for asynchronous communications, or for when you’re trying to make a record.

Today’s EMS Dashboard Confessional is another tale of the unofficial power dynamic, and the difficulties of being a newer leader facing established power structures:

“I was a new supervisor, but an experienced paramedic, and I was working with a senior paramedic who was very influential within the department. The paramedic was known for being aggressive and gruff to others but ultimately provided effective clinical skills to his patients. The shift went much better than I expected until a 911 call came in at the end of the shift. I observed him becoming more irrational about potentially getting out late over the next few minutes. His driving to the scene, introduction to other public safety personnel on scene, and ultimately his interaction with the patient and family was less than desirable. I decided to intervene and take over the scene and defuse the clinical issues and interpersonal dynamic, knowing full well the tough road that laid in front of me executing that decision.

In the moment I remember being shocked thinking maybe he’s burnt out and needs help, or maybe he’s just a jerk. Either way, if this was his best behavior riding along with a supervisor, he’s a risk to our patients and our service. I may not be supported by others but I’ll be able to sleep at night knowing I didn’t allow him to inappropriately interact.

Ultimately, it was tough after. I was judged for confronting someone so senior considering I was so new. I ended up staying for a little over a year, but moved to a different organization that was more of a match to my standards. I always look fondly on the that first leadership job because it taught me so much about what I was willing to tolerate in this extremely uncontrollable, unsupervised environment called EMS. Standing up for my integrity was important that day and continues as I actively work 30 years later.”

This month’s EMS Dashboard Confessional entry is one of the most heartfelt and moving stories that anyone has ever shared with me. The fact that he or she carries this incident around to this day speaks to the need to share these events and learn from them, and to heal from them.

Some years ago, I was the clinical manager for a major EMS system. One day, one of the on-duty medics came to me with concerns about his partner. He stated that his partner had shown up to work that morning obviously intoxicated and they had already responded on one call. He then told me not to worry because “he had not let his partner drive the medic unit while drunk.”

I immediately had the unit put out of service and reminded the reporting medic that although he had not let his partner drive while intoxicated, he had let his partner treat a patient while impaired. I tried talking to the intoxicated medic, but it quickly became obvious that he was in no condition to have a rational conversation, so we had one of the staff drive him home.

I didn’t initiate any formal disciplinary action from the incident, although both medics were counseled. For background, the individual who showed up intoxicated was a strong medic, with a very good track record with our organization. We did try to get him into counseling, but unfortunately he died a few years later of alcohol related issues.

To this day I wonder if I could have done more for him.

Jennifer McCarthy, Director of Clinical Simulation at Seton Hall University and well-respected EMS advocate, shared her thoughts on this story.

“I was sorry to read that the intoxicated provider ultimately died as a result of his or her illness but I do not hold the manager responsible for this unfortunate outcome.

This story serves as an example of second victim syndrome. This syndrome has emerged from the patient safety literature to help describe the long-lasting impacts on clinicians after a patient safety event has occurred. This is not to insinuate that this manager had an error in handling this situation.

There are two aspects to look at how this case was handled, operationally and with human dynamics. From an operational perspective, the manager addresses the immediate public and institutional threat by removing the individual from service. Additionally, the counseling of the partner who responded with him to a patient was equally as important as addressing the intoxicated provider. I would have preferred to read that disciplinary action was taken, although the description of a “counseling” insinuates that the conversations were memorialized as part of progressive discipline. It is critical that any conversation on a subject like this be documented, even if it does not lead to disciplinary action.

Moving to the human dynamics, it’s obvious that there’s pain still evident from this story. The manager did an excellent job offering counseling, but was there a mechanism to offer someone substance abuse treatment, or to require it? More importantly, from a decision-making perspective, this case demonstrates where “strong providers” and “nice guys/gals” can bias leadership and decision-making. As leaders, we start justifying the reasons for the actions instead of maintaining our neutrality during the investigation and outcome process.

This case brings to light the need for tough discussions and truthful, direct approaches with our providers. The shadow of addictive behaviors is very much alive within our industry. The first-hand experiences that each provider faces cannot be normalized. Shifting our culture to be better prepared to face these shadows, have a prepared script to discuss these situations, and programs available to heal from these events is highly encouraged. I’d like to encourage all that have read this post to take one strong actionable step towards addressing our shadows. We can collectively do this in honor of the provider whose life was lost in this example and the manager that had the guts to share the story for us to learn from.”