# Depression In EMS



## wanderingmedic

I did a search and could not find anything like this, so I figured I would try to start a thread. 

Depression is extremely prevalent in the United States. I wanted to find out your thoughts on depression in EMS because mental health is a big part of health. Three questions:

1) How prevalent is depression among EMS personel? Do you think it is higher or lower than the general population and why?

2) Do you have any direct experience with depression in EMS? This could be with a partner who struggled with depression, a friend in EMS, or even yourself. What did you do (if anything) to try to help them.

3) At what point should a EMS provider remove themselves from the field because of depression, and when should they consider returning?


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## 46Young

azemtb255 said:


> I did a search and could not find anything like this, so I figured I would try to start a thread.
> 
> Depression is extremely prevalent in the United States. I wanted to find out your thoughts on depression in EMS because mental health is a big part of health. Three questions:
> 
> 1) How prevalent is depression among EMS personel? Do you think it is higher or lower than the general population and why?
> 
> 2) Do you have any direct experience with depression in EMS? This could be with a partner who struggled with depression, a friend in EMS, or even yourself. What did you do (if anything) to try to help them.
> 
> 3) At what point should a EMS provider remove themselves from the field because of depression, and when should they consider returning?



1) Unknown to me, but I would suspect that depression runs more frequently in EMS than the general public. The effects of severe sleep deprivation, missing holidays and weekend activities, lack of job security, lack of career advancement, low pay that requires copious OT and per diem work, seeing human suffering and death on a regular basis, and stress on marriages and other personal relationships all take their toll.

2) I've seen many, many people project a miserable, irritable persona on the job. One co-worker was granted two months of leave usage (his own, not the county's) due to clinical depression from working five years at a busy station that typically runs all day, and most of the night. He almost got divorced. When he returned to work, he was relocated to a slow station.

3) Hard to say; every situation's different. If you need more than a month or two away from EMS, you probably shouldn't be in the field at all. You're just going to return to the same conditions that caused you your distress in the first place.

Edit: If you need to do a project for RN School, do one on sleep deprivation in EMS and fire. A co-worker's daughter recently polled a number of stations for her study.


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## bbmtnbb

My brother's first partner recently commited suicide but I believe that was related to the war more than EMS. That is something to consider...Who is in this job and what past experiences would add to depression?  Maybe there is more than just EMS.  btw-my brother does NOT suffer depression and works inner city EMS as a medic and has no past war or military experience.  Bottom line is get help if you need it and help others if they don't see it. :sad:


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## mycrofft

Good post.

Don't know about EMS, but the "common knowledge" is that retired law enforcement has a "spike" of suicides shortly (few years ) after retirement. Since their culture while in LE suggested that they have firearms on hand and drink a lot, and they have a high divorce rate and can't identify with or make themselves understood by non-LE their depression as expressed by suicidality is particularly lethal.

NO idea how to study this properly, since "working ambulance" is sort of like working at McDonalds for many folks, they grow out of it, hurt their backs, or otherwise leave before it becomes their life forever. And the urban experience is very different than the rural one.


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## smurfgirl

I don't see what your depression has to do with the career you choose to do for the rest of your life?


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## abckidsmom

I have a theory that EMS providers are at higher risk for depression and trouble at home because of the way that the job can enhance some of the less desirable parts of our personalities.

For some people, the constant go-go-go nature of the job, with steady, high energy interaction with people, and the perception that everything we do is pivotal, earth-moving stuff, combined with the zero-to-60 momentum swing when we go from kicking back to getting a call can lead to overdeveloped or exaggerated autonomic nervous system response.

Thus, we can go-go-go for long shifts, with sympathetic activation as needed for more go-go-go, but when we get home, the safety and comfort of home provokes a parasympathetic crash, sometimes more depending on how life is going.

This cycle can be a very bad one, depending on relationships at home.  Considering the kinds of personalities that are drawn to the field, home being the boring, sleep place set people up for negative energy when they think of home, and with low energy levels at home, the relationships can be strained when loved ones think "you can do everything you can for others, but never anything for us at home."

This applies to many people who fill "sheep dog" roles in society.  The roles are so important, and the people filling them so passionate, that the full-on energy with which they throw themselves into the job leave little for others sometimes.

I think this is a very important concept to be aware of to help in preventing the cycle, and to deal with unrealistic expectations before they become a problem and lead to conditions like depression.


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## Abel

Considering the types of individualizes that are attracted to the area, house being the tedious, rest position set individuals up for adverse power when they think of house....


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## chillybreeze

abckidsmom said:


> I have a theory that EMS providers are at higher risk for depression and trouble at home because of the way that the job can enhance some of the less desirable parts of our personalities.
> 
> For some people, the constant go-go-go nature of the job, with steady, high energy interaction with people, and the perception that everything we do is pivotal, earth-moving stuff, combined with the zero-to-60 momentum swing when we go from kicking back to getting a call can lead to overdeveloped or exaggerated autonomic nervous system response.
> 
> Thus, we can go-go-go for long shifts, with sympathetic activation as needed for more go-go-go, but when we get home, the safety and comfort of home provokes a parasympathetic crash, sometimes more depending on how life is going.
> 
> This cycle can be a very bad one, depending on relationships at home.  Considering the kinds of personalities that are drawn to the field, home being the boring, sleep place set people up for negative energy when they think of home, and with low energy levels at home, the relationships can be strained when loved ones think "you can do everything you can for others, but never anything for us at home."
> 
> This applies to many people who fill "sheep dog" roles in society.  The roles are so important, and the people filling them so passionate, that the full-on energy with which they throw themselves into the job leave little for others sometimes.
> 
> I think this is a very important concept to be aware of to help in preventing the cycle, and to deal with unrealistic expectations before they become a problem and lead to conditions like depression.







Thats the first time Ive heard it put into words but I really think you have hit the nail on the head!  I struggle with this sometimes.  When all I want to do is go home and go to sleep or rest and forget everything I have to remember that I have a family who needs me as much as the rest of my district needs me.


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## abckidsmom

chillybreeze said:


> Thats the first time Ive heard it put into words but I really think you have hit the nail on the head!  I struggle with this sometimes.  When all I want to do is go home and go to sleep or rest and forget everything I have to remember that I have a family who needs me as much as the rest of my district needs me.



They need you more, really. I find that exercising before I go home really helps fight that.


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## chillybreeze

abckidsmom said:


> They need you more, really. I find that exercising before I go home really helps fight that.



ugh!!!  exercise.....thats a bad word!!  Actually its a bad word i need to work on!  lol


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## Wheel

abckidsmom said:


> I have a theory that EMS providers are at higher risk for depression and trouble at home because of the way that the job can enhance some of the less desirable parts of our personalities.
> 
> For some people, the constant go-go-go nature of the job, with steady, high energy interaction with people, and the perception that everything we do is pivotal, earth-moving stuff, combined with the zero-to-60 momentum swing when we go from kicking back to getting a call can lead to overdeveloped or exaggerated autonomic nervous system response.
> 
> Thus, we can go-go-go for long shifts, with sympathetic activation as needed for more go-go-go, but when we get home, the safety and comfort of home provokes a parasympathetic crash, sometimes more depending on how life is going.
> 
> This cycle can be a very bad one, depending on relationships at home.  Considering the kinds of personalities that are drawn to the field, home being the boring, sleep place set people up for negative energy when they think of home, and with low energy levels at home, the relationships can be strained when loved ones think "you can do everything you can for others, but never anything for us at home."
> 
> This applies to many people who fill "sheep dog" roles in society.  The roles are so important, and the people filling them so passionate, that the full-on energy with which they throw themselves into the job leave little for others sometimes.
> 
> I think this is a very important concept to be aware of to help in preventing the cycle, and to deal with unrealistic expectations before they become a problem and lead to conditions like depression.



Very interesting perspective, and something I'll need to keep in mind in my young career. Thank you.


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## EMDispatch

1) I think adckidsmom hit a large portion of it on the head. First responders end up on a mental/emotional rollercoaster when at work. It has to have long term effects on your brain chemistry. I'd also assume PTSD plays a significant factor in all this too. In the dispatch world they throw around the term "vicarious traumatization" we experience the events through the caller, which can make even minor events emotionally draining to us. For a field provider you experience your own trauma when involved on the incident, as well as that of the patient.

2) Never had a partner in the field. Our agency tries to head off major problems with CISDs and open door policies. It all certainly seems to help.

3) The moment depression starts to impact your performance in a negative way, you should remove yourself until it can be remedied. If it takes weeks, so be it... if it takes months or years, maybe you should consider other lines of employment.


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## Anjel

My first partner was bipolar and depressed after a bad break up with her partner of 7 years. I was her replacement. She was normally fine and dandy, but there would be days where she would get on scene and stand back and just say ":censored::censored::censored::censored: it". Something would set her off and she would stop caring. Leaving me to do everything. She was attacked by a psych patient and broke her thumb and tore all connective tissue. She left the road after that. 

My last partner was depressed with borderline personality disorder. She would get a bad call and go and cut her self afterwards. With that I constantly went to the operations manager. I couldn't stand by and let her hurt herself, and I really couldn't trust her on scenes. I was constantly watching my back and hers. She ultimately left , because she couldn't handle it anymore.

I think it is prevalent in EMS because of the reasons ABCkids mom stated. I find it hard to balance having friends outside of work, because it seems like that is what life revolves around. The things I find funny leave my friends horrified. So I've separated myself from them. Same with my husband, I don't talk about my days any more. This job is enough to wear any normal person down.


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## chaz90

How have you had the privilege of having such...extraordinary partners? I've been lucky in that none of my partners, or myself, has ever been bothered enough by anything to affect work. I've dealt with the usual burnouts, but nothing (directly as partners) that got to the point where they were non functional. 

I do think that's the way psychological difficulties typically express themselves in EMS providers. Most of us don't have a sudden moment that takes us from perfect to broken, but continual stress over years does "burn us out." We may be ok physically (or we may not) but I'd say a majority of the 20 year field level providers I meet are burnt out to some degree or another. Some are still able to function effectively and don't mind working, there are a few that have managed to seemingly ward off the effects of a long career, but many are husks of their former selves at work and should leave EMS completely to heal. Problem with that is, many of them can't. Being in EMS for 20 years, many of them stopped their education at EMT-P. Unless they get one of a very few available supervisory positions, there aren't a ton of jobs outside of field work available for medics. These burnt out providers have gotten used to the wages of EMS, which while not great, may not be able to be met by another career with the education they have. We often have trouble adapting to other jobs as well, as many on here have already mentioned. Long stretches of down time with relative freedom, available but not required OT, ability to sleep at work, and 4 days off at a time are conditions that aren't available in other lines of work. Sadly, all these factors combine to keep many burnt out providers in the field long past their time, and may eventually lead to true depression or other psychological issues.


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## Carlos Danger

Interesting topic.



azemtb255 said:


> 1) How prevalent is depression among EMS personel? Do you think it is higher or lower than the general population and why?
> 
> 2) Do you have any direct experience with depression in EMS? This could be with a partner who struggled with depression, a friend in EMS, or even yourself. What did you do (if anything) to try to help them.
> 
> 3) At what point should a EMS provider remove themselves from the field because of depression, and when should they consider returning?




1. I don't know. I've never seen anything that made me suspect that the incidence of depression is higher than in non-EMS folks.

2. No.

3. I guess, when you realize that the job is a significant contributor to you depression, or if your depression reaches such a level that you just can't safely function at work.




abckidsmom said:


> I have a theory that EMS providers are at higher risk for depression and trouble at home because of the way that the job can enhance some of the less desirable parts of our personalities.
> 
> For some people, the constant go-go-go nature of the job, with steady, high energy interaction with people, and the perception that everything we do is pivotal, earth-moving stuff, combined with the zero-to-60 momentum swing when we go from kicking back to getting a call can lead to overdeveloped or exaggerated autonomic nervous system response.
> 
> Thus, we can go-go-go for long shifts, with sympathetic activation as needed for more go-go-go, but when we get home, the safety and comfort of home provokes a parasympathetic crash, sometimes more depending on how life is going.
> 
> This cycle can be a very bad one, depending on relationships at home.  Considering the kinds of personalities that are drawn to the field, home being the boring, sleep place set people up for negative energy when they think of home, and with low energy levels at home, the relationships can be strained when loved ones think "you can do everything you can for others, but never anything for us at home."
> 
> This applies to many people who fill "sheep dog" roles in society.  The roles are so important, and the people filling them so passionate, that the full-on energy with which they throw themselves into the job leave little for others sometimes.
> 
> I think this is a very important concept to be aware of to help in preventing the cycle, and to deal with unrealistic expectations before they become a problem and lead to conditions like depression.



The autonomic NS theory is an interesting perspective, but the problem with that theory is that most people quickly adapt to the acute stresses of the job. For the first few months or so, everyone gets all worked up and anxious when the pager goes off, but that fades quickly for most of us, and the conditioned SNS response goes away. Perhaps there are some people who _don't_ adapt and for them, this would help explain their problems.

I think one common contributor to dissatisfaction with the job (and potentially to depression) is simple disappointment with it. I've known lots of people (myself included) who just didn't find the job as fun or interesting or stimulating as they had hoped. Most of us adjust and either learn to like the job or move on, but some people have a real problem with it, and it affects their attitude and outlook significantly.


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## v3nn3m

Ive seen a lot of people who are just starting off take things they seen and done very personally and it effects them more than it should, I feel like its not the job for them


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## firetender

Look around you. Count the burnouts. How many have you seen disappear?The "D"  word is something rarely used but when people crawl out the door -- and usually silently -- you know it has reared its ugly head.


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## wanderingmedic

firetender said:


> Look around you. Count the burnouts. How many have you seen disappear?The "D"  word is something rarely used but when people crawl out the door -- and usually silently -- you know it has reared its ugly head.



Interesting. Never thought about that. I think it assumes that burnout or leaving EMS is directly related to depression though, which is highly plausible but lacks any studies to confirm it.


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## firetender

azemtb255 said:


> Interesting. Never thought about that. I think it assumes that burnout or leaving EMS is directly related to depression though, which is highly plausible but lacks any studies to confirm it.


 
I'm not saying there's a direct correlation. One of the major factors of burnout, though as it relates to EMS is that you are on a roller-coaster ride of emotions and challenges. One of them is the extreme highs of doing vital work followed by the ensuing depression of ho-hum life. The struggle to maintain a balance drags you down. That is, if you even try! So many of us become adrenaline junkies and part of that syndrome very much includes the ensuing crash; the depression.

Another factor is the deeper you get into the field, the more depressing your environment becomes. The sociology of despair, if you will. Most of your working life is spent amongst depressing circumstances -- people struggling to stay alive (or avoid living). After a while, it begins to look like that's all there is to the world.


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## 46Young

Match up sleep deprivation with missing holidays and family events, low pay, concerns for job security and permanent injury, severely limited career development, when you constantly see (sometimes extreme) human suffering, you're at high risk for depression. 

I've seen numerous people go from happy-go-lucky or a generally positive attitude, to having a flat affect, become increasingly prone to violent outbursts, declveloping indifference and apathy towards their patients, and banging in sick/ taking leave as soon as they get a day's accrual. This doesn't take 15-20 years to occur, either. Some people are done with EMS in 3-5 years.


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## abckidsmom

46Young said:


> Match up sleep deprivation with missing holidays and family events, low pay, concerns for job security and permanent injury, severely limited career development, when you constantly see (sometimes extreme) human suffering, you're at high risk for depression.
> 
> I've seen numerous people go from happy-go-lucky or a generally positive attitude, to having a flat affect, become increasingly prone to violent outbursts, declveloping indifference and apathy towards their patients, and banging in sick/ taking leave as soon as they get a day's accrual. This doesn't take 15-20 years to occur, either. Some people are done with EMS in 3-5 years.



The first part of your comment can't be underestimated. Sleep deprivation + any of the factors you mention is very stressful.


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## Fire51

A lot of people leave EMS because they get tired of the life, you work long hours with no sleep and then most have sleeping problem once they get home, most of the calls are just simple things like my head has hurt for 2 days I think I need to go to the hospital at 3am, and then there's the whole thing about people not careing what we do and family not understanding what you mean when you say "I had a hard shift" .the mental and physical abuse you get from patients can get old to. A lot of people get into this and end up moving on to big and better things like RN and PA school which I am not saying that's bad or trying to down anyone that did that, I am just saying there are only a few that stay and this work for life. Some people that love the job end up getting career ending injuries like back injuries. It a great career, there's just a lot that can happen in this field.


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## firetender

Fire51 said:


> It's a great career, there's just a lot  _*(of unanticipated and unwelcomed things you're not prepared to handle)*_ that can happen in this field.


 
Elaborated on a good quote just a bit.

And maybe that's the key. Not only are healthy ways of coping *no* part of our training, but there are zero safety nets in place to catch us when we slip off that fine wire.

I'll go so far as to say if an important part of you is *not* depressed while doing this work, something is wrong. Isn't this work participating in a depressing aspect of the life experience?

Because we are there, most others DON'T have to play witness to suffering. We carry a disproportionate load so the rest of society doesn't have to.


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## emschick1985

azemtb255 said:


> I did a search and could not find anything like this, so I figured I would try to start a thread.
> 
> Depression is extremely prevalent in the United States. I wanted to find out your thoughts on depression in EMS because mental health is a big part of health. Three questions:
> 
> 1) How prevalent is depression among EMS personel? Do you think it is higher or lower than the general population and why?
> 
> 2) Do you have any direct experience with depression in EMS? This could be with a partner who struggled with depression, a friend in EMS, or even yourself. What did you do (if anything) to try to help them.
> 
> 3) At what point should a EMS provider remove themselves from the field because of depression, and when should they consider returning?


I am so glad you started this topic! 

1. Yes I believe depression ranks higher in EMS. We don't talk about it and/or are afraid to get help. In my experience it was a slow process so a lot of times blame it on other factors instead of EMS. There have been times recently that I wanted to get help but was embarrassed because everyone knows me at the ER and in this small town. No one else wants to admit they feel the same. We're "too tough" "invincible" for EMS to get to us. 

2. I myself struggle with depression in EMS. I have been on the truck for 4.5 years and I'd say the 3 year mark is when I started noticing I wasn't happy, brushed it off on other things goin on in my life, fast forward to preset time, I am in such a deep depression the deepest I've ever been. I've noticed since I've been a medic my whole view on life has changed. I don't like people like I used to anymore, I don't see life as exciting as I once did, I have no energy or want to do anything that makes me happy, I barely have the energy or want to make it thru each day. I find myself wishing my life was over, never having any future plans or wanting to grow old. I never used to be this way! Ever! Until a couple years into EMS. I stayed this long because I felt like was stuck. I believe there are several factors all together that caused it. 
Main thing is it didn't turn out to be what you got into it for. We get abused for a medical taxi. We are carting around the elderly and the ones who abuse the system,ridiculous long distance   transfers from hospital to hospital that could have went by car. lack of sleep from transfers, and then expected to do emergencies in between. low pay, strain on marriage because they don't understand why you feel certain ways at times, the guilt of leaving your family for shift. Especially when having to work a second job to make ends meet. The memories that stick with you during traumatic situations. Stress from coworkers.  Then when you Get down time here it can feel like eternity when depressed. Just holed up in my room being "antisocial" as they call it. Sorry so long. I'm on shift now.

3. When you feel this down and finally realize it may be your job even tho you don't want to give up being an EMT/paramedic, try something new. Keep your license EMS will be waitin for you if you want to come back. I am applying for an industrial job and have opportunities to advance. I won't be starting in medical tho. I will be a regular operator until it opens up in safety dept. I am scared to death but I need to try something else to see if EMS was damaging me. I LOVE being a paramedic. I LOVE making the Decisions on the ambulance and being out there with my partner on our own creating adventures on the road.  Making life or death decisions is exciting. But I think going to part time could be a good thing for someone who gets burnt out or depressed in EMS. Don't worry about finances. If you are tht unhappy get out while u can!


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## adamNYC

Theres nothing that depresses me more than a lack of action, boring txp work, and a slow/no-call day at the volly. Once I've tasted the high of street-jobs, flag downs, and the occasional emergency call to SNFs, all else, especially IFT/Txp/Dialysis work is minimally rewarding


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## COmedic17

^king of resurrecting ancient posts


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## Run with scissors

well, im too much of a wussy to kill myself.


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## redundantbassist

Run with scissors said:


> well, im too much of a wussy to kill myself.





COmedic17 said:


> ^king of resurrecting ancient posts


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## COmedic17

The crown has been passed on.


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## savemachine

When we are overworked, we tend to absorb all the negative energies around us.  This include even depression. Depression is contagious, too, especially when we are working with clients who are depressed themselves or if we are in a situation that is too hard pressing on us.   Actually almost everyone may have had experienced depression at least once in their lives.  It is normal to be depressed, but it isn't normal to stay depressed.   We must take a break, have some time off for ourselves.  It is not bad to pamper ourselves and to do the things that we like and enjoy after a long hard work. We need to do the things that makes us happy as it is the way of filling in our love tanks, in order to be able to give and supply love to others too.


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## nightmoves123

Have lost 3 paramedic friends in the past 12 months through some sort of mental episode/disorder. There seems to be plenty of spotlight on military PTSD but not on healthcare workers


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## Run with scissors

Sorry man, that's always ****ty. I've lost friends to PTSD too


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## nightmoves123

Run with scissors said:


> Sorry man, that's always ****ty. I've lost friends to PTSD too



The interesting thing is none of them had the 'cry for help' type scenario...you know taking a ton of pills. One even seen a councillor on a Wednesday and then hung himself on the Thursday!


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## Run with scissors

nightmoves123 said:


> The interesting thing is none of them had the 'cry for help' type scenario...you know taking a ton of pills. One even seen a councillor on a Wednesday and then hung himself on the Thursday!



Same with my friend, he just got back from his 4th tour in afghan land. And after being home for a week. His wife and kids went out for ice cream. They came home and he shot himself on the steps. We lived on base. And he never showed any symptoms. He drank a lot. But I mean, we all did.  PTSD is a serious issue for first responders and military alike. The best defense, is a good crew who look out for each other and talk about things with each other. Sure professional help has benefits. But it can't give you that feeling of having some one in your boat helping you throw out the water as its sinking while your paddling to shore.


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