# PTSD in medics



## bled12345 (Mar 12, 2007)

In school a few days ago our teacher was telling us that the average burnout time for paramedics in our city before they either injure themselves, or become so mentally drained they no longer function at the level required for the job, is approximately 5 years.

In some ways that almsot seems like a long time, after all you are being exposed to humanity at its worst pretty much every day of the week. But on the other hand, for a CAREER 5 years till burnout is pretty short. 

What do you guys make of this? Have you had friends or known of people that finally snapped and just couldn't take the stress of EMS anymore? Another problem that was identified in class today, was that city has a hard time with medics becoming addicted to legal and illicit substances as they try to cope. (Edmonton is the murder capital of Canada)

so yeah, what are your 2 cents on the subject?  I'd really like to hear some insight before I jump right in.



I have yet to do my practicum, and a couple things kind of worry me. My mother committed suicide via prescription antidepressants, and I'm curious as to how I will deal with this scenario once I finish school and enter the profession. And the other, I get panic attacks semi-frequently, Never in high stress situations, more often than not I get them when I am just lounging around with some friends. So I guess you could call those my 2 achiles heel's mentally, but I really do envision myself being strong and level headed at all times. But enough about myself, what do you guys have to say about this subject?


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## Nycxice13 (Mar 12, 2007)

Im in NYC, and I know people who have been medics/EMT's for what seems like forever. They seem normal...


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## SC_EMT (Mar 12, 2007)

Here in South Carolina I work with medics who have been working for the same agency for 28 years, Some for 15 years and so on.


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## Recycled Words (Mar 12, 2007)

I know EMTs at my corps who've been doing it for 20-30 years and people in NYC who've been doing it as long or longer


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## Epi-do (Mar 12, 2007)

As long as you take care of yourself and have other outlets when you are not at work that are non-EMS, you should be able to do this job as long as you want.  Having a good support system is also a must.  It really is something that varies from person to person.  There are people out there that only make it a few years, and others that have been doing EMS for 15, 20, or even more years.  

As far as being concerned about certain "types" of runs, my mom had a stroke and thyroid storm and died at the age of 39.  I was 17 at the time.  Once I became an EMT, about 8 years ago, the first few patients with stroke symptoms were a bit emotionally difficult for me because I thought of my mom.  I did get past it, and now those patients are "just another run" for me, as far as, they aren't my mom and I have seperated the emotions about my mom from that type of run.  You may surprise yourself and not have any difficulties with runs where your patient has OD'ed or are depressed.  Honestly, you won't probably even know until you have that first run and see how you handle it.  Remember, your partner will be there and you can always ask them to give you some extra assistance if you think you need it once the time comes.

Stick around long enough, and you will have runs that hit close to home or get under your skin.  It happens to all of us, whether it is a particular type of run, or just a random run that struck a chord with you at that particular moment.  We are all human, and the day you are able to no longer care about what we see/do, is the day you need to find a new job.

Just remember to take care of yourself and you will be fine.


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## DT4EMS (Mar 12, 2007)

The numbers they quote in school are failry accurate. I know tons of people who are no longer in the field. I am in my 17th year and still enjoy the job.

Every job/career has a turnover.


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## burntbob (Mar 12, 2007)

*survival*

A good attitude, balanced life and work and and taking care of yourself mentally & physically are the big things. 
A big part is having a life outside of work,( not always easy),and having a good mentor or neutral person who you can explore issues with if things start to bother you. Some people find they just can't let go of certain images and calls etc. and best thing to do is talk to someone earlier than to let it fester.
Often it's the non call stuff, such a difficult partner, politics in the workplace, too many hours , shiftwork, and other stressors that cause most of the burnout.
 Physically , full time paramedic work is tough on the body and mind, it always helps to have a skill on the side, another career that you work on a bit on the side etc. in case you blow your back, tear your shoulder etc.

Bob , medic since 78.....


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## Recycled Words (Mar 13, 2007)

Epi-do said:


> As far as being concerned about certain "types" of runs, my mom had a stroke and thyroid storm and died at the age of 39.  I was 17 at the time.  Once I became an EMT, about 8 years ago, the first few patients with stroke symptoms were a bit emotionally difficult for me because I thought of my mom.  I did get past it, and now those patients are "just another run" for me, as far as, they aren't my mom and I have seperated the emotions about my mom from that type of run.  You may surprise yourself and not have any difficulties with runs where your patient has OD'ed or are depressed.  Honestly, you won't probably even know until you have that first run and see how you handle it.  Remember, your partner will be there and you can always ask them to give you some extra assistance if you think you need it once the time comes.



Well put. A close friend of mine killed himself a month before I started riding, so when I was dispatched to my first attempted suicide, I was concerned about my ability to handle the call emotionally. After the call, I was far less stressed out than I thought I would be.

If you think you're going to have an issue on a certain call/type of call, let your partner know beforehand and talk to him/her afterwards if you need to.


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## Ridryder911 (Mar 13, 2007)

PTSD can occur to anyone. Especially those that are exposed to an overwhelming event. It is a psychological and medical diagnoses where the body cannot cope psychologically to handle events and display events at a later time after such an occurrence. Don't confuse PTSD and Burn Out of being the same. They are two distinct different things. 

Burn out - (stomp out) is more related to dissatisfaction of a situation, usually occurring over time and true reality of a situation. More and more research is demonstrating that even rural areas have such a high percentage in comparison to those that work in a high call volume.

In fact there appears to be more and more representation of those that work in rural areas and haiving slow periods have as high burn out ratios. Being prepared at all times and not ever getting that "call" can lead to dissatisfaction. 

As a seasoned veteran, I have seen them come and seen them go. As well, I have been burned, fried, as much as some fried chicken...lol 

I do believe it starts from the beginning and expectation of one's career. Just reading posts on those that observe that first ride and get bit by the EMS bug, sadly will leave within 2 - 4 years, the laws of percentage tells us. 

Why ? 

Just like any job, expectations and harsh reality sets in after the "new" wears off. Understanding, that this profession has as many downfalls and pitfalls as any other career.. and sadly finding out it is just a "job"... paid or not. The excitement soon wears off when one discovers that less than 20 % of your job really involves any emergency situations. That people really do not care if you know how to take a BP or crack a chest.. rather for you to "just drive fast and transport them smoothly".. as nice ambulance drivers should.

I do believe this is one of the many reasons EMT's love patches and titles.. for self recognition. No one else but those in EMS, knows what Intermediate means or trauma tech or even EMT-P stands for... 

We are a strange breed, we do want to be recognized, but; at the same time not too much... other wise, it will appear we are bragging. Like canines.. we will suddenly turn onto each other, if this should occur. 

Many EMS educators and researches do not believe "burn-out" really occurs, rather they feel;... "expectations are not met or they were disillusioned to what the real job consists of "..
That is why I feel it is so important to inform those that are truly interested in administering patient care in the field from those interested in EMS the "bad side" of the career. 

We that have worked in EMS realize there really is very little benefit from working in EMS, and the only pay off is from a personal satisfaction that comes from with inside by delivering good patient care. Thus, this maybe the reason we may see so many leave early in their career, since this only truly comes from a person with a true desire to perform patient care.. The light, sirens, whistles and bells adrenline usually goes away very fast. As well, working two or three jobs, may not be worth the reward that one receives.. Sadly, it does not pay for food for the family, which is understandable we loose many good medics. 

Fortunately I was required to take an 8 week course before entering my Paramedic degree. It was specifically for Introduction into EMS. I initially thought it was a silly course at the time. Since it dealt with the "real" duties of a medic, dealing with spouses and families, recognizing burn out and stress and how to deal with it, professional growth and development. A panel of experienced medics discussed on how to work on problems, how not to become a alcoholic or drug abuser, how and where to turn to for help, and prevention of ruining one's career and keep from becoming a statistic. 

Ironically, all the married couples that had discussed on how to stay married had became divorced before us leaving the program..lol However; what is very unique is we had been the largest graduating class at that time (a whopping 9 of us) and that out of those.. all but 1 is still in some form of EMS. Ranging form ER physicians, ER P.A.'s, Flight Nurses or EMS Directors.... Which is remarkable, considering that was over 24 years ago. More disturbing we all have stayed in EMS longer than our personal relationships... so we must have learned at least part of the course...

It can be done, if the person understands realizes the expectations of EMS and what the true job is...and how to deal with it, one can actually have a long and successful career in EMS. 

R/r 911


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## Glorified (Mar 13, 2007)

Ridryder911 said:


> PTSD can occur to anyone. Especially those that are exposed to an overwhelming event. It is a psychological and medical diagnoses where the body cannot cope psychologically to handle events and display events at a later time after such an occurrence. Don't confuse PTSD and Burn Out of being the same. They are two distinct different things.
> 
> Burn out - (stomp out) is more related to dissatisfaction of a situation, usually occurring over time and true reality of a situation. More and more research is demonstrating that even rural areas have such a high percentage in comparison to those that work in a high call volume.
> 
> ...



Coming from a complete newbie, it is great to hear the truth and wisdom of my elders.


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## BossyCow (Mar 13, 2007)

Nycxice13 said:


> Im in NYC, and I know people who have been medics/EMT's for what seems like forever. They seem normal...




Seem normal to you maybe.. but how do civilians regard them?


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## Medic's Wife (Mar 14, 2007)

Sounds like everyone has had some really good words of wisdom for you, but just to add my two cents:

My hubby has been a medic for 10 years, and he still loves his job very much.  He has had some very dificult calls over the years (a close friend died in his arms, tragic pediatric calls, grusome freak accidents......), and I myself have wondered how he coped with it all.  I asked him one time, and he explained to me that when he's on a call, he gives it 110%, but once the call is over, he detaches himself from the emotions about it.  Sometimes he just plain old has to force himself to block out images and not think about it.  Having a realistic understanding of your own human limitations will help a lot (realizing that you can't be everything to everyone, and sometimes your best simply will not be enough).

I need to get hubby posting on here so he can start answering all these questions for himself!


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## keith10247 (Apr 13, 2007)

From reading this post, I am somewhat relieved to know that I am not the only one with this concern of not being able to handle some of these calls emotionally.  I will be starting EMT training soon (I now realize I should have went EMT instead of fire fighter 1 ) 

One thing I found interesting in my county is that it is a county enforced requirement that you cannot ride anywhere on the units until you take a CISM (Critical Incident Stress Management) class.  The class really did not teach how to handle with the stress of the job but was there to introduce you to the CISD (Critical Incident Stress De-Briefing) Team.  My county has CISD counselors on-call 24x7, I have the option to call dispatch and have them dispatch a CISD to my station or someplace to talk about the incident that is bothering me. 

I hope I do not have a call that requires this action however.


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## Ridryder911 (Apr 13, 2007)

You might want to read Dr. Bledsoe's report on the Myth of CISD and how it has been proven to be B.S.! 

Another one of the * Myth's* of EMS that science has now proven to be unfounded. 

R/r 911


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## Summit (Apr 13, 2007)

Ridryder911 said:


> You might want to read Dr. Bledsoe's report on the Myth of CISD and how it has been proven to be B.S.!
> 
> Another one of the * Myth's* of EMS that science has now proven to be unfounded.
> 
> R/r 911



I am googling for this and not finding it...


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## Ridryder911 (Apr 13, 2007)

http://www.jems.com/Columnists/bledsoe/articles/15303/

From the article _ Trying to Reason with a Hurricane Season_: _First and foremost, EMS managers should do their homework before involving their personnel in Critical Incident Stress Management (CISM), particularly the defusing and Critical Incident Stress Debriefing (CISD) elements. CISM, while initially popular in EMS, has been repeatedly proven to be ineffective and, in selected cases, harmful.1-3 Numerous organizations have recommended that CISM/CISD not be utilized. The National Institute for Mental Health (NIMH), in conjunction with the Departments of Justice, Defense, Health and Human Services, Veterans Affairs and the American Red Cross, held a consensus conference on the mental health response to victims and survivors of mass violence. The researchers did not recommend CISM/CISD.4


Further, the World Health Organization (WHO) issued a consensus paper on the mental and social aspects of survivors of extreme stressors and concluded, “Because of the negative effects, it is not wise to organize forms of single-session psychological debriefing…”5 After the tsunami devastated parts of the Pacific rim earlier this year, the WHO issued a warning reminding responders that psychological debriefing should not be used. They repeated the warning after Hurricane Katrina.6 Also, following the recent bombings in London, ambulance and mental health personnel were reminded not to use CISM/CISD or other forms of psychological debriefing.7

So now that CISM/CISD has been determined to be ineffective and possibly harmful, what should be done for victims and rescuers? The model that has emerged and is now widely accepted is referred to as the resiliency-based model and uses a practice referred to as “psychological first aid.” 

It’s recognized that traumatic stress can’t be adequately treated after it has occurred. Instead, it is best prevented. Thus, with the resiliency-based model the emphasis is on developing stress-management and coping strategies before the crisis has occurred. The literature has clearly demonstrated that having pre-existing stress management strategies and a personal support system were the most effective measures to prevent problems after exposure to a critical incident.

Psychological first aid is an evidence-informed modular approach for assisting those affected by traumatic stress. It’s designed to reduce the initial stress caused by traumatic events and foster short- and long-term adaptive functioning. Further, psychological first aid meets four basic standards that were not all met by CISM/CISD.

First, it’s consistent with the prevailing research. Second, it’s applicable and practical in the austere field setting. Third, it’s appropriate for all developmental levels. Finally, it’s culturally informed and adaptable to the situation at hand.

The objectives and principles of psychological first aid are as follows:

Establish a human connection in a non-intrusive, compassionate manner. 
Enhance immediate and ongoing safety, and provide physical and emotional comfort. 
Calm and orient emotionally overwhelmed or distraught survivors. 
Help survivors to articulate immediate needs and concerns, and gather additional information as appropriate. 
Offer practical assistance and information to help survivors address their immediate needs and concerns. 
Connect survivors as soon as possible to social support networks, including family members, friends, neighbors and community resources. 
Support positive coping, acknowledge coping efforts and strengths, and empower survivors; encourage adults, children and families to take an active role in their recovery. 
Provide information that may help survivors to cope effectively with the psychological impact of disasters. 
Facilitate continuity in disaster response efforts by clarifying how long the Psychological First Aid provider will be available, and (when appropriate) linking the survivor to another member of a disaster response team or to indigenous recovery systems, mental health services, public-sector services and organizations. An excellent set of guidelines and recommendations has been published by the National Center for Child Traumatic Stress and the National Center for PTSD.8
As mentioned above, research and experience have demonstrated that a person’s response to an extremely stressful situation is based on their personal pre-existing stress management strategies and personal support system. Such post-incident stress management strategies as CISM/CISD have been proved ineffective and possibly harmful. Post-traumatic stress disorder (PTSD) is a rare outcome of exposure to a stressor and usually occurs in conjunction with other mental disorders. In fact, following the World Trade Center attack in 2001, the incidence of PTSD in Manhattan below 110th street rose to 7.5% (higher for people closer to ground zero). But overall, the rate returned to normal (1.7%) within a few months without treatment. This trend illustrates that humans are naturally adaptable and resilient to stress.9 The vast majority of people exposed to a major disaster do absolutely fine. The few who may develop PTSD will usually do so within a few months of the exposure. These people can be identified and referred to competent mental health personnel who can use various cognitive-behavioral therapies to treat the illness.

Thus, how should we help those in this hurricane season?  First, no debriefings should be offered, and CISM teams should not be used. Simply, do what good neighbors do: Help and protect those exposed to the disaster. If they want to talk, let them talk. If they don’t want to talk, don’t try to make them talk. Keep them warm. Take care of their physical needs. Engage their personal support system. If necessary, provide access to a bona fide mental health professional who can help screen them in the upcoming months for maladaptive symptoms and, if necessary, refer them to a competent mental health practitioner experienced in treating acute stress disorder and PTSD with proven therapies.

Our most fundamental tenet in medicine is Primum non nocere (first, do no harm). This dictum holds true for all interventions, including crisis management and mental health. So, make the switch to psychological first aid. It’s what good neighbors do.

References 

McNally RJ, Bryant RA, Ehlers A: “Does early psychological intervention promote recovery from posttraumatic stress?” Psychological Science in the Public Interest. 4(2):45–79, 2003. Available online at http://www.psychologicalscience.org/pdf/pspi/pspi421.pdf. 
Bledsoe BE: “Critical incident stress management: benefit or risk for emergency services? Prehospital Emergency Care. 7:272–279, 2003. 
van Emmerik AAP, Kamphuis JH, Hulsbosch AM, et al: “Single-session debriefing after psychological trauma: A meta-analysis.” Lancet. 360:766–771, 2002. 
National Institute of Mental Health: Mental Health and Mass Violence: Evidence-Based Early Psychological Intervention for Victims/Survivors of Mass Violence. A Workshop to Reach Consensus on Best Practices. NIH Publication No. 02-5138, Washington, D.C.: U.S. Government Printing Office, 2002. 
World Health Organization: Mental Health in Emergencies. Mental and Social Aspects of Health of Populations Exposed to Extreme Stressors. Geneva: World health Organization, 2003. Available online at http://www.who.int/mental_health/media/en/640.pdf. 
World Health Organization: Single-Session Psychological Debriefing: Not Recommended. Geneva: World Health Organization. Sept. 18, 2005. Available online at http://www.who.int/mental_health/media/en/note_on_debriefing.pdf. 
Wesley S: “Victimhood and resiliency. New England Journal of Medicine. 353(6):548–550, 2005. Available online at http://content.nejm.org/cgi/content/full/353/6/548. 
The National Center for Child Traumatic Stress and the National Center for PTSD: Psychological First Aid: Field Operations Guide. September 2005. Available online at http://www.nctsnet.org/nctsn_assets/pdfs/pfa/PFA9-6-05Final.pdf. 
Galea S, et al: “Trends of probable post-traumatic stress disorder in New York City following the September 11, 2001 terrorist attacks.” American Journal of Epidemiology. 158(6):514:censored:–524, 2003.

Bryan E. Bledsoe, DO, FACEP, is an emergency physician in Texas. _

There ya go ..


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## keith10247 (Apr 13, 2007)

I can agree with a lot of the aspects mentioned.  However, in my particular squad, the members are not as close as many others.  We are a very small squad (18 volunteer members).  We are also somewhat rural so there is a "macho" complexion.  I do not think I have heard anybody express their feelings unless they were feelings of like or dislike against another member.  

I see the CISM process as a person to talk to...since the CISD team is composed of senior fire fighters.   I know of one of the officers at my station that has had to use the CISM process after a call where a 7 year old drowned in a public swimming pool because the life guard was not paying attention.  He said it helped him cope with it due to the ability to just open up.  

I do not believe that CISD should be required or enforced, but some sort of therapist should be available for some sort of PD; if the person feels they need it.


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## Ridryder911 (Apr 13, 2007)

Not to get on a soap box again   This is why evidence base medicine EMS research and treatment is so essential! Billions with a capital *B* and continuation of millions of dollars have been spent on setting up and managing CISD/CISM. What a waste of money! Even more so when national and world wide organizations has seen that it is non-effective and do not recommend it, we in EMS still have promoting another  "white elephant".
It is a wonder scam artist does not take advantage of us, we are so gullible, with any pseudoscience.

It would make sense and still does to place those funds in promoting prevention methods and placing those with potential PTSD in "real therapy: by "real licensed mental health professionals". 

If your EMS still promotes CISD, I highly suggest that you have your EMS medical director and administration perform research on current findings. Budgetary means could be saved as well as the psyche of the medics.. 

R/r 911


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## keith10247 (Apr 13, 2007)

Ridryder911 said:


> It is a wonder scam artist does not take advantage of us, we are so gullible, with any pseudoscience.



It's funny,  there is an "organization" for CISM dubbed the ICISF (International Critical Incident Stress Foundation).  I notice they have a yearly membership to be part of their organization. 

I totally agree with you that we should have access to licensed mental health providers. What would the county do with all of the CISD team members they paid to put through training though?


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## Ridryder911 (Apr 13, 2007)

You know I smelt something fishy in the beginning, when I seen a Paramedic (with a BS degree in EMS) quit being a Director of an successful large EMS to take a  a CISD Coordinator position from Federal Grant monies. 

It amazes me, on how many suckers there are out there.... This is why research and testing is so essential before we buy into any treatment and system(s) for ourselves. 

New ideas are nice and excellent, and should be placed into a scientific form to be studied so better programs can be developed, but once we have found out they are not helpful and potential harmful, would it not make sense to STOP immediately?  


Now my next battle debunking the *  Golden Hour Myth! *
R/r 911


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## Glorified (Apr 14, 2007)

Maybe instead of CISD, EMS agencies should work with psychologists for discounted psychotherapy for all EMTs/Medics.  It's just an idea.  I guess insurance would be a pain in the butt, though.


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## Ridryder911 (Apr 14, 2007)

One of the EMS I worked for actually had a psychologist that was contracted out and worked as a part time medic, to fully understand what some of the situations we encountered. 

I agree, money spent could go into a better insurance or agreement to a licensed psych practitioner.
R/r 911


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## Summit (Apr 14, 2007)

I always thought CISD sounded like a crock... I had no idea that there was so much evidence out there. One agency I am with is a HUGE believer and promoter of CISD. I don't think anyone has been forced to go, but I wonder how to convince them to not do that (especially since there are at least 3 or 4 higher ups who dogmatically believe that it works).


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## Jon (Apr 14, 2007)

Ok... as I understand it... CISD doesn't work... however, the improptu "debriefings" we have in the crew lounge, or around the kitchen table immedatly after a call are still good things... right?


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## keith10247 (Apr 14, 2007)

I think the "debriefing" that happens in the crew lounge is probably less formal than an official CISD.  Therefore, there is no structure to how it should happen and does not follow the CISM process.  I personally believe that casual talking is better than any formal therapy; especially if it is among people that experienced the same event and can relate to you.  

Our CISM instructor did mention that one of the CISM "creators" had a case study that he was using to prove the CISM process worked.  From what I understand, the person was taken all around the country to relive his story and help prove that the process did work.  Apparently the act of bringing up the memories of the incident caused the person he was using as a case study so much stress that he had a break down.


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## Ridryder911 (Apr 15, 2007)

If you read in the article that discussing and talking helps diffuse the situation and is actually promoted, but that is a lot different than "forcing" or sitting in a circle with other(s) peers and re-hashing over and over, as a group therapy type event. 

By all means don't bottle up emotions and immediate debriefing of crisis events, but the main point is recognize that a " real expert" maybe needed to go one on one or a group initially. Once you have found out that most others have the same feelings, it is easier to cope and deal with it. It is the dangers of PTSD, when coping mechanisms fail. 

R/r 911


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## firetender (May 11, 2007)

*Burnout as part of the culture*

I’m real happy to see this thread! This is a very real problem that is not getting better. When I left my 12-year career in EMS, in 1985, the burnout rate was 3.5 years! 

The difference between then and now is a statistical numbers game. Today, there is a slightly better career-track that gets a lot of the dinosaurs out of the field and into more administrative or supervisory functions. These are the guys who get to rack up the years while the grunts come and go. 

To a certain extent, especially in the private sector, longevity is simply not cost-effective. You can count on a steady stream of altruistic FNG’s to take the place of the burnouts. (I am not anti- any sector of EMS, I am only doing my best to identify systemic glitches. Economics is a driving force of so much that occurs in this country it affects all sectors.)

The assumption about PTSD is, broadly, that it is the result of a certain kind of stress that causes people to be unable to function and leave the field. The truth is, odds are more likely for you to have someone suffering severe PTSD right next to you as your partner than you’ll find as an ex-medic on the non-functioning bread lines!

The medical model of definition is often quite inadequate. PTSD has textures, like different characteristics of snow for the Eskimo. IMHO the PTSD suffered by medics is not incident related, or even incident after incident related, but the result of a progressive deadening of the medics ability to experience themselves as human beings. At some point, it all catches up and functioning starts to circle the drain.

From the get-go, we are told that in order to “do the job” we must distance ourselves from our human experience of what is perhaps the most human of all experiences, living on the edge of life and death. What results is a progressive layering on of protective shells that, after a time get so thick we are encased and lose the fluidity to respond authentically (and/or compassionately) to the moment.

Those layers are like a jumpsuit with a rusted zipper. They simply do not come off when we get home. And that’s where burnout rears its ugly head; in our relationships with others, but most importantly, with ourselves.

The biggest difficulties for medics are, unlike people in most high-pressure job functions, they have to face a constant barrage of paradoxes, contradictions, discrepancies, and hypocrisies within themselves, and they don’t have anywhere to turn for support because silence is the dominant culture.

The fact that discussion is going on right here, right now, is a sign of hope. The truth is, WE are the only ones that can help each other and ourselves. Why? No one knows the territory better than us, and few of the systems that define our roles are stepping up to the plate to help.

The dominant culture of the medic (and I am speaking broadly for allopathic medicine as a whole and most “disciplines’ of medicine taught “Western-style” as well) discourages us from talking about anything real with each other, like the concerns brought up about one’s relationship with suicide when a family member has taken that option. 

What richness there is in such discussions! By cultivating such conversations we can claim ourselves as human beings in service to other human beings rather than as what I call “Flesh Mechanics,” which, let’s face it, is what we’re trained to be. 

Aloha, Thank you, and let’s keep talking!


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## firetender (May 11, 2007)

"We that have worked in EMS realize there really is very little benefit from working in EMS, and the only pay off is from a personal satisfaction that comes from with inside by delivering good patient care. Thus, this maybe the reason we may see so many leave early in their career, since this only truly comes from a person with a true desire to perform patient care.. The light, sirens, whistles and bells adrenline usually goes away very fast. As well, working two or three jobs, may not be worth the reward that one receives.. Sadly, it does not pay for food for the family, which is understandable we loose many good medics. "

The dominant culture of the medic supports our getting lost in the lights and sirens and blood and gore and scrotes and lizards and burnouts, all for the sake of a 40 minute call once every six months that keeps us going. 

What it completely side-steps is the incredible richness of being a human being actually being able to experience this slice of life in the moment. In our headlong rush to "perform patient care" we are made distant from the wonder of being alive in the midst of it.


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