# Dealing with the stuff you see....



## drg (May 28, 2007)

I am considering becoming an EMT.  I have prior law enforcement experience and from time to time I would see some gruesome scenes.  It didn't bother me much but I didn't actually have to work on the person, like I would as an EMT.  I guess I won't know if I can do it until I try but I'm wondering what it was like for you guys at first, when you first started responding to intense trauma scenes.  Is it something you just get used to after a while? Did it never bother you to begin with? Please share your thoughts.


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## Epi-do (May 29, 2007)

My first couple really bad trauma runs, I think I had that "deer in the headlights" look for the first few seconds, but my partner was always there to give me a nudge and get me moving.  

For me anyway, during the run I don't really have a chance to think about what I am seeing.  There is a job to be done, and experience and training take over, and I do what I need to do.  Typically it isn't until after getting to the hospital that I really have a chance to digest what I just saw.

Generally speaking, most runs don't really get to me, but I am fortunate to have a great support system, both at work and at home.  Alot of times, after a bad run, it is the topic of conversation around the firehouse for the next few hours, if not the rest of the shift.  It starts out as just going over what happened, and what could have been done differently, but eventually the dark humor starts to come out and everyone begins to destress.

There are still runs that really get to me, but fortunately they are very few and far between, the latest one being a girl who was mauled by a pitt bull mix.  If the day ever comes that I am not affected in some way by the really bad runs, that is the day I will stop doing this job.


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## BossyCow (May 29, 2007)

Everyone is going to have something that makes them uncomfortable.  My husband with 20 some years on the job still has trouble looking at a long bone fracture.  Says he usually just covers it with a towel or blanket for the ride to the ED so he doesn't have to look at it.

It's pretty individualized what gets to us, but we do have a job to do and when a life is on the line, the fact that the smell of vomit makes you want to join the patient in spewing sort of takes a back seat to what you need to do.  I've seen medics open the side door, puke and come back in to finish their job.  

Trauma hasn't bothered me as much as some of the bodily fluid issues of the medical patient.  But that's just me.


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## Sophie (May 29, 2007)

I have to agree with both prior replies.  

You know what really makes me sick?  Someone spitting.  That annoys the heck out of me and I have told patients who intentionally spit in the back of the ambulance to clean it up before they go into the hospital.  Trauma doesn't get to me but spit really makes me want to puke!

A couple of years back I kept getting traumatic (fatal) pediatric calls. In one week I had 4.  I believe that was the only time where I felt it really started to get to me.  

You know what I think about though?  Nothing but patient care. I try to do everything I have been trained to do and keep up on my education as much as possible.  I can sleep at night knowing I did everything I could for the patient and that has helped me rest well the last 21 years in EMS.  

Currently we are having problems with our training, or lack of, where I work but I make sure I continue to train myself or go to outside sources.  That is what we have to do for our patients.  Make sure we know what we are doing and to provide the best patient care we possibly can.  When someone quits training and "knows it all" that is the time where they need to get out of EMS. 

Will things bother you along the way?  Yes, but don't dwell too much on them.  Just make sure you're helping your patient the entire time.  Talk to those on the run afterward. I am a great supporter of CISD and do not believe we use it near enough in EMS.


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## Artique (Jun 5, 2007)

I start school in 5 days, and Ill be working in hopefully 3-4 months. It wont stop there I plan to go as far as I can. To see how EMS funtions based on the good will of the job/human ethics is the very thing that draws me to it. I hope to work with passionate folk.


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## firetender (Jun 5, 2007)

It’s not so much about the stuff you see as it is about the moments that you’re a part of. EMS is not about being a silent witness to things happening outside of you, it is about being a participant in the struggle between life and death.

Entering the profession is almost always a heart-driven proposition: “I want to help!” Once you’re in it, the culture of (Western) medicine as a whole moves you up and up into your head until, after a while, you forget what a heart-based experience feels like. 

What you get taught is how to remove, distance, insulate, joke around, self-medicate, avoid, deny and dull the pain of being a very real human being exposed to relentless suffering. The relentless suffering is more about the day-to-day pain that many people experience in just being alive rather than the suffering over an isolated, hugely traumatic incident.

Winston Churchill said, “When you’re going through hell, keep going!” There’s probably no better description of what it takes to be proficient at the work. In fact, there’s a “tipping-point” that happens in the midst of any serious call that puts you in the position of having to, in a sense, leave your body and emotions behind so you can get through the situation and render the care you’re supposed to.

This is a skill that we all develop over time. You will, too. *My prayer for you is that responses will come to this thread that will guide you in actually “dealing with” the trauma you are exposed to, rather than guiding you into a closet that only offers thicker and thicker layers of protection and insulation to heap on your heart*. After a while, the layers get so thick you can’t even hear your own heart beat anymore. 

That’s where, for the most part, the system fails us. A businessman goes out there and blows a major project. He/she goes home and, turning to a spouse, business partner or mentor processes the experience so it is _assimilated into a larger life_. EMS, as a whole, promotes compartmentalization to the extent that, once a call is over – even though it may be reverberating in you for years to come – you are taught to “move on!” 

But “moving on” does not mean integrating what you’ve seen into your larger life. After a while, given exposure to enough traumas without assimilation of the experiences, you gather enough excess baggage to hobble you in many other areas of your life. Assimilation produces wisdom and fosters compassion. 

The way things are set up; we are a vast minority of specialists who carry the burden of the sick and injured so the rest of society doesn’t have to. We are asked to develop coping skills way, way beyond the capabilities of most of the people who are in our lives. And these skills we must develop AFTER the call has passed.

The sad part of the story is that we are almost exclusively taught how to “get through” our experiences when what we need are guides to help us “move through” what we have experienced. There’s a very crucial bottleneck there that affects ALL areas of our lives.

The great part of the story is that here, in this forum, there are all shades of experience to tap into. I’m asking future participants in this thread to really look at what this guy is asking. Share with him how you really do “deal with” the things you see and integrate them into your larger life.

Epi-do said, “Generally speaking, most runs don't really get to me, but I am fortunate to have a great support system, both at work and at home. Alot of times, after a bad run, it is the topic of conversation around the firehouse for the next few hours, if not the rest of the shift.” This leads one to suspect he’s (forgive me if I mis-interpret gender, y’all!) setting the scene for a more comprehensive process of assimilation.

But listen, really listen to what he goes on to say: “It starts out as just going over what happened, and what could have been done differently, but eventually the dark humor starts to come out and everyone begins to destress.”

De-stressing is a crucial part of the process of assimilation. But it is only one part of dealing with the distress that one has experienced. Please, share with us, too, how you’ve turned your traumatic experiences in the field into things that have made you more effective as both a medic, AND a human being, so we can all learn.


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## BossyCow (Jun 5, 2007)

firetender said:


> What you get taught is how to remove, distance, insulate, joke around, self-medicate, avoid, deny and dull the pain of being a very real human being exposed to relentless suffering. The relentless suffering is more about the day-to-day pain that many people experience in just being alive rather than the suffering over an isolated, hugely traumatic incident.
> 
> 
> Really?  I must have missed that class!
> ...


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## ffemt8978 (Jun 5, 2007)

BossyCow said:


> many in this profession who are able to understand the pain of others without being pained by it.



Now there's a skill that needs to be taught in class.


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## Rattletrap (Jun 5, 2007)

> Originally Posted by BossyCow View Post
> many in this profession who are able to understand the pain of others without being pained by it.





ffemt8978 said:


> Now there's a skill that needs to be taught in class.





Care to write up an instructors guide on that?


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## BossyCow (Jun 6, 2007)

I'm not sure it's a skill so much as a personality trait.


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## Ridryder911 (Jun 6, 2007)

It is called empathy. Not sympathy, which many develop and have to leave. It is okay to understand and empathizes that they are in pain, however; when one crosses over into sympathising then a clear objective is hard to maintain. 

R/r 911


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## firetender (Jun 6, 2007)

I feel compelled to add that we are human beings who, whether we acknowledge it or not are subject to different emotions at different times under different circumstances. NONE of us are written in stone, therefore to say that we're either disposed to the work or not, or meant to experience empathy over sympathy is to miss the point.  (Of course, some people are absolutely NOT cut out for it and hobbled by their inability to act in the moment and process later, but the point is we are fluid beings.)

Any one of us, given a set of particular circumstances (custom-designed, it seems, to tweak us!) WILL experience huge physical, emotional or spiritual challenges in the work. 

The thread's originator wonders how you deal with that when it happens. 

You know there's only two kinds of medics, those who slam into a wall and those who are going to slam into a wall.  What happens when you get slammed?


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## firetender (Jun 6, 2007)

> Not all EMS humor is an attempt to distance or to hide, our 'true emotions' there are some situations that are just downright funny! Not all failure to react to human suffering is a sign of an inability to react with compassion.


 
I couldn't agree more. The human situation and how we deal with it is hilarious! Laughing at ourselves is so important to balance, too. You ever see the Dalai Lama?  People line up for hours to just kneel at his feet where they become limp and just cry. He looks deep into their eyes and what does he do? He laughs.


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## Glorified (Jun 6, 2007)

he laughs at them?  ahahha....wait...wait.....hahahahhaa

friggin hilarious


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## firetender (Jun 7, 2007)

Glorified said:


> he laughs at them? ahahha....wait...wait.....hahahahhaa
> 
> friggin hilarious


 


He laughs, period.


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## BossyCow (Jun 7, 2007)

I guess when I see someone in pain, or suffering, my first instinct and impulse is to do something to alleviate it, not to imagine how that must feel or to suffer with them. Personally I feel my response is a lot more helpful than 'feeling their pain'.


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## drg (Jun 7, 2007)

Thanks to everyone who has replied.  I appreciate so many of you opening up and sharing your experiences.  

I am now a couple of weeks into my EMT-B class and things are going well.  I recently came across and started watching some really good reality shows on the Discovery-Health channel (They're called Critical Hour, Point of Impact and Code Blue).  From what I've seen on there, like some of you have said, there's so much going on all at once that you don't really have time to step back and think, "Man, that really looks gross; I think I'm gonna be sick now." So you just step up to the plate and do what has to get done and deal with the psychological aftermath later.  At least, that's the way I'm interpreting what I'm seeing from a second-hand perspective.

Anyway, thanks again for being so open with your ideas, feelings and opinions.  Although starting this thread was my first post on this board, I've been reading the board for a while and it had a huge impact on me deciding to go ahead and start taking the EMT-B class that I'm in.


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## Emtgirl21 (Jun 7, 2007)

I had been helping one of my friends with his EMT class. I see alot of his students when they come do their ride time with my agency. I guess bout two weeks ago I came into work and one of his students was sitting there with this blank stare. He asked me if we could talk. Of course I said yes and we went out to the bay. He was 19 y/o and had just ran his first trauma. It was a 16 y/o female who had be killed in a MVA. I guess he helped backboard and was BVMing her when they decided to call it on scene. His girlfriend is just months older than the girl that he'd just seen dead. It hit him hard and he looked at me with those BIG eyes and said " You and the Instructor never told us about this part. I though I had been prepared for everything but the book  and you guys didnt cover this at all." 

I kinda felt as if I had failed them a little bit. I think in general we dont talk to the general public or those outside our field about our feelings and emotions. Depending on the person some times we  dont talk about our emotions at all. 

I to had prior law enforcement experience also, But I feel more responsible now as an EMT because I believe that it is my job to do everything I can to prolong life. It was hard that first time realizing that during MCI some patients ya might try to save if they were the only one but "The greatest good for the greatest number."

I was actually proud of my co-workers that day. We sat down with the EMT student and talked about things like our first codes or first truama or that one call that just really haunted us. Some actually admitted to having a nightmare or two and some played it tough. 

Everyone deals with the job differently. I honestly believe that the day when I can no long mustar up some bit of emotion for a family that has just losed a loved one is the day i move to a different career. I want to be able to feel for people. However, I want to be hard enought that I can seperate my emotions from myself and do my job. I'm very open about how my job effects.....my way of dealing with things is that I write.....or put some hot lead in paper!

Thats my two cents worth.....i'm broke now.


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## firetender (Jun 7, 2007)

Emtgirl21 said:


> Thats my two cents worth.....i'm broke now.


 
That two cents is worth a million because you are compassion in action. 

Broke? How could you be when you make us all rich!


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## Aileana (Jul 28, 2007)

Epi-do said:


> For me anyway, during the run I don't really have a chance to think about what I am seeing.  There is a job to be done, and experience and training take over, and I do what I need to do.  Typically it isn't until after getting to the hospital that I really have a chance to digest what I just saw.


exactly my thoughts!  
It seems that even during practices, I become an entirely different person, take charge, and forget all about any feelings of fear or discust. Also, it seems that through looking at pictures and watching gory scenes in movies and the like, I've become somewhat desensitized to gore.


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## GayEMTNJ (Aug 15, 2007)

*Working with the new guys*

I think two thing can help.  We do a new member orientation and during that we tell some war stories but the war stories are not geared around "there was this awesome job" but more about the types of things that you see on calls.  I've shown some pics from nasty jobs and reminded the new people that one of the victims in the pictures died.  

The second thing is that we tell everyone that if they see anyone that seems to be having a hard time report it up the chain.  We'll then reach out to the person and talk with them.  We also have some people that are trained in CISD and if it seems like that person is really having a hard time, we'll hook them up with the CISD person.  

The big thing is to watch out for each other.


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## hitechredneckemt (Aug 17, 2007)

Yes i agree if someone is having problems dealing with a bad call CISD does work. Ive been through it twice, once each for two separate calls. Another thing i have in my favor is  great support at home my wife is also in EMS and CISD trained. The best advice i can give is to talk to someone, dont ever keep it bottled up it only makes it worse in the end.


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## firetender (Aug 18, 2007)

GayEMTNJ said:


> The big thing is to watch out for each other.


 

...even if you don't quite understand what they're going through. Make room!


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## BossyCow (Aug 19, 2007)

The value of CISD has been called into question lately and there are several threads on this forum discussing that.  I believe that we are all different and we all respond individally to stress and issues.  The key is to find what works for you and deal with it when it happens.  The worst thing to do is deny that something bothered you.  We had a huge thrash not long ago.  One of our long time volunteers, not an EMT had a rough time with it.  Now, CISD will tell you to avoid sugar, alcohol and to sit through one of their lovely circle, sessions with lots of water for everyone.  

There was a CISD set up for this call, but the volly with the issue was not going to attend.  So, myself and another volunteer with the district got some beer and some junk food, called him up and just let him talk.  

The key is to open up and not let the stress fester.  Know where you can go to deal with it and know how to recognize that you aren't dealing with it.


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## drg (Aug 21, 2007)

Hello again! I had originally started this thread so I thought I'd give you guys and gals an update.  I took and passed my NREMT-B exam a few weeks ago.

What I wanted to share with you though was one of my clinicals.  I had originally wanted to do my clinical at a busy hospital in Chicago but they were all booked up so I wound up doing it at a hospital in the suburbs.  I was all bummed out and convinced that I wouldn't get to see any action.  As luck would have it (My luck, not the patient's), there was a gunshot victim who was brought in.  The nurse kept telling me, "I can't believe you're here for this; we NEVER get stuff like this here...."

I got to monitor vitals, clean some wounds from where the guy fell after he was shot, use a suction cathedar and assist his breathing with a BVM.  The guy was shot in the mouth, and, obviously, he looked pretty messed up.  But I was pleasantly surprised that I was able to do what was asked of me without getting freaked out or throwing up or anything.  I guess I was able to see the importance of what I was doing and that overrode any other feeling of not being able to handle the situation.

Interestingly enough, what did gross me out were the other, much less serious things I ran into that night -- people who had drank too much and were vomiting, etc, etc.  So all in all, at least based on this one experience, I think that I am able to put aside my fears and discomfort when someone needs help.  I just wanted to pass this along to you guys.

Thanks for all your support.  Had it not been for this board, I probably wouldn't have made it through my EMT class.


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