Hello all,
My name is John and I am looking for advice, input or general suggestions concerning a project myself and a colleague are currently trying to get off of the ground at our service. I apologize in advance if this initial post is a little wordy, but I want to provide as much background as I can to elicit a good discussion. I also want to thank you in advance for any assistance with this project.
A little background about myself and the service I work for. I am a critical care paramedic (FP-C, CCEMTP), Field Training Officer and SWAT medic for a large metropolitan service. Our service area is approximately 300 square miles, servicing the gamut of urban, suburban and rural communities. We average approximately 60,000 calls for service per year, not including wheelchair, BLS and critical care transfers. We primarily operate in a medic-medic capacity due to legislative mandates in the county we serve. Our ground critical care units are staffed with an RN and CC medic. These numbers only represent our metro division; we also have out state divisions that service more rural outlying communities throughout the state, as well as a 7 ship rotor wing division that performs both scene flights and inter-facility transports that services a large portion of the state. Our metro division (where I work) currently employs approximately 150 wheelchair drivers, EMT's medics and nurses. We are a hospital-owned system, and that hospital is Level 1 trauma center, comprehensive stroke center and has multiple other Level 1 designations.
The project we are working on is based in one question: how do we care for our own after they take care of others? Since I have been a medic, I have witnessed many of my coworkers deal with job related, or more specifically duty-induced PTSD, stress, anxiety and depression. These issues don't have a singular cause, but as you may know are often a result of burnout, high acuity calls (pediatric arrests, line-of-duty deaths, significant trauma, etc.) and other stressors. These events can often have a far reaching impact, not only professionally, but personally. Marital and family issues, drug and alcohol dependence and suicide are all possible outcomes. These events can also lead to poor work performance, lack of focus and poor patient care. I have personally witnessed high acuity events affect my friends and coworkers this way, and have experienced it to a degree myself. I assume that those of you reading this have some experience in this as well.
The response to these sort of events, in my experience, has been lacking. The typical process of a CISD, while helpful to some, may not be enough, and may be actually harmful. I personally am not a fan of the traditional CISD approach, and I'll explain why. When I am a part of a high acuity call or event, I have my own perspective of the event that I have to reconcile. When I am a part of a CISD, I now add on the collective perspectives of everyone else involved. These may not have been feelings or sides of the story that I considered before, and I typically end up feeling worse for the patient and everyone involved (even if I logically understand that there may have not been anything else I could have done). I usually chose to recuse myself from these gatherings, unless I feel that my input with help others deal with the trauma. Again, these are my feelings alone; I understand that this process may be helpful to others.
We also feel that in EMS we have a "it's just part of the job, shut up and deal with it" mentality when it comes to these events. This is often followed by "if you can't deal with it, you're obviously not tough enough and this job isn't for you" sentiment. I absolutely agree that a successful paramedic, EMT or first responder requires a significant degree of mental, physical and emotional resolve. However, the dismissive nature of the aforementioned sentiments provides no benefit to ourselves or our coworkers.
So, the questions we asked ourselves are: how do we respond proactively, instead of reactively? How can we get ahead of these problems before they manifest into something more sinister? How do we take care of our own? My colleague and I began by doing what every medic/EMT does; get a certification. We went to classes becoming certified in suicide intervention and crisis debriefing. We then started brainstorming how we could make an organizational process. Here is what we have so far:
My question to you all is if you have something similar to this at your organization/company, and if so is it similar? How does your service approach these events and the potential fallout after? Do you have any suggestions or feedback on our approach? Is there anything that we aren't considering or thinking of?
I would like to thank those of you who made it to the end of this thread, I know it is very long and involved. This is a topic that is important to us, and we want to make it work. I thank you all in advance for participating and providing any suggestions you may have. Stay safe out there.
John B
My name is John and I am looking for advice, input or general suggestions concerning a project myself and a colleague are currently trying to get off of the ground at our service. I apologize in advance if this initial post is a little wordy, but I want to provide as much background as I can to elicit a good discussion. I also want to thank you in advance for any assistance with this project.
A little background about myself and the service I work for. I am a critical care paramedic (FP-C, CCEMTP), Field Training Officer and SWAT medic for a large metropolitan service. Our service area is approximately 300 square miles, servicing the gamut of urban, suburban and rural communities. We average approximately 60,000 calls for service per year, not including wheelchair, BLS and critical care transfers. We primarily operate in a medic-medic capacity due to legislative mandates in the county we serve. Our ground critical care units are staffed with an RN and CC medic. These numbers only represent our metro division; we also have out state divisions that service more rural outlying communities throughout the state, as well as a 7 ship rotor wing division that performs both scene flights and inter-facility transports that services a large portion of the state. Our metro division (where I work) currently employs approximately 150 wheelchair drivers, EMT's medics and nurses. We are a hospital-owned system, and that hospital is Level 1 trauma center, comprehensive stroke center and has multiple other Level 1 designations.
The project we are working on is based in one question: how do we care for our own after they take care of others? Since I have been a medic, I have witnessed many of my coworkers deal with job related, or more specifically duty-induced PTSD, stress, anxiety and depression. These issues don't have a singular cause, but as you may know are often a result of burnout, high acuity calls (pediatric arrests, line-of-duty deaths, significant trauma, etc.) and other stressors. These events can often have a far reaching impact, not only professionally, but personally. Marital and family issues, drug and alcohol dependence and suicide are all possible outcomes. These events can also lead to poor work performance, lack of focus and poor patient care. I have personally witnessed high acuity events affect my friends and coworkers this way, and have experienced it to a degree myself. I assume that those of you reading this have some experience in this as well.
The response to these sort of events, in my experience, has been lacking. The typical process of a CISD, while helpful to some, may not be enough, and may be actually harmful. I personally am not a fan of the traditional CISD approach, and I'll explain why. When I am a part of a high acuity call or event, I have my own perspective of the event that I have to reconcile. When I am a part of a CISD, I now add on the collective perspectives of everyone else involved. These may not have been feelings or sides of the story that I considered before, and I typically end up feeling worse for the patient and everyone involved (even if I logically understand that there may have not been anything else I could have done). I usually chose to recuse myself from these gatherings, unless I feel that my input with help others deal with the trauma. Again, these are my feelings alone; I understand that this process may be helpful to others.
We also feel that in EMS we have a "it's just part of the job, shut up and deal with it" mentality when it comes to these events. This is often followed by "if you can't deal with it, you're obviously not tough enough and this job isn't for you" sentiment. I absolutely agree that a successful paramedic, EMT or first responder requires a significant degree of mental, physical and emotional resolve. However, the dismissive nature of the aforementioned sentiments provides no benefit to ourselves or our coworkers.
So, the questions we asked ourselves are: how do we respond proactively, instead of reactively? How can we get ahead of these problems before they manifest into something more sinister? How do we take care of our own? My colleague and I began by doing what every medic/EMT does; get a certification. We went to classes becoming certified in suicide intervention and crisis debriefing. We then started brainstorming how we could make an organizational process. Here is what we have so far:
- Development of a team of peers who are designated for "emotional first aid". This team will vary by age and experience to reach every social group in our organization.
- Integration with dispatch, so the team can be automatically notified when a high acuity event occurs (pediatric arrest, line of duty death, etc)
- Immediate contact with crew following event. This will be done in person ideally, but by phone if possible. No texts or social media communication.
- Implementation of a mandated time frame after the event where the crew is out of service. This allows time for the team to contact the crew, and for the crew to defuse on their own terms. Get coffee, eat, be alone, etc. That time is theirs.
- Mandated follow up at predetermined intervals. Currently we do 24 hour, 72 hour, 1 week, 2 week and 1 month check ups with the crew. People are individuals and experience trauma differently and in different time frames.
- Consistency in follow up. Whoever makes first contact with the individual or crew maintains contact and follow up. This way, the effected crew doesn't have to relive the event and explain themselves to a new person multiple times.
- Development of relationships with mental health professionals either within or outside the organization if escalation is necessary, and of course with the individuals consent.
- Time off without repercussion if necessary.
My question to you all is if you have something similar to this at your organization/company, and if so is it similar? How does your service approach these events and the potential fallout after? Do you have any suggestions or feedback on our approach? Is there anything that we aren't considering or thinking of?
I would like to thank those of you who made it to the end of this thread, I know it is very long and involved. This is a topic that is important to us, and we want to make it work. I thank you all in advance for participating and providing any suggestions you may have. Stay safe out there.
John B
