PTSD in medics
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Ridryder911
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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
I agree, money spent could go into a better insurance or agreement to a licensed psych practitioner.
R/r 911
Summit
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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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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?
keith10247
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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.
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.
Ridryder911
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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
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
firetender
Community Leader Emeritus
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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!
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!
firetender
Community Leader Emeritus
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"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.
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.