PTSD in medics

[bled12345]

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?

 

[Nycxice13]

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

 

[SC_EMT]

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.

 

[Recycled Words]

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

 

[Epi-do]

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.

 

[DT4EMS]

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.

 

[burntbob]

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.....

 

[Recycled Words]

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.

 

[Ridryder911]

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

 

[Glorified]

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

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

 

[BossyCow]

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?

 

[Medic's Wife]

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!

 

[keith10247]

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.

 

[Ridryder911]

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

 

[Summit]

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...

 

[Ridryder911]

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 ..

 

[keith10247]

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.

 

[Ridryder911]

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

 

[keith10247]

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?

 

[Ridryder911]

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