PTSD/unprocessed trauma

[E tank]

This being an area of interest to me, I'm interested in folk's experience with this that is purely job related. Not childhood/family trauma or military related PTSD...just the effects of coming into medical/law enforcement settings that are traumatic to witness/manage over time starting at a more or less "normal" baseline.

One reason that I put it out there is that LEO/fire gets a lot of the attention and resources for this kind of thing while purely EMS gets lumped in with hospital personnel where there is effectively zero attention paid to the issue which, in my experience, is no bueno down the road.

So for everyone, do you make an intentional effort to manage by way of counseling, peer support, significant other support etc. the psychologically traumatic events you witness? Or is it pretty much Choir Practice with your buddies and call it a day?

 

[mgr22]

I've found little benefit in sharing traumatic events with others. Maybe that's because no two experiences are exactly alike, or maybe I've had unrealistic expectations about sharing one's experiences. In any case, time, thought, and patience have worked best for me.

I realize that contradicts a whole lot of modern thinking on this topic, and I'm not saying what I do is better than what anyone else does. This isn't like treating obvious physical ailments using generic guidelines; it's intensely individual and extremely variable. In my opinion, finding what works best for each of us should be limited by only one restriction: Don't hurt anyone else.

 

[Tigger]

For me, I lose my mind if I don't talk with the crew about a "bad" call. I guess because of my own personality, it is very helpful for me to go through, in nitty gritty detail, what happened and why we did what we did. I think this helps me cut down on "what-ifs" down the road, which can certainly eat you up. As the lead provider, I can do this (I think) without worsening someone else's experience by making them feel like they did anything wrong, because anything they did is my responsibility and I will own that at all costs. Nor do I think it is mandatory to participate in this, but for the most part the crew wants to do this and have in fact called on our battalion chief to facilitate a "time out" when other companies are involved so everyone can get together.

 

[E tank]

Really depends on the individual, of course, but what I've observed is what happens over the course of a career. Stuff happening at home that isn't seen to be associated with unprocessed trauma seeps into family/marriage life and really takes a toll over time. Stuff like short fuse syndrome or discipline over reactions with kids etc. The danger is to get 25 or 30 years into a career only to look back on it to see that a lot of family problems could have been avoided with some sort of awareness that this stuff affects people and their lives adversely.

 

[Peak]

I don't think that I have any kind of PTSD from EMS; however it has certainly made me quite jaded to adult care and adult behavior in general.

Unfortunately after having worked Fire/EMS and then ED for so long I tend to see a lot of the secondary gain and selfish interest by most people in society.The more time I spend taking in adult medical care the more it seeps into my life outside of work. I dislike that I become disinterested in the outcomes of many of my patients, I didn’t get into healthcare to not care.

Personally this means taking time away from adult care. I take pride in being able to provide adults high level care, but I know that I have to do it in moderation or I will get burned out. Often it just means taking a break from the adult services until I feel good enough to go back.

In my experience most 911 services pay more lip service to debriefing and after event care than real interest. It is unfortunate because in my opinion having seen those patients come back and die a slow death or the days/weeks of seeing a family suffer is often far more traumatic than the quick demise that is often attributed to trauma in the field.

Likewise many of the child abuse cases that cause so much trauma in the field can have some very good outcomes. There was a NAT I took care of when I was in fire that haunted me for a long time. It was only several years later when I ran into that kid again that I got to see him placed in a foster home and thriving.

 

[mgr22]

Really depends on the individual, of course, but what I've observed is what happens over the course of a career. Stuff happening at home that isn't seen to be associated with unprocessed trauma seeps into family/marriage life and really takes a toll over time. Stuff like short fuse syndrome or discipline over reactions with kids etc. The danger is to get 25 or 30 years into a career only to look back on it to see that a lot of family problems could have been avoided with some sort of awareness that this stuff affects people and their lives adversely.

I can certainly imagine all that happening, but I wouldn't know how to convince a new EMT that such risks exist. When I was in my 20s, I disregarded lots of good advice. Then I watched my kids do the same. I don't think I've seen any well-meaning warnings lead to behavior-changing, life-altering awareness.

Maybe the best we can do is understand why the stuff you mentioned happens, so that when it does, the wrong causes or people aren't blamed.

 

[E tank]

I can certainly imagine all that happening, but I wouldn't know how to convince a new EMT that such risks exist. When I was in my 20s, I disregarded lots of good advice. Then I watched my kids do the same. I don't think I've seen any well-meaning warnings lead to behavior-changing, life-altering awareness.

Maybe the best we can do is understand why the stuff you mentioned happens, so that when it does, the wrong causes or people aren't blamed.

When I was coming up in the early 80's, I was still a teenager. The EMS/Fire/police culture had no idea this stuff was even on the radar. There was awareness that some Vietnam guys were imploding but that was attributed to that particular war. All the while our parents were dealing with alcohol and anger coming out of WW2. No one connected the dots. And certainly no one saw any relationship to the war veteran's dynamic and ems/fire/police issues.

That said, it's my opinion that academies and training programs really need to devote a couple of hours to at least plant the seed that this kind of thing happens, what the real day to day effect of it is, how to recognize it, and how not to make it worse. At the very least it would maybe mitigate the effects of burnout and job turnover.

You're not going to see the real serious stuff until you're at least 7 -10 years in and I'd say most folks don't even stay in a purely EMS role for that long so I guess the problem stays under the radar. Like I said, police and fire do a lot better job at this kind of thing.

 

[johnrsemt]

I do better being able to talk to co-workers about stressful situations that have happened in the past, than talking to counselors.

Not specifics but just general; sometimes not even what happened to me; but helping other crew members talk through what is bothering them after a bad run that happened when I was off.
Or 'hey remember the run a year ago' leading down the path of crap wandering through my mind. Can't talk to family members about it, too expensive to talk to counselors about it.

 

[E tank]

I do better being able to talk to co-workers about stressful situations that have happened in the past, than talking to counselors.

Not specifics but just general; sometimes not even what happened to me; but helping other crew members talk through what is bothering them after a bad run that happened when I was off.
Or 'hey remember the run a year ago' leading down the path of crap wandering through my mind. Can't talk to family members about it, too expensive to talk to counselors about it.

Not talking to family members was a mistake I made. Just couldn't bring myself to do that but it wasn't because I thought they wouldn't handle it. I had it in my head they wouldn't understand, which is true to some extent, but understanding, I later realized, isn't really necessary.

It would have been a lot better than unloading to co-workers over alcohol which was the sum total of my processing for years.

 

[johnrsemt]

E tank; I am glad I never went the route of unloading over alcohol; but I do have the problem of family not understanding and not wanting to hear about it (Direct quote from my wife a few times, that and you need to keep it to yourself).
Well keeping it to my self doesn't work so well sometimes

 

[jgmedic]

E tank; I am glad I never went the route of unloading over alcohol; but I do have the problem of family not understanding and not wanting to hear about it (Direct quote from my wife a few times, that and you need to keep it to yourself).
Well keeping it to my self doesn't work so well sometimes

I have the same issue. It makes it much harder

 

[E tank]

I have the same issue. It makes it much harder

That has got to be really tough for you guys and it's a big reason why some more forward thinking departments have seminars dealing with this stuff where spouses are invited. Once spouses are clued in on the realities of day to day ems/fire/police work things can get a lot better. In the meantime, seek out department chaplains or even police victim witness advocates if your local agency has them. They're for you too if you approach them.

 

[johnrsemt]

Where I work now, we don't; we do have a military chaplain, so they help since they are used to dealing trauma (different type, but close enough).

 

[DragonClaw]

With my boyfriend he is more than happy to hear about my good and bad stuff. He's very supportive, it helps when they wear a uniform. I'm sure there's cons to it, but that's not one.

Plus he's very kind and patient regardless.

You say not family or childhood trauma, but mine starts to blend together. I don't think I can really separate. Each make the other better or worse.

With the suicidal girl the said she wanted to jump, I thought of my own brother. He jumped from a very tall dam that I considered following in suit, and hearing drum this girl how she wanted to jump.

I couldn't speak. I didn't know what to say. I wanted to hold her and tell her all the reasons you shouldn't. And that help is out there. And she can have a good life and all of that.

She mentioned how her mom said she'd get her counseling but didn't.

Then my FTO told her later how her mom (who showed up) wanted to help her.

Coming from my family, if someone had told me my mom was trying to help I would have immediately known they would not have listened to me or believed me or was on my side. I would not have trusted them, I would have lied to them about anything I thought was sensitive info and such. I would have told them all the things they wanted to hear just to make them happy and leave. And then go on believing nobody truly wanted to hear me. And use that as proof as to why I should go up to the dam and do what I thought of.

But instead, I said nothing. I didn't know how to process it all at once. I was a coward, I was weak, I took too long to think and make up my mind.

And my FTO and the medic got mad at me after the call because I wasn't building rapport with the pt and such. And I just couldn't put it all into words to them and mostly took the beratment.

I briefly mentioned the thing with the mother and they honed in on that and acted like far was my fixation as to why I uselessly stood there.

And I just couldn't tell them all what I wanted to say or how I felt. I didn't think they'd understand or something. And it felt weird to just expose my past to them and feel so vulnerable while on camera.

It's been years and years and yesterday I saw on my desktop a folder named "Interviews". I thought it was the past interview materials I'd used. Like my resume. But then it all came back. It was the files I saved from the disk that had the video interviews of the witness from my brother's suicide.

How poetic. I say this sourly.

I didn't watch them. I don't know if I want to again. But I think about it a bit now.

Maybe I should. Why should I forget?

But here I go tangenting...

It's just too hard to keep separate

And I think of that girl. The freshly dyed hair with the color still on her hands. The scene. My heart being the loudest thing sometimes. And I know I've been a **** EMT.

 

[mgr22]

But here I go tangenting...

It's just too hard to keep separate

I don't think most of us are equipped to thoroughly segregate our personal lives from business; or to ignore bad experiences while embracing good ones. I believe everything that happens helps define us. It's easier to accept that definition and reshape it over time than deny it exists.

 

[E tank]

I don't think most of us are equipped to thoroughly segregate our personal lives from business; or to ignore bad experiences while embracing good ones. I believe everything that happens helps define us. It's easier to accept that definition and reshape it over time than deny it exists.

It is odd...I'm always amazed at the vast (apparent) difference of the coping of different providers to the same event. Some just seem to "have it all together" and others...not so much....no correlation in intelligence, clinical skill, maturity...whatever...one person is ready to quit the job one is on to the next thing......I wonder to myself...do they not see the bodies piling up? Am I the only one?

 

[E tank]

It is odd...I'm always amazed at the vast (apparent) difference of the coping of different providers to the same event. Some just seem to "have it all together" and others...not so much....no correlation in intelligence, clinical skill, maturity...whatever...one person is ready to quit the job one is on to the next thing......I wonder to myself...do they not see the bodies piling up? Am I the only one?

So...that was pretty morose...we save way more than we don't...but we focus on the dead sometimes more than we should or have reason to...it's just that each fatality has that much more significance than the last and each success doesn't seem to have the cumulative effect as the fatalities do and it just adds up sometimes....just an f'in awful 5 days....

 

[mgr22]

It is odd...I'm always amazed at the vast (apparent) difference of the coping of different providers to the same event. Some just seem to "have it all together" and others...not so much....no correlation in intelligence, clinical skill, maturity...whatever...one person is ready to quit the job one is on to the next thing......I wonder to myself...do they not see the bodies piling up? Am I the only one?

I think the different ways people cope are analogous to the different ways people eat, dress, work, relax, etc. We try to figure out what works best as individuals. Sometimes we just need a little help -- e.g., a new diet, a new hobby, a new way of coping. Experiment. Accept less than total solutions -- losing five pounds instead of ten, finding something or someone you like a lot but maybe don't love, doing a job that's often stressful but fulfilling some of the time.

 

[Bishop2047]

One of the companies I work for has a pretty strict algorithm. If a call meets certain criteria (such as suicide, gross traumas involving minors or relatives, peds codes) the crew is immediately put out of service and meets with our peer support team. The initial meetup is very informal and really just to give you the option to go home or seek out help in that moment, then you can hit the road again. Afterwards (days or weeks later) there can be a debriefing that includes Nurses, Dr, and dispatchers. Otherwise they make all the regular stuff available to you and your family like mental telehealth, and more traditional therapy.

I have had crappy days and crappy calls, but don't believe I have been affected too much by the job in a negative manner. That said I am glad they do this, as I can not guarantee that this will always be the case.

 

[DragonClaw]

One of the companies I work for has a pretty strict algorithm. If a call meets certain criteria (such as suicide, gross traumas involving minors or relatives, peds codes) the crew is immediately put out of service and meets with our peer support team. The initial meetup is very informal and really just to give you the option to go home or seek out help in that moment, then you can hit the road again. Afterwards (days or weeks later) there can be a debriefing that includes Nurses, Dr, and dispatchers. Otherwise they make all the regular stuff available to you and your family like mental telehealth, and more traditional therapy.

I have had crappy days and crappy calls, but don't believe I have been affected too much by the job in a negative manner. That said I am glad they do this, as I can not guarantee that this will always be the case.

I read something that showed mandatory CISM does more harm than good. Anyone else heard that?