A nugget of EMS organizational wisdom every day. #9 Build strong scaffolding your team can rely on for support.
Answering the siren calling you to be an EMS provider means learning how to deal with the extreme stress that comes with ‘the job’ – and the Stress Gods don’t much care whether you’re in EMS as a career or as a volunteer. Either way there will come a day when some stressor you’ve dealt with successfully for years finds its way into a hole in your mental armor and punches a hole in your soul.
Recognize the toll stress takes on EMS personnel and build strong scaffolding your team can rely on for support when things get so ugly one or more of them wants to crawl into a corner and hide.
First, as a medic and then as an EMS director, I’ve lived some of those moments. I’ve attended far too many wakes, shivas and funerals for medics who could no longer deal with the night and day terrors and took their own lives. I’ve sat at my desk and hit the silent 10-7 [emergency assist] button on my portable while one of my members ran a very sharp knife over his wrists – and on more than one occasion I had to call other EMS teams to our station to help care for one of our own who crumbled under the strain of taking care of the rest of the world on a daily basis.
According to the Tema Conter Memorial Trust, 16- to 24-percent of emergency services personnel suffer from PTSD and by their own admission, the TEMA folks believe that number is on the conservative side due to the stigma associated with seeking and accepting help.
This is a collection of pieces I wrote about the stress that comes with EMS.
I bought a poppy this morning and pinned it to my baseball cap. Too early in the season for some I’ve been told. Much too late for others I know.
The ghost battalion of street medics. Death by stress, suicide, or misadventure. Casualties of battles fought on the road and in their heads. Demons picked-up along the way like black-spirited hijackers waiting for a time to take control.
Politically incorrect to imagine direct links between sudden unexpected death and life wearing the caduceus on your collar or tattooed on your shoulder.
Yesterday I received news that a young firefighter/medic had taken his own life. Another gatekeeper of the cracks who somehow managed to slip into the abyss that exists in the shadows between the ranks of fellow EMS providers.
‘He was a gentle soul who was genuinely caring and a real pleasure to work with’… and he was practiced in the art of self-isolation enough to drift in ethereal misery until he finally capped his own existence.
Jamie Flanz was murdered several Springs ago. His passing had no connection to the EMS world other than the fact that his obvious state of death probably didn’t require a streetmedic to declare the absence of life signs.
He was a good medic and was a gentle, reassuring presence with many of our most senior patients. He put in many a shift at the last minute because I called and asked for his help.
It is the transient and intense nature of EMS that lifesavers often come and go without much in the way of heralding their arrival or their departure. They touch lives and impact universes and then they move on to live the rest of their lives.
There are, apparently, no guarantees on how long the rest of their lives will be. Maybe some of them have an inkling of sunset rapidly approaching and decide to go out flaming while others simply pull the bedcovers up over their heads.
The most vivid memory I have of Mississippi is that of the wind blowing across the gulfside of Biloxi. The air was warm and heavy and reeked of death as it blew through my hair, down my neck and around my ankles. I was enveloped in the sickly sweet and savage stench of the still buried victims of Hurricane Katrina and her tidal wave.
It’s strange how my mind has played tricks with me since encountering that wind.
Somehow that smell — or the memory of it — has become lodged in my brain and that little fragment of hell has freely associated itself with life at home.
Weeks after I had returned home I was loading dishes into the dishwasher and came across a bowl of yogurt that had stayed on the counter too long. Should have smelled like yogurt gone bad. Instead, that wind in Biloxi was blowing through the kitchen. I almost gagged in the sink.
More than a decade ago – seems like only yesterday, I responded as back-up to a call for a 50-year-old patient in cardiac arrest. While rolling I thought I heard the dispatcher say the patient had been found with a plastic bag over her head. I remember thinking to myself “that can’t be right.” The dispatcher didn’t repeat the message and I thought it was because the medic crew was thinking the same thing I was and didn’t question the information provided.
I rolled onto the scene just a few moments after the crew and followed the sound of their voices into the apartment. I passed a somber group of folks gathered in the hallway around the front door. “They’re in there,” a middle-aged man with an L.L. Bean lumberjack-style shirt and a tear-stained face said to me. Heard Jen tell Boris, “No how. No way. EMS1 will be in here in a sec to confirm.” Then to Dispatch, “We’re going to need the police here. Cancel the ambo crew.”
I walked into a bedroom to find the crew looking at the body of a fifty-something-year-old woman recently deceased. She was dressed in stylish pyjamas and was wearing matching sleeping covers over her eyes. Her fingers were blue and her hands were frozen in mid-air as if she had shaken hands with Death when he had arrived. There was a plastic bag covering her hair—crinkled and crumpled and standing straight up like some macabre white plastic chef’s hat. There was an empty bottle of vodka next to the bed and several empty pill bottles scattered among the bed covers. Two sealed envelopes had been found by her brother (the L.L. Bean shirt) who had discovered the scene and had pulled the bag from her face before calling 911.
We sealed the apartment. Shooed the brother and the building manager and the guy from the apartment across the hall out of there. We waited on the police officers who took our report and then asked us to wait outside. They emerged a few moments later with some of the dead person’s identification. “Her name was —— …” There seemed to be a wave of air that came out of nowhere and hit me right in the gut. I felt an enormous weight slam into my shoulders that forced me down to my knees. I heard myself mutter, “Sweet Jesus.” And then I was kneeling on the carpet in the corridor fighting the urge to hurl vomit and bile out of my mouth.
Jen and Boris were by my side in a heartbeat. “Hal, are you all right?!” I was unable to answer at first—too intent on listening to all of the air rush out of my lungs through my clenched teeth. “Yeah. I’m okay.” Wrong answer. I tried to get back up to my feet but my sense of balance had been thrown into temporary disarray. “OhmyGod. I just spoke to her on Friday afternoon.”
She was a colleague of mine—an experienced emergency care provider who worked for a parallel health care organization. We interacted on a regular basis and had forged a strong bond during the Montreal Ice Storm Disaster of 1998. I had seen her practicing the art of caring with elderly clients forced into a shelter by the combination of darkness, cold, and ice. She had been particularly effective with the Holocaust survivors who had retreated into some tormented memories none of us could penetrate. Her combination of compassion and gutsy courage had gotten through to folks living a nightmarish flashback of forced evacuations all those years ago.
My pager went off right then while I was struggling to regain vertical mode. The message read, “Shall I send out a SMART alert?” (SMART is an acronym for our Stress Management Response Team). I radioed Dispatch, “Yeah. For me.” I was really upset that I hadn’t recognized her… as if I somehow should have realized it was her even though I had no idea where she lived. As if one might expect to encounter a friend dressed in her death-best outfit. It was an irrational reaction to a surreal scene. The lead police officer came over and asked if I was okay. “Yeah. I’ll be alright. A couple of wicked bad dreams and I’ll be ready for the next tragic response.”
I cleared the scene and then drove over to that parallel health organization where I broke the news to her colleagues. It was a rough scene. Naomi Cherow, part of SMART, arrived a few minutes after me. Naomi took the lead and walked the staff through a very tough evening of sadness, anger, and lingering unanswerable questions.
I went home and had a couple of wicked bad dreams.
The next night I had a couple more.
Then on the third day a baby boy drank chlorox and by the time I got home I was focused on ensuring all the methyl ethyl bad stuff in our home was securely locked away from the prying fingers of our daughters. No more bad dreams. Although I did have a dream wherein I saw my late colleague sleeping peacefully on a sofa in one of the Ice Storm evacuation shelters. She was surrounded by elderly Holocaust survivors. I could tell they were survivors because of the numbers tattooed on their forearms. One of them said, “She’s our angel.”
I don’t understand suicide. Never have. I can’t imagine anything that could drive me over the threshold of the living and into the valley of the dead. With no opportunity to hook a u-turn and head back home if the experience didn’t pan out the way I thought it was going to go down. It must be a torturous decision to make. I don’t know what drove my friend to the edge of the void and then into the vast beyond of emptiness. I only hope she is at peace wherever her soul has gone.
Be well. Practice big medicine.