At EMS Office Hours, Jim Hoffman looks at when an EMS provider should seek out psychiatric help to deal with their job experiences. He exhibits the same cultural blindness that permeates EMS and prevents us from becoming a real profession.
It’s not his fault, it’s mine! I was one of the guys that formed the culture in the 1970s by buying in to Johnny and Roy, master technicians but without an ounce of human wonder (or frailty) in their bones.
This is what I passed on to you and I’ve come back to tell you “I goofed!”
I apologize, I have to amend that earlier statement, I’ll give Johnny and Roy an ounce! According to an “unofficial” EMERGENCY! fan website, on their character profile pages it says:
Johhny Gage: Occasionally he becomes emotionally involved with his victims, like the time he agreed to take care of a victim’s dog.
Roy DeSoto: Though Roy often warned Johnny about getting too involved with their victims, he’s been guilty of it himself: once he took a victim’s son into his home for several days (the child reeked havoc) and another time he agreed to take care of a victim’s plants.
Yes, they had to deal with deaths of people close to them, and non-work related technical difficulties but nowhere in the series was attention paid to the reality of the paramedic’s working experience: a slow accumulation of work-related (directly or tangentally) assaults on the psyche that accumulate and eventually overwhelm the human being.
Oh my, isn’t that Burnout! Could be! And isn’t burnout what keeps EMS the Profession that never was?
Greetings from the Professional Unicorn-Tetherball Association!
Besides the fact I’m building a bomb shelter to protect me from being assaulted by Johnny and Roy fans, sometimes it feels like I stand alone when it comes to my prognosis that EMS will not become a profession until it learns to support the needs of the human beings doing the work.
My premise is simple; EMS is NOT a profession because enough people do not stick with it long enough to make the changes that are needed to MAKE it a profession. We’re talking the average shelf life of an ambulance medic is 4 years. What better statistic than that to illustrate how what has become a transient’s job description doesn’t have a chance in hell to make it as a profession? Here’s my source:
Please, let me know if I’m on the wrong track here:
Is it not generally believed in your service that if you exhibit on-the-job signs of human frailty about how you deal with calls, patients, personal relationships, your partner, your supervisors, or governing agencies both your peers and management begin to call into question your ability to respond professionally in an emergency? There is an onus on SHARING your human experiences.
Not all, of course; lots of people step up to the plate when the kids die. But how much talking, let alone rallying behind goes on when you are shook to tears when asked by a 90 year-old if they have a chance, you know they don’t, and you lie by saying “we’re-doing-everything-we-can”?What no one hears is that for you, this was a breaking point because something about that person reminded you of the Grandparent YOU loved but couldn’t help. Nope, this glitch is far too personal!
My point is, everyone has his or her hot button and there’s no one to turn to for help in even recognizing it!
I’d hazard to guess everyone, sometime in the beginning, spews about such incidents. But they quickly learn 80% of their peers are not too interested and the remaining 20% who might be, don’t make it obvious that they are available for such conversation. That 20% is largely in the closet.
We’re not supposed to talk with each other, Jim, as if such things like our human experiences mattered. But they do and what I’m saying is it is NOT the professional experiences that drive our personnel away but it is our human reaction to such experiences that drive us out the door! Right now, there’s little, if any, outlets for us to take care of ourselves AND each other in this common experience of being in EMS.
How many, if ANY of us are asked “Why?” when we limp out the door? (See this blog!)
I say our FIRST line of defense is to create safe spaces and outlets for EMS personnel to talk with each other honestly about their experiences. And I don’t think that any of our employers are going to do this for us. It’s likely if they do, it would not be fully taken advantage of precisely for the fear of judgment of participants ability to do the work.
Funny, isn’t it, considering a high percentage of us do just that while carrying significant burdens from the past!
It’s something we have to tweak our own culture to accommodate and it’s simply a matter of making more room for more honest and supportive conversations. There are no high-pressure release valves available to us unless we create them. We’ve been doing this alone — and often through less-than-healthy outlets – but now it’s time to build something with each other.
Let’s start there.
By the time most medics are ready to ask for formal, psychiatric help, it’s too late. Long before the medic him or herself decides to take that step it is usually (as Jim notes) significant others that start putting the pressure on to seek assistance. Seeking psychiatric help is a last resort, and then, if it is done right, it takes a lot of time to unravel the individual instances of trauma that grew into enough pain to prompt getting help.
Dredging out old stuff is usually much more traumatic than facing stuff as it comes up. And quite frankly, there are few professionals that really understand the territory we are asked to traverse. The simplest and most cost-effective way to deal is to work with each other, the ones who’ve been there.
The truth is, by the time you get to a shrink, odds are, if he/she is worth his/her salt, you’ll be advised to work for the Post Office — well, maybe not the Post Office because they’ve become famous for developing dysfunctional outlets — but you get my point!
The culture of EMS is all about silence when it comes to facing the demons that abound there. This is true in medicine as a whole — our experiences as human beings are NOT within our job descriptions! But with EMS, the assaults come in from many directions, at a steady (and sometimes crushing) rate. EMS is a pressure-cooker environment that stresses our people on multiple levels that include physical, psychological, emotional, moral, psychic, spiritual and philosophic issues — one call at a time.
(Here’s where I knew it was time for a perfect illustration so I searched the internet for images
of “paramedic in distress”. After viewing (no kidding, I got obsessed!) about 2,000 images, this
is what I came up with, and he’s smiling, oblivious to the importance of my blog! CREDIT)
My impression is that today MAYBE 20% of medics would find benefit in having peers with whom they could share their experiences and processes of self-discovery with; both positive and negative. The strongest facilitators would likely be within those personnel who have been most traumatized by the job. The ones who did the most personal work on facing and moving through their challenges would probably provide the backbone of this new clultural orientation.
I also KNOW that 100% of medics are traumatized by SOMETHING during their experience.
So can you imagine a culture where there is a safety-net incorporated into every system where there is at least a place and time, on a regular basis, for medics to go to for the purpose of working through the conflicts heaped on them by the job WITH each other?
I’m not talking for traumatic experiences alone I’m talking with enough time to experience the wonder; reaffirming why most of us got involved in this in the first place; something to do with making a difference if I remember correctly!
Spend a few minutes with this video and ask yourself a question: Does the culture we have in place accept this kind of emotion? Even though it’s geared toward her profession (which, by the way, in Queensland, Australia EMS really IS one!) there has to be something about the culture of EMS there that supports her blatant honesty.
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…and consider one more thing; this is what a professional within a known and recognized profession gets to say to a public that accepts EMS AS a profession. Generally, the U.S. audience does not know about what we do well enough and doesn’t respect us enough to really be open to hearing such things. It seems to be a very caring profession over there, doesn’t it? (In other video series from Down Under I’ve detected a bit more of what I’d call a “Culture of Mutual Support” there, much to my delight!)
How can we get there, Jim? I say by starting to support each other as human beings so we can make EMS a profession here in the states.
P.S. understand that burnout is by far NOT the ONLY problem that prevents EMS from being a real profession, it just hobbles any other attempts to make it one!
P.P.S. One more failed attempt at brevity; my condolences!