Mental Health and emergency services

911, what is the address of the emergency? 

Over on the Inside EMS podcast, Kelly "Ambulance Driver" Grayson and Chris Cebollero discuss (among other things) mental health in EMS responders. This is a topic I find near and dear, and one that is rarely discussed in the break room or around the dinner table in the day room.

We have to change this. Not just for field personnel, but for every person in the chain of response.

"What are we not doing for our peers that we're losing these folks in the long run?" Chris asks.

Kelly says, "We're not doing enough as agencies, as peers, not doing enough ourselves in confronting the problem. We want to de-stigmatize mental illness, depression, and PTSD among EMS providers so that people will - rather than do themselves harm - will realize that seeking help and reaching out is not a sign of weakness: it's a sign of strength"

APCO and other organizations often trot out the, "First first responders," line. (My personal feeling is that the phrase is a bit self-aggrandizing, but the concept is sound.) If you've spent any length of time in this world, you've had A Call. Most of us have more than one. I can look back over the last twelve years of volunteer field time and ten years on the console and pick out an easy half-dozen calls that have stayed with me for one reason or another.
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One of those incidents was a juvenile homicide. I took the call, which was just off initially - it was reported as a general illness. I sent a response - an upgraded response, actually, because I trusted my gut - and moved on with my shift. The ER called later in the evening to ask for the investigator's name handling the homicide, and that's when it hit me. I spent the remainder of the shift second-guessing how I'd handled the call, stewed about it that night when I was at home, and the next evening when I got to work I was asked if I wanted to attend the Critical Incident Debriefing with the law, fire, and EMS personnel who'd responded.

Nevermind the inflection and headshake my manager gave me as the question was asked; I was early in my career and I was still invincible. Me? A mental health debriefing? Perish the thought. Beyond that, I felt I'd have been an outsider. I'd just answered a phone and punched a few tone pairs... how could that match up against doing pediatric CPR?

I was wrong.

Write this down and remember it: I am as much a part of the call as the crews on scene.

We hear the pain and anguish of a caller. We try to coach a distraught family member through the first few minutes of CPR. Very few of us ever get the closure of a crew in the field knowing that everything that could be done, was done. (For the field providers who might read this, please understand that this isn't a question of trust - I believe you are all doing the best you can for every patient. Knowing something is being done and knowing are two different things.)

In the intervening years, I've hashed that call out with a handful of peers. I've replayed the call a thousand times in my head. Every person I've talked with says I didn't do anything wrong. Every time I wonder if there was some cue I missed, I hear the call again ... and I didn't.

I've accepted this. I handled the call right. There was nothing I could do that would have changed the patient's outcome.

Would someone please tell that to the ghosts?
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Kelly and Chris are right. We aren't doing enough.

I've learned to handle my demons most of the time. I changed departments and picked up a few new ones in short order. I share some of the calls with my loved ones, and I occasionally do raise a glass to the ones I couldn't save.

I've started taking walks at work when something hits me wrong. It's not weak to ask someone to cover your lines for fifteen minutes while you walk away. If you need more than fifteen minutes, take it. Take a shift. Talk to a coworker. Talk to a therapist. Talk to a chaplain. If your department has a CISM team, don't be afraid to use it. If your department doesn't have a CISM team and/or EAP and/or chaplain, take some initiative and find out where to get those services.

And above all, don't be afraid to reach out to each other. If someone takes a rough call, invite them for a cup of coffee after shift. Let them take the conversation where they will. Sometimes, all we have to do is be there.


Call me back right away if anything changes.

Slow start

911, what is the address of the emergency? 

I have a laundry list - literally pages long - of topics I'd like to cover in the coming entries. Some of it will be management-oriented, and some of it will be dispatcher-oriented... and some of it will be public-oriented.

It's going to take a while as I find free time to sit and write a post that feels "right" to me.

If there's something you'd like to see me discuss in these pages, let me know. If I can, I will.

Call me back right away if anything changes.

Stroke Signs

911, what is the address of the emergency?

This post was prompted by a similar one written by a friend.

A stroke is a no-foolin' life-changing (or life-ending) emergency. In short, a stroke is a brain attack: some portion of the brain stops receiving blood (and thus oxygen) due to a blockage of some kind. Precisely where the blockage happens and how soon it's cleared determines the type and severity of damage.

Know the signs:
F - facial droop
A - arm weakness
S - speech problems
T - time to call

Any one of the first three is a strong hint of a stroke. A combination of two or all three? We've gone from "hint" to "flashing neon signs", and now time is critical.

Thrombolytic therapy (super-duper clot-busting drugs) is the best therapy for most strokes, and the generally-accepted window for getting the thrombo's into the patient is three hours from the onset of symptoms. After that, damage seems to be pretty permanent.

If you're having signs of a stroke, the time to call is right now. Not at half time. Not after Thanksgiving dinner. Not after you've showered and dressed. Right. Now.

Call me back right away if anything changes.

A quick note on privacy

911, what is the address of the emergency?

I am extremely conscious of the restrictions that HIPAA places on me. I will share some of the details of some calls in the future... but I'm not going to get into city or state. I will not write posts immediately after an incident, won't give a date, and I'm going to change things that aren't generally relevant or may otherwise identify an incident or patient... because you don't need to know.


Call me back right away if anything changes.

Welcome back

County 911, do you need police, fire, or ambulance?

After a far-too-long hiatus, I'm reviving my efforts at this blog. There has been a lot of life intervening in the nearly four years since I first got the idea.

I've got a lot of entries on my mind. Don't touch that dial!