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.