One night, I heard someone at a cocktail party make a flippant remark about rescue workers. We were talking about the fires burning up and down the Rockies and the unadulterated moxie that’s required to sign up for the job of extinguishing them. The guy waved his hand dismissively and said, “Ah, they’re all a bunch of adrenalin junkies.”
He annoyed me because he had recently been saved by EMS providers during a cardiac event. But he got me thinking about why people choose rescue work, and what makes them jump into forest fires when everyone else is running the other way.
I know it’s axiomatic that first responders are a special breed. They hang on thin cables from 200-foot bridges to save people who don’t want to be saved; they jump into freezing waters to yank out people who might already be gone; they stand in front of bullets aimed at other people.
What drives them? When everyone else is running down Broadway—and for good reason—these men and women are running up. Are their instincts backwards? Are they all fearless? What motivates behavior like that on a consistent basis?
In more than 20 years of treating and working alongside first responders, I’ve noticed that people’s motivations for becoming EMTs, paramedics, firefighters or law enforcement officers are as different as the people themselves. Although the behavior is similar, it isn’t all the same.
I’ve found five general motivations or themes, including the one that fellow at the cocktail party pointed out.
The Love of Drama
This can, but doesn’t necessarily, involve an addiction. Some people simply have a low threshold for monotony and need to experience “spikes” in their lives more frequently than others. It often results from a form of fearlessness.
Any situation requiring a rescue operation contains either dangerous or potentially dangerous elements. A number of people in rescue work are attracted specifically to these dangers.
In order to rescue the victim, the rescuer has to face the victim’s danger. Even if the main danger has struck and passed, additional dangers are still often present. Hopefully the difference between the victim and the rescuer is that the rescuer is better able to cope with or handle the situation because they have additional training, experience and skill.
Some of the people who have come to me for treatment have had an internal imbalance that predisposes them to seek constant external stimulation. This often predisposes those same rescue workers to be equally reckless with themselves, often showing a marked interest in extreme sports that lean them over the literal and figurative edge.
Some signs of this reckless nature might be an enjoyment of extreme sports or exhibiting focused but impatient qualities. As long as their needs for “rushes” don’t complicate or compromise the quality of their work, these “drama junkies” are at home on the front lines. These “drama junkies” can be highly impetuous, quick-minded and sure of themselves. They may sometimes be deluded that they’re impervious, and they may appear stress hardy until they pass their threshold. Then they often make mistakes and break down, just like everyone else. Their problem is only that they don’t believe they have a threshold. For that reason, they may get injured or killed on the job.
A high percentage of the first responders I have treated have come in with personal histories of trauma in addition to those they suffer on the job. The statistics are telling: Approximately 3% of the population has symptoms of post-traumatic stress disorder (PTSD) and15 to 20% of EMS personnel being diagnosed with PTSD.(1,2)
Some have dealt with the trauma psychologically and emotionally. Some have not. The people I’ve treated have often found their way into EMS as an unconscious attempt to fend off their own fears by constantly confronting them, or to work on them vicariously through the lives of others.
But it’s not always about self-protection or control. Sometimes, it’s about recognizing a need and filling that need. An example comes from Placitas (N.M.) Fire Brigade volunteer and New Mexico forester Mary Stuever.
“My first experience with EMS was when they showed up at my door the morning my four-month old daughter died. We woke up and found her cold and blue. We were young and couldn’t fathom that she was dead already,” she said. “After processing it, I realized that—beyond losing Karen—some aspects of the experience were truly horrific. On the EMS side, they responded to a blue corpse, trying to revive her but knowing it was futile. And no one really spoke to us; they just kept at it till they got to the hospital. At the emergency department, the doctor on duty was indignant that they even tried to revive her and we couldn’t see for ourselves that she was dead. We were in shock.”
Stuever said she learned from the experience that bad things happen, often without reason or culpability.
“We just need other people to be there who understand and can help when those things do happen,” she said. “So, about a year after Karen died (February of 1985), I joined the Placitas Fire Brigade as a volunteer, became a captain for about five years.”
Because the experience was so traumatic for Stuever, she transformed the experience into a way to give to others what she did not get.
Using our trauma to help others is healthy when we’ve done our own homework. The danger is when we stay unhealed and unconscious. In our lack of self-awareness, we persist in using the crises of others as ways to relive our own traumas. But without some help or deeper understanding of what we’re doing, we can wind up not only compromising our ability to help others who are afraid by losing ourselves in their pain and fear, but re-traumatizing ourselves in the process. For more information on retraumatization, check out http://ci.columbia.edu/w0521/web/s1/inner/w0521_s1_3.html
The task for those of us who fall into this category is to have an elevated self-awareness. All experiences are learning experiences, but we have to know who we are and where we begin and end to be there for the patient.
Empathy & Servitude
Some of the most extraordinary displays of loyalty, love and compassion I’ve seen come from the dispatchers, cops, firefighters, EMS providers and emergency department triage teams who are motivated by empathy.
One of these is David Turner, an EMS educator and paramedic in Albuquerque. Turner said he fell into EMS because he hated feeling powerless to help others. “I was driving a delivery van bringing pharmaceuticals to drug stores and I used to see a lot of car crashes in upstate New York. And I felt really helpless not being able to do anything. So I took a first aid course and one of the guys I met was a volunteer firefighter. It never crossed my mind for myself because I saw them as big huge heroes. And I didn’t see myself that way,” he said. “I became a firefighter first as a volunteer in Mahopac, NY, and I remember my first call. It was a cardiac arrest, he was coded, and I did CPR, defibrillation, and he came back! The joy of getting a pulse back—that was it. I found my new career.”
Another respondent to an informal online survey I conducted on Yahoo! wrote, “I do it for my community. In a rural area, cut off from supply and emergency teams in storms and winter, someone should have the skills the help the ill and injured,” he said.
One woman, who calls herself Proud Navy Wife, got involved in a different sort of rescue: nursing. She wrote of her reasons for doing so on nursinglink.monster.com:
“The one event in my life that really hit me, and really made me want to become a nurse, was when my Meme, who had CHF, was placed on a vent, she had fluid in her lungs...she was really doing very poorly.” She described the day, that the doctor told the family they were going to remove the ventilator to see if the patient could breathe on her own. He told them return in about 45 minutes. When they came back, the patient was sitting up in bed and smiling.
“I thought, I want to be a part of bringing someone back to life. That was the best and most beautiful surprise we could have asked for,” she wrote.
Another example is Westchester County (N.Y.) Police Department Detective Robert Barber, who started his career in public safety as a paramedic but wound up in crime scene investigation. His story is almost quintessential Americana: “It’s probably a cliché but it was always true: I enjoy helping people. I used to watch Adam-12 and all the cop shows when I was kid. Doing the right thing appealed to me as far back as I can remember. I knew I would never be a millionaire. And maybe it’s a selfish thing for me, but I get a lot of satisfaction out of it,” he said.
The caveat—and every one of these categories has one—is that people who fall into this category tend to suffer secondary effects of trauma more often and have a great deal of difficulty saying “no.” Their sensitivities to the suffering of others can lead them to neglect themselves and their own families, sometimes to the point of physical or mental health issues and marital problems or divorce.
The challenge for this group of rescuers: balance.
This overlaps with an attraction to drama because it’s based in a deep need to be appreciated, rewarded and honored. Once again, there’s nothing wrong with this as long as the individual has a healthy level of self-awareness in addition to understanding their need for attention and consciously managing that need. It only becomes a problem when the need is so great that it becomes more important than the job.
The extreme example of this is Munchausen syndrome by proxy (MSP), where a person will deliberately injure or sicken another person so that they can either be their savior or cultivate sympathy from others.
Maggiore points out, “Another example of Munchausen by proxy is the volunteer firefighter who starts fires.”
Who doesn’t need and love a good pat on the back, a thank-you for a job well done, some well-earned praise and appreciation? Everyone does, especially the people who put their lives on the line for others.
Again, the only caveat in this is when it becomes the over-arching motivation for being in rescue work and threatens to obscure our view of all the other things that are necessary for doing the job properly. Sometimes, getting the job done or truly helping someone means no one will ever know you had anything to do with it. And, sometimes, that has to be enough.
Although many first responders would argue that there’s no such thing as a decent paycheck in rescue work, it’s at least a solid, dependable job, often with basic benefits and retirement. That’s not a bad reason for choosing a career.
My experience has been, however, that people who get involved in rescue for this reason eventually find other careers that pay better, require a smaller level of commitment and challenge, and don’t routinely put them in danger.
But many rescue workers stick it out. Members responded to another Yahoo! survey that asked why they decided to become police officers. The answer was not dissimilar—stability.
One respondent, (Danbospd), wrote, “Stable paycheck and some form of recession proof job was awesome. I must tell you - I have no fear of being laid off - that is changing a bit now for the new guys - some dept's have laid police officers off. I am very good at many things - have been offered jobs in other fields - but I find my true love is here.”
In the book, The Volunteer Army: Who Fights and Why, author Michael Massing asks:
Why are people leaving lives of relative safety and putting themselves in harm’s way halfway around the world as military volunteers? What he found was interesting: There was far less of a rallying cry to uphold American values than there was a rush to escape dead-end jobs, failed love affairs, broken homes, boredom and debt. For many of the recruits, the military had become a way out of America. For many it’s a way to get into college, to travel and to find a job.
The men and women who become rescue workers and stay involved in rescue work are unique, but they all have one thing in common: Nerves of steel.
But I think you all should share one more thing: Our eternal gratitude.
I remember one rescue told to me by JEMS.com legal columnist W. Ann Maggiore, JD, NREMT-P. When Maggiore, who said she falls into the trauma category, first moved to New Mexico and joined EMS, she had to rappel down a cliff to extricate people trapped in a car that had gone off the road and rolled into a canyon. The rescuers didn’t know whether the car was going to blow up, but they still went down there. You wouldn’t catch me on the tram up the mountain, no less dangling from a cable on a moving helicopter over a mile-deep canyon. Even listening to her story, my stomach lurched.
Whatever the reasons you have decided to put yourself on the line for your community, I sincerely thank you.
1. National Institutes of Health. www.nih.gov/
2. Gladden B. Coping with Stress a Critical EMS Survival Skill. Public Safety Degrees. www.publicsafetydegrees.com/articles/ems/coping-with-ems-stress.php