EMTs, paramedics and emergency medical dispatchers regularly encounter traumatic events. For many, the experience—plus the support of peers, managers, family and friends—is a key component in their ability to cope with the stress that’s a normal part of their job. Our organizations, Allina Health EMS and HealthEast Medical Transportation, have taken the additional step of adding us to the staff as EMS chaplains. We serve as chaplains for neighboring EMS agencies based in the metro area of St. Paul and Minneapolis. Our primary role is to support employees; support for distressed families and patients is a secondary responsibility.
Scope of Services
The EMS chaplain provides a broad and diverse range of services including:
>> Offering care and support to staff regarding critical incidents, stress management, loss/grief and other personal or professional concerns brought forward by the employee, as well as strengths, ethical decision making, difficult communication or interpersonal dynamic situations.
>> Assessing and determining a plan of care that’s appropriate to
>> Participating in interdisciplinary teamwork and collaboration;
>> Offering rituals and prayer when requested.
>> Helping interpret and broker cultures and faith traditions that impact healthcare practice and decisions.
>> Educating and consulting with staff and the broader community.
>> Building relationships with local faith communities and their leaders on behalf of the organization.
>> Providing leadership within the organization and within the broader field of chaplaincy.
Woven into the Fabric
In practical terms, much of an EMS chaplain’s time is spent riding along with an ambulance crew, sitting in with the dispatcher, participating in disaster drills, giving a presentation on self-care or having lunch with medics. The goal of these activities is to build and nurture relationships so that when a traumatic event happens, the field staff is familiar and comfortable with the chaplain. As one trainer put it, “The scene of a disaster is no time to be shaking hands—we need to know each other well in advance of the crisis.” What may appear to a casual observer as “hanging around” is actually an essential part of the chaplain’s job. We strive to be woven into the fabric of the organization so no one is surprised when we show up and wonders what we’re doing there.
For leaders, the chaplain is a resource for following up with crews that are dealing with particularly challenging calls. We recommend managers and supervisors not ask their employees if they’d like to talk to the chaplain. Rather, tell them that you’re concerned and ask the chaplain to contact them. For example, a manager might have the chaplain follow up with an EMT who went to his fifth SIDS death in a week, the dispatcher who gave pre-arrival instructions to a panicked bystander or the medic who responded to a call for a patient who died of suicide that was discovered by a highly distressed spouse and young children.
In our experience, it’s often the employee’s manager or supervisor who provides immediate support. Care may also come from peers, family, religious tradition or from participating in a critical incident stress debriefing (CISD). In addition to those resources, the EMS chaplain is available for support and follow-up. The chaplain’s support to the field medic or dispatcher may be immediate—within hours of the event—or it might be more effective the next day, after the initial shock has worn off and the employee has had time to reconnect with their loved ones. That support may take the form of a phone call or an in-person conversation over coffee at a local restaurant. One benefit of having a chaplain on staff is the availability of long-term follow-up.
Supporting Patients & Families
While our positions focus on staff support, sometimes the best way for the chaplain to support the field staff is by providing support to families. It is a tribute to the EMTs that their concern extends beyond the patient and that they view the EMS chaplain as a part of the team.
We do respond to EMT requests for care for families when feasible. However, the challenge of responding to the scene of a crisis is in the limits inherent in the job:
>> This is a part-time position in a 24/7 business.
>> Our geographic service areas are spread across and beyond a metro area, and in the best of conditions it may take one or two hours for the chaplain to arrive at the scene.
>> The fast pace of EMS usually means that, by the time the chaplain could arrive at the scene, the patient and family would have moved on to the hospital.
Given those realities, often the best way for first responders to support family, friends and bystanders is by utilizing other community resources, such as hospital chaplains, law enforcement chaplains or local clergy who are closer to the scene and able to have a faster response time. On occasions when the EMS chaplain is riding with a crew, we are present until the ambulance leaves. We entrust the care of the family to the police or other community-based chaplain who is able to stay at the scene to provide immediate care to the patient’s loved ones.
Integrating the Chaplain
One way we have sought to integrate our role into the organizations we serve is by developing standard operating procedures for when providers should notify us. We rely on supervisors and managers to assess the need for support, and asked them for their “Top 10” situations they believe merit a referral. They suggested these scenarios as representing times when contacting the chaplain could be considered as routine:
1. Any event that results in a CISD, even if no one from our organization participates in the debriefing;
2. Death of a child;
3. Multiple casualty incidents;
4. Fatalities resulting from fires;
5. Two or more high-stress calls in the same shift;
6. Employee assaulted by a patient;
7. Traumatic work-related injury (e.g., hit by a car or injury resulting in hospitalization);
8. Line-of-duty death;
9. High-stress phone calls impacting dispatch staff; and
10. Grotesque injuries or deaths such as decapitation, dismemberment or burned beyond recognition.
If the situation merits a rapid response, we ask the on-scene supervisor to have dispatch page or call us immediately. If next-day follow up is appropriate, they can send us an email.
Credentialing required for our positions is consistent with that of the standards for board certification used by the Association of Professional Chaplains (www.professionalchaplains.org). The standards for earning the Board Certified Chaplain (BCC) certification include a bachelor’s degree, Masters of Divinity or equivalent from an accredited seminary, endorsement by a faith community, 1,600 hours of clinical pastoral education, meeting competency standards and a minimum of 50 hours of continuing education per year. Additional training, such as completion of the course requirements for EMT-B and ICISF-approved training in critical incident stress management (CISM), is also valued but not required.
Chaplains are expected to be affiliated with and endorsed by a faith group, yet still be non-denominational in their approach. As professional chaplains, we are bound by a code of ethics which prohibits proselytizing. This frees us to explore the employee’s own spiritual resources for reflecting on the unanswerable “Why?” questions and provides a space to explore troubling ethical situations or feelings. These might be sadness at the patient whose family circumstances or poor choices contributed to their situation, dismay at caring for patients who are dealing with the consequences of previous medical care and the daily challenges inherent in doing a job that brings you face-to-face with the hard realities of human suffering. Everyone deserves the right to interpret their experiences and make their own meaning out of life’s events. In effect, the chaplain is able to say, “Your grief and distress are normal, and we encourage you to draw on the resources of your own faith tradition, if you have one, whatever it is. I’ll support you however long it takes.”
We are proud of the organizations we serve and their commitment to the wellbeing of their employees. Their decision to budget for a professional EMS chaplain illustrates an investment in people who face some very difficult situations every day.
Testaments of Support
“For far too long we have neglected the spiritual health of our providers. EMS professionals face ethically difficult issues on a daily basis. Their work is high-stress with little opportunity to discuss their concerns with those trained to assist them. Having an unbiased third party to explore this stress and develop strategies to address them is vital to their professional longevity. I’m proud to have a service that supports such a role and encourage others to adopt similar programs.”
Keith Wesley, MD Medical Director, HealthEast Medical Transportation
”Many times, dealing with high-risk and fragile patients makes our dispatchers just as vulnerable. [Our EMS chaplain] has the keen ability to help us work through the emotional stress, allowing us to better focus on providing exceptional care to the communities we serve.”
Angie Fox, Communications Manager, Allina Health EMS
“I recently had surgery for a non-work related injury. [The chaplain] offered great comfort to me and my family during my hospital stay. We already had an established relationship because of his work as our EMS chaplain. This allowed me to easily reach out to him when I needed a
Brian Landhuis, Employee Safety Manager, Allina Health EMS
“Having an EMS chaplain adds an additional resource for people to go to with less risk of embarrassment to begin the healing process, regardless of your faith.”
Ryan D. Lybeck, BA, NREMT-P Ambulance Operations Supervisor, HealthEast Medical Transportation