A personal connection with a young soldier who took his life gave Phoenix Fire Department Captain Dean Pedrotti a firsthand look at what war can do to young Americans. It also opened his eyes to how poorly first responders are prepared for dealing with war veterans suffering from mental health issues, such as post-traumatic stress disorder.
“A lot of what these veterans are saying is, as civilians in public safety, we really don’t understand what they’ve been through,” Pedrotti says.
That experience, along with a series of deadly incidents involving public safety personnel and war veterans, has put Pedrotti and his department on the cusp of a revolutionary training program to make everyone in EMS, fire and law enforcement aware of the potential mental-health issues soldiers returning from war face.
With this program, first responders will be better equipped to handle unique scenarios they’ll encounter when treating veterans with life-changing mental health issues. Pedrotti, a hazmat trainer for the department, hadn’t set out to become an expert on post-traumatic stress (PTS). He’s looking to drop “disorder” from the common terminology. In 2009, Adam Gibson—a close family friend of Pedrotti’s—took his life after dealing with the mental health issues stemming from his 15-months of combat in Iraq.
This experience got Pedrotti talking with other veterans and their families. Soon he was convinced first responders needed to know more about PTS and how it affects the everyday lives of war veterans.
Unfortunately, most EMS workers dismiss mental health training of any kind, and, often, such training is limited to instructors speaking to students. Pedrotti thought that needed to change.
Rather than put together a PowerPoint presentation, Pedrotti joined forces with the Arizona National Guard and the Arizona Coalition for Military Families to craft a program called “Heroes to Hometowns: EMS provider readiness to help military service members and veterans,” which puts first responders face to face with veterans who share what they’re dealing with after going through war. Just as important, the veterans told the first responders what touch points could escalate a crisis call with a veteran.
The first four classes were attended by more than 800 people who listened to a panel discussion facilitated by Master Gunnery Marine Sergeant and Phoenix Police Lieutenant Stephen Soha. Three Marines and an Army soldier, all decorated veterans, described their combat experience, their significant physical injuries and their daily struggle with PTS.
“What’s the one CE that paramedics hate? It’s mental illness,” Pedrotti says. “What we’ve learned is screw the lesson plans, leave them on the shelf and get individuals that are willing to tell their stories and talk to somebody dealing with their [issues].”
The response from the students was swift and surprising.
“It was far, far bigger than I would have expected,” Pedrotti says.
Soon the idea was hatched to start spreading the project throughout the state and beyond Arizona’s borders.
The challenges facing first responders aren’t limited to patients, but also coworkers. War veterans returning home are heading back to EMS jobs in which they may face scenarios that remind them of war experiences.
“The message that many of us now realize EMS, fire and law enforcement need to understand the depth of this problem,” says JEMS Editor-in-Chief A.J. Heightman, MPA, EMT-P.
Heightman sat in on one of Pedrotti’s sessions and called it “powerful.”
This program will emphasize that responders also need to be aware of scenarios that may escalate a crisis situation, such as using a term referring to the wrong wing of the armed forces. Likewise, the sound of a fire engine (that sounds similar to an idling Humvee) or the lights of an ambulance may trigger an unwelcome response in the patient or a coworker back on the job after a tour abroad.
“Treat it like a hazmat call,” he says. “Slow it down. The captain has to be real sensitive to the crew and the maturity level. If you have a young firefighter with a big ego, he can make one [dumb] comment and it could shoot the call through the roof.
“We have to have sensitivity for where these fellows have been,” Pedrotti says. “You have to show that respect when you speak to them.”
Using those first four classes as the template, Pedrotti is in the process of spreading the training throughout the state. The goal is to have 2,500 more train in Arizona during 2012.
Aging Patient Population
EMS educators and leaders have done a great job teaching students about average patients, but EMS providers may be facing a crisis in dealing with a growing elderly population.
“If you look at the national numbers, the biggest share of healthcare dollars and healthcare resources are devoted to folks literally in the last 10 years of their lives,” says Connie J. Mattera, MS, RN, EMT-P.
“We’ve done a very good job teaching people how to assess and manage our prototypical adult,” adds Mattera. “I don’t know if we’ve done as good a job on the book ends of our age groups.”
And that could be a bigger issue down the road. The National Institute of Aging (NIA) estimates the share of the population 65 and older will expand dramatically over the next four decades, while the share of people under 20 will remain the same. That means there will be a smaller number of people between the ages of 20 and 64—the age group that normally cares for elderly family members.
More importantly, the NIA also estimates seven million people currently care for an elderly family member from thousands of miles away. Those figures suggest the EMS world will continue to face greater challenges in dealing with a senior population. Mattera, who is the EMS administrative director at Northwest Community Hospital in Arlington Heights, Ill., says roughly 70% of the organization’s 62,000 EMS calls this past year were for patients 65 years old and above.
“We have a lot of educational challenges,” says Mattera. “These folks react differently.”
Part of the challenge is EMS folks generally like calls with rapid feedback and a quick turnaround, she says, but with elderly patients, “It’s going to be a marathon instead of a sprint.”
There’s also a perception that those calls aren’t as interesting as pediatrics or cardiac arrests, she says. Although, they should be considered just as important as the high-profile responses.
“Over the next 15 years, we’re going to have a massive increase in the numbers of older folks,” Mattera says. “I think that is going to be our world moving forward.”
Pro Bono: Reporting Child Abuse
To report or not to report—that is the question. Or is it? In light of the fallout surrounding the Sandusky scandal at Pennsylvania State University and the perjury and failure-to-report charges against two university officials, many EMS providers are now asking about their reporting obligations for suspected victims of abuse.
This sparked an internal debate in our office regarding the Pennsylvania EMS reporting obligations for child, elderly and domestic abuse. The laws in Pennsylvania and other states are, frankly, less than clear. And the laws in every state are different. State law governs your legal obligations. In many cases, the role of EMS agencies has been completely overlooked, except for a few states. But is there really a need to debate what our legal reporting obligations are in each of these three types of abuse scenarios?
Perhaps the problem as to why Sandusky was allegedly allowed to continue to have contact with children is that people were more concerned with not ruining his career and reputation than reporting something they suspected but didn’t know with complete certainty. The thought of the unthinkable may have paralyzed much of the decision-making. Perhaps the problem was not reporting to the right people or that it wasn’t clear what was happening when the alleged observations were made.
In any case, the bottom line is that few cases of real abuse are actually reported for these and many other reasons. The vast majority of EMS providers entered this field because we desire to help people. Certainly we would report it if we actually knew for a fact that someone was being abused. But another problem is that the “signs and symptoms” of patient abuse may be subtle and difficult to assess. Perpetrators are often good at disguising the truth, and victims and their relatives can’t bring themselves to believe a loved one would commit such acts. And false accusations can ruin reputations.
All EMS organizations should have a policy on reporting abuse. The policy should give examples of the various types of abuse and set forth a procedure for reporting suspected abuse. Each emergency service organization should also have a “designated individual” to whom any suspected or witnessed patient abuse should be reported. There should be education involving the appropriate social service agencies to help EMS providers better identify suspected abuse.
Organizations, such as area agencies on aging and coalitions against domestic violence, are a great resource with trained professionals who deal with these difficult issues every day. We can learn a lot from them. The importance of staying objective and not letting our own emotions and personal bias take control when dealing with suspected patient abuse should be emphasized to help avoid erroneous reports.
EMS providers who think they may have witnessed or been given credible information that indicates patient abuse has or is occurring should immediately report their suspicions to their supervisor or designated individual. Preferably, the report should be in writing, but verbal reports should not be ignored. Once the designated individual reviews the report and confirms that there may be patient abuse, the designated individual should file a report with the appropriate agency in accordance with the laws of that particular state. When in doubt, report your concerns. Use common sense and good professional judgment.
It really is that simple. Focus less on what the law actually requires you to do and more on doing what you honestly and objectively believe is right—even in the absence of a legal requirement to take action. JEMS
This article originally appeared in March 2012 JEMS as “Post-Traumatic Stress: Delineating the ‘disorder’.”