News, Patient Care

Stress Takes a Toll on Florida Medics and Highlights Usefulness of Peer Support

When the emergency crew from Tampa Fire Rescue Station 11 got the call two weeks ago about a critically injured 4-year-old boy who had been hit by an SUV on North Florida Avenue, it took less than a minute to get there.

It will take a lifetime for those images to go away, say those who responded to the call.

We all had this feeling of helplessness with this child, that this situation was even more devastating than normal, said fire rescue Capt. David Hohenthaner, who was on the truck that sped to North Florida and 109th avenues on the evening of July 20.

We got a pulse, and his vitals were stabilizing, Hohenthaner said. There was a moment that it looked like there was hope, but I guess his injuries were just too severe.

First responders get into the business to help people – victims of violence and disease, people who are near death and in pain. Young people. Old people. Children.

To do their job, they must be immune to the suffering. But what they see can haunt them in daydreams and keep them up at night. It’s a routine part of a job that results in 1 in 5 paramedics developing post-traumatic stress disorder and, for many more, depression and anxiety issues.

Hohenthaner said the sight of Marterrance Albury sprawled on that Tampa street, alone and bleeding, is one of those images. Marterrance had wandered away from home when he was hit by the SUV, which didn’t stop.

After the child was taken to a hospital, the team from Station 11 responded to two other calls that night, a difficult pregnancy and a woman who had fallen. But it was the image of Marterrance that sticks in their minds. It’s made worse because, despite their efforts, the child did not survive.

Definitely kids, Hohenthaner said. Those are the most stressful. They can’t help themselves. They can’t say what’s wrong. They are just hurting. They are the most difficult. They can’t tell you what’s wrong. They’re scared.

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Such calls cause a level of stress among first responders that few other professions have.

Dealing with the stress differs with each person, he said.

The next two days I spent with my boys, he said. I did a lot of stuff with them.

Mental health experts say the best way to deal with the stress of treating and sometimes losing patients is to talk about it.

After the North Florida Avenue call, Hohenthaner sat the team down in the station house.

I did talk with the guys, he said. Paramedics all handle stress differently. They exercise. They go fishing. Anything to take their minds off the job. You see a lot of firefighters and paramedics with second jobs so they don’t have to dwell on this one.

We are kind of our own worst enemies, he said. We tend not to seek help. We are not the best at reaching out.

Calls that can be particularly disturbing happen all the time. The same weekend Marterrance was killed, a 4-year-old boy was fatally mauled by two pit bulls in Riverview in the backyard. Paramedics were called, but the child was unresponsive and pronounced dead at the scene. There was nothing they could do.

A spokeswoman for the county this week said those first responders chose not to be interviewed for this story, in deference to the child’s grieving family.

Post-traumatic stress disorder is the result of getting upclose with people in misery, pain, often injured, sometimes with little hope of recovery. That’s the job description of first responders.

They are called out when cars crash, when homes burn, when people are stabbed or shot.

It’s difficult to let that go when you pack up the first-aid kits, defibrillators and bandages and head back to the station to finish the shift, or to leave it at the door when you head home.

PTSD is an occupational hazard for emergency medical services personnel, who are routinely and frequently exposed to their patients’ trauma and suffering, states a study published in 2006 by the University of Washington School of Public Health & Community Medicine. It says up to 20 percent of paramedics wind up with the condition and require intervention and treatment.

Remarkably, considering the frequency, nature and intensity of their duty-related traumatic exposures, the study says, EMS personnel have relatively low rates of PTSD. A number of factors probably account for their resiliency, but the bonding and social support provided by their co-workers is perhaps most important.

Other mental health experts agree that peer counseling appears to work.

Probably the most important support system for firefighters are firefighters themselves; that is, they consider one another to be family and have strong bonds that help them to maintain their resilience in the face of death and travail, said Randal D. Beaton, a psychiatrist in Seattle and professor with the University of Washington who has written extensively on first-responder stress.

Although PTSD is one potential outcome and can be considered an occupational hazard for fire service personnel, depression and the risk of alcohol abuse are also prevalent in the fire service, he said Most firefighters and paramedics are resilient and do not experience a diagnosable mental disorder.

First responders face disturbing images every day, he said, but that’s not the job’s only source of stress. Long shifts, typically 24 hours, and disrupted sleep can leave first responders sleep-deprived both on and off work, he said. The job is dangerous and often can result in career-ending injuries and even death.

PTSD does occur in a relatively small percentage of first responders, he said.

A much larger percentage and perhaps the majority experience some post trauma symptoms such as vivid recollections of a particularly gruesome incident involving a child or multiple victims, he said, but do not meet the criteria that would require treatment or intervention for a PTSD diagnosis.

Louise Dandridge, supervisor of Tampa’s Occupational Health Services, said there are plenty of support systems available for first responders who need help. But the most effective way to handle the stress of the job is for the team of first responders to discuss experiences.

Many times they already are talking among themselves, she said. That’s the best thing in the world. It’s ingrained in them to come back to the station and talk.

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The Tampa Bay Critical Incident Team, made up of first responders from the county and Tampa, gets called out a few times a year to deal with significant issues such as the death of one of their own, or of a child.

I think we have an excellent program, Dandridge said. It’s a superb team. They are volunteers; they get no extra pay or gratuity for doing this. They have sincere hearts, caring hearts, and they get called in when they are off duty, on weekends, whenever.

Tampa Fire Rescue firefighter-paramedic Tommy Velar was part of the crew that treated Marterrance on that Sunday night two weeks ago.

It was awful, he said. It sticks with you. It’s one of those things that happens so infrequently, but it happens to everybody at some point in their career.

He agreed that the best way to deal with disturbing calls is to talk with the people who were with you.

It kind of lets you get it off your chest, he said. We’re all pretty close, so if it bothers one of us, we’re not afraid to say, ‘Man, that was a bad call.’ We just kind of open up to each other.

The sessions typically start out talking about the technical aspects of the call, what we actually did, he said. But by the time it’s over, somebody always brings up the personal side. That’s the path it usually goes down.

It takes a good couple of days for it to actually go to the back of your head, he said. You go on to the next one.

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