Administration and Leadership, Columns, Operations

EMS Providers Must Ask for Help with Emotional Trauma

Issue 1 and Volume 41.

July 20, 1992, was a typical sunny summer afternoon in Houston, Texas. I was spending my break between freshman and sophomore years at Rice University taking an EMT-I course. That day I was riding with Harris County Emergency Corps doing one of my student clinical rotations. The 7 a.m. shift began as usual with cleaning and stocking of the truck, breakfast and some typically forgettable calls. At 3:45 p.m., that typical sunny summer day suddenly darkened and cast its shadow over the next few years of my life.

We were dispatched code 3 to a “man down” in a lovely middle-class suburban neighborhood. With my head poking from the captain’s chair in the back, I strained to hear the information coming over the radio from dispatch. The in-charge paramedic, David Chapman, was a seasoned veteran whom I liked and respected. As we turned into the neighborhood, he picked up the mic: “Approaching the scene, any further information?”

The dispatcher responded “Possible full arrest, 10-year-old female.” David hoped he misheard. “Repeat the age.”

“Ten. One-zero.”

I grabbed the airway kit and monitor and hurried across the front lawn and through the front door on the heels of David and his partner. We encountered a young boy who led us to the back bedroom. As I made a right turn, David yelled “Stop! We’ve got a crime scene. Back out!” I escorted the crying boy out of the house just in time to encounter a hysterical mother running up to the front door. I explained that she couldn’t go in. Through her tears, she asked me if her daughter was OK.

It’s a moment I’ll never forget—the moment that marked the first time I’d have to tell a parent their child was dead.

Except David’s partner came out and grabbed the mother, who was still asking if her daughter was OK. “No ma’am, she’s not.”

David called for me to bring the monitor. I have to admit I was frustrated I was initially kept out of the room. After all, I’m part of the team and I was there to learn. But when I grabbed the monitor and walked in, I instantly wished I hadn’t.


The room had the stench of fresh blood and looked like a scene from a horror movie. On the bed were the lifeless bodies of Kristin Wiley, 10, and her friend Kynara Carreiro, 7. Their eyes were open, staring at everyone who entered the room—eyes that to this day I can see when I close my own. We placed them both on the monitor to confirm what we already knew.

The day that started out so picture perfect became surreal in an instant. I walked out of the house after we were done and noticed crime scene tape was already being strung up. A man on the other side of the tape was pulling up a lawn chair and I heard him say he saw some men jumping over the fence, so I directed him to the police. David, his partner and I gathered at the ambulance and sat silent, all with a blank stare—the same blank stare I saw from every police officer, detective and crime scene investigator who came out of the house. We all wished the same thing: that we as first responders, we as human beings, could un-see those horrors.

The murders of those two beautiful little girls became one of the most infamous murder cases in the city’s history. It went unsolved for more than a year; there were billboards all over the city asking for tips and offering a reward. An episode of The Oprah Winfrey Show featured the case, with Kristen’s mother recounting the day and the encounter with David’s partner and I, and asking for help in solving the murders.

After we went back to the station, David asked me if I was OK. I asked him the same— we both lied! I didn’t know what to say or do. I was emotionally overwhelmed. I left the shift and went straight to my EMT-I class across town. I didn’t really feel like going, but I knew I had to in order to meet the contact hour requirement.

I sat staring at the board while the instructor was teaching about something; I didn’t really care. I had to focus on not letting my emotions take control. During one of the breaks, the instructor called me into her office, closed the door behind her and asked me what was going on. I lost it and began uncontrollably crying. She was comforting, advised me to go home and said the same thing David did: “Let us know if you need help.”

I don’t know what it is about first responders that prevents us from asking for help. Perhaps it’s because our role identity is to help others, which could lead to ignoring our own personal needs. Perhaps it’s because we all suffer in silence, preferring not to engage with colleagues about our troubles—after all, we’re tough and don’t talk about these sorts of things.

Maybe it’s because we’re used to being in control amid the chaos of the world and we’re afraid of letting uncontrolled emotions out.

Regardless of the reason, I decided to not ask for help. Worse yet, over the ensuing months, people asked me over and over again if I wanted to talk to someone about it. They could see that my enthusiasm on the ambulance had dwindled. I thanked them for their concern and continued the lie that I was fine. I can also tell you that if someone had made me go to a debriefing, I would have gone in a second. I can’t really rationalize my thinking at the time—I was 19 years old, desperate for help, but too proud to admit that I couldn’t handle it.

The constant news articles, billboards and TV shows about this case followed me over the next two years. I kept news clippings pinned to my dorm room wall as a constant reminder of the injustice in the world. My thoughts turned dark and I wondered what kind of world I was living in where two children could be murdered on a quiet neighborhood street in the middle of the day. My relationships suffered. I didn’t want to be around people and lost interest in going to class. My grades took a dive and I came close to withdrawing from school.

In February 1994, I was working as a student athletic trainer at Rice University as part of my sports medicine scholarship. My twin brother, who was also a trainer, came up to me and asked if I saw the news—there had been an arrest! Rex Mays, a part-time clown and the next-door neighbor who had pulled up the lawn chair at the crime scene, had confessed. I’d worked hard to keep the emotions at bay for the past 19 months and all of a sudden it came rushing back. I sat down, staring at a wall. I just sat there and stared until my boss told me to get back to work. I don’t remember the exact exchange, but I do remember I wasn’t proud of it and it ended with me yelling “@$#% OFF!” and storming out the door.

I’m grateful I had understanding and caring bosses who didn’t fire me on the spot. I wouldn’t have been able to afford to stay at Rice without that scholarship! They did, however, insist I talk to the university psychologist. I finally received the help I needed and, immediately after the first session, felt a huge burden had been lifted. I also immediately realized I should never have waited so long to ask for help. I’m a smart person and I knew what my diagnosis was, but information and knowledge isn’t enough to manage post-traumatic stress disorder (PTSD).

We have to stop pretending this is something we can manage on our own. We need to start sharing those kinds of calls with mental health professionals, family, friends, clergy, colleagues or whoever. Sharing is cathartic and, by purging our demons, we also allow for others to help us.

As EMS administrators, PTSD and workplace stress should be at the forefront of our minds when we see a decline in performance, an inappropriate outburst from an otherwise good employee, or substance abuse. Far too often, we ignore the warning signs and we lose too many good people to suicide, substance abuse and burnout. We must continue the effort to expand the research into PTSD in our first responders and innovate new methods to prevent, detect and treat this plague.

Mark E.A. Escott is the founder of The Legion of Saint Michael, a 501(c)3 nonprofit agency dedicated to raising money to fund research and programs to protect first responders, with a major focus on PTSD. For more information, you can contact him at [email protected] or visit

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