Operations, Training

The Deep End of the Pool: A Reflection on the EMS Educator’s Role in Teaching Emotional Coping Skills

My heart is in my stomach and there’s a lump in my throat. I just clicked the “end” button on my phone after receiving a call from a recent EMT student of mine. He called to tell me that he’s been using the training that I taught him in class. There was a hitch in his voice and a gravelly bottom to his tone.

“I got dumped in the deep end of the pool,” he told me.

I was surprised to hear from him because he had just called me the previous week to tell me about his first day off of orientation. He’d run a 3-year-old cardiac arrest on his very first day, and he wanted to talk about it.

I let him speak and listened to the emotions behind his words. I asked him about what resources were available to him at his new workplace. I asked him if his boss had talked with him, his supervisors, and his partners. I assured him that his feelings and thoughts were normal. I gave him the same talk I’ve given time and time again to sea of ever-changing faces. You’re human. You have the right to feel your emotions. You have the right to heal. You are the most important person.

The Color of No More Blood

He listened to me while I talked the talk: Exercise.  Critical incident stress debriefing. Counseling. Watch for changes to everyday activities. Acute. Cumulative. Delayed. Warning signs.

My own ghosts appeared around me as I went through the motions. The 5-pound baby. “The lions are coming to get me.” The color of no more blood. The not-person. Praying in the small room with the mother who wasn’t any longer. They’re all here with me, sitting in my office listening to me talk to this young man who told me, “I want to be a paramedic,” on his very first day of class.

My own collection of people that have become something that are not quite friends, but more like acquaintances, to guide me as I speak to my student.

“It is a privilege to be a witness,” I said. Not so much as a person providing care and using the tools and procedures we learned, but just to stand silent and present when someone passes beyond us, despite our efforts. “Your being in the room is important. You being there made them not alone.”

He then proceeded to tell me that his shift today was much worse. His small, rural service normally runs 4 calls in 12 hours and today he ran double that number. There was an opioid overdose, a “shady call,” and finally another 3-year-old who “didn’t make it.”

I stood up from my chair and started walking the room. Little warning bells were going off in the distance. He’d called me twice in a few weeks now. I advised him to take off some time from the rig if he needed to. I asked him about his support system and the people in his life. I asked him to remember his “Action Plan,” which is an activity I have my EMT students do to map out coping mechanisms for increased stress. We ended our phone conversation and I sat back down in my chair.

A Disproportionate Response

Earlier that evening, I’d driven home from an EMS educator’s conference where a speaker had talked about the mental health of the EMS provider. He’d been telling a story about a medic that had lashed out at his family because of the emotional trauma he’d amassed during his occupation. “A disproportionate emotional response,” he called it.

The response he was describing was an outburst of energy, a loud and ugly thing—but can the opposite not also be true? A lack of, or a restrained emotional response is just as disproportionate. As educators and leaders, are we not asking these providers to have a disproportionate emotional response to the scenes they are exposed to? Do we not train them to move past their inherent reactions to provide the care that they give?

We teach them to acknowledge their fear and continue on with their PPE and scene safety. To pocket that pucker-factor and manage the obstructed airway. Are we setting them up for very real, emotional failure?

In our 60-hour EMR course, the text our program uses contains exactly four pages on provider stress and grief reaction. Tucked away between exposure to infectious substances and lifting and moving patients are a few paragraphs that tell the student how to recognize signs of stress, encourage exercise and counseling. Four pages sitting on my bookshelf between my students and emotional well-being.

Is it Enough?

Student calls like this move me to reflect on my own instruction for my EMS students. I ask myself, did I do enough? Were the lectures and tools I gave them in class enough to prepare them for the “emotional ask” of the job? Do the stories we tell accurately represent the emotional toll that is intrinsic to our profession? Do we also provide an opportunity for students to opt out? Ultimately, are we prepared as educators to provide the tools of coping to our students?

EMS Educators aren’t required to receive formal instruction on how to teach the complex skill of coping with emotional stress. I remember nothing in my Department of Transportation instructor class about how to prepare my students for the experiences they’ll be exposed to.

Like all instructors, we collect our teaching from our peers and our role models. We utilize the educational standards required of us. We combine our personal experiences with the storytelling passed down from generations. We tell them of the consequences of bottled-up emotions. We give them the facts and figures; about 25% of you will develop depression, you will be at a higher risk for suicide and PTSD. But is it enough?

Out of the Gate

Our recent recognition as a profession at high risk for mental health complications has increased our awareness regarding the emotional well-being of the EMS provider. Recognition and admission of a problem is always the first step of working towards a solution.

Research, collaboration with mental health clinical experts, development of resources and training are all admirable strides in our plight to help us help ourselves with our emotional coping skills.

We’re beginning to collect the right set of tools for our EMS emotional toolkit, but are we teaching these tools to the newest generation of wide-eyed, passionate, caring young people, who want nothing more than to make a difference for others? Are we doing enough, right out of the gate, to prepare them for the emotional trauma they will be witness to?

At the end of the day, I’m happy that that my student reached out to me, and as I reflect on our conversation I’m reminded of another student I had a few years prior. She would routinely get flustered during class scenario practice and say to me, “I just keep thinking; what do I do with my hands?” By the end of the semester I had indeed taught her what to do with her hands, but did I teach her what to do with her heart?