I saw a cartoon one time. A school of fish was swimming in the ocean and came upon a plant. One fish realized that, in fact, it was not swimming through the leaves of a plant but through the tentacles of a predator, and he said: “With friends like this, who needs anemones?” If you have felt like that in the EMS industry, you’re not alone.
Indeed, during a seven year period, 5.5% of EMS professionals who died were due to suicide compared to 2.2% of non-EMS-professional deaths.1 In an industry full of people tasked with watching out for our brothers and sisters on the front lines second to none but ourselves, this reflects a catastrophic failure, but truly who has failed?
- Mental Health and the EMS Provider
- Toward a Better Understanding of Post-Traumatic Stress Disorder (PTSD)
- Psychological Trauma: The Silent Stalker
Is it the paramedic who smiles and laughs despite feeling broken with no clue how to ask for help? Is it the crew who has a “gut feeling” that something is wrong but has no idea where to begin or what to say? Is it the educator who taught the obligatory “Workforce Safety and Wellness” chapter to her EMT class awkwardly with the air of “because the state curriculum says I have to” because talking about mental health and burnout would make her, a woman, look weak?
Public safety professionals have held the stereotype of being “Type-A” personalities for generations.2 These traits—extroversion, emotional stability, initiative, organization, and even a competitive streak fuel the successes that make many providers excellent clinicians, strong incident commanders and valued colleagues.3 But all things come with a price.
With emotional stability comes an inability to appear weak or vulnerable; with initiative comes the ability to cast a shadow on others; with organization comes an adherence to structure that leaves little room for the unique traits of others. As a result, providers fear the judgement of others.
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Admitting to a broken colleague that they, too, have felt alone in a room full of people is akin to becoming the broken toy soldier at the station. Teaching a class that burnout is real, bad days will come, and even the best EMTs and paramedics sometimes find themselves crying into a cup of coffee may fuel rumors that this is the voice of personal experience and murmurings of “those that can’t do, teach.” Administrators, clinging to plausible deniability and fearful of the liability of “officially knowing” that an employee is in the wrong frame of mind, turn a blind eye to emotional downfalls and remain under a veil of willful ignorance.
Education has been referred to as the silver bullet of the industry and the solution to many problems. Failed intubation rates have resulted in mandatory classes and human resources complaints lead to remedial HIPAA training, but are providers truly learning when the hands of educators are tied?
Fearful of the scorn of students of colleagues and students alike, lessons regarding sensitive topics like provider suicide, burnout, and overall mental wellbeing are glossed over and treated with a distancing approach meant to say: “This is true of other providers, but not of me.”
Providers are quick to speak of brotherhood when they get a save, walk into a fire or come upon a lawsuit, but like many families, the tough issues go ignored or spoken of behind closed doors. Ironically enough, as I progressed in completing this piece, a fellow provider caught a glimpse of the opening paragraph and said nothing to me, yet I received a message from a supervisor wondering what it meant.
This example makes it clear: we, as providers, are comfortable addressing emotional issues with patients but not with each other. We can provide “compassion on tap” on our mental health transfers, crying parents, and injured builders but struggle to speak with each other.
Destigmatizing Human Emotions
Aaron Sorkin’s The West Wing features a scene in which one character is experiencing a crisis. Another character shares the story of a man who fell into a hole. After numerous people walk by throwing down prescriptions and prayers and continuing, a friend walked up and jumped into the hole with him. When asked why he jumped in, his reply teaches us all a lesson: “I’ve been down here before, and I know the way out.”
“What if EMT instructors could look at their students and say: “I know this seems like a blow-off chapter, but I’ve been here, and you probably will be too, so listen close?” What if providers didn’t have to worry when they looked at their partner and said: “That was a rough call, so let me tell you about one of mine.” How comfortable would we be addressing our own demons if we knew that the burden wasn’t only ours to bear and that we are not alone?
The Take-Away Point
If we’re going to our industry as a brotherhood, we need to take the bad with the good and meet our own expectations for others, and I’ll be the first. I’ll be the first to admit that the decision to terminate resuscitation feels like I’m the last person in the world to say, “I give up on you,” even though scientifically, I know that this isn’t the case. Let me be the first to say that I’ve felt your pain and I’ve been too proud or too stubborn to show you mine to make you comfortable acknowledging yours.
As you’re reading this, consider opening up for your own well-being or simply to help others realize that no single provider is the only broken toy in the box and that we’re all here to hold each other up. If you teach, let your example be a guiding light for your students and allow them to learn from you. If you supervise, show those under your care that even the best and brightest crayons in the box get dim when they don’t see the light of day.
I write this with the knowledge and firm confidence that things can change. After all, if we all admit we’ve been broken, we can’t be called weak anymore, because acknowledging it can be the new normal. If all instructors teach from their hearts, no longer will the one that does be the odd one out. If we allow ourselves to be human, humanity will no longer be stigmatized.
You’ll recall that this piece began with the single fish lamenting being caught in a sea anemone, but there’s one thing that the little fish had forgotten. He forgot that the story began with a school of fish just like him, and that no matter how alone he felt, he was surrounded by other fish. Once he made it out of the trap, one can only hope that they had the strength to say: “I’ve been there too, brother.”
- Vigil, N., Grant, A., Perez, O., Blust, R., Chikani, V., Vadeboncoeur, T., . . . Bobrow, B. (2019). Death by Suicide-The EMS Profession Compared to the General Public. Prehospital Emergency Care, 340-345.
- Gillani, Y., & Atif, M. (2015). Personality Traits and Risk Taking Attitudes Among Firefighters of Rescue Service. Journal of Public Administration and Governance, 173-181.
- Wells, M. (2016, May 9). Why do so many firefighters have a ‘Type A’ personality? Retrieved from FireRescue1: https://www.firerescue1.com/career-1/articles/why-do-so-many-firefighters-have-a-type-a-personality-teQWIQRJSIs3Rb2Q/.