A news article in on JEMS.com started me thinking about an issue. The story was about two Florida paramedics who were dead following a murder-suicide.1 Both were paramedics, both had worked in one of our nation’s best-known EMS systems (Sunstar in Pinellas County, Fla.), and one had worked for a respected county fire-rescue EMS agency. Friends and acquaintances seemed surprised and were struggling to cope with the event. Concern for the couple’s now-orphaned daughter is high among the local EMS community.
EMTs and paramedics face extraordinary on-the-job stresses and long working hours, often coupled with low wages. So one could assume this means daily living stresses often interact with the stresses of the profession. Yet, I’ve never experienced, read about or talked about any effort to really address these compound stresses or the effects they produce. I shudder to think that the important work that we do–bringing prompt, compassionate, clinically excellent patient care to those who call for our services–could contribute to mental health issues that can result in senseless deaths of EMS providers. Unfortunately, these colleagues can’t tell us what brought them to that fatal juncture, but I wish we had the capability to understand the cause, and thereby devise means of prevention.
The recent long-lasting military conflicts in Iraq and Afghanistan have brought an increasing level of stress to our military brethren–the servicemen and servicewomen who have been fighting what has now become our nation’s longest period of continuous combat. Our military organizations, too, have noticed increased stresses on soldiers, sailors, airmen and women, Marines, and military families. Rising suicide rates and examination of their causes has led to a new concept: the development of “resilience,” which is defined as the capability of a strained body to recover its size and shape after deformation caused especially by compressive stress (i.e., an ability to recover from or adjust easily to misfortune or change).
The Army has contracted with the University of Pennsylvania to develop “master resiliency training” programs that will be provided to soldiers, their families and Department of the Army civilians.2 Master resiliency training is being adapted from the Positive Psychology Program at the University of Pennsylvania in Philadelphia. The University of Pennsylvania instructs teachers (middle and high school) on how to impart resiliency skills to their students during the school year. More than a dozen scientific studies have shown positive results in students whose teachers have been trained in this program, including better grades, less dropouts and less behavioral issues.2 This program is part of the Army’s “Comprehensive Soldier Fitness” effort, which focuses on the five dimensions of strength: emotional, social, spiritual, family and physical.
It’s also clear that this isn’t just an American phenomenon. Our colleagues in Victoria, Australia (a statewide ambulance service with 3,000 employees and 220 stations) have lost eight paramedics in three years.3 They, too, are struggling to understand why and to develop ways to prevent these tragic losses.
How do we address the cumulative stress of dealing daily with human suffering, death and disease that EMTs and paramedics confront every day? How are those stresses compounded by difficult working conditions, long hours and EMS system designs that breed or maintain interagency conflict while expecting harmonious interactions on emergency scenes? I don’t have the answers, but I think there’s more to this than a “critical incident stress management” intervention after a particularly bad incident. There’s more to this than making an employee assistance program (EAP) counselor available on request to an employee who’s fortunate enough to recognize a need before the “snap” occurs.
Recently, I’ve written and blogged about a variety of safety issues in the EMS community (the encouragement of fast driving, the ethics of long shifts), and I’ve read lots of good comments and feedback from my colleagues. I’ve been involved, through National EMS Management Association, in the National EMS Culture of Safety Project. One of the most interesting pieces of reader feedback I’ve received thus far is, “If this stuff is so important, why is it given such cursory coverage in the EMS textbooks, and why is it not addressed at all in our EMT and paramedic courses?”
I wish I could answer those questions because turned into statements, they show another failure of leadership within the EMS community. Perhaps it’s because these topics haven’t been studied thoroughly, and everyone wants “evidence” and lots of footnotes. Or perhaps these complex issues don’t lend themselves to linear, PowerPoint bulleted presentations. Perhaps these issues make our educators and managers uncomfortable because they lack knowledge about these topics. (And I confess, you could write what I know about them on my thumb with a crayon!) Whatever the reason, it’s not right, and we need to do better.
We need an effort. This seems to me to be one of those non-clinical “EMS research” needs that rarely seem to get addressed. Some place out there, there’s a PhD–or a PhD candidate in psychology, occupational medicine or some other related discipline–who’s interested in EMS. Boy have we got a dissertation project (and perhaps a lifetime of work) for you.
What are the stressors? How can we manage them, and can we build this in to a “resilience enhancement” program that can begin at the entry point to the EMS community and be carried on throughout one’s career? This effort is one that could be supported by everyone–management and labor, volunteer and career, and EMSers who travel in ambulances and other response vehicles of all colors, shapes and sizes.
Like I said, I don’t have answers on this one, but I know one thing for sure: Somebody needs to work on the issue of “resilience” in the EMS workforce. Perhaps we could work on this as part of a more global effort to address the emotional, social, spiritual, family and physical strength of EMS providers, before more terrible events such as the one described above happens again.
What do you think, my EMS brothers and sisters? What can we do to build the concept of “resilience” into our world? How can we identify EMS scholars with the expertise to address something this important? How can we fund the research?
Let us know what you think about this important issue.
1. Jamison P, Sullivan E. (May 1, 2012). Murder-Suicide Victims IDed as Florida Paramedics. In JEMS.com. Retrieved May 1, 2012, from www.jems.com/article/news/murder-suicide-victims-ided-florida-para.
2. American Forces Press Service. (Aug. 7, 2009). Army developing master resiliency training. In Defence Talk. Retrieved May 1, 2012, from www.defencetalk.com/army-developing-master-resiliency-training-20963/.
3. Bucci N. (May 2, 2012). Alarm at suicide for paramedics. In The Age. Retrieved June 18, 2012 from www.theage.com.au/victoria/alarm-at-suicide-for-paramedics-20120501-1xx8m.html.