EMS Stress: When is it a Crisis?

Shift work. Long hours away from family, increased call volume, sleep deprivation and the trauma of what you see everyday on the rig in Emergency Medical Services can lead to rapid and sometimes severe clinician burnout. But when does it become critical? When does it become a crisis?

Stress from the nature of the responses themselves – the screams from parents who were just told their infant has died, the sights, sounds and smells of a horrific multi-casualty DUI motor vehicle crash, fire deaths – are all part of the job but still weigh heavily on the first responders nonetheless.

Sure, EMS is a calling. Any responder will tell you that. But sometimes we avoid asking for help, because we are educated and trained to handle the worst of the worst. Some providers won’t ask for help out of the fear of being perceived as weak, or worse, being told they are unfit to ride the rig anymore. Many are afraid to be pulled for counseling, only to be told they suffer from Post Traumatic Stress Disorder (PTSD) – a very real entity in EMS:  “They’ll send the police.” “Everyone will know.” “I’ll end up in a psych facility.”

The good news is that there are outlets. Peer discussions, even the ones that start with just a dialogue with the fellow crew, can help blow off steam. But what if the depth of that pain, the final straw of that one bad call, begins bleeding over into the other areas of that responder’s life? Family life suffers, social interaction falls by the wayside, and insomnia increases exponentially.

Many agencies have responded by offering CISM programs – Critical Incident Stress Management – usually after “the big bad one,” where clearly every first responder on scene has been affected and needs to debrief and talk it through. Usually it works the same way; everyone goes out of service, other units move in to cover the area, and CISM trained counselors herd the responders into a station and hold a group session:  “What did we do great on this scene?” “How do you feel?” “Was there anything we could’ve done better?” And sometimes the answer is, “There was nothing any of us could’ve done to change the outcome here.” In some instances, if the call is bad enough, the local Hospice group and even the department chaplain are on hand.

Beyond that, there is EAP (Employee Assistance Programs) offered by many agencies through their insurance carrier. In one referral phone call, trained counselors can assess the situation and get a clinician in trouble to a professional therapist to talk it out on a higher level.

EMSAnd what happens if all of these things fail? When the cumulative affect of all the things the responder has seen in totality finally take its toll? They are clearly at a crisis level. And then there’s the word no one wants to utter:  suicide.

There has been an industry-wide push in recent years to recognize and act on potential clinician suicide risks. In September 2015, The Journal of Emergency Medical Services (JEMS) published an alarming study on the subject. They conducted a survey that spanned all 50 states; the initial focus was on severe and critical EMS stress, with questions about suicidal thoughts and risks.

What they found was enough to give any responder pause:  37% of survey respondents had contemplated suicide over job stress. This is compared to the Centers for Disease Control and Prevention’s national average of 3.7%. And 6.6% of them had actually attempted suicide. The CDC’s figures on that are 0.5%. The Firefighter Behavioral Health Alliance has reported and confirmed 828 first responder suicides in the nation since 2012.

The National Suicide Prevention Lifeline has identified some suicide warning signs to be on the lookout for. Some may be obvious, and some may be just shrugged off as a bad shift:

  • Responder is talking about feeling trapped
  • Complaining about unbearable physical or mental pain
  • Increase in alcohol consumption, illicit drug use or prescription pill dependency
  • Appearing anxious, reckless, agitated
  • Not sleeping at all, or sleeping all the time
  • Suddenly withdrawing from friends and family
  • Feeling like a burden to others
  • Giving up on activities they once loved
  • Open displays of rage
  • Preoccupations with revenge
  • Extreme mood swings

The National Suicide Prevention Lifeline is available 24 hours a day, 7 days a week. They are always there for anyone and everyone – including our first responders – that are in crisis or contemplating suicide. The phone number is 1-800-273-TALK (8255).

The bottom line is that we need to watch each other, pay attention and act when something just doesn’t seem right. To borrow a phrase from law enforcement: if you see something, say something. You just might save a life.

Disclaimer: The content in this article is the opinion of the writer and does not necessarily reflect the policies or opinions of US Patriot Tactical.

Leah Dallaire

Leah Dallaire

Leah G. Dallaire is a highly accomplished freelance writer, editor and consultant with 28 years of experience. She has also concurrently been a paramedic for 20 years; the last 17 she spent serving the citizens of Pinellas County, Florida, which has a call volume of about 209,000 runs per year. She holds an M.A. and a B.A. in Writing & Literature from Union University. She has also just finished her first novel.
Leah Dallaire
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1 thought on “EMS Stress: When is it a Crisis?

  1. Leave,,, great job,, good info hopefully it will help people recognize the signs, so they can get the help they need!!!!!

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