It’s Not Okay To Not Be Okay

By Michael Lyons, Paramedic

Every quarter the EMS provider I work for requires mandatory quarterly training.

They pick a few things to talk about, usually protocol updates, new paperwork requirements that the county has in place to make sure that we, and by "we" I mean they get paid properly, or some similar snooze-fest. This last one was a little different. Our operations manager came in and talked about mental health and suicide. Seems like pretty standard stuff to talk about when a good chunk of the calls we run on a day-to-day basis are 5150 holds for people who are either suicidal, gravely disabled, or are a danger to themselves or others. We do it every day, Hell, I had two of those exact calls today from the shift from which I just arrived home. That day's discussion about these subject was a little different; that day we talked about mental health and suicide among EMS providers.

So, a couple of years ago, a few people in the EMS community decided to do a survey about Critical Incident Stress Management (CISM) teams and how often they are used by EMS personnel (There's a link at the end of this so you can go look at the hard numbers). I mean, every EMT, Paramedic or CCT RN has had, "that" call, right? The one that you run and think, "Man, that call was a bitch, but I'm all good." and two days later you park at the grocery store to get milk and before you know it, you've been camped out in a parking lot for almost two hours replaying the scenario in your head over and over on a loop. Well, we have a CISM team to go and talk to when we feel like we need help. Here's the thing about that: we aren't likely to ask for it.
The EMS community as a whole has created a culture of, "suck it up." We use terms like, "salty," and "crispy," to describe the vets in the field who have proverbially, "done it all." Well, nobody's done it all. You may have done a lot, but not all of it. We see some shit when we do this job; car accidents, suicides, tragic events involving children, etc. Once we've seen this stuff, we can't un-see it as much as we'd like to, sometimes. When we go on that brutal MVA on a highway or see a super-gnarly GSW, we as first responders, know that we have to do whatever is necessary to get through that call. We distance ourselves mentally from the person and situation, telling ourselves, this is not MY emergency. We run the call to the local ED or to the trauma center and the other crews all want to know about the horror_show that you just brought through the doors. There's a perception that not letting any of this bother you is cool. That it's markedly uncool or weak, even, to let it get to you in the moment. It's not okay, to be not okay, if you will. So what happens? You run calls and maybe you're totally fine, maybe you're not.
A large portion of the EMS community, according to this survey, feel totally unsupported when it comes to our mental health, not only by our management, but also by our coworkers. Why is that? Probably because nobody asks for help. Nobody wants to appear weak, or be looked down on for not being a salty ol' pro who just muscles their way through the day. You have to be a machine, and not a human being with emotions and a gag reflex. God help us if it comes to light that we are talking to the company shrink, and now we're "that guy," right? To be branded as a pariah among our peers is a pretty awful thing when, in our most basic parts of our lizard brains, we just want to fit in.
The numbers in this survey are pretty shocking, to say the least. In the general public, approximately 3.7% of people have thought about or contemplated suicide. According to this study, for EMS providers, that number is 37.7%!. Wrap your head around that...literally ten times higher amongst EMS providers. If you whittle that number down as low as it can go reasonably, it roughly comes out to about two people in every five that are EMS workers have thought about ending their own lives. That's a sobering thought, isn't it?
So, what do we do about this? We have to talk. We have to be willing to open ourselves up to, at the very least, our partners on our shift who just ran the same grinder of a call that we did. They are going through what I would assume to be an almost identical set of emotions that we are after experiencing the same or similar things. We have the CISM teams, but we have to be willing to reach out to them and say, "Hey, I'm not okay right now," and know that we aren't going to be judged, alienated, or risk our jobs. I can tell you, every EMS worker's biggest fear is being brought into the county psychiatric emergency services building, restrained on a gurney, with their coworkers giving a report about them to the same PES staff that we've been giving 5150's to for years. A fate worse than death, for some.
After that presentation, I feel a lot better about the services that we have in place in our system. Granted, I think that for me, anyhow, just knowing that I can call one of the people that I work with, who's been through the types of calls that I go through, and just have them listen, is s huge help. Sometimes we just need to vent and hear that person say, "Yeah, man, that must've been terrible. I'm sorry you had to see that." and for me to know that it's okay that I'm not okay.

References:

JEMS Article Describing The Study Referenced In This Article.

The American Society For Suicide Prevention