By Maddy Patten, Firefighter/EMT-B
May is Mental Health Month and I feel fortunate to have become a first responder at a time when mental health is finally being talked about openly in the public safety industry. We see things that no one should have to see once in their lifetime, let alone every day we come into work. My fire academy featured an intentional curriculum about how to take care of your mental health while working this job and our cadre spoke a lot about the topics of PTSD, burnout and substance abuse. As we’re in the midst of an entire month dedicated to opening up the conversation of mental health, let’s take this opportunity to talk about practical ways we can help providers positively impact their mental health.
Bear with me as I share some heavy-hitting statistics about the prevalence of mental health issues within the emergency medical services (EMS) field. In the United States, death by suicide is the leading cause of premature deaths of EMS personnel. That same study, published on the Journal of Emergency Medical Services (JEMS), surveyed 903 EMS providers and of those providers, almost one in three reported experiencing atleast one suicidal ideation in the past year. That is seven times higher than the average population (1). That’s devastating, yet not surprising when you think about what the job entails.
In the firefighting realm, the International Association of Fire Fighters has called to attention that fire fighters are three times more likely to die by suicide than by a line of duty death (2). Every shift at the firehouse we train on fire skills to prepare for and prevent line of duty accidents, which the importance of can never be stressed enough, yet fire fighters are dying from the battles we lose within our own minds. So why aren’t we talking about taking care of ourselves after calls just as much as we talk about improving our fire skills?
Back to first responders at large, another JEMS-published study reports that one in five first responders use alcohol as a coping mechanism to deal with trauma from on-the-job experiences (3). Additionally, “over 60% of EMS professionals report they don’t have enough time to recover from one incident before being called to another.” (4) Though incredibly hard to hear, I hope you’re feeling the weight of these statistics and see them as a call to action that administrations, and line personnel, need to be prioritizing taking care of their people.
We’re at the point where we see the data in front of us and we’re asking ourselves what can we do next? Is there a practical solution out there? What will actually work and make an impact? Is it mandating more critical incident stress management (CISM) debriefs? Probably not, as the data has been pretty mixed as to whether these actually help or hurt responders. Is it staffing more personnel to each shift so responders actually have time to recover before having to respond to the next call? Maybe, but staffing issues are already an industry-wide struggle. So, again, what can we actually do?
One of the JEMS studies I cited earlier suggests that implementing employer-provided annual mental health assessments “may be the impetus to ensuring our emergency responders’ overall mental health and wellness, thereby giving them the knowledge, skills, and abilities to cope with the emotions incurred as part of their job responsibilities.” (3) The First Responder Network Authority (FirstNet Authority), an independent agency within the federal government, analyzed departments and data from across the nation about mental health and produced five recommendations that departments and individual first responders can implement as soon as today:
- Engage public safety leadership.
- Integrate wellness into training throughout a public safety career – and beyond.
- Allocate broader, more equitable funding to mental health initiatives.
- Publish standards on evidence-based health and wellness programs.
- Talk about it (4).
These suggestions should not be taken lightly, as the statistics alone are a warning to administration and the chief staffs across the country. It’s time to do some continuous quality improvement not just on our practices, but on our providers.
Working with Hinckley Medical over the past few months, I’ve also begun to wonder if there are things we can implement during calls in order to relieve some of the stress we face. For example, the OneDose™ Protocol Management Tool and OneWeight™ Patient Scale were made with the intention of reducing provider’s cognitive stress during calls. OneDose allows providers to reference their protocols in real time on their phones. This makes me think back to one of the most traumatic calls I’ve ever been on, and I wonder if having that convenience could have helped ease my mind in the moment.
The call I’m thinking of was my first time seeing a dead child. I was stationed at our rural-most district and we got toned to a two vehicle motor vehicle accident (MVA); pick-up versus a mid-size SUV. Dispatch notes reported a bystander familiar with the EMS triage system reported the following triage: one green patient in the pick-up and three parties trapped in the SUV labeled as two reds and one black. My engine was first on scene and I was, for the first time ever, assigned triage myself. The reported black was a 12 year old. In that moment, I faced the familiar mental weight EMS providers experience when triaging – it was up to me to make a split-second decision on if we were going to attempt to resuscitate a person, this particular one being a child, or if we were to move on to assist a more viable patient. I saw fixed and dilated pupils, felt no pulse, triaged the patient as black and moved on to the next two patients in the vehicle. I triaged both of them as reds, and one was flown out to a level one trauma center, while I drove the other patient emergent to the nearest children’s hospital. On the way back to the station after that call I felt guilt, regret and was second-guessing my decision to call that first patient a black. I was thinking, was my pulse check long enough? Were the signs of death as obvious as I thought? I voiced my guilt to one of my partners and he did something surprising, but wildly helpful for me in that moment: he pulled up our protocols. He went through our triage protocol and walked me through it and, in doing so, proved to me that I followed our protocol to a tee and made the appropriate triage decision on each patient, including the 12-year-old. I was so relieved that tears flooded my eyes. Reflecting now, having OneDose wouldn’t have changed the gruesome scene that I saw, but it may have provided me clarity in the moment, and therefore the comfort I needed, sooner.
Recently a Battalion Chief of a department that has adopted both of Hinckley Medical’s products recounted a similar call his crew experienced, and they were able to utilize both OneWeight and OneDose on scene. He said his crew ran an MVA with multiple patients in critical condition, two of which ended up being transported by helicopter. He shared that his crew “used the OneDose and OneWeight system without a flaw and were really appreciative of how well the system worked to reduce their calculations and time to draw up rapid sequence intubation (RSI) medications.” He also added, “I wanted to share the info and tell you straight up. What you are doing is making a difference! No questions asked.”
Both of these accounts show that maybe there are ways to help providers out on calls, to reduce their stresses and therefore minimize the mind’s emotional response. Hinckley Medical’s solutions alone aren’t going to solve the mental health crisis first responders are facing, of course, but they are an example of tools that agency decision-makers can provide their personnel. Many of the articles and studies cited above were listed in the Administration and Leadership section of JEMS, which I find a testament to FirstNet’s recommendation to engage public safety leadership in the effort to better first responder’s mental health. So this May, I encourage all the administrators that read this post to take it to heart and to realize the power you hold to have a positive impact on your people.
Sources:
2 https://www.iaffrecoverycenter.com/blog/silent-suffering-firefighting-depression/
3 https://www.jems.com/administration-and-leadership/mental-health-of-first-responders/