Caring for the caregiver

Critical incident and cumulative stress are an everyday reality for paramedics, EMTs and dispatchers. Concerns about the mental health and potential suicide risk of our co-workers challenge us as an industry to be intentional about providing appropriate, professional support.

EMS Week is an opportunity to step back, recognize and care for our caregivers. At Allina Health EMS, a hospital-based EMS agency that serves more than 100 communities in the Minneapolis/St. Paul area, we established a position of EMS chaplain to focus on the wellbeing of our employees. This paid, 32 hour a week position resembles the role and function of military chaplains. I’m “embedded with the troops,” riding with ambulance crews and sitting along with dispatchers, building relationships with frontline staff and following up after potentially stressful incidents.

As a board-certified chaplain, my attention is on providing respectful, appropriate support. For some, that may involve finding meaning in a tragedy, and that may include drawing on the individual’s faith or spirituality. For others, the primary sources of support may be family, friends, nature and the arts. Wherever that conversation takes us, professional chaplains are held to a code of ethics that prohibits proselytizing. The focus isn’t on my particular faith background, or me, but on the needs, hopes and resources of the person in need.

Ten years ago, Allina Health EMS Chief and President Brian LaCroix asked if I would consider serving as their EMS chaplain. He was familiar with the work of other public safety chaplains, and wanted a position focused on caring for the caregivers. After completing a year-long chaplaincy residency at a Level 1 trauma hospital and working more than a dozen years in the ICU and ED at United Hospital in St. Paul, Minnesota, I was familiar with the emotional weight of caring for people in crisis. My EMS position began in 2007 as a one day per week position, and I continued to work at the hospital 32 hours a week. I was new to EMS, and assumed that most calls were trauma calls, and that my work would largely revolve around critical incident stress and debriefing.

A year later, after riding with crews and learning about their work, I saw that yes, EMS involves trauma and critical incidents, and it also includes cumulative stress – the chronic, low-level, day in/day out work of caring for people in need. It wasn’t enough for me to function in reactive mode. We saw there was potential to expand and transform the role of EMS chaplain from reactive to proactive. My hospital job decreased and the EMS responsibilities grew to a half-time position. I enrolled in the EMT course at a local college, so I could learn more about the work that my coworkers were doing. I didn’t want to be an EMT, but rather to get a better understanding of the field of emergency medical services. I started doing more ride-alongs and sit-alongs with field staff, dispatchers and leaders.

Growing into your profession

A hospital patient was in cardiac arrest, surrounded by the code team, when his frightened brother noticed that I was able to be at the bedside without appearing to be in much distress myself. He commented, “I suppose this kind of work gets easier over time.”

Easier? No, I told him, it doesn’t get easier, but it does get more familiar. This is also true for those of us who work in EMS, be it trauma, interfacility, community paramedic or dispatcher. We come face-to-face with the hard realities of human suffering. We are reminded that the word “compassion” literally means, “to suffer with.”

One of the things I’ve come to recognize is that our responses to critical incidents involve more than one emotion. A normal response to loss is to feel grief or sadness; a typical response to trauma is to be afraid, and all of that intense emotion can be overwhelming.

With experience, the “fear factor” is less than it used to be. Situations that used to scare me aren’t so scary anymore. I still experience some initial anxiety as I make the mental shift necessary to respond to a crisis. I notice a heightened sense of awareness, faster heartbeat and other physical responses, but I’m not as frightened. I observe my EMS coworkers responding in much the same way.

We grow into our professions. With experience and support from coworkers, family and friends, we can increase our skill at coping with stress and trauma. The fear element is reduced. We have a broader base of experience to draw on, and even though the current situation isn’t exactly the same as something we’ve seen before, we gain confidence in our abilities. It’s not easier, but it is more familiar.

Creating and nurturing a culture of support

Today we see that the concepts and practices of critical incident debriefing and follow-up remain vital, yet are secondary to a broader approach and need for ongoing and long-term emotional and spiritual health that instills resilience. Debriefings and one-to-one support remain in the toolbox, along with the work of creating and nurturing a culture of support. Chaplains are one way to provide a means for addressing wellbeing without giving the message that there is something wrong with you if you struggle to cope with the stress of your job. I find it more helpful to view stress as a normal response to an abnormal event. The focus is on long-term wellbeing and not just incidents.

A year ago, my EMS chaplain position increased, and I resigned the job I’d had at the hospital for 22 years. My focus is now exclusively on Allina Health EMS. The position may increase to full-time someday, but for now working four days a week allows me to devote every Wednesday to my 5-year-old grandson. Time playing with him is part of my self-care, and good for my soul.

My approach to this position is to build relationships, making myself accessible to employees in a variety of ways. Ride-alongs and sit-alongs with field staff and leaders remain a core part of my work. My schedule isn’t strictly four days a week. Sometimes I ride with evening crews; sometimes I work a 12-hour day and check in with our rural bases, or come into the communications center on the weekend to sit with the dispatchers.

Several years ago I initiated and co-led an IRB-approved Allina Health EMS research project called “EMS Provider Wellbeing,” and am now on the project team for a follow-up study exploring the impact of pediatric calls on EMS professionals. One of the outcomes of this study was a change in my clinical practice and I now use real-time data mined from patient care reports to follow up on employees who are involved in Code 3 pediatric transports.

When I learn of a clinician who has experienced a critical incident, or had a series of difficult calls, I schedule myself to ride-along with them. There is no hidden agenda, no suggestion that they may need additional support. My presence is an acknowledgement that they have a challenging job, and to show that we, as an organization, care about them.

If I could put my and Allina Health EMS’ philosophy on a bumper sticker, it would be this: “High Expectations, High Support.”

We do expect a lot out of each other, and we should. We also support each other in a profession that can be very tough at times, but also very rewarding.