Emotional recovery’s role in EMS safety
To be in service means sacrificing some part of yourself all the time, and providers need to be aware of how much they have left to give
You’ve done marvelous work out there. You ran your algorithms, made all the right choices, called for all the right people. You walked triumphant through the ED bay doors, gave a flawless report, turned over a viable patient with expertly executed interventions, beautifully packaged and ready for the healing touch of definitive care’s hands.
You grab new sheets; you pack up your gear, step back and watch the new wave of medical chaos crest and fall over your patient in that hospital bed, as new lab values and fresh venous access spill nurses and carts into the hallway like the drops of sweat that beaded off your brow not moments before.
Sure, you’ll turn it around for the next one. The radios will chirp and the pagers will go off and someone else will need you and your skills ... but what about you? Hopefully, you’ve analyzed your feelings and emotions during the call. You’ve pulled mantras out of your head to soothe those natural reactions to stress, and get your job done, but for what? To leave those feelings loitering up there and run to the next call? The last 60 minutes was all about someone else, at your expense. Whether that toll was a little or a lot, to be in service means sacrificing some part of yourself all the time. Now, it’s time to take this time for yourself. It is time to recover.
A conversation between partners
This next step involves a conversation between partners and an honest account of what transpired in your head during the call. Use the emotional vocabulary that’s laid out in Plutchik’s emotion wheel. Remember that you are responsible for each other and not just for the shift, so you have to know what your partner is talking about. When your partner says, “That nurse really frustrated me,” or you say, “I felt sorry for that patient,” you have to follow those feelings down to the root emotions they came from. Frustrated is rage and terror, sympathy or empathy is grief and rage. In understanding those roots, we understand that they all have opposites, and we have to communicate what we need to get there. The partnership includes a responsibility to meet those needs.
I know, you have a lot of responsibilities already, but this one is simple. Compromise is the name of the game. When I’m angry, I need space or really loud music. When my partner got in her feelings about a call, we fed her. Her needs were communicated with me sometimes along with her expression of feelings, but we had that understanding and we met the needs the best we knew how. She was my partner – my family – and we would eat and crank the music in the ambulance for 10 minutes and while that sounds like a scene from a cheesy ambulance film, it diffused that sympathetic nervous system response to the stress. After we finished our snack and the last song ended, we would talk. I didn’t go home with the unconscious and entrapped 20-year-old spitting teeth after a car wreck in my head; she didn’t leave a shift after a child had continuous seizures we couldn’t stop in hers.
We gauge our sympathetic response level just like we gauge pain, on a scale of 1-10. Zero sounds like the goal doesn’t it? Zero is not a real number. Look at the scale itself, we don’t even offer patients a zero rating. Instead of staying at a dysfunctional 10 after a difficult call or the shift, taking the time to recover and address emotional roots can leave you at a functional 2. We decide how low we need to be able to function on the next one. I’m usually a 2 or a 3, a little stress makes me more focused, but that only leaves me 7 points until I max out. I have to keep that balance or else that one really bad call impacts me more and the higher we climb, the harder it is to come down again.
That brings us to safety. We get drilled into our heads that safety is one of the highest priorities. BSI so we don’t transmit or contract diseases; scene safety so we don’t walk in to a room assuming grandma doesn’t have a shotgun; PD dispatch with an EMS call in the places that can spare them because those are the guys with the vests and the pistols and the techniques to pick apart the dangers we might miss.
What about you?
What if the techniques in recovery don’t work? What if you stay at a 2 after your recovery time, but you go back up to an 8 when you get home? That scale isn’t linear. You don’t necessarily declare yourself at a 2 and remain there. The line is fluid and that’s where your self-assessments continue. How long? Continue self assessment anywhere from 1 hour after a call up to 4 weeks after a call, which is when post-traumatic stress injury (PTSI) symptoms typically convert to PTSD symptoms (the operative words there being injury).
Safety means answering these questions:
Is it OK to come off the truck?
Should I take the day after a call that I can’t seem to recover from?
What about the system? There’s other calls pending, there’s people who need help, my supervisor will get mad, my partner will get moved to SCT (interfacility transport), I’ve put myself second to these things for so long, so now isn’t different right? Wrong. If your service doesn’t take into account that people may need to come off a unit for a variety of reasons, that’s on them.
Your needs are important and raising that number on that scale in order to protect anything outside of those needs is part of that archaic training. The system needs you safe more than it needs you present and honesty is the first step to safety.
Is it OK to come off the truck? Yes.
Should I take the day after a call that I can’t seem to recover from? Yes.
What about the system? It’ll survive. You need to too.
Honesty extends to your people too. You have to listen to them when they tell you that they are seeing you spiral. Remember, an article isn’t going to drop you off at the end of a path of self-care and old habits will die hard. When you start to shut yourself away or drink too much or stop sleeping and your wife/husband/best friend/partner tell you that they’re worried because this is what they’re seeing in you, the agreement is that you’ll listen and accept the help.
That’s sometimes the second hardest part for us as these type A heroes, accepting the help instead of doling it out. But you have to be safe if you’re going to be any use to any part of what matters.
This article, originally published in August 2020, has been updated.