Providing relational support to paramedics after a bad call

Openly acknowledge the bad calls, create space for people to be human and then get out of the way


Russell Myers, D.Min., BCC; Louise Reynolds, PhD; and Katie Tunks Leach, RN

A difficult call is a difficult call, wherever you are and whatever you call it. And the relational support given to paramedics is vital, regardless of who provides it. Louise Reynolds, associate professor of paramedicine in Melbourne, Australia, describes “good” and “bad” jobs (i.e., calls) [1].

Reynolds writes:

Beyond the minimal expression of awareness, frontline clinicians may be offered peer support, debriefing, follow up by chaplain or other meaningful assistance.
Beyond the minimal expression of awareness, frontline clinicians may be offered peer support, debriefing, follow up by chaplain or other meaningful assistance. (Photo/Getty Images)

“The categorization of whether a job is ‘good’ or ‘bad’ becomes ambiguous when a job leaves a significant impact on the psyche of the personnel. Such jobs may be ‘good’ due to the clinical challenge. However, if they involve children, traumatic deaths, multiple patients, or suicide related deaths, they may well be considered ‘bad’ because of the emotions attached to the incident. The extent to which a job is classified ‘bad’ is dependent on the individual practitioner. ‘Bad’ jobs are those that the paramedic strongly identifies with due to the emotional impact or the way in which they identify with the event” [1].

It is immensely valuable to utilize the language of “ambiguous” in describing a particular call, or job. It might be good for the clinical challenge, bad for the emotional impact. In response to bad jobs, an ambulance service will do well at minimum to acknowledge the event and its potential for anguish. As Reynolds observes, the extent to which a job is considered bad depends on the individual. Two paramedics arrive at the scene together, provide care, and transport the patient. Later, one of them may comment that the incident was challenging but not personally distressing. The other may report that it was one of the worst scenes they’ve had in a long time.

Even if no other staff support interventions are provided, simple recognition by leaders and peers that they responded to a scene that may have been a bad call contributes to a culture of support and cohesiveness. Beyond the minimal expression of awareness, frontline clinicians may be offered peer support, debriefing, follow up by chaplain or other meaningful assistance.

Proactive and reactive chaplain support

In the context of good and bad calls, Katie Tunks Leach presents key findings from a study that explored paramedic perspectives on the role and value of chaplains in the ambulance service [2]:

“Relational support (as opposed to managerial, operational or clinical) was important to paramedics. They valued having someone available who was outside the chain of command, whose sole focus was on paramedic welfare and to connect them to further support if required ... ” [2].

The study was carried out in New South Wales Ambulance, which has the largest multifaith ambulance chaplaincy program in Australia. Two themes were identified: scope of the chaplain’s role and organizational factors influencing the chaplain’s role. When relationships and professional capability were established, paramedics highly valued what they believed to be proactive and reactive support provided by ambulance chaplains, regardless of their personal spiritual or religious beliefs.

The chaplain’s role [2].
The chaplain’s role [2].

Study participants observed that chaplains were proactive, making the time and effort to build relationships. Embedding chaplains within the organization was overwhelmingly viewed as positive if they met paramedic needs. Participants spoke of a protective culture suspicious of outsiders, and how having someone ‘on the inside’, in uniform and easily recognizable to paramedics, promoted the idea that chaplains are part of the ambulance family.

“Chaplain support was seen to be mobile, going to paramedics in their workspaces rather than relying on them to make an appointment or attend a specified location. Support included taking staff off-road for coffee, standing with them at significant jobs, meeting them at hospitals, and riding in ambulances with crews to talk in between jobs…

These pre-existing relationships and activities undertaken by chaplains were seen to promote conversation and help-seeking, and normalize supportive conversations. Furthermore, participants felt safer divulging personal information to a chaplain they knew and were familiar with…”

In terms of reactive support,

“... paramedics also spoke of support provided by chaplains called out to significant jobs or ‘on-scene’. These include major incidents, patients known to paramedics, high profile jobs reported in the media, and jobs eliciting strong emotions or with personal impact (e.g. paediatric cardiac arrests and death by suicide)… Post-incident support was also identified as part of the chaplain’s role. Paramedics spoke of the value in knowing chaplains would check in on them after ‘calamitous sad stuff’ in person and via phone” [2].

These findings suggest embedding appropriately trained and equipped chaplains in EMS may in fact promote conversations around wellbeing and help-seeking, because staff are seeking help from someone they already know and trust.

Relational support is vital for emergency healthcare providers everywhere. These findings suggest that for EMS support to be effective they should openly acknowledge the bad calls, create space for people to be human, and then get out of the way. This is challenging work. Support staff do it because we care about people, even though we know that providing compassionate care will take a toll on us as providers. As the paramedics in Tunks Leach’s study summed it up: “Sometimes you just need to talk. Sometimes you don't need anyone to say anything to you about it, but just go, ‘that's terrible. You've been through hell, seeing that. How do you feel?’ Then you talk about it. I don't need any answers. I don't need help ... It comes down to paramedic wellbeing is the main function.”


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References

1. Beyond the front line : an interpretative ethnography of an ambulance service / by Louise Colleen Reynolds. - University of South Australia (unisa.edu.au)

2. Tunks Leach, K., Simpson, P., Lewis, J. et al. The Role and Value of Chaplains in the Ambulance Service: Paramedic Perspectives. J Relig Health (2021). https://doi.org/10.1007/s10943-021-01446-9

About the authors

Russ Myers is a chaplain with Allina Health EMS, St. Paul, Minnesota and is board certified by the Association of Professional Chaplains, and author of "Because We Care: A Handbook for Chaplaincy in Emergency Medical Services." He can be contacted at russell.myers@allina.com.

Louise Reynolds, PhD, is associate professor of paramedicine at Victoria University and editor of "Understanding the Australian Health Care System - 4th Edition.”

Katie Tunks Leach, RN, is a PhD candidate and chaplain at New South Wales Ambulance and author of “The Role and Value of Chaplains in the Ambulance Service: Paramedic Perspectives.”

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