EMS World Expo Quick Take: How real-world experiences shape providers

How three providers found direction through mentoring, overcame physical and mental health challenges to thrive in EMS


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NEW ORLEANS — At the 2019 EMS World Expo, a panel of EMS leaders co-presented the Keynote Session, “Where relevant meets real-world.” Ed Racht, MD, chief medical officer, Global Medical Response, moderated the talk show style discussion, interviewing leaders about their unique experiences and insights into EMS culture.  

Key quotes from the EMS World Expo Keynote 

David A. Miramontes, MD, FACEP, FAEMS, NREMT, was Racht’s first guest, and told his story of what happens when the provider becomes the patient. (Photo/Kerri Hatt)
David A. Miramontes, MD, FACEP, FAEMS, NREMT, was Racht’s first guest, and told his story of what happens when the provider becomes the patient. (Photo/Kerri Hatt)

Here are some quotes that stood out from the Keynote panelists:  

“Cancer can happen to anyone, even dorky medical directors. Firefighters especially, are five times more likely to get cancer. Get your cancer screenings done, and for god’s sake; lose some weight. You’ll feel a million times better.”  — David A. Miramontes, MD, FACEP, FAEMS, NREMT 

“The gift of time is one of the most valuable things you can give someone. We are interconnected; you impact people around you on a daily basis. A little belief can change someone’s world forever.” — Lillian Bonsignore, EMT-P, CIC 

“We only get 12 slides in our education about how to take care of ourselves emotionally.” — Ben Vernon, BA, EMT-P 

Top takeaways on overcoming adversity in EMS 

Racht’s guests shared openly about the challenges they’ve faced in their careers, and in their personal lives, and how those experiences, and their EMS and fire families, have helped them to overcome challenges and keep doing what they love most.  

Here are three takeaways from the Keynote.  

1.  Self-care is the most important care 

David A. Miramontes, MD, FACEP, FAEMS, NREMT, was Racht’s first guest, and told his story of what happens when the provider becomes the patient. Dr. Miramontes, the medical director for the San Antonio Fire Department, was suffering from what he thought was a “man cold,” when stridor and hemoptysis sent him to the nearby community hospital on Christmas Eve. 

Though physicians originally suspected a PE, they found Miramontes in fact had cancer, and after he decided to move to the hospital he worked at, found that it was almost completely obstructing his airway. “They told me I need a tracheostomy. We go to the operating room within an hour or two,” he recalled. “No airway, auto-PEEPing myself. Things were getting ugly.” He was awake for the procedure, when the lidocaine ran out, and could feel the cutting, tearing and searing pain.  

Racht displayed a photo Miramontes had shared with family and friends the day after the procedure. In it, he’s smiling, despite the trach, and flashing a thumbs up to the camera. He asked Miramontes how he was able to take the photo, and why he would think to do this after such a traumatic experience. “My family, my fire family, my friends, they all needed to know I was OK,” he replied. “Without that, they would know I was in trouble.” 

But his recovery was far from trouble-free. Miramontes recalled being hyper-vigilant and irritable in the ICU. Not letting anyone touch his trach. Being unable to sleep. Waking up from night terrors, terrified that he couldn’t breathe.  

“I was talking, walking, blogging, making jokes, but behind that was some really ugly thoughts, he said. It took my fire family, my wife, my family – I have the best fire chief in the world; he supports me 200% – that’s how I got through that.”  

In the aftermath, Miramontes once again took control of his own care plan. He reached out to a physician at Mount Sinai, and was the fifth person in the world to receive an extensive surgery in which “they transplanted parts from everywhere and rebuilt my airway.” 

Miramontes noted the drive to get back to work is what got him through the weeks in the ICU, on a feeding tube, through rehab, “I really wanted to see patients again. I really wanted to make a difference and that’s what got me back.”  

Racht encouraged the audience to think seriously about what they would do in a similar situation. “We have a choice, he said to Miramontes. “You can look at adversity right square in the eye the day after it happens, and that’s a gift.” 

2. Own your role and pay it forward 

Racht’s second guest was Chief Lillian Bonsignore, EMT-P, CIC, who after a 28-year career in the FDNY, has risen to be the highest-ranking uniformed female in the department. As the FDNY’s Chief of EMS Operations, Bonsignore is responsible for the operational oversight and leadership of more than 4,000 EMS providers in New York City where EMS responds to 1.5 million calls per year.  

Bonsignore described some tough times growing up, as one of four children raised by a single mother. Missed electric bills. Pancakes for dinner for weeks on end. “We didn’t talk a lot about where we were headed,” she explained. “I had some thoughts, but I was busy helping mom take care of three other kids.” 

“My path was completely unclear, she noted. “And then, along the way, some incredible things happened.”  

Things changed for Bonsignore when two women from her life – her pediatrician, and an educator from her school district – took an interest in her future. “These two women took an interest in a broken kid from the Bronx and gave me the gift of their time,” she said. “They grabbed on to me at the darkest part of my life and they didn’t let go.” 

Her mentors encouraged her to go to EMT school. Her pediatrician even footed the bill, telling her to spend a summer working as an EMT and then go to medical school. “It’s been 29 years. This is the longest summer job I’ve ever had,” Bonsignore quipped. “I just fell in love with it. The passion I had is the same I have now and I have the privilege to serve one of the largest EMS systems in the world.” 

As for her mentors? It’s been 35 years, and they still stand beside her at every event.  

Bonsignore encouraged attendees to not let peoples’ expectations derail a successful future, and to be mindful of the influence they can have on others. “We save lives for a living, but the lives that you save every day without even knowing are the lives of the people around you,” she said. “There’s nothing more noble.”  

3. A champion for mental health treatment 

Racht’s final guest, San Diego Fire Rescue Engineer/Paramedic Benjamin Vernon, BA, EMT-P, survived an attack on duty, and in his own words, learned a lot about mental health from the incident.  

While Vernon treated a patient at a trolley stop, an agitated bystander stabbed him multiple times, severing a nerve in his back, breaking a rib and puncturing a lung. He was spared a head wound only because when the assailant pulled the knife out of Vernon’s chest, the breath coming out of his lung doubled him over, and the next attack missed. Vernon’s partner was also stabbed in the encounter.   

“I honestly thought in a couple weeks, I’d be back to work with a good story to tell,” he recalled. But then the nightmares, and the PTSD symptoms – the post-traumatic injury – reared its head. Vernon shared a professional headshot, taken before the attack, and told the audience, “that is the face of someone who is arrogant, smug, knows nothing about mental health, who would have said ‘suck it up buttercup.’” 

Vernon has taken his experience and is working to change the culture that leads providers to feel they must bury their emotional struggles. He has helped to increase the mental health education at his department, which has added a mental health day to the academy curriculum, bringing in psychologists, and trainees’ families  

While it took him time to “shop around” and find a good fit, he credits his therapist, Mark Foreman, Psy.D, SDPD (ret.), with saving his life through “lots and lots of therapy.” 

Racht summarized, noting Vernon’s story is a wakeup call for everyone in EMS who is suffering from PTSI to say, “it’s time.” “I’ve got nightmares.” “I’m waking up and freaking my family out.” “I need help.”  

“All of us are just one patient away, unfortunately, from something like that,” Racht said. 

Additional resources on mental health, mentoring in EMS 

Learn more about mental health resources and mentoring with these articles from EMS1: 

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