The day is bright and sunny after a week of rain and cold. The pager has been quiet and your new partner has spent the day complaining about the lack of calls; the boredom and the mundane chores he’s had to do instead of “saving lives.” You smile to yourself, knowing the tide can and often will turn on any given moment.
The tones sound: “Unit 2-Code 3-Elderly male — self-inflicted gunshot wound to the head.” You arrive at a rural residence to find an elderly male unresponsive with a strong pulse and adequate respirations. The patient’s son tearfully states his father had recently been diagnosed with a terminal illness. He explains they had enjoyed the day together and talked a little about nursing home placement when the time came. The son states he went into the house to get his father a glass of water and heard the gunshot. He states he had no idea his father had the gun, but requests that you honor his father’s wishes as he hands you a signed DNR.
Whether you’ve been in EMS for one year or 30 years, you have at some point run calls that live with you for a long time. Every call has the potential to evoke a strong emotional response. Those that do almost always involve a case where your actions seem wrought with futility such as a mortal wound that cannot be fixed or a terminal illness that cannot be reversed. The cases that involve the death of a child or someone you know on a very personal level; a close friend or a relative are usually the most difficult.
Dealing with the emotional twists and turns in EMS is not something that can be taught in a classroom. There are no professional guidelines or training which directly teaches an individual how to manage intense moments of stress or strong or negative feelings. We attempt to prepare EMS students through simulations and scenarios, but the feelings experienced on a real scene are missing. Developing important coping mechanisms vary from individual to individual and develop while working in the field.
It is not uncommon to hear EMS practitioners cracking jokes following difficult calls. Humor, whether it takes the form of joking around as if nothing sad has happened or dark humor following a gruesome call, helps individuals distance themselves from the sadness and talk about it impersonally.
Common practice
Pushing feelings aside or compartmentalizing feelings is a common practice not only in EMS but anytime life events are intensely stressful or sad. In EMS, one call is often followed immediately by another and “I’ll think about it later” is a common form of compartmentalization that permits the EMT to continue to function when there is not time to manage the stress right away.
Compartmentalizing allows the individual to place the event in a special place or compartment, rather like the separate compartments of a silverware drawer, enabling the individual to respond to the next response whatever it may be. Compartmentalization should be seen as a tool, rather than the solution to dealing with uncomfortable, sad or horrific events.
Compartmentalization will not effectively achieve its purpose when the drawer is locked and the emotions are never addressed. There are necessary steps that must be taken for it to be effective and healthy.
Effective compartmentalization requires some letting go — and letting go can be extremely difficult. Rather than being thought of as “getting over it,” think of it as taking a temporary pause while dealing with something else.
It is also important to realize that putting specific feelings aside for a while doesn’t mean you are “unfeeling” or “cold” or that you don’t need to or can’t address them. In fact, it is vitally important those feelings are addressed and dealt with by whatever method works for the individual.
Critical Incident Stress Management (CISM) is one way these feelings can be addressed, working with individuals that have had some training in stress management. While this has anecdotally shown itself to be effective for some individuals, by rapidly tearing walls down all at once, for others removing one brick at a time works better.
Regardless of the method used to manage the emotions, never looking behind the wall or over stuffing compartments with more and more stress and emotion will catch up to you eventually . Make a conscious decision when to go back and deal with the stress. Choose a time, place and method to open the compartment and follow through with it. The most important thing is to open the drawer and face whatever demons emerge.
A day in EMS has been described as “hours of boredom punctuated by moments of sheer terror.” The emotions experienced during any given shift are like spinning wheels; subject to the winds and tides of those moments. There is no prescribed way to cope with the emotional side of EMS that suits everyone. EMS practitioners should be allowed to use the method that works best for them as individuals.
