Planning for trauma: How to protect EMS providers’ mental health
Communication at home, recognizing PTSD throughout the ranks and preparing in advance can help paramedics and EMTs handle the consequences of the trauma they experience
By Lieutenant Brad Bouchillon, Statesboro (GA) Fire Department
Practice is an important element in success. A football team practices plays over and over again to have their playbook memorized. An actor practices lines until they are memorized. Practicing response as a public safety professional is no different.
Paramedics, EMTs, firefighters and police officers must train extensively on a myriad of topics to be both effective and remain safe. Law enforcement officers perform active-shooter drills; firefighters hold live-fire training burns; and EMTs simulate mass casualty incidents to be prepared to respond in any situation. Yet, one of the most damaging experiences for these men and women is one that very few actually prepare for.
Public safety personnel are often exposed to horrific scenes in the line of duty. These professionals respond to tragic events that permeate all senses including sight, sound and smell. Unfortunately, there is little to no training offered to adequately prepare public safety professionals to process trauma. This training gap doesn’t make sense: Firefighters, EMTs, and police are far more likely to experience trauma, so why is there not more training to prepare them?
Communicating EMS trauma on the homefront
One way public safety professionals can prepare for trauma is by communicating better with their spouse and loved ones. When EMS providers see a deceased victim or have to perform CPR on a child, it affects them. Whether subconsciously or consciously in an acute manner, the trauma from that event is stored in our brains. Even if it doesn’t seem to have an immediate impact, that event can often resurface, affecting that individual in the coming weeks, months and sometimes years.
I can’t count the number of times I have been stressed because of my work as a firefighter or had a rough call, and instead of telling my wife about it, I bottled it up to protect her. Why should I expose my loved one to a nightmare? Over the years, I realized that it’s actually in everyone’s best interest if I share some of my experiences.
Your partner at home is just as critical as your partner on the rig; you have to communicate everything with each other. While you can spare the gruesome details, your loved one has to know why you may be behaving differently so he or she knows that you’re dealing with something that isn’t their fault.
Communicate with your spouse and consider using them as a form of counsel. I tell my wife: “Hey, we had a really rough call last night. If I am kind of quiet today or don’t do any cleaning, it is because I need to decompress.” She is always more than understanding and quickly offers to talk about the incident or urges me to partake in self-care such as fishing, hiking or hanging out with a friend. It’s important for her to know what’s going on with me, that I may not be myself, and, most importantly, that it isn’t something she did.
Making your loved one aware of this trauma is also in your own best interest. Your significant other is the one most likely to notice changes in your behavior that no one else, including yourself, may notice. If you start exhibiting major behavioral changes, like mood swings, outbursts of anger or signs of depression, there’s a very good chance you may need professional counseling or trauma-informed therapy. As the person experiencing these symptoms, you will likely not recognize these signs or be willing to admit you need help, so you need your significant other to be on alert to tell you when to seek help.
Develop a response plan for after a traumatic event
Trauma exposure can occur at any given time on any given shift, so it’s important to devise a plan about how the situation will be handled. Will you call your spouse immediately following the incident? Or will you share it with him or her the next time you see each other? Should it be a sit-down discussion or is it enough just to mention in passing? Thinking about these details can best prepare both of you for such a situation.
It’s also important to discuss how much you will share. First responders should understand the danger of exposing their partner to vicarious trauma, which is essentially creating post-traumatic stress symptoms in an individual who did not experience the trauma first-hand. Firefighters can easily avoid possibly traumatizing their loved ones by leaving out specific details about the incident.
For example, if I were to run a vehicle extrication incident involving one deceased victim and one critically wounded, I would tell my wife, “We had a bad call last night. Two people rolled their car into a tree and one didn’t make it. The other was badly injured and had to be flown out.” This explains the traumatic event and my exposure without truly exposing them to the graphic nature of the event.
I wouldn’t tell her that, “A young couple heading home from a date rolled their car several times before it wrapped around a tree. The guy was ejected because he wasn’t wearing a seatbelt and was killed instantly. We had to pick up a couple of his extremities. The girl had two broken legs with the bones sticking out and she was bleeding from her nose and ears.” This second version is more graphic and the details aren’t necessary to convey the seriousness of the incident and its impact on you.
Addressing trauma in the EMS ranks
Similarly to preparing in your personal life, first responders of all ranks should be ready to handle traumatic calls and help those who experience them. Regardless of whether someone is the day-one rookie or the chief, if a crew responds to a call and one of the members is seriously affected by what they see, that situation needs to be addressed and handled appropriately, not ignored. First responders are a team and a team does not let someone fall and hope they get back up on their own.
Agencies need to have a plan on how to provide care after a major incident. What will your agency do after a mass-casualty incident? How will it help members recover when they’re exposed to sights, sounds, and smells that they can’t forget? If someone starts acting differently and is exhibiting signs of PTSI, what resources are available to get them professional help?
In the past, fire departments often left these issues up to the supervisor or chaplain. This is not enough. It is everyone’s job to discuss events – good and bad – to ensure everyone learns from mistakes and that everyone is ok, both physically and mentally. Mental wellness needs far more attention in public safety. First responders are expected to be tough and do their job, which we all do, but not always without consequence.
There is an average of 100 validated suicides by fire and EMS personnel each year, many as a result of trauma that was never properly recognized or addressed. First responders need to do a better job of actively preparing for the trauma they’re likely to experience long before it happens.
About the author
Brad Bouchillon has been working for the City of Statesboro Fire Department for 10 years full-time and has held the rank of lieutenant for four years. He has also worked as a lifeguard for Tybee Island Ocean Rescue and as an EMT part-time for Screven County EMS. Brad holds a Bachelor’s Degree in Psychology with a specialization in Crisis Counseling. He is also starting his Masters of Arts program in the fall of 2018 in Human Services Counseling with a Crisis Response and Trauma Cognate. He is married to his wife Megan of 5 years and they have a one-year-old son. To contact the author, please email IPSauthor@apus.edu. To receive more articles like this in your inbox, please sign up for In Public Safety’s bi-monthly newsletter.