How EMS can be the voice of courage for one another

When depression or PTSD sets in, peer support is the lifeline that never fails

“They can make me show up to the debriefing, but they can’t make me say a word while I’m there. I have to work with those guys.”

An EMT said those words to me at a conference.

He wasn’t unlike a great many conference attendees over the years. Most EMTs come up to me after a lecture, eager to share their stories, or to ask the questions they were unwilling to ask when others could hear.

Photo Nate Zecco, Stretcher Monkey Photography

What made this EMT different was the pain in his voice, and the story he told. It was the story he was unwilling to share in that mandatory debriefing long ago, and what made it safe to tell me was the revelation that he was not the only person to feel despair and self-doubt, and that it was not weakness to admit it. I had said those very words not an hour before, when I shared my story of depression and recovery.

And so he told me the tale of a little girl, drowned in a bathtub. He’d been an EMT for five years, and a cop for 10 years longer than that. And he still spoke with wonder that her hair could be so pale and fine, even wet from the tub. He and his partner had tried desperately to revive her, and had been unable to do so.

It wasn’t until later, when the coroner called his supervisor, asking if the crew had noticed the bruises on the toddler’s neck and arms, that he realized the child had been murdered. And whatever forensic evidence that could have been gathered had been hopelessly contaminated during the resuscitation.

And he still blamed himself, 15 years later, for not saving her. For not being able to bring her justice.

He was in EMT mode, you see. Not enough time to worry about the evidence he’d try to collect as a cop. Too busy trying to save a life to notice the bruises. They weren’t readily apparent when they doing CPR, he’d swear to it. Never thought to check under her nails, or pay attention to what fell out of her clenched fist in the ambulance.

He was trying to convince himself as much as he was trying to convince me, and you could see by the broken look on his face that he was a far harsher judge than I. He’d never be convinced that he hadn’t failed that little girl.

I listened mutely as he broke down, sobbing in an exhibit hall crowded with people. All I could do was put my arm around him, and let him cry. My girlfriend kindly and quietly moved between us and the crowd, protecting us from view.

In the months since, I’ve learned that his story isn’t unusual at all. I’ve just never heard one like it because no one gave these EMTs permission to share. No one told them it was all right, that it was normal to feel this way sometimes.

No one told them it wasn’t an admission of weakness to ask for help. And sharing my story made it all right for them to share theirs.

I’ve heard many similar stories since that day. The circumstances change, the wounds and injuries differ, the outcomes vary. But the common thread is that the memories remain fresh in the minds of the responders, and the pain gnaws at them still.

Many of their colleagues profess cynicism that such pain is legitimate, not feigned. They speak with disdain of the mentally ill patients we see every day, and even if their professionalism keeps them from showing it when dealing with those patients, the scorn is evident in their voices after the call, as they joke with their partners about people with Low Marble Count, Chronic Microdeckia, or a tenuous cheese/cracker interface. The implication is that the broken people we see are damaged. Weak. Deficient in some way.

And often, their cynicism and disdain blinds them to the suffering of the person sitting in the ambulance seat 18 inches away. And any hope they had of reaching out for help is killed by the unwitting message conveyed by those words spoken by their partners.

Don’t admit weakness. Don’t be seen as one of those people. Suck it up, cupcake. You knew what you were getting into. No one promised you a rose garden.

The reality is precious little separates us from those broken people we see. We’re often broken, too. We’re just better at hiding the cracks with a job, a steady paycheck and a measure of self-discipline.

The issue is not that we didn’t know what we were getting into. Most of us did. But many of us thought our coping mechanisms were stronger than they were. Or we didn’t appreciate the cumulative effects of stress.

Take a PTSD screening questionnaire. Virtually every trigger listed and it only takes one exposure to trigger PTSD. EMS and public safety professionals have the chance of an exposure every single shift, often multiple times a shift.

But there is no screening test that can quantify the psychic punishment we inflict upon ourselves. After a while, the sheer weight of those experiences can overwhelm even the strongest of coping mechanisms.

It is often said in management circles that the most valuable resource in any organization is the personnel. It’s time that EMS management paid more than lip service to that fact. The story the EMT told me that day was a litany of everything wrong with the way we approach provider mental health in EMS.

His CISM debriefing was mandatory, despite expert opinion that such sessions do not help many, and may hurt some. At the very least, attendance should never be mandatory. Not everyone’s coping mechanisms are helped by a debriefing.

His EAP was capped at five visits. He was disillusioned because the counselor he was assigned had no appreciation of the pressures he faced as a cop and EMT. The counselor was not one of us, and therefore not to be trusted. He felt her priority was not to help him deal with his nightmares and guilt, but to clear him off the books and get him back to work.

His employer's health plan didn’t pay for psychiatrist office visits. At $100/hour, such visits are expensive, and he’d have to pay his $2500 deductible out of his own pocket before his insurance would kick in. Once it did kick in, he’d have to have some official diagnosis of mental illness in order to continue treatment. He feared the stigma attached to that. He feared how it would affect his job security as a cop. He feared a mental illness diagnosis would mean losing his Second Amendment rights.

He feared being seen as weak by his peers.

He admitted to as much when he told me, “They can make me show up at the debriefing, but they can’t make me talk. I have to work with those guys.”

And that is the biggest failure of all. We failed him. For whatever reason, he didn’t feel like he had the support from the people that knew him best. He was afraid to admit his despair to the people who should have understood it better than anyone else.

That has to stop. Changing department policies takes time. Setting up a comprehensive mental health wellness program takes time. Getting better insurance plans for mental health care takes time, perhaps more time than some of us have.

But what we can change – right now – is the attitude we as providers have towards mental illness. We can make it clear by our words and actions that mental illness is a disease, and that we are not immune to it. We can make it clear that admitting we need help is not weakness, it is strength.

Peer support can be a lifeline when all other methods fail.

That’s the purpose of The Code Green Campaign. We aim to crowd-source peer support, to be that voice in the darkness whispering, “Hold on,” when you can’t speak to the partner sitting 18 inches away. We aim to educate EMTs on stress, PTSD and depression, so that they can be a source of solace and comfort when a colleague is in need; a partner who has your back, even long after the shift has ended.

That’s something all of us can use from time to time.

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