Paramedic, heal thyself

Don't let burnout get in the way of your patient care

In the opening chapters of every EMT textbook, there is a section called "The well-being of the EMT." You may even have some vague memories of it; something about stress relief and coping mechanisms and support systems and the difference between eustress and distress, sandwiched in between other boring minutiae about simplex and duplex radio systems, the minimum data set, R. Adams Cowley, and Baltimore Shock Trauma.

It took me nearly ten years to realize it may have been the most important chapter in the entire textbook.

Early in my teaching career, I taught the Preparatory section of the EMT class in much the same manner I had viewed it as a student; sterile history lessons and psychobabble you had to endure to get to the good stuff about being an EMT. I often said as much to my students, "Bear with me here, folks. I know this is boring, but this is the stuff you'll have to wade through before I can teach you how to save lives."

With time and experience, I learned how to breathe some life into those lessons. I played clips of Mother, Juggs and Speed. I told entertaining R. Adams Cowley war stories shamelessly plagiarized from the EMTs who had been there, so vividly that you'd think I had been sitting at the hotel bar with him when he sketched out the Golden Hour concept on a cocktail napkin. When I taught radio and communications procedure, we did role-playing with real radios, and I showed clips of Emergency! where the actors spoke into the back side of their radio microphones. Rather than lecture about Elizabeth Kübler Ross and her five stages of grief, I demonstrated them by playing the giraffe clip from Robot Chicken.

But back then, I had never experienced burnout. I, like my students, couldn't imagine a time when I didn't want to live, sleep, eat and breathe EMS, and so that section on the well-being of the EMT remained boring psychobabble interspersed with an entertaining video clip or two.

Now, having experienced and overcome career burnout more than once, I understand the importance of that chapter, and I teach it from the perspective of a man who realized that his love for EMS would remain forever unrequited, and yet still found reasons to continue the relationship.

So now, I teach that chapter with a single, stark slide of white text on a black background: "Yes, one day you will hate your job and your patients… but you can learn to forgive them."

Without real-world strategies for maintaining a healthy life outside of EMS, those lectures about healthy pursuits and support systems are just that – lectures. It's easier said than done to leave your job at work when you clock out at the end of the shift, easier said than done to separate work from your family life.

But when you come home and your spouse starts in about how the water heater is busted and the plumber charged $200 a hour to fix it, and Sears called about the overdue credit card payment, and the car is making a funny noise, and the kids have been absolute little monsters all day and you need to go in there and have a talk with your son…

… they may not know that your last call of the day involved scooping up a ruined little six-year-old body from the spot where he came to rest after the car struck his bike, and desperately doing CPR on him all the way to the hospital, knowing against all hope that your efforts were futile, and that the only thing that kept going through your mind was he's just about the same age as my son…and the last thing you want to do is discipline your son when you get home. You want to pick him up and hug him instead, no matter how badly he behaved today. They may not know why you're upset…

…but they need to.

And the only way to build that support system is to get the heck away from EMS now and then. I'm not talking about going out with your co-workers and blowing off steam after a stressful shift, or using your vacation days to attend an EMS conference. Indeed, those are worthy pursuits, and peer support is important, but inevitably, you always wind up talking about EMS. That's not recharging your job satisfaction battery, folks, it's just a temporary jump start. You need to nurture those relationships with friends and family that have nothing to do with EMS, because they're the only ones who can replenish the joy in your life during those times when work tends to deplete it.

In his opening keynote speech at EMS World Expo, Mike Smith spoke of refilling your emotional bank account. He explained that patients are emotional debtors; they drain your account of emotional currency, and if you don't make a deposit now and then, you'll wind up burned out, emotionally bankrupt.

And when your social time only involves the people you work with, your co-workers threaten to do the same. They don't do it intentionally, but such is the nature of EMS shop talk. We do it so much, if the IRS knew how much we like to bitch and complain, they'd tax it as a job benefit.

Nurture those relationships outside EMS, and diversify your friends. If you must socialize with co-workers, make a pact amongst yourselves that you won't talk about work. If you aren't comfortable sharing your job stress with your family, at least make sure that they know the importance of your stress outlet, and that they allow you one. Doesn't matter what it is – mountain biking, shooting, working out, watching a football game on television with a beer in one hand and a bag of Doritos in the other, or naked hang gliding – they have to give you that time, and understand why it's necessary.

Even better, get them involved. Take your kid camping. Teach your wife to shoot. Introduce your teenage son to the unparalleled freedom of naked hang gliding. Take your mother-in-law hunting. I even have a nifty hat with deer antlers you can let her wear.

Whatever it is you do, make it a point to get away from EMS now and then to do it. That time away will help replenish your emotional bank account, and give you much-needed perspective on what exactly it is that you get out of your career. You'll go back to work energized, and your patients and partners will reap the benefits.

Sometimes, the greatest act of mercy you can give your patients is the one you allow for yourself.

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