EMS Chaplaincy: Evidence-based professional practice
Informed by evidence EMS chaplain Russ Myers places a high priority on follow-up with EMS personnel and dispatchers after any pediatric patient transport
This article originally appeared in the March 7, 2019 issue of the Paramedic Chief Leadership Briefing, EMS Chaplaincy | #EMSIsMoreThanaTaxi | ET3 and you. Read the full briefing and add the Paramedic Chief eNewsletter to your subscriptions.
Professional chaplains are turning to original research to provide the foundations for clinical practice. Though measurement tools are not commonly associated with the work of the EMS chaplain, our work can be informed by the intentional use of research methods. The wellbeing initiative at Allina Health Emergency Medical Services is an example of how this can be done.
EMS chaplains support EMTs, paramedics and dispatchers
The role of the EMS chaplain is to support the paramedics, EMTs and dispatchers who serve our communities. EMS professionals serve in a job with a lot of emotional weight from:
Cumulative stress of caring for people in need
Stress that comes with a critical incident
A routine call suddenly becoming urgent
The sights, sounds and smells associated with an emergency call
A call that feels ordinary for one dispatcher can trigger unexpected memories and associations for another, becoming a critical incident.
EMS chaplains proactively build relationships
The professional chaplain’s approach to this position is one of proactive relationship building. We do that by riding with ambulance crews and sitting with dispatchers on a regular basis.
A guiding principle for me has been, "the time of a crisis is not the time for us to be shaking hands."
That is, we need to know each other, so that when the inevitable high-stress calls come, the dispatchers, paramedics and EMTs know who we are and why we are reaching out to them.
A reactive model of chaplaincy would resemble the employee assistance program, in which the provider is accessible on an on-call basis. Our proactive approach does not wait for the employee to ask; rather the chaplain reaches out to the employee to express concern and offer support.
Transparency is essential to the relationship; there is no hidden agenda. The "why" of this job is "because we care." Employees know I am contacting them because we all know this is a challenging field in which to work, and we, as an organization, care about the wellbeing of our people.
Who should an EMS chaplain serve?
EMS chaplain was a new position when I started in 2007. I wondered how I would determine who had experienced a difficult call, and how to prioritize them. Together with my colleague Al Kleinsasser, chaplain at a neighboring EMS agency, we asked the leaders of our organizations for guidance in determining which types of calls were most likely to cause distress, and used their top 10 list to develop standard operating procedures for when leaders should notify the EMS chaplain:
Any event that results in a CISD, even if no one from our organization participates in the debriefing
Death of a child
Multiple casualty incidents
Fatalities resulting from fires
Two or more high-stress calls in the same shift
Employee assaulted by a patient
Traumatic work-related injury
High-stress phone calls impacting dispatch staff
Grotesque injuries or deaths such as decapitation, dismemberment or burned beyond recognition
Evidence for an EMS chaplain
This list was the beginning of the journey to create an evidence-based EMS chaplaincy practice and led to two IRB-approved studies. The first was a cross-sectional, validated survey of Allina dispatchers, EMTs and paramedics to evaluate professional burnout and an extensive list of potential risk factors.
As noted in the published paper, "Survey respondents indicated that they perceived CIs (Critical Incidents) involving children to be among the most difficult to experience and cope with. All seven of the pediatric incident types presented in the survey had very high average severity ratings, and accounted for seven of the top eight event types rated most difficult to cope with."
This is evidence, provided by our own clinicians, that pediatric calls are among the most difficult calls they get. This was not new. We know that calls involving children are challenging.
"Consistent with our findings and irrespective of methods or geography, studies universally report that calls involving children or persons personally or professionally known to the crew are among the most disturbing. Unique to the current study, however, was an examination of incident severity rating by parental status. We hypothesized that emergency responders with children might find pediatric CIs more distressing because of mental and emotional transference of the situation to children in their own lives, but our findings did not support any difference in perceived severity by parental status."
In other words, it doesn’t matter if the provider is a parent or not. Pediatric calls can be distressing to anyone. Informed by this evidence, I adapted my chaplaincy practice to place a high priority on follow-up contacts to all paramedics, EMTs and dispatchers who were involved in code three, lights-and-sirens, emergency transports of pediatric patients.
Our research team also conducted a follow-up focus group study to further delve into what specific elements of pediatric calls contribute to distress. The findings have been published in two peer-reviewed papers, to date.
The first, "Burnout and Exposure to Critical Incidents in a Cohort of Emergency Medical Services Workers from Minnesota" provides quantitative data on EMS providers’ exposure to critical incidents.
The second, "Emergency Medical Services Provider Perspectives on Pediatric Calls: A Qualitative Study" summarizes the qualitative information gleaned from the follow-up focus groups.
The next step in this process has been to identify and refine the referrals from supervisors and managers informing me of high-stress calls involving children, as well as referrals for follow-ups based on other criteria. Sometimes employees will contact me directly, on behalf of a coworker or to request support for themselves.
Another source of information about calls involving pediatric patients is the use of an automated notification program, set up through the communications center. Using keywords, the FirstWatch program generates email reports informing me of calls that meet the established criteria.
The initial notification gives basic information, such as the nature of the call, location and crew members. After the PCR is submitted, I receive that narrative as well. Within hours, usually before the end of the shift, I have sufficient information to begin reaching out to the dispatcher and crew members.
We have yet to do the work of measuring the impact of the chaplains’ care. In many ways, discovering the evidence on which to focus the EMS chaplain’s work has been the easy part. Measuring its effectiveness will be a greater challenge.