Lessons in EMS: 11-15

Well, my plan had been to publish one of these each Friday. I’m not sure that’s the best day to do that, so its a work in progress. Also, this past couple weeks has been intense in physical therapy. I had a really significant neck/shoulder/back injury a while back, and the last few months the neck pain has been out of control. In an attempt to avoid another round of steroidal epidurals, or a trip to the neurosurgeon, I’m doing PT a few times a week, for about three hours at a time. While that might not seem like much, it has wiped me out. I’m seeing results, but just didn’t have the capacity to write last week. All that to say, it feels good to sit back down at the keyboard, and if I can, I’ll start to get ahead on posts so that, even if I’m having a rough week, I’ll still be able to publish an entry.

Time to jump back into the Lessons Learned in EMS!

11: Learn to feel the emotions

I think that everyone, whether in public safety or not, that our job is emotionally taxing. No one ever calls us to invite us to a party, at least night for a good reason. The crucible of working in the public eye, of being judged by unreasonable expectations thanks to Hollywood, the long hours and physical strain, and the toll on the body of boredom to extreme stress is not something everyone can do. In fact, I used to be really uncomfortable when people would say that to me, Now, after all these years and time spent as an instructor and preceptor who has had to fail people, I think that is actually accurate. We do a job that not everyone can do, even if their heart is in the right place.

With that in mind, I wanted to talk a bit about how to deal with the feelings that will come up in this job as an EMS provider. It’s not so much a question of if, as much as a question of when. If you want, you can search #itookhome and get an idea of what I mean. This is another mention of the idea of PTSD, and I’m certain it won’t be the last on this blog. My thought today is less typical than you might here. I don’t know if I’ve ever heard it expressed before, so please, if it doesn’t sit well, find someone to process through these moments with.

Some of these calls will stick with you, and haunt you the rest of your life. I have my share, and I’m going to share some of those in later posts. There are some though, that even though people are shocked that it doesn’t bother me, I just don’t have the same emotional response to.

Some of the calls that haunt me are absolutely understandable. They are the ones that we all think of as “the worst call possible”… A bus load of pregnant, hemophiliacs crashes into a glass building and catches on fire. That sort of thing. But a few are just holding a child as they process their illness, or an older man who reminded me of my dad, who was himself on the cusp of entering hospice. There was one call for a child who drowned that didn’t bother me at all, not with nightmares or flashbacks or intrusive sights or sounds. I absolutely felt bad that this had happened to this beautiful girl, but I was actually really proud of my crew, and the firefighters and police officers that responded. We ran as a cohesive team, providing excellent care.

A couple people told me I “should” feel bad about that call. No! I refuse. As a pediatric advanced life support instructor I never told my students that a pediatric call would be more or less stressful or emotional than any other. I prepared them as best I could to handle whatever situation came at them, as calm, cool professionals. I think to some degree, we set ourselves up for struggle if we assume that a certain type of call will absolutely be our triggers.

When you feel bad about a call – ANY call – feel bad. Embrace the emotions. Talk about it. Find healthy coping mechanisms. When you don’t feel bad about a call – ANY call – don’t force yourself into that emotional space, and certainly don’t let anyone else force you into that. Be aware that it may come back at a later time to bite you, and be ready for that. The emotions and the adverse effects of this job are all too real. Don’t run from them, but don’t force them on yourself either.

12. Learn from other public safety professionals

Some of the best lessons I’ve learned as an EMT, then as a paramedic, came from our brothers and sisters in other branches of public safety. In our modern era of responding to mass shootings, cars driven intentionally into crowds, or even the most basic call of a possible intoxicated individual on a bus bench (I’m certain this call is a universal one), our physical safety is most important. Ask a police officer to teach you the proper way to search someone for weapons. Ask them to show you the easiest and best compliance holds for someone’s wrist. Ask the firefighters to show you where they keep the medical equipment in the engine. Learn how they store their gear. Even go so far as to ask them if you can learn how to pull hose, because there is a technique that works.

I know that people have made fun of me for this at times in my agency. However, the numerous knives and four guns I’ve pulled off patients tends to get people to laugh a little less. I also have been enroute to major structure fire and had the winds shift on the cul-de-sac that we were in, and while some firefighters were pulling the hose from the front of the engine, the driver/operator handed me a hose bundle and told me to run it to the hydrant because we needed water for our own protection.

My point is that sometimes, we just don’t have the ability to foresee how quickly a scene can change from safe to not safe. We need to have as many tools, even if they are simple ones, in our mental kit, to help us adapt to those changing dynamics and to overcome them and go home safe at the end of our shift.

13. At some point, start to learn above your comfort level

One of the best things that I ever did for myself, after I had my feet pretty well under me, was to stop getting paramedic-level CE’s. I’ll admit, I was really nervous the first nursing conference I went to. It turned out to be such a great experience! Not only were there incredible opportunities to network and build professional relationships that benefit me to this day, but the clinical education was amazing. I know medicine is a profession that no one can ever learn completely. There is both too much knowledge and too much craft to it. To be honest though, paramedics really only scratch the surface. I choose a flight nursing/ED/critical care conference to attend. The first time I went, I probably only understood 50% really well, and conceptually was able to track at about 85%. I then started buying nursing textbooks. (The one that I love most is called “Critical Care Nursing: A Holistic Approach” and I have no financial ties to that book or publisher.) Now I had a tool – other than the Google and Wiki – which allowed me to cross-reference my notes and dig deep. I also noticed that the nurses who had attended the conference loved having a paramedic there! They were more than willing to answer my questions – and I had a lot of them! – and offered to continue to mentor me after the conference was over. I was now able to do more thorough and in-depth history and physical assessments, and I began to conceptualize what the hospital treatment would be for my patient. This meant I could make better decisions about where to transport a patient.

It’s uncomfortable to surrender what “expertise” you may have garnered and feel like the awkward new kid again on the first day at a new school, but the payoff is absolutely worth looking a little foolish for.

14. Choose who gets to speak into your life

Speaking of those nurses offering to be mentors to me, here’s an important thought about which voices you listen to. In public safety, everyone is a critic. I admit that I am. I will place myself in a scenario and wonder how I would have handled that case. I think people have a tendency to express those opinions also, for better or worse. Actually, its for worse. Armchair quarterbacking can really shake one’s confidence and lead to paralysis-by-analysis. Even more detrimentally, it can cause someone to take responsibility for something that might have been out of their control in the moment, and cause unnecessary mental anguish. (The subtext to this paragraph is: Don’t armchair quarterback!)

To counter this, I found a very successful strategy. I chose five people who are widely respected at work, and who I personally respect a lot. One is a physician, one is a nurse, and three are other paramedics. I have talked with these people ahead of time, and treat them as mentors and our conversations as miniature Morbidity and Mortality Rounds. I will proactively come to them with cases that I struggled on, that I am unsure of how I handled myself, or that I am receiving pushback on from other providers. In my mind, I go into it with the clear goal of identifying if there are any system issues, cognitive issues, or scene issues that contributed to how I ran the call. I do this really informally in the conversation, but these are my clear personal goals.

These five people have a free pass to say anything they want to me. They can critique me, ask any question, offer any suggestion, or any encouragement. They can also ask me to look further into something, and I take that as homework and treat it seriously.

With this team assembled and a phone call away, I feel that I can then ignore the rest of the voices chirping in my ear. Everyone else can say whatever they want. I am not responsible to those people or their opinions. I choose to submit myself though to the opinions of my team, these other well-respected people. This holds me accountable, teaches me, and keeps my inner dialogue and critiques in a healthy perspective. I absolutely credit these people with making me the thinking paramedic I am today, and believe sincerely this is one of the best pieces of advice I can offer anyone.

15. We don’t get to choose the war we fight, we fight the war we are given

Expectations can lead to so much disappointment. I know this sounds kind of cynical, but its a pragmatic approach to working and to the work environment that has kept me calm while others are about to be sent for alone time in a padded room.

We have very little control of our lives at work. We come and go and are sent at the time of another’s choosing. We operate under agency policies, protocols, and state and federal law. Even things such as sleeping and eating are often interrupted because of someone else’s decisions. When we arrive on the scene of a call, we rarely get to control our environment or the people on the scene. When it is time to go home, we all know how disheartening it is to get that late call and be held over.

What we can control is our level of expectation. I am solely responsible for my attitude. The vast majority of the time, I can combat a negative turn in a attitude by realizing this is all out of my control. Maybe this is why I like having a clean truck and uniform, because in those things, I can express my own control. I can choose fun music, I can choose to be a good partner, I can choose to be polite. In doing all of this, I find myself enjoying work more than I did when I was new and got frustrated not being able to do what I wanted, when I wanted. I think that was a huge sign of me maturing as a human being, not solely as a paramedic.
Not sure when the next post will be, but I imagine it will be either Tuesday or Wednesday. Thanks again so much for reading and for the kind words and support! This has been a great experience putting these thoughts to paper!

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