First Responders Coping with Calamity, Part I
"Sucking it up" is often the first response of the first responder.
Receiving emergency calls about a person found “unresponsive” is not uncommon for ambulance services. But for a beginning volunteer, such a call is sometimes both their first and their last, says Wayne Chan, president of Monroe Volunteer Ambulance Corps.
“Over the last 20 years, 15 volunteers quit after the first call, two after CPR calls,” he said. “Being warned about a situation and seeing it are different.”
The protocol for treating a person who isn’t breathing is straightforward, as Chan describes it. If the body is warm, CPR should be done, along with defibrillation. With no response after 20 minutes, or if the body is cold when the ambulance arrives, the person is pronounced dead.
But while the procedure is clear, the experience can be overwhelming.
“You must tell the family that their loved one is deceased,” said Chan. “The family is distraught, and it’s traumatic. My first experience with CPR took me two weeks to get over.”
He still remembers, after 26 years as an EMS volunteer, the middle-aged man lying on a bed, with no pulse, not breathing.
“I replayed the scene over and over, thinking about what I could have done differently. But I was so new, I did everything by the book. It was fresh in my mind.”
How EMS workers do and don’t cope with stress
The need for strategies to manage this distress has become increasingly evident, especially since the Covid-19 pandemic. EMS providers are 1.39 times more likely to die by suicide than the general public, according to the U.S. Centers for Disease Control.
“Occupational stress in first responders is associated with increased risk of mental health issues, including hopelessness, anxiety, depression, post-traumatic stress and suicidal behaviors such as suicidal ideation,” wrote Hope M. Tiesman and her colleagues in a CDC article. Studies have also found that between 17% and 24% of public safety telecommunicators, such as emergency dispatchers, have symptoms of post-traumatic stress disorder, and 24% have symptoms of depression.
“Many first responders see more in a few weeks than most see in a lifetime,” said Chan. This exposure intensified during heightened months of Covid-19. “I have taken CPR calls twice for a one-month-old, once for a three-year-old and multiple calls for older patients--to no avail. After four or five in a row, it builds up.” He urges co-workers to take a break for two or three weeks at such points.
Chan, retired from his career as a mainframe systems programmer, is now on a critical incident stress management (CISM) fact-finding committee for the Hudson Valley EMS Council that includes five counties in the lower Hudson Valley. As of this winter, the Council had only two CISM teams, one in Ulster and one in Rockland County. They aim to have teams in all five counties and a person in each trained to spot signs of critical stress, such as agitation and a short temper. They will be prepared to counsel first responders when a disturbing call becomes a persistent problem. Having a team in each county also gives first responders the opportunity to call a counselor in another county if they prefer to confide in someone more distant from their co-workers.
“Because of pride, they may not want to open up to someone in their county,” Chan said. “In Ulster and Rockland Counties, many use the service. The mental health partners come out in the middle of the night. They’re willing to come to Orange County. They counsel people until they’re comfortable.”
Monroe EMS workers have also become vigilant about each other. In addition to having monthly meetings and drills, they call and text volunteers every day to check in with them after a CPR incident or “bad call,” especially young volunteers, 16 to 18. At the scene of a call, junior volunteers are also given the option to leave the house or wait with the driver.
However, in 26 years of ambulance work, Chan has encountered only two co-workers who have asked for counseling.
“First responders tend to hide their emotions. They don't want to appear weak,” he said. “This is a mindset we are trying to dissolve. For too long first responders have been their own worst enemy. They have quit and taken that mental baggage with them. In some cases, first responders who have held it in too long have committed suicide,” which recently happened in a neighboring county.
“I can relate to the tendency to suck it up, but I talk to my wife and hug my kids. If you talk you feel better. EMTs talk to me,” said Chan.
Talking to first responder peers who model effective coping skills can be valuable for the troubled first responder, according to the CDC. But counseling may be needed. Surveys have been circulated to determine whether first responders would make use of mental health services if CISM teams are formed.
Some mental health professionals in the Village of Monroe specialize in working with first responders, Chan said, and this can be crucial. According to the CDC, “general practitioners may not understand what first responders experience on the job or be able to relate to them in a culturally competent manner. For many first responders, the transition from being a provider to client or patient is not an easy one. When a first responder finally seeks treatment, it can be devastating to encounter an ill-prepared provider and may result in reluctance to seek further help.”
These days Chan is also looking for ways to reward volunteers, an effort made more difficult because, unlike fire departments, ambulance service is not considered an essential municipal service in New York State. For years, efforts have been made to change that, Chan said, but the legislation never survives.
“We’re always short of volunteers,” he said.
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