Managing stress, resilience critical for mental health in EMS

September 22, 2021

by Bruce Evans, Fire Chief Upper Pine River Fire Protection District and President of the National Association of EMTs

Being in emergency medical services is a pretty rewarding profession. You get a chance to make a difference in people's lives. Occasionally, you're lucky enough to save people.

But there are also a lot of stressors. And there's an incredible contrast between serving in an urban environment and serving in a small town.

In urban areas, it's the constant call volume. One patient every hour.

In a small town, it’s knowing the people you’re helping on every run. The people involved in car accidents, or the people having a cardiac event, might be the folks you see every day. It might be the dad who coaches your kid’s little league team. Or it might be an elderly couple you know from the senior center or from one of the restaurants.

And that makes it a lot more personal.

It's also a very intimate profession. A lot of times you're seeing people at their worst. You're in their home. You're in their bedroom, you're in their bathroom. Then you have them for a 20- to 40-minute transport in the back of the ambulance. Sometimes you get a chance to learn a little more about their lives or have an impact. And sometimes you don’t.

Stress comes with the job

But there are also a lot of emotions involved when you're in an EMS environment. And your senses are really challenged.

You can't unsee the things that you see. And it's not just what you see. It's what you smell. It's what you hear. Most people would tell you that the blood curdling scream of a mother when they realize that their child is gone is something you can never unhear.

Others will tell you that the smells they smell in the back of an ambulance are something they can't un-smell. Again, all the things that you see visually, there's no way that you're going to unsee them.

So it’s important we help our paramedics and EMTs develop techniques they can use to cope with these experiences. 

Helping responders cope

One of the things that's really important is to make sure that you have a pretty balanced life. You need to have hobbies, you need to have friends and family, you need to have a peer support team. You need to eat right, exercise and you need to sleep. All those things are important because those are the things that put water back into your bucket so that you can serve other people.  You need to take  are of yourself so you can serve others.

One of my supervisors in Las Vegas had a great reputation for being a caring, excellent paramedic. He would tell me that when stress built up to the point where he could feel it, he would take his boat out on the lake and go as fast as he could across that lake. He would take his sons and spend the day, and come back with his batteries recharged.

That’s the concept of putting water back in your bucket. You have to ask yourself, what are you doing to have that happen? Is it mountain biking? Is it vacationing? Is it yoga? What is it that you're doing to help put water back in your bucket?

People who don't have a way to put water back in their bucket, who don't have a family or peer group around them to make that happen, are ultimately going to be damaged by what they experience. They're going to get injured. And they're going to probably suffer the long-term consequences of serving in a profession like this.

Importance of mental health

At the National Association of EMTs, through a lot of the listening sessions we've had with our members, we’ve come to realize that post COVID, there's going to be a lot of PTSD amongst EMS providers and first responders in the United States.

There's a tsunami coming of mental health issues.

After the alarm response is over for COVID, there are going to be a lot of people that look back and say, "I ran four or five cardiac arrests per shift. I took people who were talking to me to the hospital and an hour later, they were gone. And I had to explain to their family what happened."

We know there's an incredible need for mental health services and peer to peer support. NAEMT has convened a group of excellent mental health professionals in emergency services, thanks to a grant from FirstNet®.

The team is led by a clinical psychologist who works as a fire officer on the east side of Florida. Her team has been working on curriculum that is going to be very impactful to our profession. And we're hoping to launch that in the fall at EMS Expo.

We hope it will provide some answers to folks looking for mental health services and who are going to be dealing with the aftermath of COVID. 

Peer to peer support

The mission of the resiliency course is really to train peers to have adequate skills to engage their coworkers in a positive way and know there are resources out there. There are techniques out there that have been vetted through the mental health community that they can engage with, as peers, before somebody has to get into a formal clinical relationship with a counselor or a therapist.

We know from our research that people are not comfortable engaging their employees’ assistance programs. A lot of times they don't want their supervisor to know that information. But they will reach out to a peer. And when they reach out to a peer, we want to make sure that peer has an excellent education, and knows how to handle these situations.

A rewarding career

This profession is really an honorable profession. You're spending your time, your emotion, your energy to help people. And that's rewarding in the end. After 38 years of doing this, you look back and say there are hundreds of people whose lives you changed.

In this profession, you run a lot of cardiac calls. EMS systems are typically built around the response for cardiac arrest. And in excellent EMS systems you probably have about a 45 percent survival rate for cardiac arrest.

In our system last year, we had 100 percent cardiac arrest survival rate.  Now, it was only three patients, but one of those three patients who suffered a cardiac arrest in our local fitness club had to be resuscitated. And we found out he went home about a week later.

He went back to his family. He's a local coach and he has a son and a daughter. So, it's very rewarding to find out that your hard work – the CPR, administration of medications and other procedures that occur in the field – had a positive outcome that allowed people to go back to their families.

Another case involved a situation from a previous job. I got a call from my former employer saying, "Hey, there's this lady in town says that you transported her sister about a year and a half ago and she wants to talk to you."

Immediately, a part of you assumes it’s about a lawsuit. In this particular case, the woman’s sister had been in an auto pedestrian accident in front of the Stardust hotel. And she wanted to talk to us.

She had ridden in the front seat on the way to the hospital and witnessed some very excellent care her sister received in the back of the truck. She was so inspired that when she got back home to Wisconsin, she changed her major and decided to go be a nurse. She has since gone on to be a flight nurse, and now teaches paramedics and EMTs.

So if you're a young person, and you're coming into this profession, I would tell you, you're going to see a lot of incredible things. You're going to have some successes, and you're going to have some failures. But overall, when you look back at a 20- or 30-year career, you're going to be proud of the work that you did. 

Bruce Evans has been the Fire Chief with the Upper Pine River Fire Protection District in Colorado for the last 10 years and in emergency medical services for 38 years. He started his career as an EMT at West Des Moines EMS in Iowa; then spent a couple years flying with Life Flight Des Moines as an EMT intermediate. When he received his paramedic certification, he moved to Las Vegas and worked at a private EMS company. He left that company to work as a firefighter/paramedic at Henderson Fire, where he spent the next 18 years, working his way up as an EMS captain and fire captain. He left Henderson Fire and went to North Las Vegas Fire as an EMS chief and worked his way up to the assistant chief role. He left that job to become the assistant chief at Upper Pine Fire Protection District. Chief Evans also ran the community college program at the College of Southern Nevada's fire science program for many years and has been an active member in many national organizations including the National Association of EMTs.