PTSD in Emergency Services

EH emsDo you all know who the world’s most famous ambulance driver was? Ernest Hemingway, and yes I called him an ambulance driver because that was exactly what he did. He was a writer before going to Europe to serve in the Red Cross, but while there he witnessed horrific sights such as seeing a hospital full of patients bombed and destroyed. His war experiences had a profound impact on his life, but he channelled all that into some of the greatest works of literature written in the 20th Century.

Hemingway was a flawed man for sure. He drank heavily, took risks, and loved to fight. Some might consider this posturing, but what one can’t deny is the great sadness that consumed his life and would result in his suicide in the early 1960s. What we might take away from his example is the sort of things he was exposed to, not only in his own service with the Red Cross, but during the early 20th Centuries many conflicts including the Great War, Spanish Civil War, and World War II as a war correspondent. He had a lot of demons though and those caught up with him.
My grandfather would serve in the army in a similar capacity a generation later during World War II. A field medic in the China-Burma-India theater, or CBI, he witnessed unspeakable horrors that surely stuck with him throughout his life. The man my cousins and I always knew as “Bebop” operated in conditions that were often worse than Hemingway’s. If Bebop was coming for you when you screamed “Medic!” out in the jungle you were probably getting hauled out on a stretcher if you weren’t loaded onto a pack animal like a mule or even the occasional elephant which were also used to move trees while the men under Joe Stilwell rebuilt the Burma Road into China. The incredibly difficult terrain compiled with frequent rain storms and monsoons made his work extremely difficult, to say nothing of banzai attacks from the Japanese. And I complain when my stretcher battery dies…

Some of the most tragic events he witnessed of these was the medical ship he sailed home on after the war, loaded with men who were suffering with an affliction then called “shell-shock”, but today we refer to as Post Traumatic Stress Disorder. If you’ve ever seen the film Patton, there is a tragic scene where the general smacks around an enlisted man suffering from shell-shock. While we know better now, the idea that we should stay quiet about what we experience and the way in which these things effect us often remains a staple in the EMS personal protocol. We think that admitting that an incident is effecting us is somehow a suggestion that we are weak, sometimes resulting in bottling up of our emotions, letting them ferment in our psyche until it becomes too much to handle.

I am pleased to see that there is a great deal of dialogue going on recently concerning Post Traumatic Stress Disorder in EMS, Fire, Police, Nursing and the other emergency cervices field. PTSD is an often under reported and misunderstood situation that a provider can find themselves face with. As a paramedic and a writer, I would not being doing my job if I didn’t continue this dialogue and encourage you to visit Heroes Cry Too on Facebook and give a listen to my friend G, one of the moderators of The EMS Lounge and the voice of their podcast. He is one of the great people headlining the effort to make PTSD in EMS and other emergency services workers known. The EMS Lounge podcast.

It is of the utmost importance that we, the EMS culture, begin to dismantle the idea that we keep quiet about what bothers us. Too many of our brothers and sisters are suffering in silence due to the idea that opening up makes them look weak. When I first started working in the ER as a Basic EMT I had been in EMS about a year and a half. I had seen people who had expired on calls for welfare checks, but had never been exposed to true emergency medicine. The first week of my time working in the ER I worked three codes, three more than I had ever worked and while I appreciated the experience, I immediately began seeing the results of exposure to life and death. I never fully understood the notion that I should talk about what I saw or how it made me feel. I would sit in on one CISD in my time there, the first time I worked a code involving an infant where my final part would be to put the child in a bag and take her down to the morgue. That hit me hard.

In twelve years I have learned a great deal about EMS, but one of the best things I learned is how to talk about what I saw and experienced. The worst day of my career to date was my twenty-fifth birthday, and as a full grown man I was  crying on the phone with my mother, an RN, who spoke probably the most fundamental truth about EMS that I have ever heard. “We are not Gods.” Processing these feelings takes a great deal out of us and we should not ignore the resources available to us when we need them.

The result of the worst day of my career would be a book called Twenty-Five at the Lip. Up to that point I had been sketching a vague idea about writing something about EMS, but when it came down to it I had no idea  what that would entail. One day someone asked me, “What’s the worst thing you’ve ever seen?” I’m not a fan of “war stories” because like many of us I don’t view myself as a hero, but the fundamental truth about the question at hand was that the person wouldn’t have understood what I experienced anyway. This guy, a layperson, would never have fully understood what that experience was like for me.

I wanted him to know though because it wasn’t right for me to let this fester inside me. I took a page from my literary idol Hemingway and put pen to paper the way he had in an attempt to purge myself of the grief I was holding. In the end it worked and I am happier for it because when I put pen to paper I got it out of me.

If you don’t already have a passion outside your job, be sure to find one. I know a lot of EMS workers who saturate themselves in their work and don’t come up for air, going from their service to a volunteer or call gig without taking any sort of personal time to destress and reset their minds. Humans aren’t meant to just work and in this high stress profession that chose us we sometimes forget that we need to become us againFind your novel, your painting, your fly tying, or your 1973 Plymouth Duster, whatever it is that helps you to reset. It is not a cure-all, but a treatment intended to help you depressurize. Make a habit of your hobby, and it will help you find peace.

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