We All Suffer Burnout; Coping Skills I Have Learned

In the Paramedic industry becoming burnt out is almost inevitable. The reality of burnout stress is that it can lead to other deeper problems. Over the years as a Paramedic I have been burnt out. The psychological changes that can occur with burn out are far too real, and in some cases the cumulative build up can lead to an Occupational Stress Injury. When this happens the only help for the practitioner becomes time off from work and real counselling with a psychologically trained therapist. One of the biggest keys in EMS as a whole is learning how to cope with burn out. This involves having outlets and coping skills to deal with our stress so that it doesn't become a larger issue.

Bad feelings inside your mind can seem daunting and overwhelming but sometimes, once you get them out of your head, they suddenly don't seem as big or as severe. Over the years I have tried many different ways of coping with burn out and work stress. I have tried some methods that were detrimental to my over all well being. Thankfully, due to good friends and some self reflection I have found more positive methods to maintain my health. This article is more aimed at people in the industry, as many of you that read this will become, or have become burnt out in this career.

Burnout is not something that paramedics should be ashamed of or should ever have to hide. Paramedics see the things that no one else should see. The same rings true for our brethren in the Police and Fire Department as well. When you allow a stigma to prevent you from seeking an outlet or talking about your stress you are truly causing more harm to yourself. When I started this blog I was determined to have it mean something, and my hope was for it to make a difference in people's lives. Lately there has been a lot of talk about Occupational stress injuries in EMS, and I am glad that it has come to the fore front as a topic that needs to be addressed. To learn more I encourage you to check out a colleague of mine's site, Theresa Coulter.

As promised here are some of things you can do to combat burnout. Some may seem trivial or obscure but these are things I have tried that have worked. The things I have tried that were not so good were fairly common and things many people have done to try to feel better. I found my way into the bottom of a bottle for a time several years ago to deal with stress I was feeling due to work. I was fortunate that good friends recognized it and helped me out. Drinking to excess is definitely one of the worst ways to handle your stress and in fact will cause you to become more stressed. I am and have been an emotional eater, so when things would get to me I would eat poorly, which affected my health. I gained a lot of weight, as well as developed a few health problems. I have since made several positive changes, although I do slide into old habits now and again, but we are always a work in progress.

Onto positive ways to cope with your burn out stress. These are the things that work for me, and even though you may know of them, I am just here to tell you what works through my experience. One of the first things that I have found to help reduce burn out is to ensure you get enough rest! This one is one of the simplest and most overlooked fixes for your burn out. This is as simple as taking a day and having an extra long nap, letting your self take that time for YOU. You can try going to bed a little bit earlier before you are working, and giving yourself that extra rest to be mentally prepared for what you might face at work.

The next tip I have for you is surprisingly highly effective at reducing stress, and helps your balance, flexibility and overall recovery from aches and pains. From that introduction alone you might already know I am referring to yoga. I have not personally done a lot of yoga, but the few times I have participated I have found my self feeling much better quite quickly! I know several practitioners who practice yoga on a regular basis and they have stated that this form of exercise is highly relaxing and helps to reduce stress!

To go along with more rest and an activity like yoga I highly recommend hydration and a healthy diet. High volumes of water clean our bodies from the inside out, couple this with a healthy eating plan and your stress will begin to melt away! It is rather remarkable how well this works to maintain balance. I also do advocate once or twice a week to let your self indulge for one meal in something delicious that you are craving!

As we become burnt out we will start to find ourselves dragging our feet, and feeling lazy. This is the worst thing we can allow to happen to ourselves. It is imperative at this point to get your body moving and doing some form of physical activity. Not just any old exercise, but an exercise you enjoy! I personally love to swim so I make a regular habit of swimming, which has greatly reduced my personal stress. It has also helped me maintain a healthy balance in my personal and professional life!

More and more people have been doing this one which makes me very happy as it was not something that was heavily encouraged at one time! Always remember to use your accrued time off and do things for yourself and your family that are completely unrelated to this job. Take vacations, and spend time doing activities you enjoy! I have been doing this the last few years, and I feel it has increased my longevity in this job and in life in general. The world is a beautiful place and I believe we should see as much of it as we can in our lifetime!

Last but certainly not least, and this can vary from person to person, but finding an outlet for yourself. A hobby of some sort, whether it be art, or models, or like in my case, writing. I love to write, and find it very relaxing, as well as rewarding. Even if it is something you just do for you that takes your mind out of the EMS world for a while. This allows you to focus on something completely different. This has been proven to lower stress levels and just generally help you feel better.

Our job will inevitably cause you to become burnt out. This is a first step towards permanent forms of occupational stress injuries. This is where occupational stress needs to be stopped or at least managed! I am not promising you will never end up with an occupational stress injury. The things we face on a day to day basis could still cause those kinds of injuries. It is important that you treat those injuries appropriately with the right type of help! These are a few of the things that I do to reduce my stress levels which have kept me in this industry for 16 years now. I have many years left and I still love my career. I hope that some of these ideas can inspire you to work on reducing your stress levels if you are suffering.

These ideas and coping tips can be used in everyday life as well. Everyone feels stress, especially this time of year. With our global economy in a bit of a shambles and many many people out of work it is more important than ever to find ways to reduce your stress levels. Take some time for yourself and try some of the ideas I have mentioned above. Allow yourself the freedom to recognize there is a problem and then take the time to address it and help yourself feel better. You will be much better for your family and loved ones if you ensure that you remain fully healthy.

I hope you enjoyed this read, and I encourage you to like it, share it, forward it to your friends and loved ones! Thank you for reading!

Our Best On Your Worst Day

So I been out a while and haven't posted in quite a bit. I had taken some time to reflect on why I was starting this blog. I have always been a fan of writing, and at times even seemed to be pretty good at it. I want to share with my friends and loved ones that aren't in the medical field what it's like for us as Paramedics on the street. We face a lot of heart ache, and meet many people in hard times. Each call presents unique challenges, and every call takes a small piece of us with it. When I took this bit of time off, I thought about this blog a lot and wondered if I would continue it. I wondered if people would read it, and if they would enjoy it or understand. I have many strong feelings about what I do as a Paramedic, and granted the dynamic of our industry has changed a lot over the 16 years I have been doing this. The dynamic has changed but the basic principle of what we do has never changed since the beginning.

When I think of what I want to share with you the readers; I want you to be able to look inside our world, without taking the scars with you. I want you to know that when you look at that smiling paramedic in line at the Tim Horton's, they may have just finished performing CPR on someone that didn't survive even after all of their efforts. This weighs heavy on medics at any level. The break I took was interrupted recently when I signed up for a Facebook page called simply Ambulance Drivers and was suddenly inspired. Reading their page and watching their videos got me searching and thinking about Paramedicine from a whole new angle. When I first began in this industry I was passionate, and wanted to help everyone. As time went on, I left a piece of myself with every bad call, and I know that every medic does this. You can't leave a bad call unaffected. It is simply not possible. I thought about this and have turned things around for myself and gotten back to the basics. I am here to help sick people.

Every one of us every day puts on our uniforms and we come to work. Every day, of every tour, of every month of every year paramedics are there when you need us. You don't have to think, or wonder. You know that when you dial 911 paramedics will show up at your door. You will put your world on our shoulders and we will always do our best, on your worst day. We are a different type of person. We are no better than anyone else, we are not stronger than anyone else, but we have a passion to help people and we will never give up on someone.

When I took this break, I wanted to ensure that this blog would be about something. I didn't want to write just to write. I want people that don't do what we do to understand our world. I want people that love us to know that sometimes when we are quiet or distant it's not personal. I want our families to know that we chose this, and that what we do means something to us, even when sometimes it seems like we complain about what we do. I don't want to just ramble, I want you, the reader, to be able to take something from each post and gain a bit of understanding about our world. I also want those of you that are in the industry to know that as a colleague I appreciate each of you, and I want you to reflect on the reasons you began this journey to be a paramedic or an EMT. The passion to help people is what drove most of us into this industry, not fully knowing that each bad call will take it's toll on us, physically, and emotionally.

I am hoping that this will be the beginning of a steady stream of writing about what we do, and why we do it. I will even offer advice sometimes. I want to call this blog an extension of what I am as a paramedic. I do hope you enjoy the read, and the video below! It's the video I stole the line from for the title above. Remember when you call 911, we will always be there to do our best on your worst day!

Ambulance Drivers, Why This Term Is Offensive To Paramedics

Many people equate the term ambulance driver to the people that come to their home and help them in their time of need. I don't want to upset people, but this term to Paramedics, EMT"s and EMR's across the medical industry is offensive. The term driver implies that the only thing we do is drive. The focus of pre-hospital professionals goes far beyond driving. Every level of our medical training provides us the skill to breathe for you, compress your chest to ensure perfusion until a defibrillator can be attached to you, and then the ability to use electricity to restart your heart. As each level increases these skills also increase. At the paramedic level we can provide breathing tubes, apply Continuous Positive Airway Pressure (CPAP), or Positive End Expiratory Pressure (PEEP). We can also open up a surgical airway in your trachea to breathe for you as well. These are just the invasive things we can do to help you breathe. Each of these skills requires many hours of training and demonstrated practice to become proficient.

When it comes to the rest of your body we can perform skills like Trans cutaneous pacing, synchronized cardioversion, manual defibrillation, and we can also perform chest decompressions. In the abdominal cavity we can listen to bowel sounds, diagnose inflammatory diseases like cholecystitis or appendicitis. We can take care of nausea and vomiting, perform nasogastric tubes, or orogastric tubes to prevent vomiting or to prevent abdominal distension due to air from artificial respiration.

A paramedic is able to do all of these things, and these are the skills that make up the title Paramedic. Sound redundant? It's meant to. We have earned our title, just like a police officer, or a fire fighter. You don't call Police officers police car drivers do you? When was the last time you referred to a fire fighter as a fire truck driver? You haven't because you understand that those positions are earned, as are the titles. A Paramedic has also earned their title. From beginning to end a Paramedic undergoes almost 4 total years of education. We are inundated with medical knowledge, practical training and we have to  undergo 4 hospital practicums. One in pediatrics, one in labor and delivery. We also spend time in an Operating room as well as the emergency department. Add to that the 2 to 3 400 plus hour ambulance practicums we are required to do before we are considered ready to perform our duties on our own. The training is extensive and it is important as we deal with people in life and death situations at times.

As you read this article you may have seen some terms that you didn't understand, unless you work in our industry. This was also done intentionally, to show what is meant by the fact that a driver is just a driver. I have used very basic terms above, but the skills mentioned are highly technical and invasive. My point is when you see us driving in our ambulance be aware that we are far more than ambulance drivers. We bring professionalism and high quality care as well as respect into your homes when we are there. All we are asking is that you understand we far more than drivers and we would appreciate the respect we deserve.

Let's Look At The Positives Of EMS.

Quite frankly I have seen a lot of negative light on the world of EMS and emergency services in general lately. Talking a lot about the difficulties of these jobs, and the mental trauma and anguish that we go through. These are very real, and very true things that happen within the EMS culture as well as the other emergency services who swear oaths to protect the public. I am not discounting the very real and very tangible issues of PTSD, mental burn out, physical exhaustion and high injury rates that we as emergency service providers face. I just want to take a moment today to focus on the positive parts of what we do, and the reasons why some of us find it in our very bones to get up every day and put on our uniforms to go to work.

I will speak from my own experience first and build on what I believe draws people to this line of work. As a child I used to watch one of the very first shows on TV that represented the humble beginnings of Paramedicine outside of the world of combat medics that parachuted in to battle zones to care for injured soldiers. The show as many of you will remember was called Emergency, with firefighter/paramedics Johnny Gage, and Roy Desoto. This show was a look at a fire based paramedical service that strived to show how emergency medical service was rendered in Orange County California. I used to watch this show religiously as a child, and even had a hot wheels version of the rapid response fire truck that Johnny and Roy rode in.

I didn't know it then, but even that choice to watch that show birthed something in me that would later change the direction of my life. As I grew up I became a journeyman welder and when the market fell apart in the late nineties I found myself unemployed and unclear in a direction to go. It was then that I discovered my local volunteer fire department, and the first steps to becoming an, as I called them then, ambulance attendant. The rest is as they say history.

So that's my story on how I got into EMS as a career, a cole's notes version anyway. As this story is not about me, let's change the focus back to the positives of EMS. The first and foremost positive of doing what we do is that we get to make a difference in the lives of complete strangers. When a person faces a crisis, we are the people that arrive and help to fix the problem. This is an amazing feeling whether it is from something as simple as a small cut to as serious as restarting someone's heart who has had a cardiac arrest. When we arrive and get to make a difference, and you can see the gratitude, even if it isn't shared with you at the time, it reminds us why we do this. Something as simple as holding someone's hand and hearing them when they share their problem with you is rewarding. When you offer them a simple solution and a ride to the hospital the impact you can make is sometimes completely immeasurable.

Every day our office surroundings change, we have different views, we meet different people, and we get to see entire portions of the cities we live in, areas we might not otherwise ever see! There are places I have found in my city that amaze me, and it's all because my office is portable. We get to hear stories from people we never would have met! Recently I was blessed to hear a story about a soldier in the Scottish Navy who served at the same time as my Grandfather. I wasn't able to find out if they ever met, but to hear a story from a different perspective of the same time is a surreal experience. The world is a small place and experiences can be lived through the eyes of others if you were not able to be there yourself.

These are only a few of the reasons that make this career so rewarding, but I think the number one driving force behind all of us in this business, is this ONE thing. We are all blessed with an overwhelming desire to help our fellow man in their time of desperate need! To those of you that feel embittered at work sometimes, take a moment and close your eyes, and remember what got you started in this field! Something brought you here, I know this career is not all lollipops and sunshine.  I have my days too, but despite all the bad that we see and deal with at the end of the day, we do this because we want to make a difference. When people reach the end of their coping skills, that's when they call us. It is sad that today coping skills seem to be lacking in many instances, but remembering those reasons why we started doing this should help you to refocus and will remind you why this career is the best career out there! Please share and like my posts, and feel free to comment!!

How Did You Think This Would End

In the world of YouTube, Tosh.O, Ridiculousness, AFV and other video evidence of the Empirical Wisdom of Darwinism I pose the following musing. If we can watch a plethora of bad decisions being made in Ultra High Definition, why oh why am I STILL going to people that continue to make really bad decisions. It makes me ponder the future of the human race and the question of whether or not evolution is dead.

These stories are not all witnessed directly by me, but need mention to back the question of "How did you think that would end?" I'll start with easy ones and work up to the Grand Finale of bad decisions, a call I alas was not present on but is the number one winner in bad decisions that had a dire consequence.

Let's start simple with a call I remember vividly as a thank goodness we got there when we did. The story starts with a girl on her 18th birthday, she goes out, she drinks far far more than she should.  When 911 is called we find her in a house... There are at least 6 men in the house and this one girl! I was so thankful she had made the call before anything more happened but the potential end result was obvious! This young girl was extremely lucky, and the advice to offer is simple. When you are going out for your 18th birthday, make smart decisions! Go with friends you trust, always guard your drink and try to maintain some self control to make the right decision to stay with your friends!

This next event was also a young man who managed to be extremely lucky! Picture yourself out in the open air, wind in your face,  and your riding! You decide to take the ride off the path and into the trails. More jumps,  More turns,  more fun right? This is a great plan and can lead to a great time and a great work out! Unfortunately this young man had done that and had forgotten to wear his helmet!  Well one wrong lean and a he wiped out. He knocked himself clean out and risked an incredibly serious head injury! On arrival to the patient we found him still extremely groggy and confused! Fortunately after we immobilized him, and oxygenated him he started to have a clearer head and managed to make a full recovery but he does wear a helmet all the time now.

It was a dark and quiet night in the country as we responded lights and sirens, breaking the night air with flashing lights and occasional siren blasts. As we rolled up to the scene our eyes were shocked.. What we saw was a car, but it wasn't where we suspected it should be. Our eyes were drawn up, into the tree! About 4 feet off the ground there it was. Wedged like a door stop between two trees. As we approached the car we suspected the worst. I looked in the driver window and was surprised to see a gentleman, awake(sort of), and you could smell the alcohol coming from his breath. For his trouble the gentleman got himself a hospital visit for minor injuries, but for driving wreckless and drunk he was subsequently arrested and charged with a long long list of vehicular and environmental infractions.

Before you read this final story I must warn you, it has some graphic content of a sexual nature. If you are easily offended or squeemish I encourage you to skip this paragraph.  I also will admit that I was not on this call but know the details. A young man and his girlfriend had decided they wanted a method to help him stay erect longer during intercourse. Instead, however, they did not go to a sex store and pick up any of the miriad of products that can help with this they thought they would be creative. Their thought was to place a small piece of copper pipe over his pens before it was erect. A lesson in blood flow had apparently not made it to his memory from high school biology.. Unfortunately this young man paid a dear price for his ignorance. The young man had to have his penis amputated and now can no longer have sex. 

These stories and many many more like them are a result of bad decisions. Every day we meet people that only come up with half a plan or half an idea. When you fail to think of the end consequence or fail to ask yourself... How do I think this will end? If the answer is anything other than positive, it might be a good idea to reconsider your decision.  

Am I saying you shouldn't take risks? Of course not! I'm saying calculate them, plan them and execute them safely. In other words, ideas that start with "Here, hold my drink...." should really warrant a second thought, and friend that let friends drink and do dumb shit are not very good friends! Take a moment before your next bad decision and think, is the price worth the reward, or is there a reward? 

Please share and like if you enjoyed this article!! 

5 Things To Never Say To A Police Officer

I have been struggling to find a jump off point for my life lessons and words of wisdom I can share with you. There are many thoughts and stories that run through my mind, but I felt this was a good place to start. This advice is meant for those people that tend to overindulge in the use of alcohol. I speak from a place of experience here as I'm sure some of the comments will reflect. The difference being I know what things not to say and therefore have managed to avoid unpleasant experiences.... mostly.

When you find yourself in a situation involving paramedics and police there are certain things you should never say. The wisdom you are about to receive has two positive outcomes. Number one you have a pleasant visit with Paramedics that can empathize with you, possibly pre-treat your hang over and give you a warm place to sleep it off. Number two, you don't end up hand cuffed to a bed in such way you can't scratch that really annoying nose itch that every drunk person inevitably gets.

Paramedics and Police work side by side when we deal with people who have tied one on a little too much. The police are our allies in the securing and treating of intoxicated individuals who start random fights, get beat up or generally make a nuisance of themselves. These individuals can and inevitably do say some things that land them in some hot water.

Prior to getting into those top 5 I will share the inevitable consequence of saying any of these five things. The result is generally the same so to avoid repetition here it is. When a police officer makes a request of you and you choose one of the soon to follow 5 replies this is the basic end result. First the officer who made the request will grab your arm... Then from out of no where 4 of his buddies will join him and you will find your self eating any number of surfaces... Pavement is a police favorite, but the list also includes; gravel, shale, your own vomit pile, grass, dirt and in some rural settings cow shit. Then if that isn't enough you can expect a rather large knee somewhere on the crux of your neck in a most painful fashion. At that moment you may here the words,  is he ready for sedation. At this point the medics will enter the fray and you will feel a sharp sting to your backside, and this my friend is the sedation just mentioned above. At this point if you retain any sense of self control you should stop struggling and just wait. The next phase of this battle is out of your control so resistance is futile. The medicine will take effect and you will find yourself falling asleep.  Go with it, that is best.  So without further adieu here are the top 5 things you should never say to or around police officers.

Number 5: If a police officer tells you to "back off from the scene and let the medics work". The correct response is to say nothing,  turn around and walk away. What you should not say is,  "But that's (enter any person or object here), and I need to tell them (doesn't matter what's here)." This response will not garner an immediate response BUT persistence will result in the above mentioned events happening if you continue to push your point.

Number 4: When a police officer makes a request to know your personal information you should not respond with "Go F*&k your self cop, I'm not telling you Sh&t!" This response upsets police officers as they are only concerned about your safety and they will ask again politely a few times until the decision is made to arrest you and identify you by other means. The scenario above does not always ocurr but if you become scrappy at this point... You will most likely end up in that situation.

Number 3: Here is where things can become more intense, far more quickly.  You have found yourself under arrest and as the officer reaches to cuff you you respond with "Get your Fu$&;ng hands off of me!!" And throw in a shove.... I don't think I need to explain where this ends you up. Just hope your not in a rural setting. .

Number 2: When a police officer is talking to you and your are continuing to be beligurent, and the officer voices this very simple question, "are we going to have a problem here?" You should think carefully about your answer. There is only one correct answer here!  My personal favorite wrong answer was "Only if you make one!!" At this point you will find yourself in a basic or slightly varied version of the scenario above.

And at last Number 1: the reason this story is being told by a medic. When you utter the words "I'm gunna Eff you up Medic!!" And then make a move to assault the medic. ... This illicits the quickest response by the police on scene! You will most definitely end up sedated in this scenario.

These anecdotes and words of wisdom may portray a darker side of our lives in paramedicine, but the reality is, these instances are rare. The point of this story is that we can and do encounter dangerous situations for both the police and EMS. Our response to these situations may appear harsh in the public eye, but for the number of times police officers and paramedics are assaulted on the job we take our safety very seriously.

Please remember if you see a situation as described above I want you to remember; We do not enjoy doing this to people and the part that people miss is the length of time we have tried using words and talking a patient down prior to using these methods. We are out here to help people everyday and sometimes we have to help them from themselves.

No one can predict when someone's stresses cause a break in their psyche as a result of too much alcohol or other reasons. This often results in them doing something that results in people being injured. As part of the service we provide we attempt to prevent these situations when we encounter these people in acute psychiatric distress or from just having too much to drink. We always use words first before resorting to force or sedation, and for the most part we succeed with words.

Always remember if you are headed out to party with your friends you should heed the commercials all over television and the Internet. The words are simple and true. Drink responsibly.  That doesn't mean you can't have a great time or even get pretty loaded, just be safe and be with friends and be civil. 

Please like and share this story and stay tuned for more!!

The Uniform, What It Means.

Each day or night in the last 13 years of my career I have worn a uniform. This uniform represents a culture of people who regularly come into your home and meet you in the worst possible circumstance. When a person chooses to become a Paramedic or EMT they are saying that helping people is important to them. EMS practitioners show up every day to provide excellent patient care to people that are sick or injured without any thought of being thanked or the risks they face.

The uniform of an Emergency Services worker represents pride and professionalism. It represents, that despite the risk of contracting any number of communicable diseases, entering unknown situations and risks of physical violence, we will show up. We will be there to help you in your time of need. We will drive through traffic that doesn't move for us, or stop for us. We will risk our lives to come to you and yours to patch up your wounds, treat your hypoglycemic episode, help you breathe, or start the process to stop your heart attack. We do this at any hour of the day or night whether we have had dinner or not, and we will treat every patient the same regardless of how many calls we have done that shift!

To me the uniform represents honor. It represents MY honor to be there to help you. It is unfortunate in the world that people get sick, or injured, but I am honored to be the person that you will trust with your life. In my years of training I learned many skills and vast amounts of information, but there is far more to paramedicine than skills and knowledge. This is a people industry. We are deeply rooted in a form of customer service that is unlike any other. To the patient we are comfort, pain relief, and the person there to make them feel better and on occasion save their lives. To the family we bring calm, and confidence that their loved one will be looked after. We are the front line of medical care. No one sees a patient before us when an ambulance is called. We arrive into scenes that are chaotic and often uncontrolled. It is our job to bring calm to the people, control to the scene and help to the patient. This is something that I do with honor and with pride, as I am honored to be that person that is there to help you in your time of greatest need.

The uniform is overall our way of showing that we are professionals and that we are there for you and your family. The pride that we feel each time we put our uniforms on is represented in the patient care we provide and the professionalism that we will demonstrate when in the public eye. The next time you see a Paramedic I hope you will know that at any given moment that person may be called to task to respond to a person in cardiac arrest, or a child that has suffered a traumatic injury, or any number of other serious situations. Take a moment to understand that that person who may be smiling at that moment has seen things that no one should ever see, and continues to show up to help people every day because of his deep honor to wear that EMS uniform.

Stay tuned for anecdotes of some of our more humorous calls, and some important life lessons that can be learned from the eyes of a city medic.