My Journey to Resilience (Part 1)

 

I know I left you hanging.

I have struggled with what I am going to share with you all as not very many people know my whole story and that has very much been intentional. I am not looking for sympathy or validation of any sort, however I am hoping that the details I share here will allow someone else who may be where I was to reach out and know that they are not alone. As the title suggests this is part one. I want to demonstrate how the road to darkness is not a slippery slope, it is a long winding beautiful path full of good intentions, machismo and a desire to never become a burden. 

How it all began. 

I have been in the emergency services for 23, no wait, almost 24 years. Starting as a volunteer fire fighter in 1997 after taking my EMR program I saw disturbing things from the very start. The training we had then definitely did some to desensitize us to what we would see, but critical incident stress and CISM debriefings were still new at the time. I never truly felt bothered by the calls I did at that time and thought I must be special, "built for this industry" as it were. I found that I seemed to be quite good at compartmentalizing things, or so I thought. 

As time went on, it was many years of seeing a lot of people die and a lot of disturbing scenes that no person should ever have to see before I had a call that "stuck". Due to the triggering nature of the call I won't share details beyond witnessing someone die and being absolutely helpless to prevent it, despite my training and experience. This call gave me some bad dreams, and I have vivid memories of it to this day. This was my introduction to an occupational stress injury that I could identify, though at the time it did not register. 

After that call there were several more that struck close to home, and also caused some changes in my behavior, that I didn't pick up on until later. 

Was I lucky, resilient, or both? 

That is the million dollar question isn't it? Many of you, new and old to the game, and some of you that have not worked in this industry have your own experiences, and this one is mine. One advantage that I had is that I had a strong network of friends and loved ones who would listen to me tell my stories, share my experiences and just let me get shit out. This is an important step in building resilience. You CANNOT keep that SHIT INSIDE! You need to vent, you need to regurgitate it as much as you can to get it away from your soul. I know that sounds different as many self help books and self help gurus tell you to not relive the past. They are right in their way, but when it is fresh you must expel it. It is not unlike when someone has taken a handful of pills, you have a limited amount of time to remove the source of the poison from the system before it takes hold, and you have to treat the symptoms instead. 

Trauma in my opinion is similar. Once it gets in, you have a limited amount of time to expel it from your system before it takes a hold of your soul and causes a larger scar. Let me be abundantly clear, every event causes a scar, resilience helps us reduce the size and longevity of that scar. Mental scars can be healed, and life can be enjoyed as long as you take steps to protect your mental health early, diligently and continuously. Resilience is an ongoing process. So to answer the question above, I was fortunate to have places to vent, and I had learned resiliency from other facets of my life. 

What actions can you take now?

As a practitioner it is important, no, it is your duty to protect yourself mentally from the stress of this job. Once you have broken mentally, it is far more difficult to be effective in your role as a medical professional. So to conclude part one, the lesson is learning to expel your experience. This is what a debriefing is for, however due to increased call volume and lack of resources I fear that they may not be able to happen as quickly as is needed. Find those people that you can talk to, not to judge the call, or judge the outcome, but to just get the details out of your system. 

As professionals we do our very best on every call and learning from each experience is vital to improving as a paramedic, but that is a different process than learning to go on after a bad call. You are beautiful souls that make the decision to do this as a career and your health matters. If you have no one to reach out to in your own practice, reach out to me, I will be your outlet. In the meantime, please like and share what you have read here, and take care of yourself and each other. 

EMS Credibility A Fragile Commodity

When paramedics arrive at the hospital with their patients and report to triage it's important to have our ducks lined up. The credibility of a paramedic is fragile when dealing with triage nurses and physicians in hospital. They often don't understand the conditions in which we work so it is vital that we are ready to give a solid triage report. When things go wrong on a call that's OK, that happens. This can sometimes look bad when we roll into the ED, which is why our credibility and out report is so important.

If things go wrong on a call, it's not a time to panic, it's just important to be organized in your report to triage. If we are running bush league and don't have that solid report, then we are presumed to be bush league. Don't forget our world is usually quick and dirty, they call us ditch doctors for a reason. To our nursing colleagues, it is important to remember that as practitioners we do our utmost best for our patients, just as you do. When you aren't there it is important to hear the story before you pass judgment.

In someone's home, or the back of an ambulance we potentially deal with poor lighting conditions, cramped spaces, and  limited help. These are not excuses, because this is also where we are specialists.  I once heard it said, 

"There will always be someone better at intubation than you, there always be someone better at IV's than you, there will always be some one better at assessments and differentials than you, BUT nobody can do it like you can with the wheels moving." 

This quote had always stuck with me, because it's true. We specialize in these environments and that is what sets our world apart from the world of the ER. To that end though, not every call goes perfectly. That in and of itself is not the end of the world. To maintain our credibility it is important to be honest when things go wrong, not make excuses, just be honest. Communication of what has went well and what has not gone well will go a long way to maintain the respect of your colleagues. Some might say our colleagues shouldn't judge our performance, and for the most part they don't. They do, however, know when we aren't honest with them. 

At the end of the day as paramedics and EMT's you work very hard for your patients, and the vast majority of the time you provide excellent care. That is why when a call goes sideways and your bringing them into the ER it's OK to tell them that call went poorly, these things happen  for various reasons. Your credibility will remain much higher with your colleagues if your straight up about what happened, and then as a larger team of professionals everything still gets taken care of! 

Let's continue to progress the profession and build relationships within our professional medical community. Doctors, Nurses, paramedics, RT'S, and the list goes on, all work hard to provide excellent care for our patients. Remember we are all a team and cohesiveness translates into effectiveness. 

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