The Art of Compassion in EMS

When I was a brand new emergency nurse, a long time ago, our department had shirts made up for us that said in big bold letters across the back, “I save lives for a living.” I remember being pretty excited about this bold statement at the time. I probably thought we should all have a cape and a letter, and perhaps some horns trumpeting in the background too. 

The reality check came quickly however, and after a short period of time in a busy emergency department, I came to realize the flaws in this statement.

First of all there is no “I” about it. The team effort required to save a life begins with people on the scene and a call to 911. Then it is up to dispatchers and communication specialists, first responders, EMTs, paramedics and potentially critical care transport teams to respond by ground or by air to get the patient to the most appropriate hospital to treat their illness or injury.

And then there are the pilots, mechanics, medical directors, educators, administrators and support staff behind the scenes and by our sides as we work together to provide the best care we can, often under the most difficult of circumstances.

I quickly realized that I was ONE part of ONE team that made up ONE link in the chain of survival in this complex system that constitutes our country’s Emergency Medical Services.

EMS is a significant part of our nation’s safety net, a catch-all, and a barometer of society’s ills. No matter who you are, where you come from, what you do, or what happened to you, EMS will respond to you if you call for help…anytime, anywhere. As guardians of our health and safety, those who work in EMS are constantly exposed to the fragility of life, human pain and suffering, tragic scenes and stories that are truly beyond comprehension, unless you’ve experienced them firsthand.

But at the same time we also see the awe-inspiring juxtaposition of beauty rising out of tragedy, faith rising out of despair, light shining in darkness, and the amazing resilience of even the most broken human spirit. A life in EMS can be a roller coaster like no other, and it must be noted that our current reality is that we are losing responders to compassion fatigue, burnout, post-traumatic stress and suicide. There is an immediate need to effectively address these very real and devastating issues, because they can be managed if we, as a community, are willing to face them together.

The bottom line is that EMS is about people…the people whom we serve and the people who devote their lives to this type of service, which is far more of a calling than a job. The more experienced I became in emergency medical services, the more I realized it is not so much a calling to “save lives,” as the wording on my shirt suggested. It was more of a calling to help others in their time of need. Sometimes lives are saved, but our purpose as helpers truly goes far beyond that.

When I first became a flight nurse, my mentor was a pediatric flight nurse named Barbara. Like so many in EMS, Barb is not only clinically excellent, but she is truly gifted in her ability to connect with people and she has an innate ability to understand what really matters, even in the midst of chaos and turmoil. In a word, she is compassionate.

A few years ago, Barb was called to transport a critically ill child with a rare disorder. When she and the team arrived at the referring hospital, it had just been determined that the child was not going to survive. Resuscitative efforts would continue, however, until the family’s priest arrived to administer Last Rites.

In emergency medical services, when the situation is dire for a patient despite our best efforts—our work is not done. Our attention turns to the family, and we do our best to support them in what are often the worst moments of their lives. We are no strangers to the grief of others, and many of us are no strangers to grief of our own. But experience has shown us that our own grief is often a gift when faced with the grief of others as it provides insight and understanding that comes only after firsthand experience.

In the words of Pema Chodron, “Compassion is not a relationship between the healer and the wounded. It's a relationship between equals. Only when we know our own darkness well can we be present with the darkness of others. Compassion becomes real when we recognize our shared humanity.”

And so as Barb entered the room and observed the scene in front of her, she noticed the child’s father quietly standing back, watching, and waiting for the inevitable. She also noticed he was wearing gloves, presumably because everyone else was. So in the midst of this continued resuscitation, Barb approached this father, took his arm and led him to the head of the bed where she said, “Take your gloves off…and run your fingers through your daughter’s hair.” And though he wept while he did so, he was grateful to have had that moment, which he will undoubtedly hold in his heart for eternity.

In her book, When Things Fall Apart, Pema Chodron discusses the notion of “awakening a fearlessly compassionate attitude toward our own pain and that of others.”

Barb had clearly awakened that compassion. She didn’t have to go there but, based on her past experiences, she recognized the need. She knew what would make a difference for a grieving father at this moment, and she was the light that guided him to it in his darkest hour.

It takes immense fortitude and strength to connect this deeply with others in their most personal, intimate and vulnerable moments. Those who work in EMS do it every day. Often these “moments that matter” go unseen and unheard with the exception of those directly involved. They are not charted, they are not recorded, they don’t make headlines, they are not written on the back of a shirt, and there is no horn section. They are quiet, personal and profoundly sacred. They are beautiful examples of human kindness and of selfless humanity. 

But, it’s not easy. Connecting with others on this level requires energy and vulnerability that goes far beyond that required for technical and clinical skills.

In the words of Henri Nouwen, “Compassion asks us to go where it hurts, to enter into the places of pain, to share in brokenness, fear, confusion, and anguish. Compassion challenges us to cry out with those in misery, to mourn with those who are lonely, to weep with those in tears…compassion means full immersion in the condition of being human.” 

In EMS and related professions, these are the moments that are immeasurable, and often invisible, but profoundly impactful and essential for healing.

In the movie, The Green Mile, we are introduced to John Coffey, a gentle giant who has a miraculous capacity to heal people. This gift is depicted cinematically through animation so that we, the viewers, can actually see the dramatic exchange of energy that takes place between John Coffey and those he is summoned to heal. This exchange restores the ailing person to health, but leaves John Coffey completely spent, devoid of energy, and barely able to exist himself until enough time passes for him to recover. And yet, despite this toll that is well-known to him, he’s always willing to share his incredible gift of healing.

In reality, this movie is fiction, but conceptually it is not, as it demonstrates the selfless sacrifice of those in helping professions and the toll that is exacted in carrying out their life’s work. Does that mean that in the name of self-preservation we should not expend that type of energy on others? Of course not, as it is the very essence of who we are and what we do. What it does mean is that in order to be compassionate with others, we must develop that “fearlessly compassionate attitude” toward ourselves, as individuals…and as a community.

We must recognize that though we are each ONE part of ONE team that constitutes ONE link in the chain of survival, we each have value beyond compare and the unique gifts that each of us bring individually make the collective all the better.

And so it is especially devastating when we are faced with the loss of these special people who dedicated their lives to serving others in the realm of EMS. The magnitude of grief of the families and friends of those we have lost is most certainly beyond comprehension. There is no doubt that those we’ve lost made an immeasurable difference to those whose lives they touched, not only in life, but also in death, as their legacy lives on through all who knew and loved them.

Over the course of my career I have witnessed the amazing resilience of the human spirit in the face of seemingly unbearable tragedy, and I wish that for all who devote their careers to EMS and related professions. In spite of the grief, losses and trauma you’ve experienced and witnessed, I hope you too will find beauty rising out of tragedy, faith rising out of despair, and light shining in the darkness.

Those who devote their lives to EMS are by nature resilient, compassionate and dedicated professionals. But sometimes we need to be reminded that we are all human. By virtue of being human, we can make mistakes. That’s why we talk about human factors, crew resource management and just culture—to give us tools and to create systems that help mitigate the human factors that lead to mistakes, and to keep mistakes from becoming catastrophes that result in injuries or loss of life.

And because we’re human, we can be deeply impacted by the day-to-day work we do as we care for other people, and that deeply impacts our personal lives, as well as our professional lives, as we as individuals are at the very heart of the human factors model. Our safety, and that of our patients, depends heavily on our own health and well-being. And just as importantly, so does our ability to find joy in our own lives. 

So may we all strive to awaken a “fearlessly compassionate attitude,” not only for those we serve, but also for ourselves, each other and for our community as a whole, so that the lives that we save include those of our own.