EMS World Expo: Caring for Our Own

With a job that’s so physically, emotionally, and psychologically demanding, EMS providers can be subject to a range of negative mental sequelae we’re really only just beginning to comprehend and contend with. But caring for ourselves is an essential component of resilience, Kimberly Roaten, PhD, associate professor of psychiatry at the UTSouthwestern Medical Center, told attendees at the World Trauma Symposium Tuesday at EMS World Expo in Nashville.

While major stress disorders consume a lot of attention, a lower-level hurdle many personnel face is burnout: a diminishing enthusiasm and enjoyment for doing the job. Burnout has three primary characteristics, Roaten said: emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment—the job becomes drudgery, and motivation is lost. This is recognized in many professions, and there’s even literature characterizing it in EMS. Providers in the 5- to 15-year range of their careers seem more vulnerable than newbies or long-timers, and high call volumes and lots of missed/sick times are correlates.

While burnout doesn’t generally require psychological treatment, the job’s weightier effects might. EMS providers are prone to chronic stress, punctuated by peaks with critical incidents. Beyond the normal distress and anxiety from such events, they can lead to trauma-related psychopathologies that include recognized maladies like PTSD and acute stress disorder. Estimates of PTSD prevalence among EMS providers range from 6% (in line with the general population) to 30% or so.

Roaten specified three key disorders to which we might be susceptible:

• Major depressive disorder, characterized by continual sadness and lack of interest;
• Generalized anxiety disorder, a persistent, excessive worrying; and
• Acute stress and post-traumatic stress disorders, which differ primarily in when they occur: The former develops in the first month after a traumatic incident, while the latter happens after a month.

Be open-minded about how the symptoms of these manifest, Roaten said, as individual presentations can vary.

On the flip side of disordered reactions to terrible events lies the concept of post-traumatic growth. This idea holds that some survivors of great adversity can ultimately draw benefit from it and rise to higher levels of functioning, with an enhanced appreciation for life, better relationships, and greater sense of personal strength.

How can we make that more likely for EMS providers who witness bad things? Roaten’s take-home points started with robust peer-support programs. As opposed to seeking support from professionals outside the department, peer support is more comfortable and acceptable to many EMS providers and carries less stigma and fear of repercussion. It’s also effective, yielding improved social functioning and support and decision-making.

To create an effective peer-support program, look for good listeners with experience and understanding (these shouldn’t be hard to find in an EMS system) who are respected parts of the community. Mental health professionals can be a background part of selecting these members but should not lead the process. Peer-support personnel should be trained on aspects like confidentiality and know when to escalate a need for assistance to a higher professional level.

These aren’t just resources for high-stress incidents, though; they should be widely available and well-integrated in departments, with easy access. Peer-support programs should further be monitored for efficacy, and leaders must be sure to take care of those personnel too—just because they’re helping others doesn’t mean they don’t have their own needs.

Roaten concluded with an outline of psychological first aid, an intervention developed by the National Child Traumatic Stress Network and National Center for PTSD with input from disaster researchers and responders. PFA is designed to assist adaptive functioning and coping in both the short and long terms following traumatic events. Some victims experience more distress than they can effectively cope with, and their recovery can be helped by caring, compassionate responders.

Anyone can be trained to deliver psychological first aid. Like peer-support personnel, though, they should be visible, trustworthy members of the department, with initial and ongoing training, briefed in privacy and confidentiality issues and when to move a case up the line. They should be a constant presence, well-publicized and known.

For more on psychological first aid, see https://www.nctsn.org/treatments-and-practices/psychological-first-aid-and-skills-for-psychological-recovery/about-pfa.