Being the Bridge: Peer Support in Williamson County

After that guy got mangled in the spinning auger: “I wonder if he was listening to ‘Twist and Shout’ by the Beatles when it happened.” “He failed the morning safety drill!”

After another guy got mangled in a giant meat grinder: “He had to quit, that job was a grind!” “I hope that doesn’t end up in the chuck wagon at the station.” “He said he would meat his boss halfway on safety measures!” “He really threw himself fully into his work.”

Yes, a fair number of folks seem to get mangled, maimed, throttled, and just downright dead where I work and likely in your area too. We’ve all struggled to make sense of what we’ve seen, the stuff you can’t unsee. Later the adrenaline wears off, the jokes are slightly less funny, and we stuff that nasty crap down deep till we think it’s out of sight. Years ago we called that doing what you had to do. We said to each other, “Suck it up, buttercup!” Unfortunately it could come roaring back with a vengeance. The beast in me might yell at my wife about how she hadn’t done squat to mind our home during my 27-hour absence when really she held our household and me together. Maybe the beast would drink too much scotch or have a long bicycle ride and a bold, unexpected cry that could only end in a pitiful whimper born of complete exhaustion.

I’m sure many of you have adjusted your expectations a bit. Does anyone in EMS still think the “suck it up, buttercup!” option is better than peer support? Let’s hope not.

I’m not going to bore you with a CE-appropriate lecture on what peer support is. What I can share with you are some of our experiences developing a peer-support team at Williamson County EMS in Texas. 

Getting Started

Let’s start with some basics. We initiated our team with eight members in 2015 after a series of our peers lost their jobs, families, and in one case attempted an early departure from mortality. Our team leader, Cdr. Tom Watson, began by ensuring our team was trained with a variety of courses like Mental Health First Aid, Group Crisis Intervention, and Assisting Individuals in Crisis. Mentors from around central Texas included experts on PTSD, licensed counselors, and clergy presenting mostly secular approaches to assisting others. Our department funds retraining on these classes every other year. We also seek out opportunities on our own at conferences like EMS World Expo.

The WCEMS way of peer support was never intended to replace licensed counselors or any other valued noggin-shrinker. Recognizing issues by providing a safe space and timely link to the pros has always been the goal. After learning new skills, many of us wrestled with the concept of how to best limit ourselves from the land of the cranium-crackers. None of us wanted to say, “How’s that working out for ya?” to a peer a la Dr. Phil. One team member, Capt. Matt Biasatti, remembers “wanting to be the bridge. We’re all human, and sometimes we all need help getting ourselves across to the right kind of assistance.”

Our initial setup was simple: Confidentiality was essential. Any staff member could contact us. We also had a list of call types that would automatically trigger our commanders to notify the peer-support team via an e-mail/text system. The first available member would take the call.

From there things got a little murky. Some peer support occurred in person, some over the phone. Peer support was a visit immediately after the call or next shift. It also became clear that our nine field commanders were not consistent, and sometimes rightly so. They knew their crews well enough to make good judgements most of the time. We also collected data on which team member provided peer support and for what purpose. Unfortunately, our team members were not always consistent with entering data. Did every intended contact actually occur?

More Tools

In March 2018 these concerns led us to provide more stress-identification tools for our field commanders. The goal was that they might identify situations more evenly. The training we provided led to an immediate tapering of peer-support notifications. No call type led to an automated peer-support dispatch; it was only at the commander’s discretion. After about six months we asked ourselves, “Are we leaving anyone behind?”

We decided on an anonymous poll to shed some light and improve our process. More than 80% of our staff felt our peer-support team was beneficial. The remaining did not have a strong opinion. No one found it useless. While only 28% of our staff contacted peer support themselves, 70% of them found it helpful. The rest were neutral, with only 8% finding support to be not helpful. Many comments about the team were supportive, but not all. A few folks provided teachable moments: “I’ve had a peer-support member blow me off” was a stinger. We recognized the importance of follow-up and how a chain of custody might avoid this. It’s something we’re working on.

Nearly three-quarters of our staff have been contacted by peer support due to an automatic activation from a commander. Of those, only 6% said it wasn’t helpful. More than a third (34%) had a neutral experience. Does this mean we should target our crews more effectively for auto-activation? Perhaps it’s better to overactivate and have folks who don’t need us? Many comments suggested maintaining a wide net. The feedback led us to change our contact time window. Our ASAP approach to contact has become an initial contact via text. The text lets the provider know which team member they can rely on, immediately if needed. This soft initial contact allows the peer an opt-out too. In the text we can detail a future contact, giving them time to process and realize what level of support they desire, if any.

We don’t know if there’s a problem until we ask or someone gets hurt. We plan to ask regularly as our peer-support team evolves. Justify this however you like—just culture, “they’re like family,” “I’m a mensch.” Watson says, “The most important thing is to get started and adapt as you go.” The lives of your peers depend on it.

Capt. Dan Cohen is a provider of clinical education for Williamson County EMS in central Texas.