Planning for Emotional Disasters

“I have been impressed with the urgency of doing. Knowing is not enough; we must apply. Being willing is not enough; we must do.” —Leonardo da Vinci

Over the last few years the veil has started to rise on the stigma surrounding mental and emotional health issues EMS providers might be afflicted with due to on-the-job incidents. This is a wonderful turn of events, but awareness does not always correlate to preparedness.

We are in the preparedness business. We expect the "what if," and have an answer to the question, "what now?" We buy ANSI vests, helmets and reflective jackets for physical protection, but what do we do to protect ourselves mentally?

As a whole, we are not prepared to respond to critical incident stress or chronic provider stress and its manifestations on our providers and agencies. Failure to plan for this inevitability can lead to the decimation of your agency. Providers under acute stress burn out, leaving agencies understaffed, which can lead to public relations or employee relations problems from less than exceptional performance by a stressed workforce. Much like a LODD, provider suicides touch all members of your agency, possibly leading to multiple resignations or cluster suicides.

Much like other physical disasters we respond to in our communities, we need to plan for emotional disasters within our agencies. To help your agency plan for such events, ask these questions:

Does your department have an SOP or SOG for department action after a critical incident?

This should define what the department designates a critical incident and what employees and supervisors are to do after an incident or when someone suspects a peer or subordinate is feeling stressed. Contact information for your department chaplain or debriefing agency should be included and updated as it changes.

Do you have a CISD team, chaplain or counselor trained to deal with emergency services personnel who you can contact immediately and set up a session?

The time to secure one or all of these is before the incident occurs, ideally during the planning phase. Supervisors should have easy access to contact information for the above.

Does your agency have resiliency training in place to mitigate burn out?

The American Psychological Association (APA) defines resilience as an individual’s ability to successfully adapt to life tasks in the face of social disadvantage or highly adverse conditions. Being proactive and not ignoring stress or problems, taking care of yourself physically and emotionally, and building a community of others who provide emotional support are all recommended by the Mayo Clinic. As an agency, developing a peer support program might be useful in addition to initial resilience education.

Is your leadership trained to recognize signs and symptoms of mental and emotional distress, and do they have the ability to address these issues with your staff?

All leaders in your agency should be trained to recognize the signs and symptoms of mental and emotional distress, particularly impending signs of suicide. Most important, the direct supervisors of the line staff should have these skills. These are the supervisors who spend the most time with providers at the agency and would notice a change in demeanor or actions and have the interpersonal connection necessary to start a conversation with the individual.

Do you have an EAP plan? If so, is the plan trained to meet the needs of first responders?

Not all Employee Assistance Plans (EAP) are created equal. Many EAP providers are unprepared for emergency services culture and the traumas that we experience on a daily basis, much like many civilian mental health professionals have a difficult time providing counseling to first responders without specific training. There are EAP plans that are first-responder specific. Ask your insurance provider about these.

Does your agency offer retirement planning? Not just financially, but mentally?

Many first responders who complete suicide are retirees. Retirement planning generally focuses on finances, but not filling the need for community the EMS profession provides. Some have second careers to help them integrate with society, and others provide volunteer services in various settings. The key is planning for the whole individual, not just their bank account.

Does your department utilize alternate stress relief mechanisms?

Physical fitness is widely accepted as necessary for responders’ health and adequate job performance. Many agencies have developed fitness and healthy eating programs to the benefit of their responders. Why not include promotion of healthy sleeping habits and supporting guidelines for the amount of hours an EMS provider can work continuously? Healthy sleep helps to cleanse and repair the brain, benefiting both physical and mental health. Is yoga, tai chi or other meditation included in your fitness program to promote mindfulness and stress relief?

Do your leaders support culture change related to provider mental health or long term mental health problems?

Earlier this year I had the opportunity to talk with EMS providers about provider suicide, PTSD and CISM. After the class was over, a few providers stayed to share their experiences with provider mental health wellness at their agency. One paramedic responded to an address for suicide via carbon monoxide—the patient was her children’s school teacher. When she returned to the station, her lieutenant did not inquire if the paramedic wanted to talk to someone, have a debriefing or ask how he could help her. Instead he asked, “Are we going to have a problem?” She went home that day and no one called her for several days to check on her.

After hearing about her experience, I started to wonder if any of the responder suicide and PTSD awareness matters if we don’t implement a change in our beliefs about mental health problems and admit that sometimes everyone needs to let their guard down and get help to prevent or treat work-related stress. Will any awareness program matter if our fellow responders continue to talk ill of the citizens we interact with who have mental health or addiction problems? Will any program matter if we continue to promote a culture that requires a game face 100% of the time?

If you are a leader, do you engender a culture in which your responders don’t feel broken by having feelings and can acknowledge their feelings? Do the members of your agency feel safe coming to you or one of your other managers? Do they feel safe with each other?

Awareness is the first step in addressing EMS provider mental health and suicide. Now, the leadership of our industry and individual agencies must be proactive and provide a plan to mitigate the emotional fallout that is often a byproduct of being a prehospital provider.

Individual providers are responsible for their agency’s mental health wellness as well. If your agency doesn't have a plan in place, make sure you ask your leadership about it! If you are in imminent need of a CISD meeting after an event, request one even if it’s not offered. Someone else might be in the same position as you, but too embarrassed to ask. If you or another provider are showing signs of PTSD or impending suicide, don’t be afraid to ask for or get help. Most important, we must drive the impetus for culture change in EMS. Programs and plans are a framework, but we must do the actual work of respecting and caring for one another.