“A paramedic? Oh, you must see some terrible things!”
It’s kinda the first response line people give you when you answer that small talk question of “what do you do for a living”. The far bigger question being posed across the emergency services industries is how do first responders cope with trauma?
Because it’s true; we do see some terrible things. Whether it’s the bleeding body, the distraught family member or the victim who has suffered years of abuse: we hear horrible stories, see disturbing things and meet tortured people.
It’s an occupational hazard. If you believe the numbers that are coming out at the moment, odds are by the time we end our careers whether its in 5 years or 50, we’ll all have PTSD to at least some small degree. As someone who’s only been in the job 18 months I can tell you now that I’ve already got my own share of mental images to repress when someone asks the question “what’s the worst thing you’ve seen?”
So how do paramedics and other first responders deal with trauma?
To explain I’m going to tell you about Steve.
Early on Steve sat me down: “Any day now you’re going to walk into a room and there’s going to be crap everywhere. You’ll have no idea whats going on or how it got to this point. Then you and your team whether it’s two or four or whatever, are going to take that problem, punch it in the face, follow your protocols and solve it one little bit at a time. There will still be crap everywhere. By the time you get to hospital you may still not have any idea what the hell just happened. But you’ll manage it, handover to the doctors, walk outta ED and high five each other ’cause you’re freakin’ awesome. Then you’ll spend the next 10 minutes to 10 years talking through that job with those other guys, your clinical support team, your friends whoever.
And in summary, that’s it. That’s how we deal.
But perhaps the biggest aspect of this grand plan that Steve forgot to mention was the externalisation. See when Steve and I were crammed in a bedroom with 2 other ambos and a student on her first day placement, trying to manage the airway of a guy who’d attempted to hang himself, crushed his trachea and started seizing just to make things interesting, we weren’t thinking about how this patient was a father, a partner, a son. We didn’t contemplate what effects this may have if he survived (at least not then). We saw him as a patient, not a person. We made jokes (in typical dark humor). We checked how our student was coping. We made sure we were following our guidelines. We could do anything we wanted except mention or refer in anyway to the fact that this patient was actually a person.
Because the moment you do that, the moment your awareness becomes comprehension, that job becomes real. Outcomes can become your fault. That guy seizing on the floor develops a name, along with hopes and ambitions, dreams and relations that will all suffer because of what happened today and what will happen over the next 48 hours.
So Steve makes some comment like “now everyone, let’s check we’ve got our priorities in order” and as he goes through his checklist and we prepare to head off to hospital he throws out “and most in-f***ing-portantly did someone get my jacket?”.
It distracts us. It perpetuates the externalisation.
See I don’t remember that patient’s name. None of us do a week or two after a job.
Because that’s how we manage.
We only remember the names of people who are important to us. We crack jokes to keep things at a distance. We prevent ourselves from seeing that broken down machine as a human or worse as a person.
We only take in the job, that patient one little problem at a time. We take that overwhelming picture, break it into tiny little bits we can solve piece by piece, and then go home to our families and hold them tight.
Yeah we see some terrible things. But something is only terrible if you perceive just how tragic and horrible it truly is. So like the little kid in the car crash, covered in blood that isn’t his, we reject the harsh reality of what we see, focus on the bits we want to understand and get out of there with as little exposure as possible.
That’s why the guys who stay on scene longer have it worse. That’s why the guys who stew on it and go over it again and again end up screwed. That’s why we’re all just one bad job away from retirement.
Each person copes differently in the aftershock. I pray it out and talk to ambos from other states. Others work out or study like crazy. Sadly some people bottle it up, and even worse some take it to the bottle.
My point here is the way a lot of first responders ‘cope’, the way we deal with it, is by not dealing with it. It’s by distracting ourselves from it.
It’s the handful of jobs that slip through the cracks that we really deal with. The kid that looks like ours. The patient who we actually do know. The job that was one too many at that point in life.
Those are the jobs we need help dealing with.