big city vets, mental health

[bled12345]

So firstly, I just want to say I mean no arrogance in this post, but there is definitely two types of people in EMS.. The eager rookie / slow paced rural / volunteer EMT, and the seasoned 10+ year paramedic who has worked in a big city and been in the :censored::censored::censored::censored:. The first is more than eager to tell you awesome stories about their EMS experience, and the latter is more likely to look at you with a coy look when asked "whats the craziest thing you've ever seen?" Because the "Craziest things they've seen" is something they have to cope with and deal with for the rest of their lives.


I'm getting alot closer to the latter, in a couple years I'll be the 10+ year big city medic, and I just want to hear from some of the seasoned people there thoughts on the long term aspects of personal health, and mental health in EMS.

I remember hearing or reading about some article that said the suicide rate in the general population is something like 1/5000 and the suicide rate among paramedics is like 1/1200, a senior paramedic in my service once said at a debriefing, that the first 5-10 years is easy, and nothing bothers you... but emotionally we all have a bucket of different sizes, and every :censored::censored::censored::censored:ty call is 1 more drop in the bucket, and slowly but surely over time that bucket begins to overflow.

I'n the last few years, I've seen pediatric hangings, shootings, stabbings, brutal home invasion murders, informed multiple loved ones that their family member has died, infant codes, palliative cancer patients punch their ticket, had colleagues die, late trips, early calls, barely a chance to pee, eaten the majority of meals cold out of the truck, or had the awesome options of 7/11, or mcdonalds for night shift meals.

I feel like its slowly but surely stacking up, I've gained wait, I have alot less faith in humanity, my compassion is a shadow of its former self, and although I'll admit truthfully I'm nowhere near being an alcoholic, I definitely drink ALOT more than I did few a years ago lol.


There seems to be two types of vets in my service with 20 plus years working in a big city... The insane, burned out, chewed up and worn out paramedics, and the paramedic that somehow is still a cool well balanced individual. Unfortunately the latter seems very few and far between.

How do you keep yourself together after a decade or more in EMS?

 

[DrParasite]

I feel like its slowly but surely stacking up, I've gained wait, I have alot less faith in humanity, my compassion is a shadow of its former self, and although I'll admit truthfully I'm nowhere near being an alcoholic, I definitely drink ALOT more than I did few a years ago lol.

There seems to be two types of vets in my service with 20 plus years working in a big city... The insane, burned out, chewed up and worn out paramedics, and the paramedic that somehow is still a cool well balanced individual. Unfortunately the latter seems very few and far between.

How do you keep yourself together after a decade or more in EMS?

copious amounts of alcohol, lots of casual sex with slutty women (outside of EMS though, don't fool around where you work, I have a thing for ER nurses though), a steady stream of nicotine and caffeine in my blood stream, and enough overtime to support the previous 3 habits.

Actually, the previous sentence is all crap, and exactly what not to do. The truth is, EMS is a young single person's job, especially the busy systems. Your body can only take so much abuse, and your brain, well, the human mind can only tolerate so much crap. That's why most people don't stay in those busy systems for 20 years, or if they do, they are counting the days until they retire. They might spend 10 years in a busy system, and when they have had enough, move to a slower paced agency.

I am NOT a 20 year veteran paramedic. I haven't seen it all or done it all. But I do work with a couple people who are in that category, and they have told me some ways to survive until retirement:

1) do your job, and go home at the end of the day. once your shift if over, leave all the stress and headaches at work, and go home. keep your work life and home life separate

2) work your 40 hours, and that's it. OT is nice once in a while, but do stuff besides work. your life includes your job, your job is not your life. have a life outside of EMS

3) take vacations. take time off away from work. use your vacation time. take mental health days when you need it.

4) find stuff to do off the ambulance that you enjoy. supervising, teaching, special ops, dispatch, find a lateral transfer position for when the ambulance becomes too much. Everyone needs a break, even if it's just doing something different. Have an end game in place for when your body can no longer physically do ambulance work, despite your mind wanting to.

5) you aren't the first person to go through this, and you won't be the last. talk to coworkers who you trust when things get too bad. Don't bottle it up, and don't drink away your problems.

 

[Aidey]

Actually, the previous sentence is all crap, and exactly what not to do. The truth is, EMS is a young single man's job, especially the busy systems.

Care to elaborate?

 

[DrParasite]

Care to elaborate?

Sorry, that should have been single persons job. I was generalizing about single people, and put man instead of a more gender neutral word. Women can do EMS just as good as men, and I didn't mean to imply otherwise.

Please accept my apologies if you took offense in that, as it was unintentional and not intended to be malicious at all. I have edited it to be more gender neutral.

 

[firetender]

How do you keep yourself together after a decade or more in EMS?

Every word before your final question was such a wonderfully accurate description for a turning point that most if not all the Last-gaspers face!

Most medics, as you know, bail long before they even begin asking those questions, and most of the guys/gals who stick it out beyond the ten year mark keep their lips zipped!

You choose not to but that's to your credit.

From where I stand this was always a tough wanna-be profession and in the forty years of its existence it still has not learned how to look out for its practitioners.

In your case, we can say man, wouldn't it be nice if the system you work for had something in place where you could face and work through some of those on-the-job nightmares with others who understand? Maybe out of that you could better choose your next step.

If the human-experience thing isn't your bag then wouldn't it be Grand if there was a Career-track for you to take your street-savvy to? A position that lessens your on-scene time and makes use of supervisory or training abilities.

Yeah, I know, those jobs are few, far between and someone has to die before one opens up, but really, from what you said I think you still want to contribute to EMS and you might like something that makes use of your experience.

The problem is, in most systems, both of those avenues are severely limited if not closed and that's the problem with EMS, no where to turn.

All that means is, if you want it, you gotta look far to find a system that can use you AND support you on economic and human levels, or do what it takes to sell yourself into a position that YOU define.

This might just be a good time to further your education in areas of medicine that you were attracted to while working as a medic. And you don't have to leave EMS either. Why not reduce hours, go back to school and basically live for something else?

That something else could involve applying an education in Business Management or Human Services for the benefit of EMS as well.

Bottom line is, in the current culture, you're the one that's going to have to do the seeking here.

Great question, thanks!

 

[Veneficus]

Stepping out of the box

How do you keep yourself together after a decade or more in EMS?

First and most important, there is no balance.

My peer group and I are all in. We do not try to have a "normal" life, what we do is our life.

Every prior experience is just information and knowledge to be used for the next patient.

Many of my friends when stressed actually volunteer to work more. They are successful, their results make them feel good about themselves. There is comraderie. A definate sense of belonging.

Bad things happen to both good and bad people. Choose your battles. You cannot change the unfortunate events of the world, you can sometimes just nudge it in the direction you want.

What do I do?

First, my best coping mechanism is more work. SInce the next patient doesn't care what you did or didn't do for the last one, there is not a whole lot of time to dwell on the last one. When that doesn't occupy my total mind, there is always somebody asking me to look at their patient too. Now I have more here and now to think about.

Second, I ask "why?" when things do not go my way I have to know why, sometimes the answers are found in a book, other times in the experience of "older" clinicians. Sometimes it just ends with "no idea," and I am cool with things being beyond me today.

Third, there is the constant desire to make things better. So a lot of effort is given to that. I like to help good providers become great providers, so teaching, coaching, that sort of thing. I spend time on this website because it not only lets me do that, but the problems of EMS I think are rather easy problems.

Fourth, I never drink after work. I never drink when I am stressed over work. My alcohol consumption is always in moderation and always by a choice to let my guard down a little, never as a reaction.

Fifth, a short break. If I am away from work for more than 2 days I start to get irritable. (a lot) But I do require a break now and then. I find things that either remove me from the realities of life, like going to the theatre, reading fiction, watching movies, playing videogames, etc.

I have also started back with martial arts. (Way better than going to the gym I think) but this time I picked one a lot less functional, a bit more mystical and much less violent.

I make time for my family everyday. Even if it means missing a few hours sleep.

Perhaps my most powerful coping mechanism is "me time." When absolutely nobody bothers me and I can relfect and do something for myself. I think healthcare providers, especially people with my persnality type, give a lot emotionally to others. Removing the others allows me to focus on me.

Finally, humor is the best medicine. I like to laugh. I like to make people laugh. Whether with non-emergency people or my friends and peers (the later of which we like to clear out tables from our vicinity when we go out with our stories) there is always something to laugh about.

I'm in for the long haul. I suspect I have at last another 30+ years in me.

 

[NYMedic828]

You forgot the third and fourth EMS personalities.

The eager young guy, who volunteers, works in the big city, works a second job on their day off just for the hell of it and has the ambition to go further than medic.

The senior guy who never learned a thing outside of his class and no one wants to work with because he has been a moron for 10+ years.

You can't just group everyone into two sets of traits.

 

[med51fl]

1) do your job, and go home at the end of the day. once your shift if over, leave all the stress and headaches at work, and go home. keep your work life and home life separate

2) work your 40 hours, and that's it. OT is nice once in a while, but do stuff besides work. your life includes your job, your job is not your life. have a life outside of EMS

3) take vacations. take time off away from work. use your vacation time. take mental health days when you need it.

I am hitting my 20 year mark working in a busy urban setting and the above is what works for me. I have realized that this is the profession I chose (and still enjoy), but it is not my entire life.

 

[usalsfyre]

What your describing is burnout. It happened to me not after a hell hole urban system but after bad experiences in rural 911. You need to take a step back, get away and evaluate what to do next. Maybe it's a move to education or management, maybe it's time to get out entirely.

So firstly, I just want to say I mean no arrogance in this post, but there is definitely two types of people in EMS.. The eager rookie / slow paced rural / volunteer EMT, and the seasoned 10+ year paramedic who has worked in a big city and been in the :censored::censored::censored::censored:. The first is more than eager to tell you awesome stories about their EMS experience, and the latter is more likely to look at you with a coy look when asked "whats the craziest thing you've ever seen?" Because the "Craziest things they've seen" is something they have to cope with and deal with for the rest of their lives.

Fail. Serious, serious fail.

In urban EMS, its very unlikely you'll tube the guy who lives down the street, transport a coworker's son who dies enroute after an MVC, sit in the side of the road with two critical peds because there's not another truck to take care of the green patient, or cease resuscitation on the lady who brought you cookies every week. All things I or various rural coworkers have done over the years.

I've worked urban and rural. The "in the caca" BS had more to do with the attitude of the providers and organizational culture than "dealing with this call forever".