I have no doubt this piece will be misunderstood, it will be polarizing and it will make people angry.

PTSD is not something to be proud of, it is not something to brag about, it is not an excuse to act like an asshole and it is not a thing to rally around and sell paracord bracelets or challenge coins about.

With frequent pictures of ghost surrounded, sobbing angel-winged  EMS providers and numerous gofundme sites for nonsense* like horse therapy for EMS providers with PTSD…Are we trivializing those who are really injured?

PTSD is no more glamorous than a work related back injury. It should be treated like any other work place injury, not some sacred cow that is above reproach. It is a very real thing, that is not up for debate. People are exposed to things working in EMS  that may cause a mental or physical injury.  I am asking all of us to really take a look at how we view these injuries and examine how we are portraying them.

Have we created a culture where it is now taboo to ask questions about PTSD, where it is frowned upon to examine what is and what is not legitimate? Where do we draw the line? First hand exposure to trauma seems reasonable, how about being a dispatcher and just hearing the calls? Is there claim to PTSD legitimate? How about a QA officer who has to read countless reports of these calls and imagine what it looks like? Would  their claim to PTSD be legitimate?

Have we turned this in to a money making complex or worse a cult of damaged hero worship?

Some EMS providers have gotten confused and made assumptions that if you are in EMS long enough you will acquire PTSD at some point in your career because of all the things we see.  Mistakenly, a portion of EMS providers have taken PTSD and turned it in to some materialistic badge of merit, like a scar from a war wound it adds a sense of legitimacy to them, a red badge of courage for distinguishing the real EMS veterans.

Today a well-known EMS artist  published a photo of a female EMS provider with what appears to be a life threatening gunshot wound and a police officer holding pressure on the wound while returning fire. 14 hours after being posted on Facebook over 1200 people clicked on the “love this” button.  What the fuck is wrong with people? A female EMT just died this week in NYC and the artist knows that because he made a picture of her as well. I don’t understand the position of advocating for treating EMS acquired mental health issues at the same time as posting photos of dying EMS workers as art.

I have no doubts the artist could make a picture of a depressed EMT putting a pistol in their mouth or slitting their wrists in a dirty EMS station bathroom and that thousands of people would love that picture.

Can I blame the artist for giving the audience what it wants? I don’t know.

The unpopular truth is many of us have been in EMS for years and have no mental health ills from it. Sadly, this needs to be said because there are people taking the position that all of us in EMS are damaged, that we are all considering killing ourselves and are all suffering from wok acquired mental health illness.

This is not a slight on those that have suffered a mental health injury. We should support those that are dealing with a work acquired mental health injury, but at the same time we need to not paint a picture that we are all one more bad call away from suicide, that we are all struggling with addiction or other mental health woes.

I love my job and if anything, the things I see at work make me appreciate other things in my life more. I would go as far to say that my career in EMS has improved my mental health.  Just as we should not dismiss work place mental health injuries we should not propagate the notion that everyone in EMS is suffering from them, or will be at some point.

The notion that we are all ticking time bombs is bullshit.

Why do I care? First there is the propensity for EMS workers to self-diagnose. Secondly there exists a very real possibility where a lazy or incompetent mental health provider will fall prey to a confirmation bias and say “oh you’re in EMS and having mental health issues? It is PTSD.”  It seems that many EMS provider suicides are automatically assumed to be from work acquired PTSD when we have no idea why they killed themselves. What ever happened to garden variety depression? People kill themselves all the time from depression. How about substance abuse? Perhaps burnout? Or even compassion fatigue?  Are all of these treated the same?

Health-PTSD-Time-Bomb

We need to be honest with ourselves and others. Being completely honest is not easy, it is not popular, it gets you in trouble and it alienates you from those who wish to be shielded from reality.

In the spirit of honesty I am angry. I am tired of seeing people making memes about how damaged we are as an industry.  I struggle with this because I do not want to ostracize those with legitimate work acquired mental health injuries but at the same time I won’t stand by idly while people make all of the industry out to be unable to provide the service we promised we would provide.

I have grown weary reading about all the people with mental health issues from EMS who blame the toxic culture and refuse to bear personal accountability for their own wellness.

There are toxic cultures, I don’t want to downplay that,  but I would argue that it is not exclusive to EMS and it is likely just an unpleasant part of human nature. Sometimes the world is a terrible place and we have to work with people that are frankly, assholes. We toss around terms like resiliency at the same time blaming the toxic culture and making people in to victims. Somewhere there has to be a more balanced approach, a middle path to be taken.


We are not special because of all the things we have seen. Thinking we are somehow different than others because of all the things we see is nonsense. Life is full of terrible painful things. Much of human history is full of disease, suffering, loss and violence. Perhaps it is only in recent times that we have become shielded from that reality and when the curtain is removed we are faced with having to reconcile our beliefs about how the world is.

We need to be honest and up front with those coming in to EMS. They deserve the truth. We owe it to them to let them know  they are not going to be heroes, they will save very few lives, there will be no thank yous or gratitude, most of what they do will not matter and they will bear witness to countless terrible things.  They will have a front row seat to the human experience. They need to care, but not too much.

Day one in EMT class should start with “You are going to see dead babies, you are going to try and save people and you will fail. This is what you are signing up for. You will probably see images of things you wish you did not see over and over in your head, how you deal with them is important. How you help others deal with them is important.”

Here is the truth as I see it. If a call fucks you up, then be fucked up. Unless the macho front you manufactured can’t handle that crushing blow. Are you really trapped in a prison of your own making? Be a genuine person, maybe for the first time in your life. Drop the façade. Make no mistake, it is not always an easy thing to do, to be genuine; some people would rather kill themselves than do this.  If the dead person you saw doesn’t bother you in the least that is also fine. If a call screws with your head and you can’t stop seeing images of that scene that is okay too, be honest about it. Be strong enough to ask for help.

No one who matters is going to think less of you because of it.

If you need help now: http://suicidepreventionlifeline.org/

 

*There is no evidence of efficacy in using equine therapy for the treatment of PTSD.

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4 thoughts on “Red Badge of Courage: Has PTSD Jumped The Shark in EMS?

  1. You’re not wrong, at all. The things that bother me about EMS have nothing to do with patients, medicine or customer service. The things that make me worry, get anxious and discouraged are operational and managerial practices and low pay that remind me just what opinion senior leaders have of me as a paramedic.

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    1. I have a differing opinion. I think, and I think many would agree with me, that PTSD exists on a spectrum. Not every case, or even the majority of them, are the sterotyical burned and crispy medic.

      But when you look at the symptoms of PTSD objectively, we will see many of them in ourselves and our co-workers. We may not think of them that way, until you see the actual characterisitics. I recall reading some fo the research in my various PSYCH clases and going”that is my partner, that is my friend, and ..yep…I have that one too…”

      I think it is abolutely essential we have awareness. We need to treat it as objectively as we need better safety training in a lot of things.

      So, I think you are thinking you are hitting up some “straight talk”, but I also think you may cause some harm by causing us to discount those who are on the more subtle end of the spectrum, yet need help just as much.

      OK. Bring the flame on.

      reference:

      Clohessy, S., & Ehlers, A. (1999). PTSD symptoms, response to intrusive memories and coping in ambulance service workers.

      British Journal of Clinical Psychology, 38(3), 251-265.Grevin, F. (1995). Post-traumatic stress disorder, ego defense mechanisms, and empathy among urban paramedics. Dissertation Abstracts International, 56(2-B), 1089-1089.

      Leblanc, V., Regehr, C., Birze, A., King, K., Scott, A., Macdonald, R., & Tavares, W. (211). The association between posttraumatic stress, coping, and acute stress responses in paramedics. Traumatology, 17(4), 10-16. doi:10.1177/1534765611429078

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  2. You have some good points here, but I think your anger is misdirected and possibly triggered by misunderstanding the intent of Daniel Sundahl’s work and the intent of organizations like the Code Green Campaign (pretty obvious who you’re referencing here, were you just avoiding saying it explicitly for legal reasons?) I’ll lay out what I’m thinking here…

    1: You say that PTSD is a fact and not up for debate. Yet, on EMS1 just this week several of us had to take a gentleman to task who was firmly ensconced in the philosophy that PTSD symptoms are bullshit and that individuals only experience distress because they lack moral backbone and fortitude. He said if people were that week they’d be better off just killing themselves so others wouldn’t have to deal with them. Holy yikes, what a terrible thing for this guy to say… There are many in our profession who do not understand mental health AT ALL, let alone understanding PTSD and that developing PTSD as an occupational risk is not a matter of choice, weakness, failure- it is indeed, as you put it, just another occupational hazard inherent in the work that we do.

    2: Daniel Sundahl started creating his art as a way of processing and communicating his own traumas as he’s explained on his website and in many posts over the last few years, and lo and behold his art has resonated with several in our profession (as well as many who work in the ED, LEO, firefighting, etc.) because it demonstrates some of those images that are hard to shake while not being over-the-top. It’s a reminder of what we see and what we process, and a clear message that we are not alone in those experiences. For people who have a good support network to talk to, perhaps that is not so important, but for those others who are more isolated or who find it difficult to examine their own experience, seeing these images can be helpful. Also, Daniel is a talented artist and his work is visually interesting. People didn’t “love” the actual idea of the female medic bleeding out on the ground with the hero cop kneeling over her trying to protect them; people loved the imagery of “yeah, we’re all in this together, and some of us in EMS are afraid of being the victim in these scenarios and this image speaks to this emotion.” Sundahl has shown a LOT of imagery of the “internal struggle” and processing that many of us deal with, and it is instantly relatable.

    3: Code Green Campaign is working to promote awareness and understanding; they spend lots of effort online and at conferences providing good solid education on mental health for the first responder. Yes, they sell challenge coins and bracelets, but that’s secondary to their larger purpose. They also track first responder suicides (as the data currently available from other sources is not the greatest, they’re providing a grassroots effort to better catalogue the data so we can really see how large of an issue this is.) They’re not glamorizing mental illness; they’re simply normalizing it and spreading understanding so that those who experience it might feel more comfortable speaking openly about it and what it entails.

    4: The whole problem here is a larger one with our society; everyone understands physical injury- you were in a car wreck and have to learn to walk again? HOLY GOD, let me bring you some casseroles! Your child was burned in a horrible freak accident? Let us help you with childcare and expenses! Mental illness is treated like so: Your brain got tangled up and you can’t seem to get out of bed, or focus, you haven’t slept in weeks or you’re self medicating to numb out emotions you can’t process? WTF is wrong with you, you weakling? Have you tried meditation or long walks in the forest?

    5: The problem with the above societal setup is that it leads to two extremes: Those who never talk about what’s going on internally (often those who surprise us with untimely death by suicide, leaving grief and chaos in the wake of their loss- ask me about what my workplace is dealing with right now with TWO RN spouses who suicided within a week… one of whom was an RT and employee at one of our hospitals…) and those who seem to be flaunting the “red badge of courage” and fetishizing the psychological injuries incurred. The much quieter, and larger section of us who have managed to accept a mental health diagnosis and learn coping techniques to manage it (just like we do with any other illness… as I said in another discussion I didn’t choose asthma and Prinzmetals and I certainly didn’t choose PTSD either) and who are able to calmly discuss and validate the realities of living with said issues with our peers who come forward wanting to talk about it.

    Thank you for bringing forward your opinion- like I said, you have some very valid concerns, but I think some of the frustration is misdirected given the larger context. Have an excellent day.

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  3. This is a needed discussion. It’s not supposed to be a contest. For my first 13 years I had no problem for I knew what I was in for and armored myself for it. Then I got off shift one day and walked into my front door. I had only taken my shirt off when my RN wife coded right in front of me. 911 screwed up the call and she didn’t make it. Our son was 10. That was enough to pierce my armor but in 1990 PTSD was for soldiers. No CISD then. I worked another 2 years before I was terminated because I couldn’t do the job anymore. It was another 2 years before I was diagnosed.

    I’ve seen kids complain about seeing blood or something for the first time. Well, that’s the job. A few describe a much more difficult problem and I don’t want them to ‘suck it up’ and shun care. If you aren’t sure, ask. It’s not my job to make fun of anybody’s feelings.

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