“We don’t honor people very well when it comes to mental health” Jordan said sitting in his air-conditioned car getting reprieve from the early summer heat. He’d just finished mowing his church’s lawn as he spoke with me for our second conversation about the dog-eat-dog world of paramedicine in the United States.
From changing careers or burning out after as little as 5 years on the job, to working the hours of a corporate lawyers for a fraction of the pay, working in EMS takes a heavy toll on the medic. What is seen daily is glossed over as a mere fact of life like the statements ‘the sky is blue’ or ‘water is wet’. “You can see two pediatric deaths in one shift and be expected to get right after that next call without skipping a beat” Jordan says, “or without so much as some time to debrief and decompress”.
The desire to help and to jump to the aid of others right when they need it is what makes many medics great at their jobs. It’s a pretty handy personality trait for this career because it turns out that emergencies don’t wait until you’ve caught your breath.
As far as traits go, it’s great for saving lives and getting the job done. It’s also an exploitable trait and the low pay, bad hours, and relative lack of mental health services that medics receive seems to be evidence of that.
Like many in the profession, Jordan got into it because he feels a calling to help others in whatever capacity they need. His involvement with his church, his choice of profession and university studies, and his devotion to raising a healthy, happy family all come from that very same place.
As does his fight to make paramedicine a more sustainable career.
It is useful to understand that the human mind (like any other complicated ecosystem in nature, for instance) gets more brittle and more susceptible to damage the longer it’s subjected to constant stress. “24-to-36-hour shifts are difficult enough in a short-term environment, but the long term wear and tear from mental fatigue and physical exhaustion have a compounding effect on the health of the provider.” When talking about ways to reform Paramedicine in the United States, then, the first thing that Jordan recommends is working shorter shifts (not longer than 12 hours) and giving more frequent recovery periods to lessen constant stress. And as with any well thought out solution to a problem, Jordan’s “take the time you need” solution isn’t so one-dimensional.
Part of Jordan’s “time-taking” strategy includes the ability to go off call after particularly disturbing calls.
Emergencies wait for nobody to catch their breath but where possible, teams of paramedics ought to be allowed to have a period of rest to debrief and decompress after a call. He even goes so far as to posit that “dispatchers should monitor medic teams and the calls they attend and force them sometimes to take debrief and decompress breaks”. Jordan knows all too well how a paramedic’s desire to help and their hesitancy to admit when recovery time is needed can make these changes difficult to work into the culture.
Yet, as the world’s most famous scientist/inventor/founding father and part-time kite enthusiast Ben Franklin once said: “an ounce of prevention is worth a pound of cure”. And that guy helped make a country, so we might consider paying attention to that shocking bit of wisdom.
The zeal with which paramedics engage in their career makes them eager to take on longer hours and shoulder more burden. It can be a point of pride to talk about how many coffees you put down range with one hand during a sleepless 48-hour shift while saving lives with the other, all while missing your family’s Christmas dinner. In in Jordan’s words: “It’s often talked about how many birthdays, holidays, and anniversaries are spent away from our families for the sake of serving our community.” That seems right though… after all, isn’t this what you signed up for? It’s exciting for sure, but, Says Jordan, “there needs to be a different approach. Changing the cultural mindset that pushes ‘work-until-you-burn-out’ and stigmatizes PTSD should be a priority.”
Many people, naturally, link their identity to the job. The problem is that “Without knowing who we are, it is easy to be preyed upon by management structures that exploit our zeal and passion to work more shifts than we are already scheduled for.” The result is a baked-in assumption that a medic, if they want to be one badly enough, will continue to give and give and give.
Recalling the analogy from part 2, if building psychological resilience is like building a strong ecosystem, then having a diverse support network to help absorb blows to your mental health is key. What’s truly important, then, (and this is Jordan’s second recommendation) is that paramedics use the extra time they should be given to develop a strong sense of self outside of the career, and not make a monolithic personality based on paramedicine.
Having the time and space to take a larger role in your family, friend groups, extracurricular activities and hobbies helps to build a diverse support network for your mind. In Jordan’s words: “We must recognize how much overtime is being worked and encourage them [medics] to spend more time with their family or themselves outside of work”.
Commentaires