On a day like today…

So many short years later, Father Judge’s last homily is a reminder and a blessing to all of us on the job. I found it last night once again and wanted to share it, as I often find this homily to be a balm for the various wounds life and this job can visit on us. I hope you find his words to be as well. The emphasis in color is mine.

“Good morning, everyone.

May the grace of God the Father, peace of God the Son, and the fellowship of the Holy Spirit be with you all.

We come to this house this morning to celebrate renewal, rejuvenation, new life.  We come to thank God for the blessings over all the years – the good work that’s been done here and especially the last few days.  We can never thank God enough for the reality of the lives we have.  So, standing in His presence this morning, and truly this is a chapel, let us pause for a moment, perhaps close our eyes, and thank God for some special blessings in our individual lives.

Let us pray.

Thank you Lord for life.  Thank you for love.  Thank you for goodness.  Thank you for work.  Thank you for family.  Thank you for friends.  Thank you for every gift because we know that every gift comes from you, and without you, we have and are nothing.  So, as we celebrate this day in thanksgiving to you, keep our hearts and minds open. Let us enjoy each other’s company, and most of all, let us be conscious of Your presence in our lives and in a special way in the lives of all those who have gone before us.  And Father we make our prayer, as always, in Jesus’ name who lives with You forever and ever.

That’s the way it is.  Good days.  And bad days.  Up days.  Down days.  Sad days.  Happy days.  But never a boring day on this job.  You do what God has called you to do.  You show up.  You put one foot in front of another.  You get on the rig and you go out and you do the job – which is a mystery.  And a surprise.  You have no idea when you get on that rig.  No matter how big the call.  No matter how small.  You have no idea what God is calling you to.  But he needs you.  He needs me.  He needs all of us.  

The retirees – He needs your prayers.  He needs your stopping by occasionally to give strength and support and to tell the stories of the old days.  We need the house and to those of you that are working now, keep going.  Keep supporting each other.  Be kind to each other.  Love each other.  Work together and do what you did the other night and the weeks and the months and the years before and from this house, God’s blessings go forth in this community.  It’s fantastic!

What great people.  We love the job.  We all do.  What a blessing that is.  A difficult, difficult job and God calls you to it.  And then He gives you a love for it so that a difficult job will be well done.  Isn’t He a wonderful God?  Isn’t He good to you?  To each one of you?  And to me!  Turn to Him each day.  Put your faith and your trust and your hope and your life in His hands, and He’ll take care of you and you’ll have a good life.

And this house will be a great, great blessing to this neighborhood and to this city.

Amen.”

fr judge

Fr. Michael Judge

Chaplan FDNY

EOW 09/11/01

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Paramedics Love Pens

If you don’t have anything nice to say, make pens?

While sitting at post today waiting for our next assignment I was scrolling through Facebook and happened upon a dark humor page I hadn’t seen before. Honestly, I have unfollowed or ignored a lot of these pages because I lose my mind, get sucked into arguments and just like recent political internet arguments- nothing changes. As the adage goes, if you argue with a fool we all know who LOOKS like a fool in the end.

While scrolling through the new, unnamed page I found this:

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I get the gist of the joke. It’s not funny.

While we’re on the subject of jokes about suicide, that “it’s this way not that way.” That’s not funny either.

Dark humor and making fun of the most horrible things in the world are ways for EMS providers to keep their sanity when joked about in the right setting. Suicide is never one of those things.

What kind of atmosphere does that create for the provider that has been hedging on asking for help, but now feels like a joke because of an offhand comment? How we talk about and treat our patients demonstrates to our brothers and sisters how we might treat them.

Awareness and education on provider mental health and suicide are only a piece of addressing this problem. Each of us must commit to changing the culture of our service to allow the helpers to ask for help when they need it. These kinds of statements perpetrate the culture of silence and suicide in our industry. Open lines of communication begin when our brothers and sisters don’t feel judged before they open their mouths. Words are powerful- whether as weapons to tear down or tools to build up.

Most of us don’t even realize we are sending unintentional messages.

Be aware of the things you say and how you say them. The solution to helping the helpers begins with us.

 

IF YOU ARE THINKING OF SUICIDE:

National Suicide Prevention Hotline: (800) 273-TALK

National Hope Line Network: (800) SUICIDE

Safe Call Now (First Responder Specific): (206) 459-3020

Is Too Much Starch A Bad Thing?

This blog is part of a larger “What-If-We’re-Wrong-a-Thon” by several EMS bloggers where we attempt to view the opposite point of view on a topic we have previously taken a stand on. You can find the other articles here.

This weekend I had the opportunity to attend the Connecticut State EMS Conference (more on that in another post). One of the sessions was about professionalism by Dr. David Powers. Honestly, I wasn’t sure how much more there was to say on the topic, it seems pretty straight forward. However, after attending I came away wondering is there such a thing as being too professional?

Google defines professionalism as: the competence or skill expected of a professional; the practicing of an activity, especially a sport, by professional rather than amateur players. This leaves quite a wide berth for perception of what is professional in terms of being an EMS provider. Please note it does not say “volunteer” or “paid”, but rather “professional” or “amateur”. I think we can all imagine some folks on both sides regardless of their compensation status.

Of course, there are some issues related to being “professional” that are non-negotiable:

-personal hygiene
-general cleanliness (people and equipment)
-using some sort of identifier that you are a responder and not just a bystander
-using any clothing or items related to safety (ANSI vests and the like)

Now that we have laid a foundation to be able to assess what it means at a base level to be a professional, how can individuals in various roles perceive professionalism differently? Is your Chief’s perception of what it means to be professional different from yours?  What do our patients think a professional looks like?

Cast from Nightwatch
Cast from Nightwatch

The cast from Nightwatch was one of the examples brought up in the lecture I attended, specifically about some of the cast members visible tattoos. In the past visible tattoos have been a hot button depending on your location and agency. Some providers were required to cover visible tattoos or wear long sleeves all year to keep them hidden. However, tattoos are now readily accepted in most of society and they could be used as a tool to related to certain patients.  To be sure, all patients are different, and some may take offense, particularly if the art in question is garish or overtly sexual, though that doesn’t seem to be common. Do they look professional to you? They look clean, their uniforms are neat and shirts are tucked in, pants held up with a belt, the tattoos are noticeable, but not the first thing you notice. If their community members and agency accepts it, they look like good providers to me (note we didn’t even discuss their clinical skills yet… perception is everything).

EMS Provider or Police Officer?
EMS Provider or Police Officer?

 

Could we look neat, clean, and in uniform, but be perceived by patients and family as “professionals” other than EMS providers? In the appropriate circumstance this uniform is appropriate and necessary for personal safety, but what about everyday use? If you were not involved in our service would you know if the man above was an EMT or paramedic or a police officer? Could looking militaristic be averse to excellent patient care?  Could our uniforms cause more anxiety for patients and exacerbate their already compromised health? Could a uniform like this lead to safety and security issues for crews while they are on duty due to mistaken identity or intent?

 

chiefs

Another part of the conversation in class was looking “too” professional. Funerals and special events do require an extra degree of attention to your uniform, but on a daily basis is your uniform so perfect you look like you didn’t work at work? If you are a white shirt, could your subordinates feel distanced from you because they feel you don’t relate to the “workers” and forgot what the “street” is like? Of course, this is not an excuse to roll out of bed and into the ambulance looking rumpled and bedraggled, but could looking too perfect be intimidating; like the proverbial beautiful woman who can’t get a date because men feel she is unapproachable?

While we shouldn’t throw away the idea of becoming professionals and being at the top of our game, particularly in our industry where life and safety are at the top or our responsibilities, we should take a step back and imagine the situation and perception that may be applied when we arrive on scene. Being presentable and clean are still important, but is a creased patch an absolute requirement to do the best CPR or be kind to a scared patient? Perhaps, less starch could be used in application to the topic of uniforms and appearance by staunch advocates, such as myself, when reviewing everyday EMS scenarios.

Magic Is Not Just For Harry Potter

legacy

The pulse at his jugular notch was racing. I could count it’s beats visibly without palpation. I wondered at the intricate systems that worked to keep a heart beating and continue the magic that is life.

Then I solemnly remembered that one day that pulse would be stilled and the magic of the soul would disappear. I wasn’t sad or even angry, rather encouraged to use up my magic before it is spirited away suddenly. I was reminded of a conversation I had earlier in the day.

“Let the thing you regret be not working enough EMS shifts. Not, not spending enough time with your family.”

Many of us, including me, get caught up in the to do lists of life and miss small moments of wonderment that present themselves unexpectedly. We all need to work and have daily obligations for our day to day to function, but one day there will be no more “tomorrow” to fritter away. We need to be mindful of both large goals and small moments of wonder for the fuel to keep going and feel fulfilled.

big things

Love those who are precious to you. You never know when you, or they, will be gone.

What’s On Your Batbelt?

We pulled up to the desolate truck stop, our headlights shining on the sole person in the lot. Presumably she was our “sick” patient. She wore a pink head rag, dingy t-shirt and jeans, with even dingier keds carrying a bag full of her only possessions in the world. Her face showed a perpetual weariness that sleep would never cure. Not exactly how prostitutes are pictured on TV.

images (2)Richard Gere and Julia Roberts in Pretty Woman

My partner called out the driver’s window as she walked toward our ambulance, “Hey, you called 9-1-1?”

“Yeah, I called.” she replied as she stopped in the bright glare of the lights with her hand popped up on her hip.

“Well, what you want?” he shot at her.

“Just got back from Boston and I have a rash. I wanna see the doctor.” she explained.

“How long you had the rash?” my partner asked with a sneer.

“’Bout a week.” our patient responded with a head bop, her voice starting to show her impatience with his questions.

“A week! Why ain’t you go to the hospital in Boston?”

The interaction took a decidedly nasty turn and would have continued for a while as she was not going to “just leave” as my partner had hoped. I noted my partner’s exasperated sigh as I stepped out of the front and asked her to come to the side door so we could start the trip to the hospital and end this shouting match.

After much consolation and introducing myself and asking what hospital she would like to go to this evening, she relaxed and started to explain her complaint of a rash and boils in her vaginal area and previous related history. I didn’t do much for her other than take her vital signs and ask questions. But, by the end of our trip she was so grateful that I was NICE to her. That I didn’t judge her for her life and previous choices and related to her as a human being.

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Honestly, I was only extra “friendly” at first because I didn’t want to have to argue the whole way to the hospital. By the end of the ten minute trip I was sad that she had to deal with these issues and the life associated with them. She affected me in a greater capacity than I could ever have hoped to help her.

I am still thinking about her ten years later.

We are privy to peoples stories every time we are dispatched. How often do we see these “stories” in a one dimensional light? How does this skew how we react to patients and how can it affect our patient care in terms of clinical treatment? Could we be harming our patients by viewing them from a preconceived ideal rather than as unique, three dimensional, human beings? Could sharing our humanity be a better prescription than any medication we carry or any protocol we develop?

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There are situations where it is not safe or permissible to share a part of ourselves with our patients. But, there are some opportunities where it is okay for us to be humans and relate on a different level with our patients. You don’t have to always know the right words to say, sometimes a genuine smile and your presence is enough. Holding a frightened patient’s hand is not passe.

batman_vs_superman-batman-vs-superman-insider-scoop-on-batfleck-e2346155-2caf-4986-86be-1363bf2bb097

I recently had a discussion about what makes Batman a hero and Superman lame; my counterpart’s theory is that Batman is a regular guy saving people and Superman has special powers allowing him to save others. While he has awesome tools and a cool outfit, Batman’s superpower is his empathy and humanity. I submit that is our superpower as well. We don’t always have to wear the cape and tactical belt to be a “super” EMT or paramedic.

Be Contagious

We spend our days complaining about how life what isn’t what we expected or how we haven’t reached our expected timeline instead of accepting that, letting it go, and focusing on our dreams.

joseph-campbell


I’m too old.

I can’t afford it.

I’m not that smart.

I’m (insert any excuse here).

Life is hard. No one warns you about getting kicked while you’re down or what reality is like when you are young and idealistic. What makes an individual remarkable is that they prevail despite every unfair and awful thing that tries to intervene. If you were dying today, what would you want to leave as your legacy?

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We are all dying right now.  Put aside what you “think” you should be doing and live your passion. Don’t make excuses, just start to do it. Share it  and yourself with others. That is what builds a legacy.

Three responders from my area died in the line of duty this week, all cut down in their prime.  Their lives were electric and touched many people because they loved and were passionate about life. They pursued their dreams and impacted many people on the journey. Their legacies live on in our hearts via their examples of how to live life contagiously well.

If God graces me with another day tomorrow, I hope I can do those legacies justice and celebrate the lives of those individuals by starting to live my life contagiously and stop letting excuses steal my legacy.

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The Silent Killer

 There is a great hypocrisy in the world of Emergency Services.  Our job is to help people in any circumstance, at any time, at any place usually where unimaginable scenarios present themselves.  These are the worst days of peoples’ lives, but they shouldn’t affect responders…at least that is the popular conception within our circles.

This is why our coworkers, employees, partners, mentors, friends, brothers and sisters fall prey to treatable conditions unseen and unheard.  We look away at the worst time of their lives when they need the most help, but cannot ask for it.
“If ‘the job’ bothers you, then maybe it’s not for you.”
“I don’t know why you are so upset, you can’t save em’ all.”
“Man up!”
Maybe, there was no warning at all.  No complaint, no altered personality, no telltale sign of something amiss.  These people who we would protect and defend in the street are consigned to silence by the fear of our judgment in headquarters.  If you have been in this business for more than 5 years you have witnessed the phenomenon yourself.  Someone mentions that a particular call affected them or they seek treatment before the feelings progress and suddenly they are riding a desk or are forced out of the agency.  The typical line that is produced by the powers that be at the time is, “We have to know our people can make sound decisions under pressure.”  I admit this is a necessary component of our profession, but have you seen some of the people that get hired?  These providers are usually veterans who know to get help before the issues progress and were attempting to obtain help.  That is not good decision making?  What makes this whole situation worse is that we at the bottom then complete the abandonment by ignoring the person affected.  The person we used to be a brother or sister to is now treated like a leper because we “don’t want to deal with THAT.”
Some responders even commit suicide.  These are our friends!  We swim in each others pools and eat each others food.  We celebrate holidays together when we cannot be at home.  Our children play together and we tell each other secrets our loved ones wouldn’t begin to understand.  Yet we might as well show up to the funeral en masse in our dress blues and turn our backs for how some of their families are ostracized.  
Got cancer? We have a fundraiser.   
Got injured?  We come help around your house.  
 Have PTSD and kill yourself?  Oh, I’m sorry, do I know you?
There are no hard and fast statistics related to EMS or Fire related suicide.   Quite honestly, there are no statistics related to suicide by EMS providers. There are several reasons why: 70 percent of fire departments in the United States are volunteer departments and death certificates are completed with a profession noted, not volunteer activities.   Until recently the hero culture and machismo within Emergency Services had absolutely no room for discussion on first responder suicide, but like many things, the military attention on PTSD and responders with PTSD after 9/11 have shifted our attention to the topic.  The demographics within the EMS community are more varied than the Fire Service, but we are all exposed to some high risk factors for suicide.  We are all exposed to violence on a higher level than most citizens, whether via patient care or being assaulted during the incident ourselves.   Death is encountered by first responders in the normal course of duty and the loss of one’s life is accepted as an occupational risk.  A study, Occupational Fatalities in Emergency Medical Services: A Hidden Crisis, published in the December 2002 Annals of Emergency Medicine found that EMS providers are almost as likely to be killed at work as police officers and firefighters.  Between 1992 and 1997, 12.7 per 100,000 EMS Providers died at work compared to 14.2 per 100,000 police officers and 16.5 per 100,000 firefighters.  The national average for the working public is 5 death per 100,000 workers. We are also exposed to suicide or attempted suicide at higher levels than most citizens. This elevated exposure desensitizes providers to violence, death, and suicide and can lead to disinhibition and likely a more evolved capability for suicide than the general public.
Many non-demographic risk factors of suicide related to Emergency Services include alcohol abuse, mental illness, divorce or separation and the presence of a firearm in the home.  As you are well aware, we work long hours at multiple jobs, we don’t get paid very much, we deal with copious amounts of stress on a daily basis and this can lead to a myriad of difficulties in our personal lives without an outlet to release it all.  We all know someone, or maybe have had personal experience, with financial difficulties.  Having a strong work ethic is commendable, but 100 hour weeks dealing with everyone else’s problems is bound to lead to problems of your own. After working all those hours that’s just enough money to live in a tiny apartment eating butter noodles because that is all you could afford after paying your bills so you could get to work to do it all again next week.  We have all been cheated on or know someone who has or is currently involved in a love triangle (or square).  Everyone knows everyone else’s business in our world and in twenty years people will still remember.  And whisper.  If you are married or have a relationship with children involved this can lead to custody issues and likely a lawyer bill that your butter noodle budget cannot afford.  You know what happens when you don’t have a lawyer.  I’m sure we also know someone that lost their home because things got out of control and lived in their car and showered at the gym or work.  As if ALL that wasn’t bad enough add being ignored and told to “man up”  to the list.  The solution to the issues listed above is not simple or easily unraveled, some of it is the nature of the beast and some are personal choices.  These issues need a national forum for solution and voices from members of our community demanding change and improvement.  Some of these issues need better decision making skills in our personal lives as well.  It won’t solve the problem of suicide outright, but improved lives and life choices will contribute to stemming the tide.
FDNY EMT Daniel Stewart
While there aren’t many numbers to quantify first responder suicide what we do know about suicide in general is alarming. Of those who completed suicide, 70 to 80 percent suffered from alcohol abuse and a mood disorder, 40 to 60 percent were intoxicated at time of death and 56 percent used a firearm to carry out the suicide.  These are statistics for the general population, but closely resemble the majority of first responders.  In a study conducted by the International Association of Firefighters (IAFF) alcohol abuse was qualified as more than 2 alcoholic beverages a day for men and more than 1 alcoholic beverage a day for women.  The “two” beers and shots at the bar or party on your day off is qualified as binge drinking which is related to alcoholism as well.  Some other alarming numbers: various studies have cited PTSD rates, specifically related to firefighters, range from 16 to 24 percent while the average for American adults diagnosed with PTSD in their lifetime is 6.8 percent.
 Philadelphia Firefighter Jack Slivinski (left)
While suicide can be preceeded by a number of mental health issues, recent studies are linking PTSD and Suicide.  Per the Mayo Clinic, PTSD symptoms can include: flashbacks, upsetting dreams about the event, reliving the event, avoiding thinking or talking about the event, feeling emotionally numb, avoiding activities once enjoyed, hopelessness about the future, memory problems, trouble concentrating, difficulty maintaining close relationships, irritability, anger, overwhelming guilt or shame, self-destructive behavior, trouble sleeping, being easily startled or frightened, and seeing or hearing things that aren’t there.
Unfortunately, many of us, including our leadership are not educated on these warning signs.  Alternatively, the psychiatric and counseling communities are not usually well versed in our culture to understand the unique parameters that define our workplace.  Fire, Police and EMS units (unless aligned with a hospital) do not typically have Employee Assistance Programs (EAP) to call and speak with.  Those that do have programs in place still have providers with fear that their job will be affected.  These responders either pay out of pocket to go to a counselor of their own so the treatment does not show on their insurance or don’t do anything at all, letting the feelings grow in strength.
Chief Kyle Ienn of Ralson, NE Fire Department
There are many wonderful people advocating and researching PTSD and First Responder Suicide.  Peggy Sweeney of the Sweeney Alliance promotes educational programs for dealing with stress, trauma and grief and writes several newsletters including Grieving Behind the Badge.  Her colleague, Shannon Pennington is the founder of The North American Firefighter Veteran Network and together they have produced a training program for first responders called FIRST STEP HOPE: Not All Wounds are Visible.  Both have been first responders and understand the difficulties faced in our line of work.  Jeff Dill holds a Master’s degree and is a Licensed Counselor. He is also a Captain at Palatine Rural Fire Protection District in Inverness, Illinois and the founder of Counseling Services for FireFighters.  He educates leaders on the importance of counseling and awareness of PTSD and Suicide.  He is also compiling statistical data based on confidential reports of Firefighter and EMS provider suicides.
 Awareness, like many other topics in our profession is key to prevention.  Having an Employee Assistance Plan (EAP) and CISD Teams and leader education is a great first step, but until the change in our culture flows through the ranks, our brothers and sisters will continue to be cut down by this seemingly silent killer.  Ask about your workplace EAP Plan or why you don’t have one.  Educate yourself on issues that affect providers socially and emotionally and ask to have them addressed. Help each other when you notice a change.  Let your legislators know EMS needs funding for studies on these issues and ask what they plan to do about it. 

We strike for better pay and health benefits, we complain to get better couches or recliners to watch TV in, we gripe about not enough milk in the fridge for afternoon coffee.  Why don’t we speak up and stand in the gap for our friends and ourselves?  Who will pay attention if we don’t?  How will the culture change if we don’t change it?
If you are thinking about suicide or need help you can call the National Suicide Hotline.  It is open 24 hours a day, 7 days a week.  1-800-273-8255  1-800-273-TALK