Jennifer Fyler, MD, Brattleboro Uniformed Services Program medical director
Barbra Southworth, RN-C, staff nurse with Brattleboro's Uniformed Services Program
Ever since that call two months ago—which you don’t even like to think about, let alone talk about, even though it’s constantly rattling around in the back of your mind—you’ve been struggling at work. You’re short tempered, your sense of humor has grown dark and after a shift you’re drinking more, and harder. Everyone you know chalks it up to long hours and little rest, the stresses of the job that you all endure.
As EMS providers you deal with more stressors than most, and you’re taught to compartmentalize it and move on to the next patient. If you didn’t, you wouldn’t last long. But what happens when the stress becomes too much? Where can you go? Who can you talk to?
Places like Brattleboro Retreat in Brattleboro, VT, often seem intimidating to people not accustomed to asking for—or getting—help, but Brattleboro, which has been around since 1834, is unique in that it has a program focused solely on people like you. Brattleboro’s Uniformed Services Program (USP), is specifically designed for uniformed services personnel, including EMS providers, first responders, firefighters and more. EMS World recently spoke with Jennifer Fyler, MD, USP medical director, and Barbra Southworth, RN-C, staff nurse with USP, to learn more about the services Brattleboro’s USP provides.
Please tell us about the work you do in the USP.
Jennifer Fyler (JF): We are a full-spectrum psychiatric facility with inpatient units, outpatient residents and partial programs. The largest focus we have is around post traumatic stress disorder (PTSD), but we also have a strong emphasis on substance abuse issues. In addition we see uniformed services personnel who have depression or anxiety or other issues. It’s a partial hospital level of care with a residence, so we do treatment groups and individual work throughout the day, seven days a week, and our clients live in a residence not far from where the treatment is given. We use a number of cognitive behavioral therapy techniques, including Acceptance and Commitment Therapy (ACT), mindfulness-based stress reduction, meditation, trauma-informed yoga, exercise group, individual work, neuro-feedback, exposure therapy and substance abuse recovery.
Barbra Southworth (BS): One of the things that works very nicely is the way the residents interact with each other. This is a difficult place to come to because these are folks have a hard time asking for help or even acknowledging that they need help. Oftentimes it’s taken a particular call, a tragic call that maybe went bad. For the most part they’re taught that it’s just part of the job, so when they come to treatment it’s a really hard choice for them. But their peers can help them see that they’re not alone.
How did Brattleboro Retreat get involved in providing services to EMS? Are there any other programs like this?
JF: We noticed how difficult it was for this group to ask for and get help. Part of the goal of the program is to provide access to treatment to a group that couldn’t get it before. I don’t think there’s a program quite like ours. There are residential programs that treat substance abuse, but I don’t know of another place that in such an integrated way treats PTSD and substance abuse together. The two issues inform each other and it’s very common for these groups of people to abuse substances, especially alcohol, and that’s really part of the culture for many. What we know from the research of treating these disorders is that if you treat them separately it doesn’t work. We get a much better outcome if we treat them at the same time.
Are you seeing more stress, trauma or addiction problems within the EMS community?
JF: It’s hard to know the prevalence because that would involve studying the entire population of EMS providers, but I think the word is getting out that we’re here and we’re getting more referrals.
BS: When one member of a department has problems that are recognizable and they step up to get help, that’s how word gets out. It’s a true domino effect. When we talk to our clients and ask them how they found us they often say word of mouth.
JF: Our estimate is about a third of the people who come through, about 35%, are EMS personnel or firefighters. It’s always a large presence in the group.
What other services/treatments does Brattleboro Retreat offer? Do you see patients return to the program?
JF: One piece we provide that’s sometimes part of what we do is a medically supervised detox program where patients will spend a couple days before they come to the USP. Sometimes people will come to us with more severe psychiatric issues where they’ll need an inpatient stay for a few days. Once people are discharged from USP, if they live locally, we’re able to follow them through our outpatient program as well. It’s a full continuum of care.
BS: The average stay is 10 days to 2 weeks. We have had folks come back because when they went out they struggled. But when they do come back they’re quick to call. They may just call for support and recommendations, but when they come back it’s usually successful.
Are your services covered by insurance?
BS: Yes. Our patients are usually seeking what’s called a partial hospital level of care, which most insurance companies cover. We do have to get authorization from the insurance company, and the patient gets reviewed throughout their stay by the insurance companies. Medicare also will pay for a stay in the hospital and Vermont Medicaid does, too.
What advice would you give for EMS providers struggling with these issues?
JF: By all means give us a call. We’re at 1-800-RETREAT (800/738-7328). Making the call is the hardest part. We can figure out the various ways a person can get support but the hurdle is making the call. Sometimes knowing they’re going to be with their peers, their brothers and sisters, the people who have been through similar experiences, that’s what makes it possible for them to take that first step.
BS: These are folks who look good on the outside. They know how to make it appear like they’re cool and collected. Meanwhile on the inside they’re oftentimes falling apart. Their values have changed; they may be abusing substances and even getting into legal trouble. We need to remember the human factor. EMS providers are not machines.