What impression would you have of a patient with this chief complaint?
“Something happened yesterday that just put me over the edge. I need to sleep, see my friends, see my fiancée.
“I want to make others happy and put their happiness before my own. I always have. But I guess I need to find a balance.
“Maybe it was just a bad day, but after today I feel like I’ve had enough.”
You’d be concerned, wouldn’t you? Even if the subject’s affect were unremarkable, you’d probably label your patient potentially unstable and conclude there isn’t anything in your drug box to address those signs and symptoms.
Here’s another unsettling presentation:
“Life to me is a game of many turns, hills, tests and sacrifices I must face. I’ve been to war, and I’ve made it back home, but making it back home is what I would give up to have the friends I’ve lost be able to come back home to their families.
“I’ve been told money means more to me than love. That’s one reason I look at life differently today. When the day comes that I must leave the life I’m living, the only question I have for myself is, did I live life the way I wanted to, or did I live the life someone else wanted me to?”
Note the signs of sadness, loss, lack of focus and perhaps even suicidal ideation in this patient’s self-assessment. I don’t know about you, but I’d be wondering how dangerous he might be to himself and others.
These quotations, which I’ve edited for brevity and confidentiality, aren’t from patients; they’re from EMS providers—people like you and me experiencing, at the very least, what the first EMT characterized as a “bad day,” or perhaps something much worse. I mention our fraternal connection to those sufferers only to dispel the notion that we are somehow above public displays of misery.
I see signs of profound despair on EMS forums several times a year, and even more frequently on generic media like Facebook. They make me wonder if those same social networks I’ve often criticized and occasionally ridiculed might have value as surrogate confidants. I’d like to believe no form of digitized communication is as effective as face-to-face conversation, but perhaps I’m being old-fashioned. I see dozens of postings each week that seem to be cathartic for the originators, based on the reinforcing tone of ensuing dialogues.
Sometimes, though, there is a sense of desperation that supplants the recreational tenor of most posts. I’m not talking about rhetorical references to global warming or indignant exposés of allegedly unfair bosses; I mean gut-wrenching expressions of emotional distress that challenge even the most impervious EMS veteran to sit idly by. Such anguish from colleagues may be particularly unsettling, but a victim’s occupation shouldn’t determine whether we pay attention.
We’re trained to recognize many types of illness. How should we react to the kind that’s hard to measure clinically and occurs at such great distances, we have no duty to engage?
Note signs of distress. Pay particular attention to provocative message headers and topics, like “I’m done” or “It’s over.” Cries for help aren’t always frantic; often they sound more like dispassionate determination to take affirmative action.
Get involved. You don’t need permission or protocols for this step. Initiate contact privately—even if the post was public—and indicate a willingness to talk. Show concern, but don’t be quick to claim understanding unless you have significant experience with a specific aspect of the sufferer’s complaint.
Let someone know. Most of us don’t have the training to handle psychiatric emergencies alone. Explore local resources with your correspondent and consider highlighting the distress call to a forum moderator.
Follow up. Check back with the subject a few days after your initial dialogue. Be particularly sensitive to expressions of hopelessness (e.g., “Nobody cares”), hypothetical questions about medications or weapons, and rambling, disorganized rants.
I’m not suggesting we dial 9-1-1 every time we encounter a “people suck” post. Sometimes simply having an outlet for frustration allows our online neighbors to maintain balance in their stressful environments. Consider, though, the steps we routinely take in the field to err on the side of caution; none of us wants to confront what could have been done.
Mike Rubin, BS, NREMT-P, is a paramedic in Nashville, TN, and a member of EMS World’s editorial advisory board. Contact him at firstname.lastname@example.org.