Every day, 20 of our nation’s veterans and service members take their own life.
With skyrocketing numbers of armed forces veterans returning from deployments—often with disabling physical and mental conditions—EMS providers must be prepared to care for their unique needs, both physical and emotional.
“They’re coming back and they’re struggling,” said Dean Pedrotti, CEP, BS, MA, retired captain and paramedic for the Phoenix Fire Department. Pedrotti co-presented “Responding to Veterans and Service Members in Crisis” with licensed professional counselor Annette Hill, MC, LPC, NCC, Thursday morning Feb. 21 at EMS Today Conference and Exposition in National Harbor, MD.
Transition and readjustment to civilian life are difficult following military service, whether the veteran was deployed or not, Hill said. While service members perform admirably in the most extreme demands of military service, they often have difficulty just living life back home. Paying bills, caring for children, survivor guilt, inner conflicts and interacting with family and peers who don't understand or care about what they've been through can trigger extreme emotions. “That’s got to go somewhere,” Hill said.
While PTSD is widely discussed in media and professional circles, “moral injury” is an evolving concept that’s being acknowledged as the signature wound of this generation of veterans, Pedrotti said. Defined as committing, witnessing, imagining or failing to prevent events that can be judged as evil or harmful, moral injury can emerge long after the experience and can result in sorrow, shame, grief, regret, alienation and feelings of betrayal.
Moral injury differs from post-traumatic stress in that its effects arise from the person being the actor—they did or didn’t do something that goes against their moral code. One example is killing a teenager strapped with explosives in order to prevent a deadly attack. While the symptoms of PTS include fear, flashbacks, anxiety and avoidance, moral injury presents more as grief, regret, shame, alienation and loss of purpose. Shared symptoms between the two conditions include anger, depression, nightmares and self-medication.
When called to assist a service member in crisis, validating the veteran’s experience and making a meaningful connection is the best first step, which can often be achieved via shared understanding of how to cope with suffering and loss. Assess the service member's stress level and if possible, remove them from the stressful atmosphere in a way that doesn’t demean or shame them. Bring them into the present moment by asking them pointed questions about what they hear, see and smell right now. Other de-escalation techniques:
Don’t bang on the door
Turn the radio volume down
Ask them about tattoos, medals, license plates, flags, photos or other meaningful memorabilia to facilitate a dialogue
Slow down and be prepared to stay on scene for a while
Respect their personal space
Your next priority is connecting them with resources that can help. EMS may be the veteran's first contact with a health provider, so treat it as the initial step toward healing. Resources include:
Veteran Service Organizations such as the VFW and American Legion
Local nonprofits including Goodwill and United Way
Team Red, White & Blue, www.teamrwb.org
Veterans Resource Centers of America
The Mission Continues, www.missioncontinues.org
When a veteran first opens up about their experience and the fact that they’re struggling, it’s a significant and potentially life-changing gesture. Treat it with the care and attention that it warrants. “That is a sacred moment,” Pedrotti said.