Burnout, PTSD, early retirement: these are issues not uncommon in the field of EMS, and yet they often remain unaddressed and unresolved, often due to a lack of action from leadership. If the EMS profession continues on the stigmatized path its currently on where providers are discouraged from speaking about their mental health struggles and ostracized when they do, the system itself—from providers to patients and to the stability of organizations—is going to suffer immensely.
“Provider mental health starts with culture. Offering resources isn’t enough,” said BJ Jungmann, fire chief of Burnsville Fire Department (Minn.), one of four panel members who spoke in the EMS Today Conference and Exposition session “The Mental Health Perspectives from Medics to Leadership: Insight into Current Research,” on Feb. 20 in National Harbor, Md.
Jungmann offered his views on fostering a positive mental health culture from a leadership perspective. It can be difficult having open conversations, he said, but effectively addressing mental health issues early on helps employees get energized to return to work later and helps preserve the well-being of the crew as a whole.
Jungmann said the chief handbook doesn’t provide instructions on how to respond when your assistant chief is sitting across from you telling you he’s suicidal. It’s essential for leaders to have specific response protocols in place for mental health crises within their organizations. Simply sending a struggling employee home on sick time isn’t going to resolve anything.
“What’s the alternative if you do nothing? The statistics show we have high rates of suicide,” said Jungmann. “If there was any other epidemic, we would try to fix it. There are things we can do for suicide, too.”
While departmental culture is coming around to destigmatizing discussions on mental health, the process remains a slow one for many. Crews may not trust one of their own members who have been cleared to come back from mental health recovery. But a mental health injury should be treated no differently than a back injury—the chief needs to provide reassurance to the crew that their colleague is just as reliable as they were before, while also providing ongoing support for that returning member to ensure they continue moving forward in a positive direction.
Jungmann asked audience members to raise a hand if they knew someone in the fire or EMS service who had committed suicide. A quick glance around the room revealed most did. “It doesn’t matter what line of leadership you are in—we can all make a huge impact. Your organization needs you to do that, because the stats are telling you that and the hands in this room are telling you that. The industry needs to change,” Jungmann said.
Have the resources available for your crews, he said, but think about the cultural impact you’re making and what you’re going to do to improve it. The way you and your employees treat and talk about patients dealing with mental health issues will impact a provider’s decision on opening up about their own and reflects the way they will be treated by their peers if they do. In 2016, the department issued a statement that crew members are not allowed to talk poorly about mental health calls they’ve run. And to uphold the department’s values surrounding the promotion of good mental health, Burnsville Fire has annual training on mental health, a peer support program, and a health and wellness committee.
“What do you value as a leader?” He asked the audience. “If you really value your people, you need to have a plan and more than just resources. An EAP card isn’t going to fix your issues culturally or in getting your crews the help they need.”
Unfortunately for paramedic Doug Butler, Jr., he’s all too familiar with the dysfunctionality of a poorly-managed EAP. When he decided he needed to utilize the program, it took nearly 40 phone calls to get in contact with someone to assist him, and when he was prompted to select a reason for taking leave, his was not even listed as an option: PTSD.
Butler worked as a dispatcher during the 2017 Sonoma County Wildfires. He answered 957 calls on the first night. As there were no protocols for a disaster of this scale, dispatchers were just instructing people to evacuate. One of the calls he took was his neighbor reporting that his own house was on fire. While his dog was saved, his house was not.
When news media outlets began reporting on the fatalities, Butler recognized three of the addresses of individuals he had spoken to before they lost their lives to the fire. He said it was emotionally tolling, but amazingly, after four days of working dispatch, he went on to working 14-hour shifts as a paramedic, sleeping on cots and couches along the way.
After the fire had been contained, the county gave its public safety employees time off, yet Butler decided to go back to work in dispatch. After taking one call, he stood up for the first time in his career and said, “I’m leaving.” He took four months off from his part-time dispatch career—19 other dispatchers worked nonstop but didn’t take advantage of the EAP. His experience had a huge impact on him.
“My life has changed,” Butler said. “Think about what your department has and what your options are for your employees. Hopefully, it’s more than EAP.”
Medical Director Perspective
“You know you’re going to be dealing with death and disability,” said Michael Wilcox, MD, owner of the WGH Group, LLC and medical director ofRural EMS Services and the Community Paramedic Program at Hennepin Technical College (Minn.). “Bottom line is: if we don’t accept this issue as something that needs to be addressed, the patients we work with aren’t going to receive the best level of care because we aren’t taking care of ourselves.”
Wilcox said his perspective on mental health in EMS has changed significantly in the last 10 years as positive shifts in the cultural acceptance of the issue occur both societally and in EMS. He shifted his focus onto the crew members because if they are suffering, so will others in their lives: their patients, family, and friends. Social isolation is quick to follow once those relationships become neglected, and that’s when things can start to unravel.
Departments need to assist crews in finding resources to prevent this unraveling from happening in the first place. Wilcox incorporates initiatives into his EMS crews’ yearly training programs which focus on the concept of mental health awareness and early recognition of mental health issues. He uses CrewCare to monitor the mental health of his crew members, a free app designed for first responders to anonymously input their health data and stressors to receive insightful feedback on improving their mental health. Wilcox said using this app helps him to enact aggressive and early management of mental health issues among his crews.
Panel member and epidemiologist Morgan Anderson, MPH, played a key role in leading the CrewCare project. She highlighted the importance of keeping track of providers’ mental health, as increased levels of cortisol in the body caused by chronic stress leads to debilitating issues that impact job performance, such as impaired cognitive function, being in a constant state of “fight or flight,” an impaired immune system, and increased risk of heart disease, blood pressure, and diabetes. Anderson was named an EMS10 Innovator for 2018 by ImageTrend, Inc. for her role in the research and analysis aspect of the app’s development.