EMS is a demanding profession. Long hours, rotating shifts, aggressive patients, personal danger, tragic scenes, and sleep deprivation are just a few of the common challenges. Knowing all this, why did you choose it? Chances are your primary motivation was to help others. As emergency medical providers, empathy and compassion are among our greatest strengths. They fuel us when we’re on the 14th transport of the shift, hungry, haven’t slept, and desperately need to pee. In the absence of effective skills to cope with all we encounter, however, these strengths can become pathways to cumulative stress and injury.
EMS work presents many known challenges to our physical, mental, and emotional health. Far less familiar are the other impacts we rarely stop to consider. For example, how do these challenges impact our relational wellness and social health? Typically we see our relationships impacted by long shifts, odd hours, sleep deprivation, our finely honed but dark sense of humor, overtime/second jobs, trauma exposure, and resultant stress injury. The stress generated by these factors can diminish the quality of our personal and professional relationships in both obvious and subtle ways. Odds are you never received healthy relationship and communication skills during your training; yet your job is predicated on your ability to relate to strangers in crisis and then shift gears to return home to daily life. These days the COVID-19 pandemic brings additional challenges to our well-being that can place additional stressors on our relationships. No emergency medical provider is 100% prepared to address every relationship challenge they’ll face, but you’ll improve your chances if you learn effective ways to manage those stressors and mitigate negative impacts on your relationships in a world where long shifts are now followed by social distancing.
From a relational standpoint, one point of note is the regularity with which the coronavirus pandemic brings fear to the surface of almost all relationships. But that fear doesn’t always look like fear. In many cases that fear looks more like anger. For most of us it’s easier to display anger than the underlying emotions of fear or hurt. Short tempers, inappropriate responses, and out-of-proportion reactions to situations are all telltale signs people are afraid and feeling out of control in their lives.
In light of all the changes society is experiencing, most of us are finding our lives restricted in ways we never dreamed possible. Of course we feel out of control. There is no precedent for what we’re experiencing, and we don’t know when it will end. Emergency medical providers are on the front lines of the battle against this invisible enemy. We grieve the loss of the normalcy and perceived safety of the familiar past. At the same time we continue to respond, balancing our love for the job with grief for what we’ve lost and the new fear of exposure, potential illness, and possible transmission to those we love.
Self-regulation starts with self-awareness: When we notice ourselves spinning up, feeling angry or irritated, we can make the choice to regulate. This can be as simple as taking a deep breath followed by a long, slow exhalation. The exhaling stimulates the vagus nerve, helping to down-regulate our sympathetic nervous system, calming us. This simple step can put you in a healthier place mentally, physically, and emotionally to support your own needs and well-being, making you better prepared to serve your community and be present for your family.
Consider frequent flyers: The repeat customers most demanding of emergency services are often the individuals who struggle most with self-regulation. Self-regulation allows us to remain calm in stressful situations, avoid impulsive behavior, cope without abusing substances, and avoid toxic people or situations. Without these abilities this population becomes dependent on 9-1-1 to help them manage daily life. The risk for emergency medical professionals is that we see these individuals as set apart from ourselves—them, not us. We see their lives and situations and believe that could never become our reality. But that’s just false—we are just as at risk for unhealthy relationships, just as at risk for increased trauma, and just as at risk for addiction-based coping strategies if we don’t acquire (and use) healthy self-regulation skills.
As responders we have set an expectation that we should place others’ needs ahead of our own, often denying that we even have needs. We pay so much attention to whether our rigs and equipment are ready, but how often do we look at ourselves through that same lens of preparedness? As humans, we all have non-negotiable basic human needs. Think Maslow’s hierarchy: Each tier of needs supports the one above it. Without the solid foundation created by meeting these needs, our lives collapse. A healthier approach is to regularly check in with ourselves, identifying what those needs look like for us and whether we’re meeting them in the context of our family, friends, and romantic and work relationships. To make this practice easier, the Center for Nonviolent Communication has compiled this list of basic human needs. Asking yourself how and whether you’re getting each need met in your life can help you identify areas needing attention.
The more needs you have that are properly met, the more success and satisfaction you will experience in your life and relationships. Basic human needs are like sleep: You might be able to get by with less than you need, but you can’t thrive.
As responders we are the rescuers—we do not want to be the ones needing assistance. EMS professionals often see help as something we give to others, not something we ask for ourselves. This is tragically reflected in the number of responders who take their own lives rather than reach out for help. Many responders view needing help as an indication of being weak, unfit for duty, or simply not good enough. We fear being rejected by peers and loved ones.
In response some of us isolate to hide those feelings of inadequacy. This may lead to crushing loneliness and the belief that no one cares. Loneliness is generated from walls we create to avoid being seen, but we desperately hope someone will see through the façade and reach out. Statistics show 100% of people lack the capacity to read another’s mind. We must acknowledge our struggle in order to receive help. None of us would attempt to raise a stretcher with a patient on it by ourselves; in this situation we all ask for help by default.
The irony of being reluctant to ask for the relational, emotional, or psychological help we need is that as EMS professionals, we spend every day responding to calls for help. People calling 9-1-1 recognize outside intervention and professional help are the only things standing between them and the loss of life, limb, or loved one. Every day we strive to make a difference for them. So why won’t we let anyone make a difference for us?
If COVID-19 has taught us anything in the few short weeks since social distancing became the norm, it’s that we weren’t meant to get through this all on our own. You know how great it feels to make a difference in someone’s life; you do it every day. Asking for help gives someone else the opportunity make a difference in your life. It’s not weakness, it’s mutually beneficial. The healthiest cultural change we can make is to set the expectation that we ask for assistance when the mental or emotional lift is too heavy, just as we would when the physical lift is.
Sometimes help might take the form of financial counseling. Sometimes it might involve learning better stress-management skills. Or it could entail a handful of sessions with a mental health professional. You might ask for help and then find yourself having coffee with a peer support team member. These days you might just need someone to tell you where they’re finding toilet paper. You can get by without asking for help, but allowing help when you need it makes life a lot less crappy.
Rhonda Kelly, EMT-P, ASN, BS, is national director of health, wellness, and resiliency for Global Medical Response (GMR). She is also the founder of Responder Strong, a collaboration between emergency responders and the National Mental Health Innovation Center at the University of Colorado Anschutz Medical Campus, working to improve mental health support for responders and their families. She has served as the medical provider on Antarctic icebreakers, as a volunteer and career EMT, as a firefighter/paramedic for 17 years, as a paramedic educator, and as an ER and psych ER nurse prior to her current role. She also has several certifications in wellness, health coaching, mindfulness, and nutrition.
Jonathan Dickerson, MBA, is community engagement manager at The Center for Relationship Education.