I first became intrigued with EMS and the fire service by the TV program Rescue 911. After seeing how first responders saved everybody and always had a positive outcome (it seemed realistic enough, right?), this was what I wanted to do. I didn’t know the mental toll this career would take on me—Rescue 911 never showed us that.
Throughout my career, I have worked for a private ambulance company, two HEMS programs, and a fire department. Like a lot of you, I’ve seen and experienced some terrible things. In my career’s early stages, I’d commonly stop by a bar after my shift and have some beers and a couple of shots to blow off some steam. This was the only way I knew to relieve a bit of the stress. We handled our emotions differently then—you were expected (as some still are today) to “suck it up” and “get over it,” because “you’ll be OK.” I am here to tell you, that is the biggest lie you will ever hear or tell yourself.
As my career progressed, I started to experience other stressors. Beyond the patient interactions were the losses of brothers and sisters who committed suicide. In 1999, during my time as a flight paramedic, one of our helicopters crashed returning to its base, killing three of my coworkers and friends. Then 3½ years later I lost three more colleagues the same way.
As the cumulative stress grew, I felt stuck; I couldn’t tell anybody what I felt, as they would perceive my pain as a weakness. This fear added more stress to my dilemma. I was in a place from which I couldn’t escape.
As these events unfolded, I lost the resiliency to deal appropriately with my emotions. The beers and shots advanced to drinking to excess at least 3–4 times a week. Ultimately, when things became really dark, even alcohol was not enough.
I continued this path for approximately the next four years. The more I had to suppress, the more I used to forget. It wasn’t long before the shame and guilt of not being able to tell anyone what I was feeling combined with the shame and guilt of my alcohol and substance abuse to make further coping impossible. There came a point I hoped to overdose so it would all go away.
This insanity continued until I finally chose to get clean on January 9, 2006. I have remained free of all substances since.
I know I’m not alone in experiencing this scenario. Being caught between two negatives is sometimes our personal and professional reality. This column is the first time I have publicly shared these tribulations. My hope in showing how I handled them, or didn’t, is to demonstrate there is hope if you’re trapped by the stigma and don’t know where to turn.
A Combination of Resources
I don’t think there’s a single solution to this very complex issue. I think it’s a combination of resources that will help combat the mental health crisis in our fields. I believe properly run Critical Incident Stress Management (CISM) programs are an invaluable resource. Peer support teams add another option for those who don’t feel comfortable in a group setting. With the emergence of mental health concerns in the first responder field, EAPs have now stepped up their game and often have mental health professionals who specialize in trauma intervention and CISD.
I have become a proponent of proactivity in combating these issues. We can do a better job of preparing and arming the next generation of emergency service workers for the not-so-great parts of our careers. I feel we should add to their curriculum a section solely dedicated to self-care and resiliency. I have recently proposed this idea to one of the top EMS institutions in Southern Nevada, and it has been well received. We are currently in the process of adding that subject matter to its curriculum. By giving our young men and women these tools, hopefully they will be able to adapt in a healthier way than some of their predecessors did. I believe the more proactive we are, the less reactive we will have to be.
If you are struggling, please reach out to a coworker, friend, or family member—you owe that to yourself. We all have tough jobs, and we should be able to foster an environment in which it is OK to talk to a peer and let them know when something is bothering us. We should have programs in place for further assistance with confidentiality. Addressing these thoughts, feelings, and behaviors is extremely important, for experience has taught me that you need to be able to deal with your emotions, or they will eventually deal with you.
Michael Worthen, NRP, is an EMS battalion chief with Nevada National Security Site Fire and Rescue north of Las Vegas. He has approximately 28 years of experience in emergency medical services. Reach him at firstname.lastname@example.org.