A 9-1-1 caller frantically told the dispatcher a 9-year-old child had been seriously injured in a traffic accident. The dispatcher paused and took a deep breath, thinking for a moment about his own school-age children. The ambulance crew responded to the scene, which had been witnessed by a dozen frightened bystanders, including children and parents. Quickly moving the child into the ambulance, the paramedics initiated a Code 3 transport to the hospital.
Before the end of the day, the department chaplain had been notified of the call twice—once by the duty supervisor, who recognized the potential for emotional distress, and also by an automated notification program set up through the system’s communications center. Using keywords, a FirstWatch program generates e-mail reports informing the chaplain of calls that meet established criteria, one of which is Code 3 pediatric transports.
Provided with this information, the chaplain reached out to the dispatcher and crews, acknowledging the call and its potential to be a distressing incident. Listening, supporting, normalizing the employees’ stress response, and offering to follow up are all part of the chaplain’s role. Outside the chain of command, the chaplain is a neutral, safe place for employees to seek and receive support.
A Focus on Well-Being
I serve as chaplain at Allina Health EMS, based in Minneapolis. The position of EMS chaplain was new when I began in 2007. I was an experienced hospital chaplain but unfamiliar with EMS. The organization was equally unfamiliar with the role and function of a chaplain.
Initially the operations leaders helped me determine who had experienced difficult calls. From there we worked on developing standard operating procedures for situations when leaders were asked to notify the EMS chaplain. It was a list any EMS leader would recognize: pediatric emergencies, MCIs, fatalities from fires, employee injuries or assaults, and high-stress calls impacting dispatchers.
But the chaplain isn’t alone in providing support to our employees. It is a team effort, and EMS agencies can have access to a variety of tools. Resources for providing staff support include supervisors and managers, peer support teams, an employee assistance program (EAP), post-incident debriefing, and resiliency, suicide prevention, and other related training and education. In our organization the chaplain is a part of a companywide effort.
There are individual as well as business reasons for providing tools for the well-being of frontline providers. We all know the risks to individuals: This is a high-stress job, with significant impacts on individual health and well-being, as well as marriage and relationships. On the business side, organizational health is essential to the success of any company. Chaplains are one way to provide a means for addressing well-being without sending the message that there’s something wrong with you if you struggle to cope with the stress of your job. Stress is a normal response to abnormal events. Our focus is on long-term well-being and not just incidents.
This approach is not unique to EMS. Healthcare in the U.S. is being transformed to a focus on preventative care. Businesses of every size encourage employees to eat healthy, exercise, get enough sleep, and tend to their spirituality. It is in organizations’ best interests to provide support and resources for employee well-being. Rather than an expense, view employee support as an investment. These services are provided by a variety of practitioners; chaplains are one of those, and uniquely positioned to serve in emergency medical services.
Retention and Other Benefits
A growing body of research tells us well-being is enhanced when physical, emotional, and spiritual needs are addressed together. Corporations that take this seriously see benefits such as improved employee retention and a more engaged workforce.
To speak only of retention, one study estimates the cost of replacing one paramedic to be in the range of $72,000.1 In addition is the loss of cohesion and comradery among employees. Efforts to create and nurture a culture of support impact the bottom line.
Author and motivational speaker Simon Sinek’s discussion of trust provides another perspective on why an EMS agency might consider hiring a chaplain. Think of it in terms of organizational culture. Trust is a performance category that is nearly impossible to measure.2 Sinek writes that: For those within a community or an organization, they must trust that their leaders provide a net—practical or emotional. With that feeling of support, those in the organization are more likely to put in extra effort that ultimately benefits the group as a whole.
Great organizations become great because the people inside them feel protected. People come to work knowing their bosses, colleagues, and the organization as a whole will look out for them. This results in reciprocal behavior. Individual decisions, efforts, and behaviors support, benefit, and protect the long-term interests of the organization.3
One of the ways an organization can build and maintain an organizational culture based on trust, providing an emotional safety net, is by hardwiring employee well-being. A chaplain alone cannot do this; it takes a broad-based approach.
What Is Chaplaincy?
With its roots in religious tradition, modern chaplaincy focuses on providing care and compassion in secular settings. Chaplains are found in a wide variety of venues and come with a range of education and training. Many are clergy; others come from the fields of counseling, teaching, social work, or psychology. Public safety chaplains sometimes come from the ranks of frontline providers. I have identified two basic types of chaplains, each with two subgroups.
Clinically trained professional chaplains have completed the education and training required for board certification and adhere to a code of ethics that prohibits proselytizing. Some have taken the additional step of completing the certification process and are board-certified professional chaplains.
Traditional chaplains may have completed the education and training for certification but are not held to the same boundaries around religion and/or have not completed the graduate education and clinical training requirements for certification.
Some chaplains are congregational clergy who make a lateral move into chaplaincy. With an orientation to the institutional setting, experienced clergy possessing good interpersonal and pastoral care skills can provide very effective chaplaincy service.
The requirements to serve as an EMS chaplain vary by institution and are determined by an HR process or the leader who oversees the program. A valuable resource for both traditional and professional chaplains is the Crisis, Trauma, and First Response Certificate offered by the Spiritual Care Association.4 While I advocate for professional chaplaincy, I recognize many EMS agencies will not have access to clinically trained chaplains. Whatever model an agency chooses, I emphasize the importance of having a code of ethics built into the program for the protection of everyone.
How to Provide Support
One of the simplest and most effective things any of us can do to support our coworkers is to acknowledge their experiences. Don’t assume they’re doing OK, traumatized, or anything in between. Sometimes the best thing a supervisor can do is take them out of service, even for a short time, without asking if they want it. Our first impulse may be to ask, “How are you?” but I’ve found it to be more helpful not to ask anything. Just tell them you’re aware of the incident, express your concern and support, and keep your mouth shut. If they are visibly shaken, don’t try to fix it. Everyone deserves the right to interpret their own experiences in their own way. Tell them to expect a call from the chaplain in a few days to check in.
Introducing a chaplain into your organization is a culture change. It can take several years, and some people prefer to get their support from other places. But once the chaplain is integrated into the organization, their expressions of concern and support are understood to be a matter of routine: The organization has your back. We care. It’s who we are.
1. Patterson PD, Jones CB, Hubble MW, et al. The longitudinal study of turnover and the cost of turnover in EMS. Prehosp Emerg Care, 2010 Apr 6; 14(2): 209–21.
2. Sinek S. Start With Why: How Great Leaders Inspire Everyone to Take Action. New York: Penguin, 2009, p. 84.
3. Ibid., pp. 104–5.
4. Spiritual Care Association. Crisis, Trauma, and First Response Certificate Course for Chaplains, www.spiritualcareassociation.org/crisis-trauma-and-first-response-certificate-course-for-chaplains.
Russell Myers is chaplain for Allina Health EMS, based in Minneapolis, Minn. He is board certified by the Association of Professional Chaplains. This article includes excerpts from his forthcoming book on EMS chaplaincy.