The COVID-19 pandemic has amplified social injustices so mightily that they are impossible to ignore: inequities in healthcare among minorities, low accessibility to treatment for people with substance use disorders, lack of access to adequate healthcare in prisons and understaffed, mismanaged nursing facilities.1,2 But one issue that permeates all populations, especially first responders and healthcare workers during this global crisis, is mental health.
This isn’t a novel issue, but it has gained traction in recent years as research demonstrates EMS providers, firefighters and police officers face disproportionate rates of suicide and PTSD compared to the general population due to the highly stressful nature of their work.3 Healthcare providers, too, particularly those working in emergency medicine, experience significantly higher rates of PTSD.4 Add a pandemic to the mix, and now these high-risk populations find themselves in the trenches of a war against a lethal and highly transmissible disease we know little about. Existing industry stressors become peripheral issues as providers navigate a foreign environment in white-knuckled fear hoping their PPE protects them as other colleagues fall sick with the novel virus.
In New York City, the epicenter of the pandemic in the U.S., we saw the intense stress, fear and trauma experienced by frontline providers take their toll on FDNY EMT John Mondello, 23, and Dr. Lorna Breen, NewYork-Presbyterian Allen Hospital’s ED medical director, both of whom died by suicide within days of each other.5,6 As the global medical and public health communities feel their way through the darkness fervently learning how to treat COVID-19 even as new complications emerge, frontline workers in the throes of this battle have barely had time to process the events. Unprocessed trauma may turn into post-traumatic stress. These vulnerable populations need the tools to not only survive these overwhelming times, but know how to thrive in them.
We need to ensure the mechanisms in place to protect our providers’ mental wellness are in top shape. Have your crews ever expressed distrust of or dissatisfaction with your CISM or Employee Assistance Program counselors? If so, have the contact information of external first responder-oriented counselors on hand to refer them to (or maybe the existing programs should be reassessed). Do your members have access to a list of mental health resources, whether physical or digital? (If not, here’s a quick reference guide.) There are also lesser-known but evidence-based, highly effective therapies such as EMDR and ART that first responders and veterans swear by. Look out for anyone who might be using maladaptive coping strategies. Providers who were overburdened with extra shifts and longer hours during the peak of their community’s curve may have turned to substance abuse or other unhealthy behaviors as short-term coping strategies. But these can quickly turn into long-term coping skills among even the most balanced individuals without adequate time to recuperate.
Equally important is to check in on those who are experiencing vicarious trauma during this crisis: Families of first responders and healthcare providers, hospital support staff, journalists providing pandemic news coverage, and essential workers in other industries at greater risk of exposure to the virus than other civilians. The reality is that fear, anxiety and stress have struck us all, regardless of profession, but it would be remiss of me not to acknowledge that those undoubtedly most severely affected by COVID-19 are first responders and healthcare workers who have witnessed unprecedented suffering and death in a matter of months. We must guarantee the proper mechanisms are in place to care for those who are always there to care for us.
Don’t forget to lean on each other. Leaders, thank your providers for their dedication and perseverance. Providers, thank your leaders for their guidance and mentorship. The public has certainly been showing its gratitude to EMS now more than ever—I’ve heard of many agencies not being able to eat all of the food donations they’ve received from their communities, with some even rejecting offers of donations so the others didn’t go to waste. Know that you’re appreciated and remind yourself daily of the things you appreciate in life. A little gratitude goes a long way.
Valerie Amato, NREMT is associate editor of EMS World. Reach her at email@example.com or @ValerieAmato2 on twitter.
Pappas S. American Psychological Association, apa.org.
Diamond F. Infection Control Today, infectioncontroltoday.com.
Stanley IH, Hom MA, Joiner TE. A systematic review of suicidal thoughts and behaviors among police officers, firefighters, EMTs, and paramedics. Clin Psychol Rev, 2016; 44: 25–44.
Holly H. Psychiatry and Behavioral Health Learning Network, psychcongress.com.
Tracy T. New York Daily News, nydailynews.com.
Collman A, Mahbubani R. Business Insider, businessinsider.com.