As Paramedics and EMT’s, you serve in one of the most intense professions known to man. We all know it isn’t the non-stop, prime time drama every shift that is portrayed on TV. But in EMS you are faced daily with challenges, atrocities, and extremely stressful situations. You may be in a large urban setting or a rural community; both environments offer their own challenges. The types of calls vary from medical emergencies to traumatic injuries. Patients range from elderly to newborn, and everything in between. You encounter people from all walks of life. Shifts are long and hard, and taking proper care of yourself is difficult. Fast food and gas station grills may be your best friend. The only people you can truly talk to about the troubling runs, the ones that stay with you, are the very people you work with. Most people outside of EMS are incapable of understanding your feelings. This stress, demanding lifestyle, and limited emotional outlets pose a risk for EMS providers to walk down the path of addiction.
From data complied of medical treatment received in ER’s from 2003-2007, 99,400 non-fatal injuries and 65 fatalities were reported¹. Almost half of the fatalities were due to MVC’s; 33% of the non-fatal injuries were typical back and extremity injuries². Let’s look at some risk factors for addiction: Stress, pain, and sleep disorders. Do any of those affect EMS providers? All three are challenges that they face every shift. Most EMS workers will at some point receive an injury on the job that requires medical treatment. Back strains, disc issues, and hand injuries are common. Treatment options include physical therapy and often, narcotics for pain management.
The problem doesn’t lie in the medication but in how the EMT or Paramedic suddenly feels improvement from their daily aches and pains, and their emotional pains are slightly dulled as well. Many good EMS providers have had careers ended after battling addiction to narcotics following a work-related injury. As educated healthcare providers, we seem to have a self-inflated sense that we can “control” the medication, instead of the other way around. We view addicts as the people we pull off the street or from a rave party, not the uniformed reflection we see in the mirror.
We have an ease of access to medications that most people don’t. We are in positions of responsibility, trusted with other’s lives. While services have a variety of safe guards and checks in place, people can get creative in “working” the system. Most of what EMS providers do is only witnessed by another pair of eyes, if even that. Let’s think about this very real scenario:
Paramedic Joe had a back injury and received pain meds for several months.
He took the medicine mostly as prescribed, but Joe “understands” the medicine, is
a trained professional, and knew he could handle a “few extra”. Joe is good friends
with a couple of the ER doc’s. He explained he was still having a little trouble.
They wrote him a prescription for more. After those ran out, Joe suddenly realized
he needed that “help” every day. The service he worked for had a system in place
to keep an eye on all the meds, but with some creative tweaks and false documentation,
Joe started drawing from their supply.
Maybe you are doubting the above scenario, but it is one that has played out across the nation. News stories are in abundance about supervisors in charge of narcotic disposal using the medications on themselves. Or paramedics falsifying patient documentation and never administering the medication to their patient. These deceptions can go on for quite some time before someone notices.
PTSD has received much attention of late due to the overwhelming amount of military personnel returning from duty with the disorder. But every day, EMT’s and Paramedics are placed in situations and expected to handle the fallout with barely a pause. They can go from a burn victim to a baby involved in a crash to a cardiac arrest patient discovered by their spouse in a matter of hours. Being called to the scene of a suicidal patient who took their life leaves the EMS provider with a feeling of complete helplessness and frustration. Facing patients with excruciating trauma, treating a patient that reminds you of a loved one, or witnessing a partner receive a horrible injury can leave a lasting impression. One that you don’t really know what to do with or how to handle.
PTSD in EMS is a worldwide issue. In Australia, estimates of PTSD in EMS workers are 1 in 10. In America, not much research has been done on the actual rates of PTSD in EMS workers. One problem facing those wanting to treat the issue is the stigma around admitting difficulty with handling the stress. While most departments have access to mental healthcare, EMS providers may look at it as a weakness or with fear of losing their job. Turning to narcotics or other medications may seem to some the only way to manage.
Signs of Addiction
As an EMS professional, you are trained to recognize signs and symptoms. But it is hard to recognize in yourself or a close partner. But the signs will be there, you just have to not turn a blind eye.
- Suddenly withdrawn
- Sudden change in weight/appearance
- Mood swings
- Flushed skin
- Sweating/tremors/memory lapses
- Obsessive behavior
Finding the courage to come forward if you are struggling with addiction may seem impossible. But you can do it. Talk to a trusted friend, have them help you seek resources. You may fear losing your job, or your family if you do come forward. While there may be consequences to face, you are guaranteed to lose it all if you continue down the path of addiction. You need help getting out. Don’t function in denial that your profession hasn’t exposed you to traumatic events. No one can do this job and simply walk away unscathed by what they see. You are not weak for needing help. Resources are out there, you just have to be willing to take a chance.
Station House Retreat is a recovery center that focuses on first responders. You are not going to be surrounded by people who have no clue what it’s like to treat a child abused by their parent, or hearing the agony of a loved one crying over their spouse who just died. Your peers are exactly that, your peers. They come from different departments, function under different protocols, but they know what it’s like in your shoes. The staff at Station House gear topics and treatment options specifically for you, the first responder. No generic material. Information and resources that offer you realistic help.
¹Reichard, AA; Marsh, SM; Moore, PH. (2011). Fatal and Nonfatal Injuries Among Emergency Medical Technicians and Paramedics. Prehospital Emergency Care, 15(4), 511-517. http://dx.doi.org/10.3109/10903127.2011.598610
²Reichard, AA; Marsh, SM; Moore, PH. (2011). Fatal and Nonfatal Injuries Among Emergency Medical Technicians and Paramedics. Prehospital Emergency Care, 15(4), 511-517. http://dx.doi.org/10.3109/10903127.2011.598610
³ Brook, B. (2015, October 29). World first: Guideline to manage post traumatic stress disorder among emergency workers launched in Sydney. News.com.au. Retrieved from http://www.news.com.au/lifestyle/health/world-first-guideline-to-manage-post- traumatic-stress-disorder-among-emergency-workers-launched-in-sydney/story- fneuzlbd-1227587357115