Paramedic with PTSD

An Update, A Warning, And A Plea

EMS personnel are suffering from PTSD.  On 14 August 2016, I posted about my PTSD and “seeing faces.” (Original post can be found HERE ) This is an update, a warning, and a plea.

Three years after that post, almost to the day, my PTSD influenced my life greater than I could have anticipated.  While I am acutely aware of the effects it can have on you PTSD does not care about that.  I ended up needing and receiving intensive assistance for more than a week, and although I am out, and stabilized, I understand it is not over yet.

I also want to apologize to my family for the stress and fear I placed them in.  I am deeply sorry for that.

I want to bring attention to the view of PTSD and EMS.

PTSD And EMS

Medic suffering from PTSDIt appears, while it is sort of recognized, it is still a relatively unrecognized element among mental health providers and the general public.  In an interview by a nurse practitioner, she asked me how I could have PTSD from my contact with the patients, after all, I only saw them for about an hour and then dropped them off at the hospital.  I did not see them long term so therefore there is no reason for me to have it.  I explained to her a few of the things I saw and having to deal with families in those intense situations, but she only reiterated that same question and basically blew off that I may have PTSD, even though I was diagnosed with it back in 2005.

Later, while discussing it with therapists and fellow patients, they also could not understand what I was talking about, except for a single former soldier and police officer.

Back in 2005, while searching for help, no therapists, counselors, or psychologists could even remotely understand.  I finally found a counselor that did and paid to see her because she was not in-network with my insurance.  Unfortunately, she ended up moving to California.  It is only now that I was able to find someone else, fourteen years later.

Recognition of PTSD in EMS

When I was coming up in EMS in the 1980s medics sort of considered them the wild west cowboys of emergency medicine, or at least that was my perception.  It was a tight-knit community, and family, that supported each other, even if the support they gave was misdirected.  We would compare scenes to see who had the worst one that week.  We would have big parties that would last three days with a lot of drinking (Partygra anyone?).  We would brag of how much we could drink, and of sexual escapades, whether they were true or not is another’s guess.  I was working two jobs on the ambulance as most medics did.  I spent more time with my partners than I did my own family.

Nobody cares about your paramedic problems and can worsen PTSDThe idea of PTSD among EMS workers was pretty much unheard of.  The term only came out in 1980, and even then, it really only applied to war veterans, replacing the terms “shell shock” and “war neurosis.”[1]  Anytime a scene bothered you your fellow medics would simply tell you, “suck it up cupcake.”  “You’re a paramedic, you are better than that.”  After that, we would go enjoy a meal of lasagna or spaghetti and joke about how it looked like the innards of one of our scenes.  Dark humour is one thing that appeared to carry us through.

But that really is not enough.

I was aware early in my career as a paramedic to the effects severely intensive scenes could have on the mental health of EMS and was a founding member of the Bluebonnet Critical Stress team.  I left after our first major training event due to burn out, but I still feel I helped fellow emergency workers managing their stress due to those scenes.  What I was not aware of was the long-term effects.  This is that story.

I assisted in a few debriefings over my time; sometimes as the facilitator, sometimes as the one being debriefed.  The dialogue is always the same.  It was out of your control.  Your feelings are normal.  Get plenty of sleep, exercise, and eat right.  Working 96 to 120 hours per week does not lend itself to sleep, exercise, or even eating properly.

The debriefings were geared to helping the responder with the immediate situation, but not the long term.  That was left up to the individual to deal with. 

EMS IS Not Recognized

Paramedic grieving in ambulance. This is a picture of PTSDIt is only very recently that the idea of PTSD among medics is making its way forward.  Even then, the public still does not understand that EMS can suffer from PTSD.  Whenever you read news articles, see news broadcasts, or even read laws and regulations you will see that emergency workers are generally defined as police and fire, never EMS.  In the state of Texas, it is a capital murder to kill a police officer or firefighter in the commission of their duties, but not emergency medical personnel.[2] It is only this year (2019) that the Texas legislature introduced modifications to the penal code to add emergency medical services personnel, but it was never added to the calendar after leaving the Criminal Jurisprudence Committee with a 5-4 vote but was never voted upon by the House.[3] The state apparently still sees EMS as a lesser profession.

Even among the Texas regulations for EMS they can lose their certification or license for a simple traffic ticket, while under Texas regulations a nurse and act out towards others and not even receive a reprimand by the state.

It is this inherent lack of support and understanding by the public that adds to the problems of PTSD among EMS.  The good that EMS does is rarely recognized, but God forbid if they ever screw up.  When they mess up, they are seen as under educated morons who should not even touch a patient.

The only ones we can turn to are our peers, who are beginning to understand the problems, but many still refer to the old “suck it up” solution.

And now back to me.

My Battle And The Warning

Again, I was diagnosed with PTSD back in 2005.  I was able to deal with it through working and my research and genealogy work.  I was physically active and was basically able to keep the tendrils of PTSD back.  That was until July 2018.

In January 2018 while playing with my son I broke my neck.  I had surgery on my cervical spine, C3, C4, and C5.  Some medics will recognize the, “C3, 4, and 5 keeps a man alive).  The neurosurgeon informed me my cervical spine was so degraded he was unable to secure the plate to my C3, in the stead just rested the plate against it to provide some support.  By July 2018 I was physically hurting so bad it was hard for me to sit or work. 

Finally, in January 2019 I was diagnosed with fibromyalgia.  My doctors wanted to figure out why I was hurting so much so they did an MRI of my full spine and discovered I had severe damage to my lumbar spine for which the neurosurgeon operated on in March 2019.  I came off the table paralyzed in my right leg.  They are still trying to figure out why I am paralyzed.

You may ask, what does this have to do with PTSD.  Well, after my cervical spine surgery I was not able to do as much physically, and then in March of 2019 when I became paralyzed I could do even less.  My mind and my body lost their weapons to battle the PTSD and then the disease began infecting me even more.

I can only relate my experiences with PTSD as other medics may have their own symptoms.  I basically relive scenes in full, technicolor detail and hear every sound; I smell odors I may not have been aware of in the instant and see the carnage in glorious detail as well as feel the blood on my hands.  The feel of the family holding me tight, begging me to save their family members.  I feel the sweat running on my forehead, from then and now.

Any description of a scene on this page could never relay the full impact of it, and I experienced it on an almost daily case during my years before leaving the emergency side of EMS, but then I had similar issues when working as a transfer medic.  Just my work in the government EMS services could total almost 40 years since I was working both, two jobs, for so long.

I have gone from simply “seeing faces” to total immersion into the flashbacks and I lose time as I fall into that pit.  A cigarette I just lit will be burned down to the filter next time I look at it.  I will be sitting at the table and suddenly come to later, drenched in sweat and tear, lying huddled on the floor.  Anytime I go anywhere I pass scenes where I have to close my eyes and think of DNA or genetics while the PTSD struggles to take hold.  I become physically ill passing these places.

I cannot even leave my house without running into two major scenes I responded to.  I go left out of my driveway and come to a location I made a double murder and rape of an elderly couple.  I go right from my driveway and I come to where I made a triple fatality accident of a mother and her two children.  I cannot even leave the house to escape.

Blood covering the back of an ambulance, a cause of PTSDThe fatality accidents, shootings, and stabbings are too numerous to list, nor do I want to remember them.  The hangings and suicides are just as bad.  While the patient may have found peace in their suicide, I am left to try to help the family, most begging me to fix it; to save their child.  I am aware of at least 400+ CPRs I performed, from newborns to the elderly, each time with the family believing I was going to save them, but I rarely was able to.

On a cognitive level, I understand I helped a lot of people, and even have the letters, cards, and newspaper editorials that state such, but those instances are overwhelmed by the devastating tide of those I could not help.  A tide is a good way to explain it.  It slowly enters your mind and then when it finds space a tidal wave of thoughts and experiences overtake you.

Again, it was because of these tidal waves of PTSD that I hit my lowest, enough to deprive my family of their husband, their father, their son.  Luckily my paramedic brain kicked in at the last moment and I sought help.  Too many of my friends and comrades have done otherwise, losing their license because of drugs and alcohol, and others to suicide.  Over half of my former partners, fellow employees, and friends who have died sought the final pain release.

I, luckily, am not one of them at this time, and I am being proactive to keep it that way.

An Apology

To my family, my wife, my children, my parents, and my friends, I am truly sorry for placing you in that position.  I do love each of you deeply and want to see what the future holds for you, for us.

The above was the warning, and now the plea.

The Plea

Suicide and PTSDThose of you in EMS, or considering a career in EMS, and the families of the medics, PTSD among EMS is very real and very deadly.  Reach out to others for assistance, to talk with, to joke with, to feel safe with.

For the families and friends of those in EMS, please do not keep quiet if you see any, and I mean any, changes in your loved one’s behavior or outlook on things.  Do not keep quiet, thinking it is only a phase, because that phase may end suddenly, and not in the manner wanted.

For the public, please realize these “heroes” are underappreciated, misunderstood, and generally blown off until a tragic time in your life arises.  Police and firefighters receive a lot of attention for various reasons, but the only thing you see in the news about EMS is they transported someone to the hospital.  After 911, the Oklahoma City bombing, mass shootings, et cetera, you hear about the heroic efforts of firefighters or police, but you never hear of the medic who was shoulder and shoulder with those very same professionals.

Medics are the unknown heroes in our lives.  They are medical professionals, nurses, psychiatrists, rescue experts, counselors, and sometimes simply caring individuals that hug you in time of tragedy; and they have feelings.

We are the good guys.

Tears

The good guys are also human.  The good guys have emotions.

The good guys cry.

Please, please, do not it be the last cry. 


[1] M.A. Crocq and Louis Crocq, “From shell shock and war neurosis to posttraumatic stress disorder: a history of psychotraumatology,” Dialogues Clin Neurosci 2-1 (March 2000): 47–55; U.S. Department of Health & Human Services, National Institutes of Health, U.S. National Library of Medicine, National Center for Biotechnology Information (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181586/ : accessed 31 August 2019).

[2] Texas Penal Code Title 5, Chapter 19 §19.03(1); State of Texas Statutes (https://statutes.capitol.texas.gov/Docs/PE/htm/PE.19.htm : accessed 31 August 2019).

[3] HB 1573 (86-R), Texas Legislature (https://capitol.texas.gov/BillLookup/History.aspx?LegSess=86R&Bill=HB1573 : accessed 31 August 2019).

** Several of these photos are “borrowed” from other sites.  Credit is given to them.