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Hey Mobey... Longevity in this industry is almost an oxymoron. I had a couple minor meltdowns before I learned what you did. I wish that I could have learned those lessons a lot earlier and also wish I could engrain it in the rookies before the crash & burn. Thanks for sharing your personal story, I think it will make a difference in someone's life & career. And hang in there, you're not alone.

Alot of threads have been headed in this direction lately, and I personally have been questioning my own career longevity lately. Since I don't blog, I decided to write out my strategies to prolong my mental health, and career, and identify the problems we face as time goes by on the forum. I feel really passionate about this topic, and hope for alot of productive responses. First to identify the challenges: Although the number of years I have been in EMS is hitting double digits, the first time I was truly affected by a call was only about a year and a half ago. I was driving to my farm after treating a post partum hemmorage on a young redhead girl, I recalled all my actions from starting large I.V.'s to performing bimanual massage (not technically in my scope, but try stop me!). Eventually the hemmorage was brought under control, and all ended well for her. As I drove down the highway, I felt like I entered another atmosphere. Suddenly the air got thicker.... I became short of breath, the temperature in the vehicle seemed to rapidly increase, and I got a huge feeling of impending doom, as if something out of my control was going to happen. I pulled over and grabbed some fresh air, and it passed quickly. I thought to myself "man, that was wierd.... I must be dehydrated". I went to work, seeding peas that evening. While driving our 4WD tractor pulling our seeding outfit I crested a hill and looked around my fields, with no neighbors for many miles I got a feeling of being too alone. Almost immediatly, my patient from earlier came screaming into the picture, I could see her freckled face clear as ever, the innocent look in her eyes as she gazed at her first born through tears and wincing in pain as I assaulted her uterus in an attempt to control the bleeding. Finally I had to shut down the outfit, and get out to regain my composure. That evening I went in for supper, and my father remarked that I seemed "distant". I told him I just had a tough call, and needed a day or two to get over it. I returned home a day later (I farm somewhere else), to my wife and kids. My wife proceded to tell me about some problem she was having... likely something about what her sister said on the phone, or how one of the kids smart-mouthed her. I quickly shut her down, telling her she should be so lucky as to have a family. She had no freaking idea what I was talking about, but could tell I was not in the mood for chit-chat. The reason I told that story was to point out 2 very important warning signs that something is going off in the ditch. Warning #1 - Panic attacks. Seem to come on unprovoked, can be anything from minor hyperventilation and anxious feeling, to an all out bawl-fest Warning #2 - Deprioritizing the needs of the ones whom count on us. The story goes on...... Another week or two goes by and I have a dream: It is an older lady that I recognize, it is the first patient to ever go from living, to dead while in my care. We are in a crowded mess-hall, and I get that same choking anxious feeling. I immediatly get up out of my chair (in my dream still) and everyone is staring at me. The lady starts to bleed profusely from under her dress as she sits at her table, she looks oer at me and cries in a helpless crackling voice: "Marc.... I'm dying, you have to help me". I awaken from my dream with severe chest pain, I can feel my heart pounding, I am sweating profusely and can't catch my breath. I have to get up out of bed, and grab a drink to calm myself. I tell my wife about the dream, laughing as if it was no big deal. The next few nights are short, as I have difficulty falling asleep with images of the elderly lady, or the young redhead, or that stupid dream, flash through my mind everytime I close my eyes. As soon as I awaken while i am still laying in my bed a slideshow plays in my mind of faces of people I have treated, I keep seeing pictures of intercostal retractions on a tiny chest, blue lips, concaved chests from CPR, blood running down a cot mattress.... ugh... I gotta get up, no sleep in day for me! I attend some more rather critical calls, being the sole Paramedic for hundreds of miles around has it's perks, and it's challenges. 2 successful neonate resucitations, 1 shakin baby case with increased ICP, a few transfers to the city (3-4hrs away) for different reasons, couple intubated transfers and of course some routine lodge type calls.... all in all exactly what I am educated to do. Please don't let me fool you either, there are many days I don't even do a call. But as I have said before 3-4hr transports makes for some pretty long days too. I'll be honest with ya, I have alot of Paramedics dream jobs. Work from home, Salary nearing an RN, being the only Paramedic in this area the Dr's respect me, and the surrounding (BLS) services look up to me. But this brings great responsibility. like the responsibility I feel as I back up a crew with a pregnant trauma victim, and they look me in the eye and say "thank god you're here" as if I am going to ensure she will surive.... she didn't. Or the responsibility I feel when I get that Difficulty breathing call wondering if this will be the tube I miss, with backup many many miles away. But this is not exclusive to me. Yes I may be in an extreme setting, however those in air medical have similar resources. Even a overworked city ambulance may not have backup available. These are the regular stresses of the job. The problem is, if you do not deal with them, one day... they sneak up, and tear you down when you least expect it, just as they have done to me. So as I sit here now, on another night shift, with my heroic Paramedic eppaulettes, and my tactical looking narc pouch on my side, I feel totally unprepared for battle. I have lost the will to prepare or seak out a good healthy meal, I am not sleeping as much as I should, and I am pretty quick to snap at my family since thier problems are not "real", not like the problems of my patients, so i have no time for them. This brings me to Warning #3,4&5 Warning #3 Failing to maintain a balanced diet & excersise Warning #4 Sleep disruption Warning #5 Flashbacks So just what do I intend to do? Well here is my plan of action to increase my longevity in EMS Find an arbitrary confidant. An EMS provider from outside this area I can bounce calls off, and discuss treatment without too much judgement. Someone without thier own agenda of always "1 upping" as we often do Make a conscious decision, starting today, that fast food is no longer a part of my life. It can and will be avoided. Fast food is a fast track to failure in this industry. Occasionally seek a professional: Periodically I will be making an appointment with a mental health professional. i go for physical checkups.... why not mental health checkups?? Make sure holidays are not EMS related. This means no popping in to staff meetings during holidays, no wearing wacker gear, no scanner, no accepting cell phone calls from co-workers, nothing! Just family, and friends. Find an outlet: I loooove being alone, but with a family of 5, it is harder and harder to do. I need to find an outlet where I can be in my "happy place" and organize my thoughts and do some filing. I think I`ll buy a vintage car to tinker on. I always think of my life as a car, I am driving, but right now all the shit that should be in the trunk is cluttering up the dashboard and making it hard to see what is ahead, and for some reason I have a HUGE rearview mirror I can't stop staring into. It's ruining my driving experience, and I know I am headed for a crash. Define the line between work and home. This has gotten to be a grey mushy mess, I spend way too much time writing work emails and work related calls from home. That is not nesessary, when I walk into my house, the uniform shirt gets hung on a hook, and THAT is my mental signal - switch - You are a husband, father, son, and brother now. Thoughts?

Mobey, you have put an excellent post here!!! You are doing a great thing for yourself and your family by sitting down and looking at things like you did. You have made some great points and plans. Thanks for sharing. I didn't realize how much I needed to read something like this right now. There are a few folks here that know, but I'm just coming back from a bit over 2 weeks off after my mother was killed in a DUI accident. She was about 4 miles outside my response area (rural area) where she was ejected and killed. I'm looking at what I need right now, in the way of counseling, because of this and the other stressers in my life. Your post touched me deeply. Thanks!!!! Herbie1, you've got some good point here too. Thanks to you too! I hope that you've found the help that you need.

Well Mobey I certainly had a big WOW come out of my mouth after I read your post. Its a good thing that you have recognised the red flags in your life. The fact you have seen them, have taken the appropriate actions to get your feelings in check and have a supporting wife is half the battle. The other half will just happen with some work. A friend last week said "I feel like Im fighting a loosing battle" I responded "You only loose if you quit" We all have our things in life and we all have our ways to figure it all out. Take care Mobey and I hope it all goes well for you and your family, remember you too are only human

Mobey- you clearly are a smart cookie. You have taken the critical first step- recognizing there is a problem. You have also taken the next step- outlining a plan, and I think you are dead on in your ideas. Food, health, exercise- and mental health assistance PRN. As was mentioned, it does sound like PTSD- not necessarily from one specific incident, but the cumulative stress and pressures of the job. I have never been a big advocate of therapy, but recently have began seeing a psychologist- for personal issues, but those issues impacted my work and how I perceive my life and my future. It's too early to tell what will become of these sessions and if they help or not, but I can see the value in them. As you say, an outside, nonEMS, impartial observer is vital to get to the root of the problems you are having. I always thought asking others in the business(trusted friends and coworkers) was key to getting a handle on things. They have been there, they understand what you are going through, but I think too often they are not forcing you to dig deep enough to get to the core of what is really affecting you. In my brief sessions, I have learned that the problem often lies not with the type- or even volume- of issues you are having, but our perceptions of those problems and our reactions to them. The way we respond to stressors and problems is key in determining if we are adequately coping and processing things. I think when we are new to the business, often times we are single, with no family and few responsibilities beyond ourselves. Coping is a lot less complicated. Having a rough stretch at work? Take a few days off work, take a vacation, go hang out with friends, indulge in a favorite hobby- whatever makes us happy. There is nobody we need to answer to, or consider when taking these mental health breaks. We do not need to focus on anyone else, and handling stress is easier. Once families come into the picture, life becomes more complicated, and the accumulated stress of years of bad calls, lousy sleep patterns, poor eating habits, and the baggage adds up. Anytime you need to talk- shoot me a message, and I would be more than happy to help out. I'm about as far away from your working situation as possible- busy urban area vs rural, but I think the essential issues are universal. It's a lifeline, brother, and I wish someone had tossed me one(or recognized if someone did) some time ago. It would have saved me a lot of heartache. You are not alone.

UK: on top of C1 class I had to do D1 but this is no longer mandatory. We also do a 3 week advanced driving course. Week 1&2 covers the system of car control, reading the road ahead, controlling skids (on a skid pan in an ambulance and car - including FWD, RWD and 4x4), manoeuvring in tight spaces, "making progress", avoiding red mist etc. Week 3 is Emergency Response driving...driving on simulated emergencies under response conditions. It is extremely intensive and taught by Ambulance or Police Highway Patrol instructors. Pass marks are 95% and the failure rate is high. On top of this, my service enforced a further 2 weeks driver training with the Police when gaining a position on a rapid response car. So, on top of my normal licence, I had to have 3 yrs experience before gaining category C1 and D1 on my licence (vehicles over 4.5t and passenger carrying vehicle of up to 16 persons). I then undertook the 3 week driver training with the Ambulance Service plus a further 2 weeks for the response car. On coming to Australia, I had to gain a LR category on my licence (roughly equivalent to my UK C1&D1 categories).

The other thread about changes in aircraft flight made me remember this. This is a recording of an ATC conversation and management of a Learjet that lost cabin pressure at a high altitude. Listening to the manner in which the pilots speak and act is a great way to see how a patient that is hypoxia could present. Towards the end they descend to 11,000 feet and the difference in the way they interact is quite striking.

I dno bout that nobody would understand what we are saying ERDoc to English translator Anesthesiologist = Anaesthetist Attending = Consultant BP cuff = not a requirement for buff NYS vollies CT = An expensive test; also a state EMT = A requirement for buff NYS vollies ER = ED Fuggetaboudit = Don't worry bout it bro Health insurance/HMO = Tool of the devil Intern = House Surgeon/SHO MD = Very expensive degree on how to order expensive tests financied mainly with loans Pie = Pizza Resident = Registrar The match = finding out if you're going to pay off your loans before you die or not The Mitten = just the worst place on earth to even consider living, I mean seriously?

Mobey, Your post has touched my heart in so many ways. My thoughts and prayer go out for and your family I am pretty new at EMS but also have put some time into "thinking through" mental health. I started having the dreams early on as some of my very first calls were absolutely horrible. I am comforted that in some of my dreams I am still the hero. I think that providers here can not only relate but have felt similar horrors at some time in their career. I am only a basic but everyone in my area thinks I am hot s**t although I know that I am not. It stinks because these are so few people I can actually help. The high regard and respect we get can be intoxicating and toxic at the same time. I have tried very hard to create a standard where I live up to my own expectations and not the expectation fantasized by others. My expectations are based on scope of practice, protocol, and the true realities of the call, not the almost superhuman expectation of miracle work that others have set for me. I remind myself of this every shift. It sounds to me that your wife is a wonderful and understanding woman and I can see that you love your family very much. I have found it productive to talk to my wife about how I feel when i get home from a shift. She will ask me how the day went and if I respond that it was tough she will be available for when I feel like talking to her. She does not understand the interventions and procedures but she does understand her man is hurting. Once I realized that she understood I was able to confide in her and find another outlet of release. It also allows her to feel she has participated in helping me. Our wives can empathize with our feelings without understanding the circumstance that provoked them. This is possible. She came to this realization because I took the time to not hide my monsters from her but let her try to help. I have a friend that had me talk to his wife about the job for him and this helped her realize the pressures we are under. You might even be able to visit the psych pro as a couple on occasion. I know I am rambling but I wish you and your family the best and hope that some of my thoughts may aid you in this difficult time. We all live far, far away but you are not alone.

I know exactly what you mean. To be honest and up front, I never understood the meaning of flashback, or having a flashback. Until about the last six months. Vivid, things/people trigger it out of nowhere. I don't wanna say any more than that at this point. I have someone that I can vent to; and I like to go on long drives. Although that can get a little pricey. Mostly, I just like to go somewhere and be completely alone, so if I gotta cry it out, I can, and the only person to judge me - is myself. And I'm a pretty harsh judge, and a sore loser when it comes to EMS. I know these people, I take it personally (the care I give) and it takes a toll. Esp. on the GI system. Acid reducers and bottles of Maalox. Can't take anything with Iron, so I know if what I'm doing isn't working.

Mobey: The best thing for you is that you are recognizing that there is an issue that needs to be dealt with. When you have accumulated stress over long periods of time and no way to release it, it starts to affect things.not eating right, not getting enough sleep, night dreams of previous calls & Pt's , irritability, short fuse with friends & family are all signs. Thats why they call it PTSD. We deal with lots of mental trauma on a regular basis and all need to find a release. Been there, done that, Got to the point that I worried what would happen if I went away for a couple days. I got better! You can too.