Kicking Yourself About Tough Calls

[HERBIE1]

Rookie

Ease up on yourself. You'll thank yourself for it in time.

EMS practitioners are by far, the worst offenders of being one's own worst enemy when it comes to looking back and wondering what could have been.

After 21 yrs in EMS (17 + as an ALS practitioner and 18 as an EMS educator) this I know; trauma patients die. A lot. And mostly in spite of what we do.

Five years ago on Memorial day weekend, my brother in law suffered a cardiac arrest in the driveway. He was 43.

I was with him the day before when he was complaining of palpitations and like all of us would, strongly advised him to go to to the ER. Not strongly enough.

I, like you, beat myself up over it, over and over until the weeks turned into months and the months to years. In the process I began to lose my faith in my abilities as an ALS practitioner, insomnia set in, then came a couple of med errors, (strangely things continued to get worse despite my avoidance of the real issue), my long term relationship failed (not related to this incident), and my desire to care took flight. I was the poster child for EMS related stress and Accumulative Stress Disorder.

I existed as a shell of myself for a little over two years, until I became seriously ill. The illness was the last straw and I ended up on stress leave. Four months later I walked away from my twenty year career without blinking an eye.

After a year and a half of unemployment, some menial jobs for minumum wage, and five months on welfare, I returned to prehospital health care. I kicked my arse for a long while for not getting the help I needed when I needed it.

Don't make the same mistakes many of us have made, Rookie; everyone makes a mistake or two, and most of them are not life critical. Some mistakes are, but I doubt yours was.

Given the chance to do the call again, knowing what you know now, the outcome would be the same. Trauma patients die. A lot.

If you need to speak with someone professionally have your service provider make the arrangements. Speak with someone outside of your service / agency.

And stop beating yourself up over something that would have happened regardless of what you, I, or anyone else would have done.

Also keep in mind; you weren't the only one on scene; if whatever it was had been obvious, someone else would have caught it.

I don't have all the answers, just a lot of experiences of things not to do again.

I wish you only the best, and then some.

Take care of yourself,

Paul

That's quite a story, Paul- thanks for sharing it. Sounds like you went through hell and back.

Yours is an object lesson anyone can learn from.

I tell all my students and new guys/gals that one of the most important things you can do is watch the back of your coworker. We have had several members commit suicide or drink themselves to death over the last few years. I realize you cannot help someone who isn't ready to accept it, but you have to try. Hopefully you can intercept someone before they go down such a dark road that turning around is nearly impossible.

Here's a little story. About a year ago, a friend of mine- an Iraqi war vet returned to the job after his tour of duty. As with many vets, he was having trouble adjusting to life back home and ending up with personal problems- a divorce, anger issues, and discipline problems at work. I notified our employee assistance people that this guy probably needed some help. To make a long story short, there was no program in place to deal with vets and their issues unless the person requested it. We all know how stubborn public safety folks can be about asking for and/or accepting help, so clearly we need to be more proactive in our efforts to reach out to folks. My buddy was approached by the counseling staff, was agreeable to the help- thank gawd, because it may have saved his life.

He received counseling, the divorce was settled, after awhile felt a lot better, and he's dealing with everything in a healthy way.

[funkytomtom]

Thanks for the replies. I've managed to relax a little bit about this call since my first post. In relation to Herbie mentioning pediatric arrests, this was one of those calls. Two pediatric deaths in the back of the rig. And to Dwayne, I just came here as another resource because I have never had to deal with anything like this and felt you probably all had. I do appreciate your comments, I think the mistake did involve a little bit of tunnel vision, but yes the patient was almost surely doomed. Anyways, I'll be ok, and all your comments have helped.

[scubanurse]

Thanks for the replies. I've managed to relax a little bit about this call since my first post. In relation to Herbie mentioning pediatric arrests, this was one of those calls. Two pediatric deaths in the back of the rig. And to Dwayne, I just came here as another resource because I have never had to deal with anything like this and felt you probably all had. I do appreciate your comments, I think the mistake did involve a little bit of tunnel vision, but yes the patient was almost surely doomed. Anyways, I'll be ok, and all your comments have helped.

I really hope that you continue to "get over" this call and move on in a healthy and productive way. Feel free to reach out whenever you need! Best of luck to you!

[DwayneEMTP]

Thanks for the replies. I've managed to relax a little bit about this call since my first post. In relation to Herbie mentioning pediatric arrests, this was one of those calls. Two pediatric deaths in the back of the rig. And to Dwayne, I just came here as another resource because I have never had to deal with anything like this and felt you probably all had. I do appreciate your comments, I think the mistake did involve a little bit of tunnel vision, but yes the patient was almost surely doomed. Anyways, I'll be ok, and all your comments have helped.

Good for you brother. I'm grateful you took my comments in the spirit intended. I too think that you will do outstanding. Sometimes we get kicked in the boys and need to rely on our friends to tell us to stop, think, then rethink, and then get back to work.

I'm practically a mistake factory. What keeps me up and running is identifying what I would have liked to have done differently, make a plan to help insure that I do so in the future, and then refuse to waste a bunch of mental energy, that my patients can use, telling myself what an idiot I am.

I'm proud of you for deciding to be a professional, to take a little time to be confused, accept that that's sometimes necessary, seeking help, steering yourself back up out of the ditch and onto the road and going back to work.

Good for you man...

Dwayne

[aussiephil]

funkytomtom,

glad to hear you are feeling better & I have waited to post because i think there are some principals we all need to remember here.

It has been so well put before but we do need to remember patients do die. Trauma patients especially & the younger they are, the harder it is.

Your reaction is/was a normal reaction to an abnormal situation. Self criticism, while at times can be self destructive is a necesarry part of the way we in EMS grieve (yes we grieve the loss as well as the family). What we need to remember is this should only last 2-5 days. If it persists then you really need some further help. The longer you have been in the system, the more likly you are to suffer from PTSD. There can be a cumulative effect.

What I have read from you is what we would expect to see over a few days. Acceptance that you did your best. There are many jobs where the patient has a negative outcome, & in reality no matter what we do, nothing would save them. Not even 0.001% of a chance.

Take heart, it gets better & those jobs are few & far between.

When you dont think about it, leave the profession, you have become to callous.

[spenac]

Key to surviving in any medical field is to quickly review each case. Learn form any mistakes you spot. Then let it go and move forward. Everyone has had patients that could have faired a little better or had a slightly better chance of survival had they done everything perfect, yet none of them are perfect. But you grow as a provider when you learn and improve rather than dwelling and withdrawing.

[Richard B the EMT]

Also, although not to any extreme, take a clue from M*A*S*H's Frank Burns. His attitude was, any patient who died on him was either unsalvagable, God's decision, or someone else's fault.

Having said that, NEVER let it just roll off your back. Follow any and all of the suggestions made, and that will be made, in this string. One or more of them will be the right answer(s) for you.

[HERBIE1]

Thanks for the replies. I've managed to relax a little bit about this call since my first post. In relation to Herbie mentioning pediatric arrests, this was one of those calls. Two pediatric deaths in the back of the rig. And to Dwayne, I just came here as another resource because I have never had to deal with anything like this and felt you probably all had. I do appreciate your comments, I think the mistake did involve a little bit of tunnel vision, but yes the patient was almost surely doomed. Anyways, I'll be ok, and all your comments have helped.

You'll be fine, bud. Peds arrests are horrible. ALWAYS. Regardless of the situation. They will make you angry, sad, disgusted, amazed, and every other emotion in between- as will any call you run. The problem is, with peds, the most vulnerable of us all, those emotions are amplified 10 fold.

I have no idea what your call volume is or where you work, but there WILL be more horrible calls. You'll question yourself(and that is a good thing), question your personal deity, and question the sanity of the human race. The longer you do this, the more you'll realize that we do our parts, do the best we can, and despite it all, people live, and people die. Sometimes we can change those outcomes, sometimes we cannot.

Go hug your child, a relative, and appreciate what you have. It helps.

[spenac]

The problem is, with peds, the most vulnerable of us all, those emotions are amplified 10 fold.

.

Why? Death is death. Sorry no difference in death of a newborn or granny. Learn from every call and go forward.

[HERBIE1]

Why? Death is death. Sorry no difference in death of a newborn or granny. Learn from every call and go forward.

Most of those I work with would disagree with you- from new guys to old farts like me.

Ironically, I've been told by many that I can be a cold-hearted SOB, and that may very well be true- except when it comes to kids.

If an 80 year old dies, is it tragic- of course. The family experiences a loss and they mourn the death of a relative, but the person lived a long life, had the opportunity to experience all kinds of things- raise a family, work, contribute to society. When a child dies, I look at the wasted potential, of all the things they could have done, of what they could have become, of what might have been. This child could have grown up to find a cure for cancer, or solved our energy problems. Any child- regardless of their surroundings, has nothing but possibilities and a blank page they will fill.

Different strokes, I guess.