What happens when the dispatches catch up with you?


· Mental Health

Words by Marissa Rose

When we first start our career as paramedics, we seldom think about the effect it can have on us as an individual. We train and study tirelessly at university for 3 years, jumping through hoop after hoop. Once we are released into the wild, where there is an expectation that we perform at a certain level, not just by the community and our peers, but also by ourselves. Paramedics clinically hold ourselves to a golden standard, particularly in Australia. People’s lives are influenced by the decisions we do or do not make. We sometimes perform in high acuity and dynamic environments interjected by moments of chaos. But, to us, this is our bread and butter, this is what we train for, this is what draws us to this line of work.

However, in today’s paramedics age, we don’t just need to concern ourselves with the jobs that may negatively affect us. We also need to contend with working in a post-covid world, a world entirely changed by a virus both in the clinical and personal sphere. We need to operate at a new, heighted operational tempo, where our resources are constantly outweighed by community demand. We must learn to cope with a workload we may never get on top of, 12+ hour shifts with no breaks, no time to de-brief, no time to process the tough jobs. A new operational world where finishing on time means finishing two hours late and our days off are no longer always spent doing the things we enjoy, but rather recovering from the run of shifts we have just survived.

Although paramedics are inherently “built tough”, and as a cohort of people we pride ourselves on this admirable attribute, what happens when the job and the dispatches catch up with you? What happens when we find ourselves in a state of overwhelm, compassion fatigue, and suffering post traumatic stress symptomology? We no longer need to only worry about these issues arising from challenging jobs, but also the environment in which we operate, as both are critically important, unavoidable, and part of our operational duties. It is this new world in which we now find ourselves, of increased operational demand, relentless PPE, increased shift lengths, decreased (if any) meal breaks on top of the challenging jobs we attend that worries me. Our environment is worse than it has ever been, the jobs don’t go away, both in terms of demand and in terms of those that stick with us, so, what can we do?

Studies show that paramedics in Australia have almost double the incidence of PTSD (16%) when compared to the general population (4.4%). These numbers increase further when looking at the incidence of anxiety and depression. To me, and most likely to you, this comes as no surprise. Things like distressing dreams, flashbacks, avoiding activities and places that may trigger these memories, irritability and difficulties in concentration and sleeping as well as hypervigilance both inside and outside of work is typically the norm and are all things I personally have experienced throughout my career, sometimes much more than others.

Although PTSD is generally the “doom and gloom” of mental health diagnosis within our field, many of us may find ourselves unwilling to admit experiencing many of the aforementioned symptoms. For me, a turning point was a few years ago, when I was experiencing the worst mental health symptoms I ever had. Depression, withdrawal, hypervigilance, disliking putting my uniform on, struggles with sleep and concentration, compassion fatigue, irritability, you name it, I had the royal flush and I felt incredibly alone. For me, upon reflection, this was a combination of workload, the jobs that had accumulated over my almost 8-year career, the uncertainty and new operational environment created by Covid and some personal issues. I knew when my irritability and mood was affecting my interactions with loved ones and patients that I needed to act and do something, or I would get to a point of no return and completely drown.

When I recognised these things within myself, I kept most of it to myself, sometimes out of worry of judgement, and other times because my ego would get in the way and I didn’t want to “expose” myself or admit that I was struggling. I knew so many other ambos who had been in the job longer, and as far as I knew, never felt themselves get to a point like this…but I soon learnt how wrong I was. What I was experiencing was not isolated to me, and it turned out, as I began being transparent and honest with my struggles, others came forward too, and we had shared experiences…we had, and shared, what I now know to be growth, or more to the point, post traumatic growth.

When I was in my deepest point of struggle, I took a year of leave from my full time position and decided to take a rural and remote appointment for a private contracting company. This allowed me the time I needed to de-compress and de-compartmentalise the struggles that I had been enduring. And it turns out, they didn’t just spontaneously start, it was certainly and accumulation of things that resulted in my breaking point. But from this experience, I gained a better understanding of myself. I began to step into the next phase of my life and paramedic journey which was into post traumatic growth and resilience. I had built resilience throughout my career, but this felt different. This break allowed me to be kinder to myself, to understand the importance of recognising my “triggers” or the signs that I am struggling, getting to the root of it, and ensuring I always take time to do the things that “empty my cup”.

I have learnt through experience that whilst paramedics are incredibly apt and intuitive at helping others when they are struggling, we are not so good at doing it for ourselves. One of my greatest joys now is to try and encourage paramedics to talk to each other, to share my experience and to highlight the importance of taking care of ourselves both physically, emotionally and mentally. For if we are no good, we cannot be good for others. Part of being an operationally fit paramedic is not just about being clinically sound but being emotionally and mentally sound. It is our responsibility in this ever changing and demanding world that we now exist in to put our wellbeing at the forefront of everything that we do. And an incredibly important take away is that all suffering is not for nothing, for in the suffering and the hardships, we find greater resilience, greater empathy, a greater understanding of self, and a greater connection with your colleagues. This can all result t in you becoming not only a better paramedic, but a better human being. We are all connected, we are all in this together, so let’s step into the phase of growth and connection.