"So Others May Live" - At What Cost?

The time is anytime, the scene inherently unsafe. From far away the job seems simple; put out the fire, administer medical care, save lives. Any time the alarm sounds, tones drop, or pagers beep, brave men and women in both paid and volunteer fire and EMS companies across the United States dawn their gear, board their respective vehicles, and race to aid those who are calling for help. But what about the responders themselves? What is being overlooked by the society that relies on us in the fire and EMS service? Everything comes at a cost, and the protection of life and property afforded to the public by first responders is expensive. These payments however, made in private by those who respond, and are rarely seen by those we serve. We who have sworn to “do no harm” and to give our all “so that others may live” have to deal with the physical and emotional trauma resulting from the high stress, high risk jobs that we have dedicated ourselves to perform.

It’s a normal Wednesday night in the fire house at the Port Washington Fire Medic Company #1. The 17:00 to 21:00 crew had just finished dinner and left the building, and my overnight crew and I were settling in for the evening. My crew had done every Wednesday overnight for the entire summer, and we were ready for another average night of “diff breathers” and “injuries from a fall.” This however was not to be the case. At 23:00 the radio sounded off: “Firecom for Port Washington, a Signal 9 [ambulance call]  for a sick male.” Expecting the average, my crew and I got in the rig and went to scene where we were brought into the kitchen of a residence to find a larger middle aged male laying on his side propped up against the counters. The patient was experiencing obvious tremors and said he had been feeling sick and week for a few days, and it had just gotten so bad it caused him to fall. The patient reported no head trauma, pain or other medical history. At this point I had my driver call for advanced life support (ALS) backup, because some gut feeling led me to believe that this call was going to quickly take a turn for the worse. I couldn’t have been more right. After I finished my initial assessment, my partner and I rolled the patient onto the reeves and as we were transferring him to the stretcher, he let out a blood curdling scream that I will never forget. His eyes rolled back in his head, his jaw clenched, he began foaming at the mouth and he went into a full grand mall seizure right in front of my eyes. ALS still hadn’t arrived on scene yet, so my crew and I rushed the patient to the ambulance. In the ambulance I started suctioning his airway, administering O2, and checking vitals and pupils, but nothing seemed to help or give me any clue on what was causing the condition. I felt absolutely helpless, even though I had followed my protocols precisely and done everything I was trained to do. ALS finally arrived at this point, started an IV, did an EKG, and assisted me with maintaining the patient’s airway. Once the ALS providers had a grasp on the situation my partner and I were dismissed from the call to take the ALS fly car back to the station while they completed the transport. I was shell shocked for the rest of the shift and for the next few days. In between calls I was stare at the walls of the rec room and hope that my pager would never go off again. But when it did I was ready and willing to get right back on the ambulance and help the next person. Even though I was later told by the ALS provider who completed the transport that my initial actions and call for ALS were likely to have had a significant positive impact on the patient's recovery, the sights, sounds, and my feeling of helplessness from this call continue to haunt me.

This is just one of many stories like it. EMT’s, paramedics, and firemen all over the country carry emotional and physical scars from the calls that they have had to work through. The people in the communities we serve rely on us to be strong, level headed, kind individuals who are always ready and willing to step up at any time and lay down our lives “so that others may live.” They often forget though, that we too are human. Firefighters deal with traumatic injuries from unsafe scenes and dangerous operations. Later in life they may have to face diseases from exposure to the carcinogenic products of combustion. EMT’s frequently walk into potentially volatile environments then work quickly to asses and provide emergency treatment and transport to desperate patients. On particularly traumatic calls these EMS providers are left with unanswerable questions like “what if I had done something differently” or “was there something I missed.”

These conditions and beliefs held by the public result from a long history of deep rooted traditions and pride in the emergency service. At service academies and classes across the country new recruits are taught that personal safety comes before all else and “to do no harm,” but everyone, even the public, is familiar with the romanticized image of a firefighter running into a burning building to rescue the inhabitants at great personal risk. Many people in emergency services choose this as the ideal to hold themselves to. It takes a lot of time and effort to break long held traditions such as these, and progress is being made. New firefighting and emergency gear is making it easier for firefighters and EMTs to protect themselves, and training at all levels prioritizing personal safety permeates emergency services. Organizations like OSHA and NFPA have created widely adopted policies and guidelines that training and equipment must meet, promoting safety and workers wellbeing. In some departments, annual medical checkups are required for all personnel and emergency care is provided for things like exposure and on the job injuries. From the mental health perspective, which is where most of the invisible scars lie for EMS professionals, Critical Incident Stress Management and other post-call debriefing must be made available to help responders get over traumatic calls like the one discussed above. 

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