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Paramedics Under Pressure

Updated: Oct 15, 2018

Yes we do a traumatic job but what makes it worse is a harmful management culture


Thu 20 Jul 2017 10.14 BSTLast modified on Tue 17 Jul 2018 08.51 BST

When I was 15, a teacher found me during lunch break and asked if she could have a word. Confused, as I was generally well behaved, I followed her to the office. I was told that a close friend of mine had been found by his parents that morning hanging in his bedroom. He was in intensive care at the local hospital but his family had been asked to prepare for the possibility that he would die shortly. Growing up, the ideas of major depressive illnesses, self-harm and suicide were almost entirely foreign to me.

People often ask whether this was what motivated me to enter healthcare at 17 and eventually land in my current position as a paramedic by 20. Frankly, I don’t know. What I do know, though, is that while suicide was a foreign concept to me at 15, it certainly isn’t now.

Almost a quarter of ­ambulance staff have post traumatic stress disorder, according to research published in the British Medical Journal, and about one in three suffer from mental health problems. Statistics are hard to come by, but reports of paramedics killing themselves suggest suicide in the profession is a problem. The Age in Australia reported that the rate of suicide among paramedics for the year to April 2010 was about 20 times higher than that of the general population.

Paramedic stress: 'We're micro-managed by people checking response times'

I require antidepressants daily to numb thoughts of self-harm and suicide. I was diagnosed with major depressive disorder nine months after starting work with the ambulance service. When I attend call-outs to patients in a depressive crisis or who have self-harmed, it is like looking in the mirror. When resuscitating patients who have tried taking their own lives, it is akin to looking at what could have been.

It was after one such callout to a young man who had hanged himself in the living room to be found by his wife and young child, that I broke down.I was in the middle of my fifth 12-hour shift, I had just had to pronounce a man not much older than myself deceased, counsel a grieving wife, assist the police with their investigations and ensure appropriate members of family and friends were coming to be with her. Having never called in sick in five years, I radioed the operations centre and asked them to stand me down as I would be going home for mental health issues. I was weeping, I was trembling, I was unsafe to continue working.

I will never forget the words that came back to me through the radio that night. “But there are calls waiting, can you not just wait until your days off?” After explaining I was no longer safe to work, I was begrudgingly allowed to return home. I sat in silence for hours. The emotions of every patient I couldn’t save, every patient who had tried to hit me, every patient who had shouted at me while I worked to save them or their family came crashing over me like a wave.

Publicity around paramedic suicide generally focuses on the traumatic aspect of life on the road. What is either less known, or perhaps conveniently ignored, is the pervasive culture in ambulance services seemingly designed to incite suicide. Rostered 12-hour shifts which almost never finish in under 13 hours; missed meal breaks to attend more calls; threats to place poor performance markers on our record if we book ourselves unavailable to use the restroom more than once per shift; and, of course, frequent exposure to trauma most people will experience just once in their life are some of the stresses of the job.

Rather than immediate referral for six sessions with a psychotherapist, available to all employees, any request for help is almost universally met with the question: “Are you sure this is the right career for you?” This is followed by almost daily phone calls hounding for a return to work and questioning our commitment to the communities we serve.

This leads to any paramedic in a mental health crisis feeling unsupported and, worse, feeling they are weak. The worst part is, we all believe it subconsciously. We are afraid to take days off for mental health, fearing what our colleagues will think, fearing they will think we are weak, fearing what management will do. It is this dark undercurrent in ambulance services that continues to push paramedics to take their own lives rather than face their mental health problems.

In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.

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