This article was written by Adrian Mintz, a 25+ year firefighter and EMT with the City of Sedro-Woolley, WA and Skagit Fire District 5 in Edison, WA. He also serves as Emergency Reporting’s cofounder and board member.
One of the hardest parts of working as a firefighter, in my experience, is dealing (or not) with the emotional consequences of other people’s loss.
Often, people in this industry become callous to the events that we witness. Telling a spouse that their loved one died unexpectedly becomes an almost “fill in the blank” operation that goes like this:
“My name is _______ and I am a (EMT or Paramedic) with (my agency name). I am sorry to tell you that, despite our best efforts, your (husband, wife, other) _______ has died. I’m so sorry for your loss. A support officer will arrive in a few minutes to help you in this difficult time.”
Detach the heart monitor and other equipment from the body. Drape a sheet over it. Release the scene to law enforcement. They’ll ensure the body gets picked up by the coroner or nursing home.
Pick up the medical garbage that gets strewn everywhere. Get back in the rig. Close the door and drive off. It’s that easy.
But it’s not.
Some deaths are expected, but many are not. Even an “expected” death can suddenly be “unexpected” to those around a loved one who suddenly realize that the end is near.
Responders take all of this in stride.
Over time, many of us become so accustomed to this process we start to forget – on some level – that there are real people impacted by all of this, and that this is likely the worst day of their entire life.
Adding empathy to the family will help everyone in this difficult time, and taking care of our own mental health is also critical to surviving the repeated doses of fire/EMS life.
Take CPR calls. These follow a very specific series of steps with only a few possible outcomes at the end – generally the patient will live or die, with a few unpleasant outcomes in between.
I can recall many such instances where I had to have honest conversations with spouses about their loved ones and the result of the CPR efforts.
In the past, in the heat of the moment, I may have not used as much tact as I could have. I’m a lot more sensitive to these kinds of conversations today, as I try to keep the following in mind:
- Look the family member in the eye while speaking to them.
- Listen to them when they speak. Really listen. Don’t just wait for them to stop talking.
- Don’t sugar coat anything. Honesty and forthright communication are more valuable than a positive spin on the situation in the moment.
- Ask family members for their input about the situation. Sometimes they can produce needed information about medical conditions, DNR orders, recent patient statements, etc. This also shows caring by the responders for both the patient and also the family members.
- Tell them if the patient is being transported, and to which exact hospital. Tell them that “We’re going to hurry but you don’t need to. Please drive normal speed and meet us at the hospital.” Tell them the condition of the patient, at the time, so that they have some gauge about what’s going on and can begin to prepare for an unpleasant outcome.
In the end, remember that although the family member may not remember what you said, they will absolutely remember how you made them feel. Be respectful, and remember that they have needs too.
It’s important to have empathy for yourself and your crew members as well. Sometimes, there isn’t a specific sign that “there’s something wrong,” just a sense that you or another person may be struggling, either in the moment (e.g. when speaking to a patient or family member) or more generally.
- Talk about calls with fellow responders after the fact. This simple step can be very helpful.
- If the incident is high-impact (above normal intensity or severity), then there are usually Critical Incident Stress teams that may be available for the agency. These teams are specifically trained on how to assist responders with mental health after the fact. Not all agencies have these resources, but if they are available, don’t hesitate to use them.
- Professional mental health counseling is also an option. This could be in response to an individual incident or to stress that’s built up over time.
- Be alert to substance abuse in responders or others. If a person starts drinking more than usual, that could be an indication of a problem.
- Changes to sleep patterns is another indication that a fellow responder may be encountering difficulties.
- Keep a healthy diet, home life, and get plenty of exercise. These things can have a huge impact on mental health outside of any emergent response.
As hard as it is, you can’t completely close yourself off to the suffering you see as part of your job. In doing so, you could run the risk becoming too callous to what family members are going through. A measured dose of empathy for yourself and others – even if it can be difficult to offer in the moment – is usually appreciated.