Code Green – Mental Health in EMS


It’s time to call a code on our mental health.

Everyone in EMS experiences stress. Some of us work for rural, remote EMS services that make only a few runs a month. Some work for busy, urban services that make hundreds or thousands of runs a month. There are many ways in which such services differ, but no matter the size or type of service, we’ve all been stressed out by a call, by a patient, by a coworker, by home life – and at one point or another, you will have a hard time dealing with that stress. EMS workers are known for having a dark sense of humor, often discussing things over dinner that the average human might find abhorrent. We joke about stepping in something we shouldn’t have, or overhearing an (humorous) intimate detail about how a certain object ended up in a orifice it should not have. We smile. We snicker. Yes, there are parts of our job that make us laugh. What about the parts of the job that make us cry?

In EMS, we sometimes witness horrible, awful things. We are called to help when there’s nobody else left – it’s the patient’s worst hour on their worst day. Something has happened that they called 911 and asked for a complete stranger to come to their house. They put their lives in our hands, having never met us before. If that responsibility by itself doesn’t stress you out, then you haven’t ever truly considered the gravity of the career you have chosen. Those horrible, awful things we witness – they can stay with you. They can haunt you. PTSD doesn’t only apply to soldiers coming home from war. We fight our own mini battles every day as we work to save a life, help a child, straighten a limb, breathe for a patient, stop a bleed, or even just provide a helping hand or a comforting word. Every day you are a warrior, hoping for a positive outcome, but always knowing that the worst is a possibility. For some of our brothers and sisters in EMS, those battles became too much for them to handle on their own. The stress of caring for so many other people was too much of a burden, and they found a way to escape that burden. Some left EMS for other fields of work. Some turn to drugs or alcohol. Some turn to therapy, either professional (like a licensed therapist) or informal (like talking to a family member, trusted friend, or religious leader). Some, sadly, took their own life. The suicide rate in public safety is known to be well above the rate of suicide in the general public population. It’s been documented over and over again that we lack the resources to council our peers on the stress of being an EMS provider. Some agencies provide EAPs (Employee Assistance Programs) as a way to reach out, but there is often a stigma attached to needing help. We’re supposed to be the helpers, after all, right? We should be strong enough to handle all of this on our own, because, after all, when John Q. Public is feeling suicidal, we’re the ones who respond!

The Code Green Campaign was established to help erase some of the stigma of mental health concerns in public safety. The fact of the matter is, we all get stressed out, and we all will need help at one point in our career. The question is, are you ready to help your brother or sister? If you recognize signs of depression in a coworker, are you ready to step up and be there for them? Code Green offers many different types of resources to assist all of us in recognizing signs of depression and other mental health issues, in our coworkers, and in ourselves. It’s worth perusing the website and seeing if there’s something there that could help you out. The general premise is that we call code blue, code stroke, code stemi – but what do we do when we need help? The answer? We call a Code Green.

I wake up in the middle of the night sometimes, having just re-lived my “worst call ever” for the umpteenth time. On an “Unknown Medical/EMS Assist” call, I am walking up to a single family home in a nice neighborhood. Out comes a mother, running through the front door, holding her lifeless infant. She tosses the girl, blue, into my arms and says “help my baby” before falling down on the ground, scared, sobbing, and unable to hold herself up. I start CPR. I give rescue breaths. Fire arrives on-scene. My partner and I work in concert. We start an IV. We push fluids. We push drugs. An ET tube the size of a coffee stirrer is prepared and inserted. A firefighter still wearing his bunker pants breathes for the patient with the smallest BVM you can imagine. I can see the pain on his face as he looks down at our tiny patient, slowly counting breaths to himself. An EKG is obtained with child-size combo pads, still too large for this infant. V-fib on the monitor. We shock. We give more drugs. We squeeze her chest. Asystole. More drugs, more CPR. We’re moving down the road. PD is following with Mom in the cruiser. Radio report to the ER, “incoming pediatric cardiac arrest. V-fib on-scene, one shock, now asystolic. 5 minutes out.” We arrive at the ER. The patient, a 9 month old girl with curly brown hair and dark brown eyes that stare open and empty at the ceiling, is on our stretcher as we wheel her into the trauma bay. There are doctors and nurses waiting. The code team arrives. They check our tube. Start another IV. Push more drugs. More CPR. Rhythm check…. still asystole. Mom arrives with the police officer. Still crying and still hardly able to walk. Her eyes go wide when she sees her baby, who only an hour ago was laughing and learning to lay on her belly and lift her head up, now lays lifeless on the enormously oversized ER stretcher. A nurse does chest compressions. A doctor asks to hold compressions while he listens with a stethoscope. Nothing. No cardiac activity, asystole on the monitor. She’s been down for almost 45 minutes now. The doc looks around the room. “Any objections?” he asks. Nobody says anything. Mom lets out a wail that I will never forget the sound of, crying, sobbing uncontrollably, as she realizes her baby is dead, and there’s nothing else to be done.

I had to call a “Code Green” for myself after that call. I sought out my area’s Critical Incident Stress Management (CISM or CISD) team. We talked. We cried. I talked to a therapist. I talked to my coworkers. I found some balance in my life and my career again. The memory didn’t go away, but it got easier to live with. I carry that patient’s image in my mind’s eye, in my heart, every day. It’s one of many “ghosts” of patients who I think about often. People talk about stress in abstract terms when say things like “I’m stressed out” – but many don’t know what real stress truly is until they witness what we see on a daily basis as EMS providers. Are you stressed out? Do you have an outlet? Do you have somebody to talk to? What do you carry around with you that “stresses you out”? Let us know in the comments below. You can be the one to start a dialogue that saves a life, maybe even your own.

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