IT’S SPRING IN LAKEWAY, Texas, and the weather’s nice. The 3-year-old runs out of the car to see her dad in his office at the radiology clinic.
A delivery truck runs over her. The tire cuts through her pelvis, eviscerating her abdomen. The driver thinks she’s part of the speed bump.
Paramedic Timothy Morris gets to the scene and calls for a helicopter, which goes to the wrong location. The girl is in shock – her veins have collapsed, the blood drained out of them, making it hard to insert an IV. Morris instead injects fluids into her bone marrow through the hard cortex of her tibia.
“I’m just angry,” says Morris, who is now retired, recalling that day 18 years ago. The situation was “needless,” he says.
Despite her injuries, the 3-year-old survived. The only thing she remembers about the incident is Morris sticking a needle into her leg, he says.
Morris, though, can’t forget the girl’s pain. The flashbacks – from the incident and others in his career – didn’t end when his shifts did.
“I have had periods where I had nightmares, could not sleep, depression, emotionally upset for no reason, anger easily, difficulty focusing on task,” he says.
Today, there is a growing movement to provide professional help for first responders like Morris, whose line of work can lead to mental health conditions like post-traumatic stress disorder and depression, and to raise awareness among emergency workers that they should get help.
Often, first responders don’t want to admit they need help, thinking they should be tougher.
“PTSD does not go away,” Morris says. “You learn to live with it.”
A study published in 2004 in the Emergency Medicine Journal showed that more than 20 percent of 617 emergency ambulance workers surveyed in the U.K. had evidence of PTSD, while about 1 in 5 had likely clinical anxiety and nearly 1 in 10 had probable clinical depression. Research in Canada also has indicated that paramedics had a higher rate of PTSD than firefighters or municipal and provincial police.
The Tema Conter Memorial Trust, a Canadian nonprofit that raises awareness about mental health stressors faced by emergency and military personnel, reported 16 cases of suicide among Canadian paramedics in 2017, a total 60 percent higher than suicides that year by members of the military and about 45 percent higher than those by firefighters. In 2015 and 2016, the organization’s data show suicides among paramedics were roughly on par with suicides among military members.
Yet despite the prevalence of conditions like PTSD among first responders, advocates in the U.S. say support systems have not kept up with the growing need for mental health services, and some are attempting to fill the gap.
In Atlanta, paramedic Heather Harp founded a nonprofit called CARE – Courage Affects Responders Everyday – after two of her colleagues died by suicide. The group “is raising awareness about PTSD, raising awareness about suicide prevention, better mental health and pushing for more departments to have things in place for when (paramedics) need to see or talk to somebody,” Harp says.
Harp wishes something like CARE was in place when she first started experiencing symptoms of PTSD herself. “I definitely suffered with depression, with anxiety,” she says. “I did have PTSD, and yes, was diagnosed with that.”
Fire departments, police and emergency medical services agencies need to work together to provide better mental health care for first responders, Harp says. “You start thinking about the faces of the people you can’t save,” she says. “You think about the family that was distraught and crying and begging you to save their family member, but you weren’t able to.”
CARE created a critical-incident stress team comprised of peers – paramedics, firefighters, police, emergency medical technicians and dispatchers – and supported by psychologists, psychiatrists and chaplains.
“That’s what an ideal system should look like,” explains DeAnna Johnson, critical incident stress coordinator for CARE. She says team members are mobilized after an agency, supervisor or affected individuals themselves let them know help may be needed. “We’ve never had any team like that anywhere in Georgia. There are no services available. That’s why we’re doing this.”
Ernie Doss, deputy director for EMS and trauma at the Georgia Department of Public Health, acknowledges there is no funding to develop a department-run critical incident response program. “There have been discussions in Georgia,” Doss says, “but at this time the department is unable to provide any of that training.”
CARE’s goal is to intervene promptly after paramedics first exhibit symptoms of emotional distress.
“When you take care of (mental health) issues at the beginning of them, you save money having them not go for a long time,” Johnson says. “If I can get to a peer within 24 hours, I can identify if they’re going to go on and develop PTSD. And I can stop that in its tracks if I can get to them within the first 24 hours.”
There are U.S. agencies where first responders work that have safety nets of their own. The District of Columbia Fire and Emergency Medical Services Department, for example, has a trained critical-incident, stress-debriefing team for episodes that involve significant emotional trauma.
Team members “meet with the people involved in the incident and work with them, talk through any issues they may be having,” department spokesman Vito Maggiolo says. “We activate that whenever we have a situation where we really, really feel that there could be considerable psychological or emotional distress.”
Sarah Roque, who manages the Health Care Services division within the district’s fire and EMS agency and trains peer counselors, says the counselors practice “psychological first aid” after a critical incident occurs, performing mental triage and referring emergency workers to mental health experts and other resources if their assessment suggests the workers may have symptoms of PTSD.
“There are several critical-incident response teams in D.C.,” Roque says. “Most emergency response departments or organizations have such a thing, not only in D.C., but across the country.”
Lisa DeMarco Tilley, a licensed professional counselor and a behavioral health specialist who has experience working with firefighters and paramedics, helped open the Public Safety Resilience Center in Prince William County, Virginia, in 2016. The center, a division of the county’s government, provides mental health services for paramedics and other emergency employees.
“(The program) has gone so well, and people have been provided with so much support, that the entire county has now embraced it and opened it up to all public safety,” Tilley says.
Still, a 2016 national survey on mental health services for EMS workers showed that 58 percent of respondents – which included paramedics and EMTs as well as EMS managers, directors and training coordinators – indicated they were dissatisfied with the mental health services provided by their employers.
The survey also showed that some respondents felt the counselors available to them through employee assistance programs were not equipped to deal with the needs of emergency personnel.
“(Paramedics) would go to counseling, and they weren’t getting what they needed because the therapist was trying to learn about their job or what they do from day to day, and they just didn’t understand the concept and it would turn them off and they would just stop going,” Tilley says. “Firefighters and medics have very unique roles, and you really need to know what it is that they do and they deal with from a day-to-day basis in order to be able to assist them and talk their language.”
To bridge the gap of understanding and empathize more with her patients, Tilley says she’s gone on shift ride-alongs, visited firehouses and learned “their system, the dynamic, the culture.”
“That’s really assisted me with being able to be someone they can come to, someone they can trust to understand what they’re going through or understand their language,” she says.
Echoing Tilley, Shelly Hudelson, a representative for the International Association of EMTs and Paramedics labor union, advocates for emergency workers when they experience traumatic events and their employers don’t get them the help they need.
“You can’t just send an EMS worker to any mental health facility or any kind of counselor,” Hudelson says. “When you really get to the (counselor’s) office, you find that they’re a family health counselor … and they’re actually not trauma-trained the way they should be.”
In California, the union is pushing for an EMS bill of rights to improve protections, including mental health care, for emergency workers. “There’s just so many (EMS workers) out there, and they tend to not ask for help,” Hudelson says. “It’s always been the whole, ‘Suck it up. It’s your job.’ But now we’re seeing higher rates of suicide because of that.”
Morris, the retired paramedic from Texas, wipes away tears as he talks about seeing decapitations, babies shaken so hard their eyes go in different directions and kids – still strapped into their car seats – crushed in the backs of cars.
Yet despite his two decades of assisting others, he doesn’t seek help.
“I self-correct if I am depressed or having problems with my emotional or mental state,” he says. “I manage my issues internally.”