The Struggles of EMT's and EMS Workers

In a perfect world, violence, plane crashes floods and other disasters would not occur.   Disease and illness would be non-existent.   Emergency medical services would not have a basis for fruition.   Unfortunately, the world is not perfect place.  EMT's and other EMS workers are vital to all societies globally.  According to the American College of Emergency Physicians, the definition of an emergency services is, " Emergency services are those health care services provided to evaluate and treat medical conditions of recent onset and severity that would lead a prudent layperson, possessing an average knowledge of medicine and health, to believe that urgent and/ or unscheduled medical care is required."  The following pages will illustrate the struggles of an emergency medical technician and other emergency medical service workers.

        Deciding to become apart of an EMS workforce is a life changing decision.  One must take into consideration many factors that may hamper one's effort to perform the job correctly. Violence against emergency workers continues to emerge (Anderson 1991). In recent years, EMT's and EMS workers have become targets in urban areas.  EMS workers enter urban war zones daily and face many man made dangers.

        One peril an EMT may face is the continuing growth of gangs.  Gangs have branched out from big cities into smaller towns (Staten 1991).   Frequently, EMS

responders are attacked without provocation.  In most cases, the EMS workers are responding to a call when they are ambushed by a variety of things.   It has been documented by the Emergency Net New Service that fire bombings on EMS workers and their vehicles have increased in at least ten major U.S. cities (Staten 1995).   

        In addition, EMT's and EMS workers are faced with the dangers of driving into already volatile situations.  For example, after the Rodney King verdict, cities such as Los Angeles, California and Atlanta Georgia erupted into massive riots.  EMS responders were thrust into physical danger.  Both cities were set afire and gangs of people rushed to loot local stores (Feiner 10).   EMT's and other EMS personnel put their lives in direct jeopardy to perform their jobs.

        Besides rioting and gang violence, EMS personnel are often faced with other more maniacal acts of violence, such as domestic terrorism.  The most gruesome example of this is the case of the bombing of the Federal Building in Oklahoma City, Oklahoma. The direct targets for this disaster were the civil servants that worked in the building.  EMS workers suffered emotional trauma from the shear devastation of the building.  News reports depicted the various branches of the EMS workforce as relentless in their search for survivors.  EMS responders appeared to be exhausted, but yet somehow were able to continue their tasks in victim recovery.

        Lastly, the weather conditions or the climate the rescue is being performed can be a natural danger to EMS personnel.   For example, one can evaluate the recovery effort by rescuers of ValueJet Flight 592.  The plane crashed into waters of the Florida Everglades. The crash took place in murky waters and hampered all recovery efforts

(Macko 1996).   The search for the plane and the body recovery was difficult due to the location of the crash.  The crash site was inaccessible because it was far from any road

and could only be reached by airboat or helicopter  (Macko 1996).  Secondly, one can also evaluate the efforts of the rescuers of the more recent crash of SwissAir flight 111.  Although the response of rescuers here was swift, the darkness and stormy conditions limited the recovery efforts until daybreak.  By early morning, only 18 bodies were recovered from the 229 passenger's list (ERRI Emergency Services Report 1998).

        What can EMS personnel do to protect themselves?    The following are some recommendations made by the Clark State, EMT-P, Assistant Chief Paramedic (retired) for the Chicago Fire Department.   Chief Staten list of "Do's" include:

A) 360 degree view of the scene at all times.

B) Watch your partner's back and have them watch yours.

C) Carry more than one source of artificial light.

D) Cooperate and communicate with the policing officials.

E) In cases of crime, do your best to preserve any potential evidence.

F) Keep accurate records and know your administration's policies.

Chief Staten list of  "Don'ts" include:

A) Never extricate a victim from a crowd without the assistance of ample

security.

B) Never stand in front of doors when knocking them down.

C) Never stay in a situation where cannot see impending danger.

D) Only use the maximum amount of force necessary when defending yourself.

E) Don't forget plan ahead-always have a way out.

In addition, Chief Staten suggest during times of social unrest, EMS personnel should

obviously be provided with bulletproof vests.

Besides facing natural and man made emergencies, an EMT's and EMS responders are at the risk of suffering emotional stress (Schimelpfenig 1991).  This stress can be caused by a number of ways.  Initially, an EMT may encounter feelings of the immediate despair and destruction of the scene.  The scene itself may be so gruesome and confusing that the EMT would go into "auto pilot."  Additionally, the surrounding scene may cause a flight or fight reaction.  Avianca flight 52 illustrates just how devastating a disaster can be.  One EMT described how bodies were everywhere.  The EMT further described how she came across a small child covered with blood and screaming.  The mother was already dead-"still intact in her seat almost on top of the child" (Gasparini 69). She further detailed the site was "an endless line of patients screaming in pain for help." (Gasparini 69).  At one point, all she could do is take a deep breath and go on.

        Secondly, an EMT can also experience stress caused by frustration.  The frustration can stem from a number of factors.  Many times, EMT's become frustrated by the difficulty of reaching the site.  Additionally improper or inadequate communication can cause more stress.   Lack of or outdated equipment may also increase the level of frustration (Kelly 62).

        The frustrations experienced by the EMT may lead to stronger, more conscious emotions.   The sense of urgency of the situation fuels the adrenaline rush. In fact, some become "addicted" to the rush provided by adrenaline, constantly seeking out circumstances that will provide the feelings associated with adrenaline.  This can result in anger and anxiousness.   Once the anger and the anxiety fade, the EMT may begin to feel fear.  The fear can result in self-doubt in one's own abilities to perform the job. Stress can

also manifest itself on a more sub-conscious level.  Many EMT and EMS workers awake in the middle of the night from flashbacks and nightmares.  Nightmares and flashbacks are common in emergency response. Stress can also manifest itself through panic attacks, nervousness, depression, grief, hopelessness and irritability (Schimelpfenig 1991).

        Stress may not appear immediately.  The stress reaction can be delayed and masks itself.  There are several signs of delayed stress reactions.  The EMT may begin to have a more macabre sense of humor.  In addition, a pattern of continuous sick leave will develop (Schimelpfenig 1991).  Other stress reactions may be a reluctance to enter into stressful situations, withdrawing from others, obsession with the stressful scene, suicidal thoughts and feelings of inadequacy (Schimelpfenig 1991).

 An important part of EMS training is learning how to cope with the stresses of the job.  In order to be a success as an EMT, it is recommended the EMT learn how to cope with the disaster or emergency.  The EMT must learn how to cope with the stress.  Counseling is usually effective to resolve emotional issues associated with stress.  Another form of stress management is building a strong support system and support groups.  Untreated stress can lead to psychological deterioration.     In addition, if the stress is left untreated, the stress may also lead to the deterioration of one's effectiveness to perform the job (Kelly 61).

        EMT's contribute unique capabilities, perspectives and experiences to every individual emergency response.  The purpose of the EMT and EMS personnel is to provide optimal, acute health care.  Each day presents many physical and mental challenges.  To be effective as an EMT, occasionally you must reflect on your past

 performances.  You can step back and say to yourself, " I've been hurt too much by what I've done and seen and I cannot do my job anymore."  Conversely, you can put those feelings aside, re-dedicate yourself to your profession and begin each day anew.  One must always keep in mind the life you save may turn out to be the life of a future world leader, astronaut or scientist. 

Works Cited

American College of Emergency Physicians. "Definition of and Emergency Service"

        URL http://www.acep.org/POLICY/POO4154.HTM               (11/9/98).

Anderson, Paul. "Emerging Violence Against Emergency Workers"

        URL http://www.emergency.com/emviolc.htm                         (11/9/98).

"Avianca Flight 52," Emergency Medical Services Magazine.  July 1992,

        Volume 21, Number 7.

"Can Your System Survive?" Emergency Medical Services Magazine. July 1992,

        Volume 21, Number 7.

ERRI Emergency Services Report. "ESR Closeup: No Survivors of Swiss Airliner that

        Goes Down in the Atlantic…" URL http://www.emergency.com        (11/9/98).

"It Happened One Night,"  Emergency Medical Services Magazine. July 1992,

        Volume 21, Number 7.

Macko, Steve.  "Recovery Effort Called 'Extremely Difficult' by Rescuers"

        URL http://www.emergency.com/vj592b.htm                 (11/9/98).

Schimelpfenig, Tod. "Stress and the Rescuer"

URL http://www.nols.edu/Publications?FirstAid/Stress'n'Rescuer.html

                                                                                (11/24/98).

Staten, Clark.  " Emergency Action Drill"

URL  http://www.emergency.com/acrndrill.htm                     (11/05/98).

Staten, Clark.  " Street Survival in the 90's."

URL  http://www.emergency.com/acrndrill.htm                     (11//98).

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