November update and future plans.
I’ve spent the majority of my public service career as a Paramedic. Those who know me are aware that I’m not exactly the quiet type either. I try to organize my experiences and observations for the benefits of others these days in order to accomplish some greater good. We have a lot of room for improvement and it seems that we are on the way to a culture shift in how we deal with taking care of ourselves.
The word “wellness” is something that employers and organizations are starting to throw around more and more, but what exactly are they encouraging? What should that mean for our first responder communities?
Wellness can be defined as “the state of being in good health, especially as an actively pursued goal”. This leaves a fair amount of room for interpretation and presentation to others. Typically when we see a wellness program or resources pushed to us, it includes several variations of tacky stock photography including actors dressed in generic uniforms, water flowing over rocks, and phrases taken from various places on the internet. There isn’t normally a defined process or set of resources especially for us; it’s a general program rolled out and meant for the public and doesn’t always address our specific needs. They can be everything from temporary to things we just simply aren’t interested in. I know that from going through my own process that mind-body activities like mindfulness and specific forms of yoga are helpful in maintaining that healthy balance of needs and emotions, but I also know that some random person showing up at work who can’t handle our often dark humor or outlooks on society and may not be able to perform to our standards or expectations. We are different people, and there is no way around that. It should be managed how it is - not how others feel it should be.
I was having a discussion with someone recently about a wellness event that their employer sponsored about a year ago. No, I’m not talking about mine with this, so don’t bother emailing and calling them please. This event had various services there to explain all about what they do and how wonderful being well is. This person went off-duty and was surprised to see that all the workers were out doing work, but all the bosses were there engaging. Almost a year has gone by and nothing in how the organization deals with their employees has changed. Within the last few months they had someone in their organization commit suicide and they have now renewed the interest in promoting wellness. Sometimes it’s just for show, unfortunately. I hate to be blunt, but often the people orchestrating these events don’t have a good understanding of exactly what they are trying to accomplish in the first place. Sometimes it seems akin to throwing a hand grenade into grandma’s flower garden. You have a grenade and want to show it off, but at the same time, you care about nanny’s petunias. Let’s find a more constructive way to use the grenade without blowing up the petunias.
So where should we start? Every service, employer, and organization has different needs that should be discussed with the worker base - the people who do the work - rather than administrators following trends on social media or a Google search. This doesn’t have to be difficult or expensive; there are simple things that can be done that can have a positive impact. Here are some things to start:
1. Scheduling: Do you have a schedule that works for your needs? Can one be created that satisfies the needs of the service as well as to allow the people to live outside the world of public service? The answer is yes. Sometimes you have to push for it. There are many scheduling programs that allow for doing so and sometimes it’s just as simple as getting to know them. We work in industries that are 24/7 without an absolute way to know what the need for services is going to be so there are always unknowns. There are ways to plan around that using the analytics from past service utilization; it just has to be done. Having the ability to keep a professional schedule that allows for free time, taking care of loved ones or family, and maintaining a balance of the professional world and personal world is important and goes a long way keeping everyone happy, healthy, and productive for the organization. It may sound a bit silly and obvious to say, but it’s well established that when an organization invests into keeping the workers happy, the production and service benefits. Properly rested and maintained employee bases show increased benefit to the patient population. Things like positive attitude, positive work environment, and satisfaction go a long way to how we deal with the public. Proper schedules ensure balance with other activities including sleep and rest. With this, I think it’s safe to assume a reduction in things like medication errors, complaints, and better interaction with other professionals is all within the best interest of everyone. Speaking of which:
2. Sleep: A fairly large percentage of people in public service industries suffer from sleep problems, and I think it’s safe to say that what we mentioned before has a large effect on people. I’m familiar with the saying “I’ll sleep when I’m dead” implying that between overtime and other responsibilities in life, sleep is not always a priority. Your sleep is a far more complex situation that you may be aware of. Sleep disorders are one of the most frequently undiagnosed and mismanaged problems among the population, and we are no exception. We all know that person at work who does nothing but slam coffee and energy drinks all day. We know that is not healthy, but it’s far better than falling asleep at work. Even worse, literally every month there is another incident somewhere in the nation involving a responder falling asleep and crashing the vehicle causing injuries, death, and property damage among other things. It is common that during the course of the investigation, it becomes known that the person driving reported feeling tired or recalls falling asleep at some point. I find this to be a big problem, but I suppose that is just me judging from the amount of people who have no choice but to work dreadful hours like at 24 hour shift with no consideration of rest. Though it is illegal in some states, it still happens. Complicating the issue is when shifts are created during the hours that disrupt the normal human sleep cycle. Humans are designed to sleep when it’s dark. That’s just the way it is. This can be managed by proper re-cycling and acclimation to the scheduling, but an effort has to be made to do so and correctly. There are many things that can tip you off that you or someone else has a sleep disorder. Things like falling asleep during typical work hours, noticeable lack of attention or attention span, decreased activity, mood swings (that person who is always grumpy at the beginning of the shift), feeling tired all the time even after decent sleep (hypersomnia), problems falling asleep or staying asleep (insomnia), persistent headaches, waking up choking (may be obstructive sleep apnea), nightmares, problems with controlling hypertension (high blood pressure), frequently falling out of bed or sleep walking and a whole host of other things. Improper sleep can also aggravate existing issues like depression or cause an increase of events associated with PTS. You need your sleep to function, so why not have your organization take an active role in assisting you? Find a reputable Pulmonologist with a board certification in sleep medicine. In most cases, you will need to start with your primary care provider to “trial” some simple medication if deemed right for you. Most insurances require this anyways, so you may have to “follow the rules” or “play the game” to get started. The best way is to have a sleep study, and that can be coordinated. Those who know me are aware that I am the “king of sleep disorders”. I suffered for years before taking the steps to address it and I’m glad I did. I sleep better, I feel better, and I have an awesome sleep specialist that I now refer people to. Don’t be afraid of the CPAP machines either. The new systems are cheaper, more effective, and most can communicate via your home WiFi with your specialist to send data and make changes without an office visit. There are apps to see how you are doing (you may see me post them from time to time) and remind you about routine cleaning and maintenance. They can also alert you and your specialist to events that may require more attention and study that may not have been caught during your sleep study and would otherwise remain unknown. When I had my initial study, my oxygen levels dropped to 70% and I was having almost a dozen “events” per hour like incomplete breath cycles, waking up without being aware of it, and complete airway obstruction. Several months into having the machine at home, I got a call from my specialist. The conversation started off with “So, how’s your sleep?” and quickly evolved to “… so you stopped breathing about 18 times in the last week and I had to adjust your machine settings…”. I thought the headaches were from allergy season, but apparently not and I never would have known otherwise. Turns out the magic was in the change of my schedule and because of the tracking through the machine and monitoring from her we were able to determine that change and justify that on a medical basis. I worked with my HR department and scheduling coordinator to make the change. It was quite a difference. There is also the option of not having the mask that we all know about. It is far more comfortable and easy to work with than years ago. If you can’t tell, I love my machine! Don’t be afraid to reach out with a question about your sleep. I’m no sleep expert, but I’ve been through just about all of the problems with sleep disorders.
3. Access to primary care: Get a reputable primary care provider and stick to the visits. Get your organization involved to promote it. You may even be able to find a provider who will come to your organization and do the exams on-site and during odd hours. Most places require an annual physical evaluation for initial employment, but not all require it on a continuing basis. Since our jobs are completely stress-free (lol) we definitely don’t have to worry about things like: high blood pressure, high cholesterol from the wonderful diets we all have, weight gain, unhealthy habits, deterioration in health, and age related issues - right? Not so much. We are still humans (well, most of us) and prone to the things that plague others in addition to our own problems. Get off your butts and take care of yourself. Anyone who has taken an American Heart Association class should know that things like high cholesterol and high blood pressure knows that those two things can be mitigated through simple medication or diet management rather than killing you 30 years too soon. Most of these screening are available to you to free anyways (insurance depending) and may be required, but not always enforced. I’m looking forward to being 90 years old and ramming into other peoples carts with my scooter while shopping, and you should be too!
4. Your spine: Take care of things before you are disabled. I advocate for Chiropractic care a lot. We do a lot of lifting, bending, and carrying that is far from ergonomic and considered normal. This causes many issues with joints and specifically with the spine. People are often turned off when it comes to the field of Chiropractors, and it’s no wonder when you do a simple internet search. Chiropractic typically falls under the category of “alternative medicine” and tends to be ridiculed by other, established branches of medicine for various reasons. Perhaps some of that has to do with the founder of the speciality promising to cure everything with a few snaps of the spine. One thing that should be kept in mind is that this was not uncommon for the day in the medical establishment, so feel free to do your own research. As things have evolved, the care has become more streamlined and evidence-based like other branches. As with all things under the umbrella of alternative care, the secret is in the provider. If they are trying to sell you snake oil, then you should think twice. I love the smell of lavender oil, but I also know that isn’t going to cure me of my insomnia - just like a Chiropractor who tells you that doing spine adjustments is going to fix your heart disease is full of crap. Look for a provider who does proper assessments before working on you. Things like a screening and proper imaging which are typically X-rays. If you walk in and they offer to start manipulating your spine (or any joint) without knowing what is actually going on, you should promptly walk out. Part of the theory around the spinal adjustments is being able to flex those joints so they move properly and align in the proper anatomical position. If your disc is destroyed or there is a problem with arthritis that is so bad it could cause injury to do the manipulation, a good Chiropractor will not touch you and likely refer you to a spinal surgeon instead. This is what you want. It may not have been what you had in mind, but I presume being in a wheelchair or confined to a bed isn’t either. I caught quite a bit of flak for engaging in his years ago, most of whom are people I see every day. One person I work with suffered from back pain to the point where bending over or down became a task involving groaning and selective profanity. I mentioned seeing the Chiropractor that I did and was initially met by additional profanities and accusations. It wasn’t until they bent over to pick up their keys one day and couldn’t get up that helped the decision to reluctantly call and schedule an appointment. Their back was pretty close to destroyed to the point of surgical intervention, but was appropriate to a slow start to the therapy. Three weeks later, I noticed a marked improvement of their overall appearance, attitude, and reduction in the use of said profanities. It’s been about four years since then and they haven’t had a regret besides not doing it sooner. Keep those joints moving when possible; it’s not worth being sore all the time and being miserable from the pain. Most insurance plans offer a set number of visits with a low copay. I would encourage you to get others involved after finding the right provider.
5. Routine mental health evaluations: The sooner your baseline is established while working in the public service sector, the sooner others may detect an issue and avert crisis situations. I know this is going to strike a nerve with most of you, but the fact of how working in these fields changes you as a person cannot be denied. We often aren’t aware of these changes as we progress through our careers, but that doesn’t mean someone shouldn’t be looking out for it. We do not offer crisis services here, but occasionally people who are in danger to themselves or others come to us and we handle that accordingly. Putting some barrier in the cycle of the disaster that may strike us or another coworker is something that needs to be established, taken seriously, and maintained. You should encourage your organization to get interested in doing this on at least a semi-annual basis. Find a provider, likely someone who is a LCSW or Ph.D, with the proper credentials and clinical experience looking to get involved. You will benefit from having the oversight of a provider with the right mindset and experience of conducting these evaluations and rendering opinions on how to improve the way people are cared for. You may have the idea in your head that these evaluations will involve someone sitting in a chair etching notes on a pad while bobbing their head saying “I see..” as you spill your guts while you lay on a couch. We get these ideas from what we see from various films and stereotypes; not from reality. It is not a test, there should be no pressure, and it shouldn’t be painful either. It may involve some uncomfortable questions, but keep in mind that the process is designed for a reason - and that is to keep you and others alive and well. Depending on the data you look at, we are around three to six times more likely to resort to substance abuse and/or suicide than the general population. No one wants to hear it, but that doesn’t make the problem dissolve. Take the steps to save yourself or someone else.
6. Make it accessible: most administrators work such challenging shifts like Monday through Friday, 9-5 with no weekends or callbacks and get to enjoy holidays. The rest of us don’t have that luxury. So why does it make sense to have these things available on a schedule that benefits only a few? it doesn’t, and you should speak up. It’s not usual to have specific services available all the time, but there should be some discretion and choice as to what is. If you are holding an event or educational outreach on these things, make them so the majority can benefit from it. What’s the point if everyone can’t get involved? Use the tools out there that people use - you have the internet, social media, email, and word of mouth. Get out there and get it done.
As it has been said, “Rome wasn’t built in a day, but they sure burned it down quick”. Take your time and get the right things in place. Start simple and work from there. Find what is effective and necessary without falling for trends or aiming to make a show. In the end this involves us all, so it’s worth the investment.
Do you like our cause? We do. Please consider a donation to keep us going!
Note: Before you continue, no matter your personal or professional backgrounds and experiences, I ask that you surrender those for a moment. Read this objectively, do your own research, and get the conversation going. Don't make the mistake of following the masses on social media or falling for false promises claimed by others. This affects more people than you may understand.
The topic of addiction, in particular to opiates like heroin, has been in the news and our social media feeds frequently in the past few months. A lot of what I see is uneducated opinions, personal biases, and information from people who frankly have no particular background or experience with addiction. Addiction and substance abuse/misuse is not a simple problem; therefore there is no simple solution. As long as humans have been roaming the earth, someone somewhere has had an addiction. This can even be seen as far back as some of the early Chinese dynasties. Opium had become such a problem with the population that it was punishable by death. Even with the extreme consequences associated with even being in possession (or sometimes just associated with) we still see a world-wide problem with substance abuse - and it isn’t likely to ever stop. It will always be an issue in our societies no matter how hard we may work on it, the laws that are passed, or the alternatives offered to those afflicted, and particularly in how we personally view it. How we respond to this problem is what will make the biggest impact. This is not just for ourselves, the ones we love or care for, but also for society as a whole and the world we are leaving for the next generations.
Since the beginning of my recovery, I have never kept a secret what happened to me and the circumstances that lead me down the road I took. I am open about this because at the time, no one else would be. The public service realm is particularly bad with this because we tend to be private people and always want to put on the best show of who we are whenever we can. We often hold the issue of addiction as a personal problem when it is so much more than that. It affects not only our health, social lives, personal lives, professional being but also our families, those we work with, and the world we survive in. I discuss what happened to me for a few reasons: I don’t want people to take the path I did, I want you to understand that there is help, this can be managed if you are willing to do what it takes, and most importantly that you are not alone. Since I went public with my story and began my outreach work I have met and helped many people with similar issues and a range of addiction coupled with other issues. I was initially a little taken back by just how many people experience issues in the public service sector, but after talking with them it makes more sense. You would be very surprised to know just how many people secretly deal with these problems. Addiction has been referred to as one of the “great equalizers” - your social status doesn’t matter, your professional abilities or experiences don’t matter, your living situation doesn’t matter, and what you have accomplished in life doesn’t matter either. Addiction does not discriminate either. It doesn’t matter what your ethnic background is, religious affiliation (or lack of), status in society may or may not be. The simple truth is that we are all human and therefore inherently flawed and prone to the same issues as anyone else. Stories and circumstances may vary, but there is always a majority commonality in everyone that is often overlooked - sometimes purposefully.
When we talk about addiction as a “disease” people are often confused or resentful of that for a variety of reasons. People tend to think of a disease more like cancer or tuberculosis because they can be contagious and produce physical and noticeable effects. Others may see substance use or abuse as a pure, purposeful, well-educated decision and could just “stop at anytime” unlike my Aunt Sally who died from cancer. While that may ring true to an extent for some people and with some of the “lighter” substances out there it isn’t particularly true. It’s not quite that simple; because if it were we wouldn’t be having this discussion. You are getting hung up on the word and not the process. Addiction is a disease of the mind and body. Though not contagious it features physical and emotional manifestations as part of any disease process. Continuing to do something, in this case the use of a substance, despite the often deadly or otherwise undesirable consequences implies that a process is not working correctly - in this case the brain and how things are processed and the individual reacts. Even if you chose to stop using, there are very real physical effects to doing such (like withdrawal) coupled by many mental aspects. Like most diseases, addiction ends in one of two ways: you get better or you die. That is the hard reality of the situation. Ever try to quit smoking? Multiply that by around 100 and see how likely or successful you are to quit. Opiates, in particular heroin, are especially difficult because of how quickly and vastly it changes your brain chemistry. There is far more to the process than we may realize.
An often overlooked or marginalized issue with addiction is that these people very frequently have underlying issues, particularly with mental health or general wellness. These individuals are referred to as having a “dual diagnosis”. The most frequent misstep I see is when someone elects to get help they are treated for the substance use only - not for the underlying issues. This happens a lot because addiction is very often a visual thing. It’s typically easy to tell when someone is strung out or acting inappropriately and otherwise frequently making poor decisions. That tends to mask any causative factors that cannot be easily identified. I mean issues with trauma, abuse or sexual assault, depression, mood disorders like bi-polar disorder, chronic pain, brain injury, anxiety or panic disorder, and many more. When elected to treatment, the most frequent misnomer is that by eliminating the substance abuse everything else will “fall into order” and they will “get better”. It reminds me of some of these terrible TV shows where celebrities go in for treatment and after a few days are “back to normal” with no residual effects. If you follow them, you’ll understand that is rarely the case. While that may be true for some, as a general rule that is incorrect. The two issues often feed off each other and if both are not addressed the risk of relapse and falling back into the prior habits and behavior are typically very high. Being clean and sober is one thing, but not feeling well once that is achieved results in a significantly increased risk of future events. In my experience it has also contributed to accidental death during relapse and suicide. An individual who has elected to be well and sober for a period of time will occasionally decide to “tempt fate” in a momentary relapse. After being without the substance for a period of time, your body no longer has the tolerance it once did. In their mind, they often pick up where they left off resulting in undesirable situations and death. This is particularly true with opiates and alcohol. The body no longer has the tolerance it once did, but the mindset tells them they do. People often take failure very hard and personally, so when they feel like they fail (or are a failure) they can get into the mindset that they are hopeless and abandon their wellness. Relapse is very often part of recovery, so if someone does relapse it is important to have a prevention and management plan in place to deal with it - and a realistic one at that. A relapse should not be an automatic death sentence or be explicitly labeled as a failure. Doing so is not only false and provides negative emotions for the individual but only perpetuates the wrong mindset of going through recovery with “absolutes”. An absolute would be “well, they completed treatment so they will never use again” or referring to a “cure” with no possibility of future problems. The bottom line is that all issues need to be addressed and by competent clinicians who will help plan for the future and proper care after treatment.
Another important thing to remember is about the mindset of addiction. If the individual is not ready or willing to commit to being well, there is very little that can be done to help them. That does not mean that you should enable them however. No money, no rides, no assistance or active role in enabling the behavior. We can pass every law imaginable, stand them in front of a judge, have family and friends plead with them, send them to jail, remand them to a treatment center, or any other forceful mitigation but a simple truth remains: if they aren’t ready to make the commitment, it usually results in failure. Though putting them in prison may technically force them to become sober there is rarely a long-term benefit. Just look at anyone with frequent or recurring arrests and convictions and that becomes clear. In a time where budgets and funding are being unceremoniously slashed or eliminated, many prison systems either have a lack of or severe inability to properly address their issues. There is rarely any justice to be had in these situations either. Putting someone in prison for 60 days just to have them be released and continue the same behavior is incredibly useless to everyone. I’m not suggesting that a “free pass” is granted to them. Consequences are often a deciding factor for the individual to seek help and setting limits is important; but you have you stick by your word and the boundaries you set. Part of the mindset of addiction is manipulation or exploitation, so that cycle needs to be broken.
Personal accountability on the part of the person is also important during the recovery process. As mentioned above, there should be no passes on past behavior barring of course an extenuating circumstance. Answering for and doing your best to mend the issues created in a time where you were in a bad position is important to do. This is particularly important in people who take the “12-step” process. It creates a better understanding of their situation and assists in the healing process for everyone - not just the addict. This should be done in a way where they are educated about the effects of what happened in order to maintain a working understanding of their actions, behavior, and habits. Doing things like revoking their yearly invite to Christmas dinner is not positive feedback and only serves to alienate and (in their mind) justify prior activities. Space can be good, but cutting someone off without the possibility of reunion or reconciliation serves little or no purpose. Life is only so long; holding a grudge or hostility over someone else’s circumstance just isn’t worth it. As the line goes: “hate is baggage in the end”. And to be clear, I am not talking about instances where abuse was involved. With that, you need to seek your own guidance and do what is best for you.
For those of us in public service, there is no question that opiate use (particularly heroin) is more frequent and wide-spread than most of us can remember. Communities all over have expressed their concerns and rightfully so. An interesting event has taken place over the past few years where the antidote for opiates (Narcan or Nalaxone) has been placed almost everywhere. Fire and EMS have had access to this for years but recently many Police departments, schools, and public buildings are equipped with it. You can also get a prescription for an auto-injector if you or a family has an opiate problem and most pharmacies can hand it out when asked. Narcan is only a temporary solution for a long-term problem. Our elected officials tout this program as a way to save lives from the opiate epidemic. While this is partially true, it is not the “fix all” solution that it is very often sold as. While it’s great that you now have the ability to save another by just spraying something up their nose, it creates several other issues. Narcan is not as inert of a medication as it is often billed as. Serious complication are relatively rare but can happen. There is also a trend where every time someone sees another unconscious person Narcan gets blasted up their nose. Though unlikely to cause harm, it’s not always the best option. Issues can arise with acute withdrawal and seizures, heart failure, and a host of other issues. Occasionally the opiate overdose can mask a serious problem with mixed drug use or other medical problem such as a head injury. Anyone who has ever administered Narcan to someone only to have them regain consciousness and start fighting because they also snorted an eight-ball of cocaine knows what I’m talking about. If you’ve never administered any drug to someone there needs to be a certain amount of caution exercised in doing so, and if you aren’t trained in it also be cautious and do your best to seek professional guidance. I would have rather seen a program where people were taught the basics of CPR and airway management first. That would benefit a far greater demographic of people. Basic logic dictates that outcomes are better when a procedure or medication is given by people who have experience with it and know what to expect. Since the introduction of this program, the amount of people getting Narcan has drastically increased and the death rate from opiates has increased as well. This program had more to do with making it seem like they were trying to curb an epidemic than effectively manage or mitigate it. It’s not all bad, but it shouldn’t be looked at as a primary deterrence either.
Speaking of Narcan, another interesting series of events is starting to unfold. Since the demand for the medication has increased, so has the price. As the potency and mixing of opiates has increased, more doses are required for resuscitation. Agencies and municipalities who pay for the supply are now feeling the financial burn, some over the six digit per year mark. This has prompted some officials to advocate for a “three strike” policy and try to impose that on our first responders. Basically after someones third time of being resuscitated with Narcan they would limit the provider in giving any more. While this logic makes sense in a punitive fashion to the typical old angry grandpa, it is incredibly unethical from a medial and legal standpoint. It’s a lot closer to manslaughter than trying to prove a ill-conceived theory. The reigning principle in medicine is “do no harm” not “well because I think this person is a scumbag they deserve to die”. This is a good example on the lack of education or working knowledge exercised by our officials. It simply isn’t going to go anywhere and I highly doubt that even through some odd stroke of bad luck becomes an acceptable practice will have any effect on the use or distribution of opiates. It’s another fool-hearted effort of making it seem like they are trying to address the problem while taking a stand against all that medicine stands for and basic human decency.
Addicts need to be in recovery or at very least have the proper access to those resources and dealers and suppliers need to be in prison. Any variation of this will likely result in failure. Rarely is it ever the case where someone picks up a substance on a whim and starts using. As discussed earlier there are normally reasons why people decide to use substances; weather trying to manage a problem themselves (self-medicating) or out of circumstance. The people who supply these drugs are not dumb either. They know who to pick potential “clients” and how to run a business model that works to their benefit. They are predators. It is rarely coincidence that people go back to the same life they may have just gotten out of without some help. Harassment or threats from former dealers, opportunistic preying, and a readily available supply are all factors. The “customer” needs to be redirected (recovery) and the business (dealing and supplying) needs to be shut down whenever possible. The cycle needs to be broken somewhere in order to effectively manage this problem. Issues with our current justice system are a conversation for another day. We seem to have a well-established system of predators and victims that shows no sign of slowing in the near future. I hear often about how the hands of law enforcement can be tied in dealing with this. It’s time to find a new way to handle it - and aggressively.
Recovery resources can also be very difficult to get ahold of. This is particularly true of people on government funded insurance plans or are underinsured with little financial means. I worked with someone a while back who was looking to get into a detox program to start their journey. All of the ones in Connecticut had a wait list of at least a week and out of state programs that had space didn’t participate in their program. Government run health plans also rarely come with out of state benefits as well making it financially impossible. It was a real mess, and more often than not acts as a deterrent for those seeking help. It has been my experience that when someone reaches out, you typically have less than 24 hours to get things going before they change their mind or die waiting. It needs to be addressed that for situations where initial recovery need to be started that they can reasonably access it. Despite calls and pleading with the HUSKY office, they were able to offer nothing of help. This individual ended up having several interactions with various public services, visits to the ED, an admission to the hospital, and several other things that could have most likely been avoided if they had the proper access to care. They are now doing well, but the road to being well again was far more difficult to access than it should have been. It is a disservice to everyone in these situations and contributes to expenses that likely could have even avoided in the first place. And they aren’t the only one I’ve encountered this issue with either. If you don’t believe me, go to a local AA or NA meeting and gently ask around if anyone would be willing to share their experiences. This is a multi-layered problem.
We need effective, driven, and evidence-based methods for dealing with this. A few new and creative ideas couldn’t hurt either. Until those who create policy actively listen to those who have been down this road, change will likely be slow or nonexistent. Empty policies and political rhetoric are going to get us nowhere. This will always continue to plague us, but there are things we can do to make ourselves and our communities better - we just have to push for it.
Keep this in mind the next time you deal with someone with an addiction problem. Their life is very likely not full of rainbows and unicorns pooping candy - there is likely a sad and unfortunate set of circumstances behind it.
I haven’t provided an update or insight to the organization in a while, so I’m going to take the time to do it now. I do my best to keep everyone up to speed, but sometimes time gets away. I thank all of our followers a dedicated supporters out there that have been on our side and support our cause. This is a difficult space to navigate sometimes and we greatly appreciate all the support we get. It has been common that during our pursuit of advocating for wellness, the majority of support comes from the people who do the actual work; not from the administration and so far certainly not from regulatory agencies or other forms of oversight. I sincerely hope that changes in the future, but that push is going to have to continue for now. Topics like mental health, addiction, and wellness are all important subjects that those in positions of power are quick to advocate for because it sounds good, but when it comes to the practice or accountability (or often lack of) the subject seems to fizzle out. There are many reasons for this, but that is an entirely different conversation.
We are a fully accredited and recognized 501 (c) (3) nonprofit organization. We have completed our first full year as such and all the appropriate filings have been made. It has been an interesting experience going through all of this. Forming this organization properly required a substantial personal investment as well as the initial funding support from our followers. We intend to keep the promise of being there for you when things are going well and in times when it’s not so good. We are expanding our services and providers and will be updating that accordingly.
It’s no secret that there are some shady nonprofits in the world. When I was building this organization, I took a fair amount of time to look at other organizations - both successful and failed for whatever reason. As I was examining some of these organizations it became a common theme that while they had a fair amount of revenue and put on a great public relations appearance, they actually contributed very little to their cause. They had an extensive payroll, unusually high expenditures (I found one small nonprofit that spent $14,000 on chairs for their conference room) or had a lot of “seminars” and “business conferences”. My personal favorite was something labeled “network development” for an absolutely obscene amount of money. I find that bothersome. I just cannot support that type of blatant mismanagement of funds. I know there are some legitimate conference and travel variety events out there, but there should be a point where whoever is in charge says “enough is enough” and limits how the organization spends. There are organizations out there collect millions of dollars a year, but only contribute a very small portion to their intention of which they were formed. My personal favorite is one that paid $12 million for a series of commercials, paid their executive board several million dollars each, and ultimately ended up giving $8,000 to the actual cause. It doesn’t make any sense to me, and it is essentially a legal scam. I will not name them, but feel free to poke around the internet if you don’t believe me. We also do not indulge in such activities like spending money on food for “business meetings”, useless trinkets, or anything else that is essentially a waste of money. As much as I wouldn’t mind having gold dusted lobster tails during a business meeting, I don’t find that an appropriate use of funds. When you operate a nonprofit company, that should imply that you are well-committed to doing the max with what you have and not treating it like your very own source of tax-free extravagance. I’m not talking about legitimately hiring staff or handling business expenses, it’s about abuse masquerading as charity.
We differ from most other organizations in this field by one major concept: raising awareness versus action. We are an action organization first and advocate for awareness secondly. I don’t mean that to minimize some of our fellow awareness organizations who do an awesome job, it’s just that we do things differently from what you might be used to. If you contact us with an issue, we direct you to the proper resource and provide follow-up. We do not do a Google search or read from a Wikipedia article based on what you having going on. While we do advertise, it is directly to our target audience with the intent to push the information that we are out there and willing to help. You do not need to purchase a membership or create any accounts. You contact us, we help you. It’s that direct. If we don’t have what you need, we will do everything we can to get it for you or point you to where you can. We handled a request for help several months back with an individual with a very specific and rare issue. It was not something that we had dealt with before, but through our network we were able to get them definitive care. Not many organizations can make this claim, and we are proud that we can. Unique or unusual situations do come up from time to time and thats ok - we are just glad you finally reached out. There’s no judgment, we aren’t going to be calling people and laughing about it or divulging any information to anyone without your permission, we just get you to help. Unless a set of circumstances arises where it is absolutely necessary or otherwise mandated by law, we don’t tell anyone anything except the provider we refer you to. Even then, it’s typically only the basics (circumstances depending) we as the organization gather from you. We try to leave as much as possible between you and the provider. Besides, none of us are in any position to judge you anyways.
Currently this organization does not have a very large monetary fund, and that is ok. The mission is what is important to us. Having some money is obviously important for basic operations, but we have exceptionally little overhead as was built into how we do things. I designed this organization to run on “zero dollars” and anything over that is a bonus. No one gets paid here; no money exchanges hands with our providers, you are never expected to pay for anything we do for you (unless it’s a situation where it’s actually necessary or voluntary for whatever reason). Most of our expenses consist of internet services like our website and email system, accounting software, printing of educational information, and posting about our offerings including the occasional mailings. As you may have seen last year with our survey, we did invest some money in that because it was worth the expense. The data collected was very useful and we plan on doing another one later this year. Finances for services (providers) are between you and the provider and your insurance company. We will do our best to mediate and advocate for you should you be in a financial hardship, but every case is taken individually. If you need something and can’t afford it, we will do what we can for you. We can be pretty creative.
One goal for this year is to add funding to the William W. White Memorial Fund. Billy was a personal friend and fellow Paramedic who passed away unexpectedly a little over a year ago. He was an avid supporter of our mission and a very caring and loving person. This fund is set aside in the eventual hopes of being able to provide support to first responders and families who are experiencing financial hardship as the result of pursuing wellness. A majority of employers and disability insurance plans have zero interest or ability to provide support for someone who has elected to go through the process of wellness - in this case we are specifically talking about rehabilitation and recovery services such as inpatient stays. Even for those who have supplemental disability insurance will receive no coverage if you opt to go out of work for the purpose of recovery. It’s an awful mess and one I unfortunately have first-hand experience with. While my employer was as supportive as possible (thankfully), any of the insurance and disability safety nets that I had been paying into for years failed me. Even with average medical insurance coverage, the cost of everything was enormous and weighed significantly on me as I was going through the process. It’s a damn shame, but that shouldn’t be enough to discourage you. Lack of financial support, or often just the threat of, is often a deterrence for people to seek help. We see this frequently. An individual may understand and acknowledge they require help, but will avoid it specifically on the basis of not being able to afford the time off from work and the expenses associated that are not covered by insurance. What we have done in some instances is advocated on behalf of the individual with the treatment center or provider and came up with a mutually agreeable payment plan as well as directed them to private funding that may be available to people in need. These things are generally not advertised, but are available in the right situations and if you ask in the right way. Having us behind you for that helps a lot. The sad reality for many people is that their issues only get worse with delay, no matter what the reason for it is. The situations do not get better without some variety of intervention or action. This has resulted in incidents of suicide, self harm, and substance abuse or misuse as well as hospitalizations that could have been prevented. At this point they may be mentally, physically, and financially broken which also hinders and complicates the process of recovery and wellness. If we can break that link and get people what they need sooner, it typically provides a much more desirable outcome. Contrary to popular belief, not everyone needs to hit “rock bottom” in order to get well. We subscribe to the method of thought that early, direct, aggressive, honest, and effective methods of intervention and treatment is far more beneficial to everyone rather than waiting for that person to fall so hard that getting back up is almost insurmountable. When you are laying at the bottom of the well you just fell down, looking up at the light makes it feel impossible you’ll ever get up there. If we can catch you before you fall down that well, it’s far better. As I’ve shared my story in the past, I can tell you that being at the bottom of that well feels pretty hopeless. It is terrible, lonely, and the uncertainty is terrifying. It is also full of regret, and that can follow you for a very long time. The cycle of dysfunction or unrest needs to be broken early. It is often overlooked that for a majority of people, recovery and wellness is something that effects the entire family - and they often require support to either understand the process or be able to heal or recover themselves. The overall goal of this fund is to be able to provide that finical support for these people. We want you to choose to be well and not be distracted by finances during that process. I understand that sounds like quite a challenge, but I can tell you that from past fundraisers that we have done for families in bad situations that this is a necessary challenge and something that needs to be done. As it was very bluntly put to me by one of my counselors “Money comes and goes, but you can’t pay your bills or take care of your loved ones if you are dead or passed out under a bridge every day”.
These issues quite literally can rip families apart and destroy you. It is pure hell for everyone involved. It is also no secret that incidences of substance abuse, mental health problems, and suicide are significantly higher in public servants than other professions. Depending on what literature you are reading, it is determined at between 6 to 12 times higher than the average population. The numbers aren’t very great because the data is very poorly collected, if at all. It is also a subject that is rarely, if ever, talked about. At the beginning of the year, we launched an initiative to try and establish a database containing a reporting structure for tracking first responder suicides, suicide attempts, and assaults. One would think that something like this was tracked by someone at some state or regulatory agency, right? Well, not in Connecticut. There is no mandate, statute, directive, or any other discussion on even reporting or tracking assaults on first responders and even far less suicidality or incidents of mental health or substance abuse issues that can be correlated with this line of work. Seems strange, doesn’t it? Well from the standpoint of administrators it makes perfect sense. If you do not have any data on a subject that would directly imply that there is a problem somewhere in the framework of your industry that could potentially cost money and require additional accountability, the general thought process is to completely avoid it.
Last year, a firefighter put his dress uniform on and stood in front of a train. An EMT shot herself in the chest after a recent traumatic situation she handled that caused her distress. A police officer tried to shoot himself in the head while his family was asleep but failed because he was too intoxicated to use the weapon (thankfully).
This is only a small portion of what has been going on for many years, but those in authority continue to ignore these situations. These are not isolated events either - they are just largely ignored and swept away.
But there are definitely no problems within the public service fields… because the lack of data says so….
So if you approached a state entity, oh lets say the Department of Public Health, Office of Emergency Medical Services, and informed them that you have designed a reporting structure for tracking these incidents so help could be distributed where needed that they would express interest. Let’s even throw in there that no cost was going to be deferred over it, the tracking would be private and secure, and the statistical information would be shared to those who can use it for good. We would be open to a partnership and guarantee oversight of the data to a designated person. The only thing needed would be support from the agency. The actual answer was no answer at all. No returned emails or phone calls. Not even the decency to say they weren’t interested or the typical maze of words saying they aren’t in a position to do anything. Not a word or acknowledgement after six months of emails and several calls.
Frankly, I could care less who ends up tracking this data. It just needs to be done, it needs to be published, and needs to be a cornerstone in directing resources to those who need it.
I see nothing, I hear nothing, I say nothing. That is how the people at the top are looking at these issues.
There certainly are some exceptions, but those are in organizations who have an employee or member backed initiative. Many of them do very well and it’s because they’ve lived through the hardship and tragedy of losing someone in these situations. But these are the exceptions, not the rules.
Some agencies have begun to embrace the concept of peer groups and making services known or more available. They’ve acknowledged, at least internally, that simply ignoring the situation isn’t making the outcomes any better. It’s frankly just filling the cemetery.
If you have an idea or thought on how we can push this as a priority and necessity, I’d like to hear from you.
To a bit of a brighter note, we are planning an outing for early fall. The people at North Parish Artifact Recovery have been working on securing equipment and land for a stress reduction exercise. We will be metal detecting, so it should be an interesting event. As we finalize the event we will post appropriately. You will need to register and we will have a certain amount of equipment available.
We will also be making an appearance at the Connecticut Firefighter’s Convention this year. It is located in Norwich and is taking place in September. More details will come as things get closer.
We continue our monthly meetings in Norwich and all first responders and veterans are welcome to attend. Family is also welcome. Details are posted on our website and to our Facebook page if you are interested. No RSVP necessary, just show up.
If you are interested in donating to the William White Fund that was discussed, you may access it here. As you have probably figured, all donations are tax-deductible.
Thank you everyone! - Dennis@uniformedhelp.org
Very recently I was asked by a colleague to give a more elaborate version of the story I shared with you all several months ago for a collection that has some support for publishing. Over the past few days I’ve had a lot of thoughts about it and probably not for the reasons that you are thinking. I can’t help but think that by being more elaborate on my own person situation that I’d be selling industry secrets. But the reality is that these are no longer secrets, but rather issues that need to be addressed by our administrators and leaders before we reach an even higher level of crisis than we are already in.
We as public servants see the worst things that humanity has to offer; the full spectrum from death, dying, and the chronically ill to extremes of rape and murder. We are called to bear witness to some of the (if not the) most traumatic events in people’s lives and are often expected to do the impossible and find some resolve in situations where there is often no easy answer. Bad things happen to good people every day, and we often (either consciously or unconsciously) carry it with us for the rest of our careers. I cannot help but think that by being more elaborate in my own story, I will expose an industry that is woefully incapable of making significant change in a time when it would benefit those in the field at at time when it is needed most.
As of the writing of this article we have received a total of 19 requests for help - everything from issues relating to anxiety, PTSD, family issues, and substance abuse. Every one of these people has had one thing in common - they didn’t believe that their agency had the ability to provide them the help they were seeking. These people were drawn from a variety of public service backgrounds but a majority of them have been from EMS. So what does that say about the industry?
In dealing with these individuals it has been made clear to me that EMS has to make some significant changes in the way it takes care of their employees. Most have stated that no matter how well-intentioned their agency was, they were in no way equipped to provide proper resources for what they needed and that is why they came to us. The standard response they had received was to contact their employers EAP program and go from there. The unfortunate reality of a majority of EAP programs out there is that they provide a small amount of resources that are only available for a limited amount of time. It is basically a patch for problems that require additional, on-going care and typically at some point specialized care. After the EAP resources run out, these people are often left to their own devices and often become lost in a broken system. This not only compounds the problems at hand but is of no actual service to those seeking help.
I can speak from my own personal experience that EMS doesn’t like to talk about things like mental health and especially addiction. While some of the people in charge may actually care about an issue that you are experiencing, they are often untrained or undertrained to handle situations like this. Some agencies are making headway in being more equipped to take on these problems, but it is largely still a work in progress. What we need is a significant culture change - and change like that has to start from the top of the administration. It is no secret that people in EMS do not talk about things that bother them. There are many reasons why this occurs but most of it is a cultural thing. From our first day of training we are taught to keep our emotions aside in order to care for our patients - and that is essentially all the training we get in dealing with emotions. We are also taught that this strange event that happens from time to time called CISD (Critical Incident Stress Debriefing) exists but more often than not, it is sold as a joke and something of no real value. My own personal experiences with CISD has been mixed at best. Often the person running these events have a significant lack of understanding of what occurs in the public service sector and how we typically deal with - or do not deal with these critical events. Thankfully in recent years, this has begun to change. Newer models of the debriefings exist and are starting to be implemented. But being as young as EMS is to the public service industry we often listen to those who have many years of experience, and when they have had negative experiences with these sessions they are not afraid to tell you all about them. This is where our administrators need to step in to educate and inform the newer generation that things are beginning to change and these events may actually be of use to them now. CISD may not be helpful to some individuals as was indicated by our survey, but I don’t think we should undersell these anymore. They should be just one resource in a toolbox that an employer has to help those affected by adverse events.
As is common within our culture, drinking problems away has always been popular. Alcohol is cheap, accessible, and oddly gives you exactly what you are looking for - even though it is temporary. That is what makes it so dangerous. Binge drinking has been - and continues to be - an acceptable coping mechanism for the stressors of the job. Now more than ever I have seen a dramatic increase in the number of people who have received DUI’s or other negative punitive actions resulting directly from their intake of alcohol. I firmly believe that this is directly due to a lack of education starting from initial training all the way up to employment. Any agency can have the most solid drug and alcohol policies but in the end that does those who do the work absolutely no good. It is only good for protecting the agency. There has to be a culture and leadership change. Information needs to be made available and alternatives to seeking substance over actual means of dealing with stress and trauma need to be made readily available without the threat of recourse or discord within the person’s employee record. Substance abuse and trauma have a very clear and distinguished pattern of correlation where it cannot be ignored any longer. We have to be willing to take care of each other before we implode.
As I've said, I feel like I’m revealing some dirty secrets on the industry, but the reality is that anyone who has been in public service for a good amount of time already knows this or is already engaged in this type of behavior. They probably know it, but don’t know where to turn before they reach the point of self-destruction. I know I didn’t, and that took it’s toll on me. That is why we are here.
We have established a first of it’s kind network for first responders and veterans where we can usher people directly to help. From the world-class care provided at the Brattleboro Retreat to local therapists, drug and alcohol specialists, trauma specialists, medication assistance, and even sleep medicine. We can help you to where you should be in life, but we can’t force people to seek help, and unfortunately a majority of cases people have already begun to destroy their personal and professional lives before they realize that they need help. That needs to change, and begin to change quickly, but I believe that the people who do the job have to be the driving force behind this change. If a majority is willing to finally begin to address these issues, our leaders will have to initiate the change that is so much needed to keep our communities well.
Just like anything in life, we as public servants come from all walks of life - all social backgrounds, economic areas, and financial situations. Some of us are “lifers” in the industry and others are using their time in public service as a stepping stone to something else. No matter what you reason for working in the public service sector, we all have one very big and potentially dangerous issue: overtime work.
For many, overtime work is the difference between having extras in the household and being able to meet the minimal expenditures in life. And lets be real - EMS is probably at the bottom-tier for pay making it much more likely that you will come down with the overtime bug. I remember being young in my career working 80 or more hours a week and that not being uncommon. Still many more add to their responsibilities by holding a volunteer position or adding a second or third job into the mix. It is not uncommon for us to work an excessive amount of hours per week and find it completely normal.
Overtime can come about in various ways. From call-outs to needing to fill extra coverage due to call volume all the way to issues with hiring and employee retention. This presents an opportunity to you to bring extra money into your household - and rarely do we think twice about jumping on the opportunity. Why should you be cautious?
Here is why: working an extended shift or extended hours will begin to take its toll on you mentally, physically, and will eventually begin to cause stress in your relationships. If you haven’t been there yet, I assure you that at some point in your career you will be. Working extra time presents another challenge: increased exposure to trauma and stress in addition to what you generally expect from your normal work cycle. You can also be missing out on important things like quality sleep and relaxation time which are essential for managing stress. People who work the most tend to be the worst at managing and coping with stressors in life. This causes a cumulative effect which can be difficult to dig yourself out of. This is also especially true for those who work rotating schedules. The temptation of overtime often overrides your general instinct to say “no” because who doesn’t love extra cash? Being well takes effort and most of all time. How can you reasonably expect yourself to be happy, healthy, and steady when you are not taking the time to take care of yourself? The answer is that you can’t. And that is why it is important to take into account the amount of hours you work and the amount of time you take to yourself and your family.
Balance is everything in life and if you find yourself suddenly on the outside of what is typically normal for you then there is clearly a problem. Overworking yourself has a direct impact on how you manage stress and keep your personal life together. Finding a balance to keep all three where you need them to be can be challenging; especially if you are trying to put yourself through school or support a family on a moderately low wage. Pay and public service is a special subject to me, but I won’t get into that right now.
You should take an hour or so every few weeks and plan out how you plan on spending time for the next few weeks. Plan your normal work schedule, plan time to yourself and family, plan time to engage in a hobby or some healthy form of coping, trying some exercise, and then plan on picking up extra time at work. If you aren’t taking care of yourself and your own personal needs, you aren’t doing yourself or the public any favors. In fact, you are only headed to the stage of “burn out” much faster than you think. Many people may be in denial that they have reached that stage, but it is always obvious to your coworkers. It has been my experience that management staff tend not to pay attention to these issues for one simple reason: they need stuff done, and when it’s getting done, they are doing their job. It is not their responsibility to ensure that you are taking proper time to take care of yourself, it is your job. You must do it; no on else can do it for you.
Be mindful of your time, make a plan, and stick to it. Limit your extra hours to the extent where you can manage your life and still remain healthy in the process. Your job will still be there when you come back, we promise. You should be the most important thing you have to manage - because without you, nothing will be worth the sacrifice.
I encouraged my wife to talk about my situation. I've been very open about what happened to me because I want it to be a pathway for others who are suffering; both partners in different ways. All the lies, the deceit, the broken promises - it's a tough life to live and there is no reason to suffer anymore. There is help out there, and we can assist you in becoming well again. This is what she wrote for me:
I had finally gotten home and I walked into the kitchen when I had found it. It was a simple piece of junk mail with some illegible blue scribble on it but one phrase stood out. “Love you always” those words were like a hot poker right in the heart. Then it finally happened, then I sunk to the floor and I cried. For the prior two years I’d gone through hell. My husband had been struggling with drinking and PTSD. I had done everything in my power to help him but nothing ever seemed to work. Love was just not enough to overcome the demons that had taken over.
When I think back I know there were lots of warning signs and I kick myself for not pushing harder. My family wasn’t a drinking family, but his family was. So often times when he would drink I’d tell myself I was just a drinking prude and try to drop it. I started to notice though that the drinking didn’t seem to have a limit. He would drink whatever was available. He never just had 1 or 2 drinks he had half a bottle or a 6 pack. The drinking started becoming more frequent and I would often times get angry. It started to affect my life because I couldn’t count on him. I’d come home from work and find him drunk, or his friends would come over to help paint our new house and there would be bottles everywhere and no work done. Most of it I just figured was young age and a phase that he would grow out of. I never realized that the drinking was a bandaid to a deep dark wound.
We occasionally would discuss his job but he never really seemed to be bothered by it. He just kind of brushed off the bad calls. I’d occasionally probe him about something that was on the news and he would always just shrug and say its part of the job. When I first met him in high school the fire department was his life. Most of our conversations always were about the fire department or the police reports. After high school we had lost touch for a bit but when we reconnected he was a paramedic. I was not surprised, it seemed like he was always destined for a first responder career. I always wondered how he did it, how he sat with someone he knew was breathing their last breath. How he listened to the screams of family members as he was helping their loved ones. We would go out with his co workers though and they would all laugh and make jokes about the gross things they saw. They were like magicians who just turned off their feelings whenever things got tough.
In 2011 I had been reassigned for my job. One of my co-workers and I were discussing how he had chosen our careers. He told about his experience as a paramedic and how he had to leave his job because he couldn’t take it anymore. He told me about seeing people’s faces when he would go to sleep. Something about that conversation hit me hard. I remember it was like it all clicked and I realized that my husband probably was experiencing career burn out. I wanted to have a baby, so I decided to have a come to the table talk. We discussed his drinking and we discussed careers after EMS. He did admit he was drinking too much and agreed to stop so we could start a family. He also said that he didn’t think he had burn out and when he got to that point he would letme know.
Our baby was born and we struggled through the first few weeks like most parents do. It’s an adjustment that no books or classes can prepare you for. I decided to take some time off of work and things seemed to be going really well for us. The one thing no one ever told us about was how emotional parenting can be. Suddenly all the stories on the news about babies dying in car accidents or to neglectful parents hit home HARD. I often wondered if that’s what broke him, when he started to feel every single call. After about 6 months I went back to work. Shortly after I had gone back to work my husband had an episode. I came home from work and after our son had gone to bed he started drinking. He was vile, suicidal, and so I decided to let him sleep it off. I slept on the floor the night in a ball, I didn’t know what I was going to do. He was very apologetic and we agreed he needed to go to a therapist. He went and this was when he was first diagnosed with PTSD. He said he felt a lot better, and I assumed that this is when it was going to stop.
In the Summer of 2014 he started to seem to be failing apart again. I just was very suspicious of everything he was doing. He would just send me strange text messages, or the conversations seemed odd. I’d come home from work and I’d smell booze coming out of his pores. He would tell me I was just imagining it. Then one night the worst happened. I was at work and I called home because I hadn't heard from him in a few hours. When he answered finally my worst fears were confirmed. He said some nasty things to me and eventually sent me a text message with a gun in his mouth. I had to call the police. I spent the next few hours in an abandoned parking lot with the police waiting to hear if he was ok, if our baby was ok. It was a nightmare. I knew he was going to be furious, but I couldn’t not react. When I called the hospital to find out what was going to happen the clinician was very rude with me. She demanded my insurance card, let me know that I couldn’t have any information because my husband declined consent and that he would be unavailable until visiting hours the next day at 7pm. I didn’t sleep at all that night, I just sat and wondered how we got to that point. Were we even married anymore? It felt like the worst break up of my life. At the same time I felt so relieved because the giant elephant was finally out of the room. I had never told anyone about my husband’s drinking because I didn’t want people to not like him or to judge him. I was afraid to let my parents down, to disappoint our friends, and most of all to raise our child in a broken home. I called the nurses station that day and they let me know my husband didn’t want to talk to me still. I just sat and waited, wondering. Eventually we had a long talk. We decided he needed to go into a program and get real help.
He went to a good local IOP program and he made good progress. I remember he would come home and show me what he had worked on. I cried a lot because there was a lot of things I didn’t know. I had been so engrossed in the baby that I had failed to see the big red flags waving in my face. He seemed to be on a better path and I could only see good things to come. After a few months my hopes and dreams were crushed. He was working and I was cleaning up, I went into a cabinet and found a bottle. I was devastated. I didn’t understand why or how? I confronted him and made him leave for a few days. I didn’t know what to do at this point because I had such mixed feelings. There were moments where I loved him so much I couldn’t imagine living a day without him, but I certainly couldn’t spend the next year continuing to suffer. The next day I was sitting on a hard bench in a musty old lawyers office. I had googled names and his came up. I decided it wouldn’t hurt to pay a visit. The lawyer as unbelievably nice, and as I sat there crying he looked at me and he said “You know I can’t dispense love advice, but just remember that divorce is permanent. If you have any doubts then you shouldn’t be here yet. When you decide you’re ready then you know how to find me.” After I left there I met up with my husbandhe said it was an old bottle and I had over reacted. I knew that wasn’t true, but I couldn’t prove otherwise either. Thankfully, he found a mentor, and my family was really supportive so he was able to get back on track. Truthfully, he became a stranger that I couldn’t trust. I had to plan everything 3 times. The way it was supposed to go, the way it was going to go and an emergency plan incase I caught him drinking. He thought he was good at hiding things but I always seemed to catch him. He would have some amazing story to go with it.
On August 5th, 2015, about 8 hours before I discovered the junk mail, I was at work and I got a text message from my husband who was home alone. The wording of it made me suspicious that he was drinking. I was supposed to go to the dentist after work and I was having second thoughts. Thankfully a little while later my son’s daycare teacher called to let me know she thought he wasn’t feeling well. On my way to the daycare I decided to stop at our house to confront my husband. As soon as I walked in the door I looked at him and we both knew. There wasn’t much of any exchange, I just said “why? why would you do this? I see you’ve made your choice”. I left, it was sunny that day so I wore my sunglasses. No one at daycare had any idea that something was wrong. I brought our baby to my parents house to wait out “the storm”. I told my dad my marriage was over, I think that I couldn’t take it anymore. After a few hours I decided to leave and head back. I was going to visit my grandmother but I hadn’t heard from my husband. Usually he would apologize after a while, or say something. Instead it was silence. When I got to the house, I started up the stairs. I heard him breathing and I knew what I was about to find. He was dying in our bed, his face was purple. I quickly grabbed the baby and put the tv on downstairs and went back. I just remember going through the motions, I didn’t panic, I just started dialing phone numbers, first a friend to come by, then 911 then my parents. The time was a blur, it all went by so fast. I walked into the emergency room and it felt like everyone was staring at me. I figured everyone was wondering why I wasn’t crying, but there was just no tears. I was so angry at him and at myself for saying what I said. I felt guilty because I knew I had probably been the reason why he did this. I loved him so so much, but I was so tired of waiting for the storm to pass. He was laying in a bed on a ventilator because his own lungs weren’t working. His face had a sheen to it, and the doctor stood there letting me know that he was probably going to die or be severely brain damaged. He looked just the way he would look in a casket, I thought, and maybe this was the only way he was going to find peace. So I left, not knowing if the morning was going to come and I was going to be a widow.
The next few months certainly weren’t easy, thankfully my husband survived and went to a program designed specifically for first responders in Vermont called the Uniformed Services Program. The program helped change the way he viewed things and gave him the ability to cope and process all the emotions that he had been suppressing for so many years. For me being able to glue alcoholism and PTSD together was a huge part of me understanding and forgiving. No matter how much I loved him and tried to help it was never going to fix what was broken inside him unless he decided to fix it. The past two years were some of the loneliest times because I lost a lot of friends/ kept myself secluded. I know a lot of people do not understand why I would’ve stayed in that situation. My husband is a good man who has been emotionally broken. In my mind I see him headed toward a scene dragging his heart behind him like a ball and chain. If he never grew up with healthy coping mechanisms, then it is not surprising that that’s the first thing he turned to. I want our child to grow up knowing that we aren’t all cookie cutter perfect and that the “better or worse” part of marriage can really hold true. The most important thing is giving up expectations of situations and just living in the moment. Stay strong, help is out there.
For our first year in operation, and as a plan we will conduct annually, we released a survey to public service professionals on the topic of mental health and addiction. Questions on the survey included things about employers and personal information and experiences that people have had. The results were not exactly what we had expected. We identified some holes in process of seeking help from your employer or agency and we also got some good feedback on what we should be doing as an organization. As with anything on the internet, some trolls made an appearance. We were able to weed out these responses and keep it to a solid information base. Overall, 129 viable responses were scored which exceeded our goal for our first survey by 29. Please take special note to questions that have answers like “I should be, but I am not” or “I’m not sure”. A majority of the people surveyed are from EMS which in relations to numbers, makes this an effective EMS related survey as well. Please note that we did not include all of the comments to employers/agencies as some were duplicates. We have also redacted or generalized portions of the responses as they were too specific to remain anonymous. Here are the results:
1: How did you hear about this survey?
- FaceBook: 96.1%
- Email: 0%
- Word of mouth: 2.3%
- Other: 1.6%
2: What best describes the industry you work in?
- Fire Department: 33.3%
- EMS: 58.9%
- Law Enforcement: 3.1%
- Dispatch: 3.1%
- Disaster Services: 1.6%
3: Does your agency offer an Employee Assistance Program (EAP)?
- Yes: 76%
- No: 11.6%
- I’m not sure: 12.4%
4: Do you feel that your agency is capable (or competent) of responding to a mental health or addiction situation?
- Yes: 35.7%
- No: 42.6%
- I’m not sure: 21.7%
5: Have you ever utilized your employer or it’s EAP services for a mental health or addiction situation?
- Yes: 17.1%
- I have not had this experience: 59.7%
- I chose other means of seeking help: 23.3%
6: Have you ever suffered a mental health or addiction crisis?
- Yes: 52.7%
- No: 41.9%
- Prefer not to answer: 5.4%
7: Have you ever attended a Critical Incident Stress Debriefing (CISD) or similar program stemming from an event in your area?
- Yes: 68.2%
- No: 27.9%
- These are not offered in my area: 3.1%
- I am unable to attend these: 0.8%
8: Would you attend a CISD or similar program if it were offered to you?
- Yes: 82.2%
- No, these program do not appeal to me: 17.8%
9: Are you currently under the care of a Physician or medical provider for mental health purposes?
- Yes: 29.5%
- No: 57.4%
- I should be, but I am not: 11.6%
- This does not appeal to me: 1.6%
10: Are you currently under the care of a Physician or medical provider for a substance abuse/misuse issue:
- Yes: 1.6%
- No: 93%
- I should be, but I am not: 4.7%
- This does not appeal to me: 0.8%
11: Have you ever thought about suicide?
- Yes: 48.1%
- No: 48.1%
- Prefer not to answer: 3.9%
12: Have you ever attempted suicide?
- Yes: 8.5%
- No: 89.1%
- Prefer not to answer: 2.3%
13: Do you take, or should you be taking medication for a mental health or addiction problem?
- Yes: 27.1%
- No: 66.7%
- I should be, but I am not: 7%
14: Do you feel that your agency or employer has adequate resources to help it’s employees or members?
- Yes: 30.2%
- No: 44.2%
- I’m not sure: 25.6%
Notable comments from suggestions to employers on mental health and addiction:
- Start a peer group.
- Talk about it more.
- More peer support and less formal, management driven support.
- The Chief of my department is a strong supporter of peer support and wellness in the department. With that being said the peer support team is not funded in the budget. We need to start funding behavioral health.
- Make help feel less intimidating, make it easier for people to reach out as asking for help is the hardest step.
- Reach out to employees who are obviously in need.
- Spread the word about available programs more than they do. It’s just a word of mouth thing right now.
- Make services available without the stigma that information will be utilized against the employee.
- Develop our team within and use outside resources. They are not committed to mental health workers. Work them to the bone for us. Don't restrict things like PTO and sick time.
- Provide better insurance to cover mental health.
- I think that my organization is doing a great job on breaking down the stigma of asking for help or admitting that you experienced something traumatic. However, sometimes their approach to helping feels blanketed and not targeted for individuals.
- When they think someone has an issue, have a department meeting with the help of a Psychiatrist or counselor.
- Provide EMS specific treatment.
- Work toward and supervisor to crew relationship where a supervisor can talk about a tough day or mental health issue with a crew member instead of being shut in their office or fly car all the time. I’ve only had one I could talk to and he left.
- Offer continuous/ongoing groups.
- The agency acts as if every should be pillars of steel. They must break this attitude down and make sure that an employee in need should be the number one priority. The only time EAP is suggested is when you get into trouble or do something wrong.
- I feel my agency goes above and beyond to support those in need, but they need to be proactive with monitoring at-risk members.
- Easier and fast access to mental health help.
- Have help numbers available.
- Better resources and job-specific providers that understand the job and schedule.
- Pay more attention to it’s members and be there for them rather than making them jump through hoops.
- Stop attaching a stigma to people who seek help.
- More available time off; a boss who cares.
- It seems like the only options are disability when PTSD is a diagnosis and is clearly documented by a Physician.
- The higher-up staff need to work in the field to be able to understand what psychological stressors the employees are facing. It seems all too common that management forgets where they came from.
- I would suggest posting brochures or other types of papers with information on where people can go for help with their needs, both local and out of town.
- Be aware of employees circumstances. Offer CISD to employees affected and let them decide if they want to participate.
- While I was Deputy Chief, I was able to get our town to extend the EAP to cover department members. The current Chief has basically squashed my efforts due to him being stuck 30 decades ago. I would like to see a state law requiring all departments to implement a plan.
- It’s a constant battle against the stigma; they could be more open and less judgmental.
- Be more supportive when an incident occurs.
- Keep trying and adding programs. Knowing that they are at least trying to have programs helps.
- Add confidential one-on-ones and the ability to become part of the healing process for others.
- It’s a serious issue that being seen more today and should be focused on a lot more.
- Managers need to realize that some of the strongest people shouldn’t be taken for granted.
- Get involved more. Posting a flyer is not enough.
- There’s always a risk of losing your job.
- With past suicides, it’s time to address the lack of resources.
- Find a way to offer mental health or crisis debriefing/aid, or be able to send the member in the right direction for these resources.
- I wish they actually cared about us as a people, not just “meat in a seat”.
- Any employer should be 110% behind ay of their employees that seek any services requiring help and be committed to them.
- Be more observant.
- Train on EAP options more; make it understood as an option.
- Treat your employees like people, not numbers. Try actually caring about them and not just shoving a piece of paper in their face.
- Don’t turn a blind eye to it, and not assume the employee is faking it to get time off from work, and that a mental health issue is fixable so the person can come back to work once the issue has been addressed.
One of my favorite quotes is from Mother Theresa: “I know God would only give me as much as He knows I can bear. I just wish he didn’t trust me so much”. I never thought that would become my mantra.
My son is my qualifier. It has been 3 years of hell. Three years of sleepless nights, more tears than I have shed my whole life. Three years of lies, broken promises and manipulation. I hate this disease! It is either upfront, in my face, during a relapse, or lurking in the corner of my mind waiting for the next episode of craziness.
If I had to sum up in one word, my experiences as the mother of an alcoholic, that would would be fear. Fear is trying to rule my world. I am fearful when he doesn’t call and fearful when he does. Is he not calling because he has been drinking? Has he lost his job and is afraid to tell us? When he does call, will it be a 3 AM call from an Emergency Department asking us to come get him as he has sobered up enough to be discharged? Is he coherent? I can tell when he has been drinking. He can’t fool me anymore. Is he calling asking for money? Are we really helping him get through a difficult time, or just enabling him when we give him money? Where is that line drawn? Is he calling asking us to come over to his house? We have done that may times, only to find him passed out on the couch; the house a mess and him not showered, smelling of alcohol. When we wake him will he be belligerent, argumentative, and disrespectful?
I’m afraid of his future. Will he find a successful, fulling job and keep it? Will he find a good relationship with someone special? Will he relapse again? I know relapses are common. I truly feel in my heart that he wants to get better and end this madness. Especially since his involvement with USPC. My biggest fear? That I will have to decide to detach, with love, from his situation, in order to preserve my physical and mental well being. That’s my biggest fear. There is a special bond between mother and child that should never be broken. Sometimes that has to happen.
I am slowly learning to try to get control of all this fear and worry, through Al-Anon and the support of people, like those at USPC, I know I didn’t cause this disease. I can’t control it and I can’t cure it. I can have hope that my son is strong enough to get through this with the support that is available to him.
What I want for him, is sobriety and happiness. What I want for myself, is peace.
Matt Shobert medically retired as Fire Chief on December 30, 2014, after completing nearly 30 years in the Professional Fire Service with four departments, across two states. He also served as Fire Chief for two other jurisdictions during his career. He has a Master’s Degree in Organizational Management, a Bachelor’s Degree in Business Management and an Associate’s Degree in Fire Science. He was also a 2007 graduate of the National Fire Academy’s Executive Fire Officer Program and has five times been accredited as a Chief Fire Officer Designee.
Additionally, he completed the arduous 2.4 mile swim, 112 mile bike ride and 26.2 mile run – at "140.6" Ironman Arizona in Tempe on 11/17/13. This level of fitness would help save his life on July 2, 2014.
Chief Shobert was nearly killed on the morning of July 2, 2014 and has greatly struggled with the troublesome aspects of his physical, mental, emotional and spiritual recovery from the traumatic and nearly fatal accident that lead to his premature exit from the fire service that was his life.
On the morning of July 2, 2014, an Engine Company from MFD and Matt were invited to an urban-interface (heavy brush near a developed area) area in Murrieta, CA. to observe a brush clearing operation, due to the tenuous fire conditions in Southern California this time of the year; where a simple spark could start a conflagration.
He arrived at the clearing operation prior to his Engine Company and a brush-clearing tractor was already clearing brush. He exited his Fire Chief’s vehicle with a Garmin weather device to check temperature, wind speed and humidity.
Of course, he didn’t realize it at the time, but at around 09:00 AM, a fist-sized rock was launched a distance greater than half a football field, by a Bobcat with a commercial mower attachment. The rock struck him on the left jaw, just below the bottom corner of his mouth, ripping off the lower left side of his face and mandible.
He awoke face down in the dirt, unaware of what the hell was happening. The first thing he recalled was having numbness and tingling in his arms/hands. Was he stroking out? Was he having a heart attack? “Why in the hell was I laying face down in the dirt,” he thought?
He tried to get up and couldn’t. It was then that he noticed the profuse bleeding from the area of his face where his lower jaw used to be. He quickly figured out that he was bleeding to death. The Bobcat operator was nowhere in sight. The fire chief was alone and dying. Matt eventually made it to his feet and recalled a spare T-shirt in the back seat of his Tahoe. He stuffed it into the bottom of his face and drove his chief’s vehicle a few hundred yards to a maintenance shop. He held his face together with one hand and picked up his radio’s microphone with the other. In a garbled voice, he told his dispatch center that he thought he’d been shot in the face and needed immediate medical care.
His firefighters and dispatchers saved his life with quick action and critical care, Inland Valley Medical Center further stabilized him, Mercy Air flew the critically injured fire chief to Loma Linda UMC, where a team of surgeons worked for five and a half additional hours saving his life.
His fitness level and intuitive training assisted in his survivability. The doctors said, "98% of the general population would have died in the dirt that day."
He has been through six comprehensive surgeries over the past two years. He suffered a minor TBI and struggles with PTSD.
He has had thoughts of suicide and struggles with his ongoing physical recovery, TBI and PTSD.
Matt’s wife of 26 years – Tami, has helped greatly during his recovery. She has stood stoically beside him, throughout the difficult and comprehensive recovery process.
Additionally, “Butters,” his PTSD Service Dog has been essential to Matt’s survivability, as well.
It is his hope and goal that sharing his story will help bring firefighter suicide, PTSD and stress issues to the forefront. The fire service always preaches physical fitness, but mental health issues are a private and “dirty little secret.”
Below is his personal mantra that actually saved his life:
“Today’s physical, mental and emotional preparedness, determines tomorrow’s performance. Train like your life depends on it – because it does!
The Fire Fighter Behavioral Health Alliance’s (ffbha.org) Director, Jeff Dill, actually pointed Matt in the right direction during the darkest hours of Chief Shobert’s recovery process; suicide had become a viable option for him.
As part of his physical, mental, emotional and spiritual recovery, he plans on competing Ironman AZ 70.3 in October 2016 as part of his “full-circle” recovery process.
-Matt Shobert, Fire Chief (retired)
It becomes commonplace in emergency services to have dark humor. Everyone thinks that this is how we cope with the everyday stresses of the job. This is the culture of emergency services. We look at this as being acceptable, and to a point, it is. When does that dark humor become more than just jokes? This is a common thing that occurs in emergency services.
This can become very confusing and difficult to deal with. We look at this as normalcy, but we all have a point where we may become concerned. The very difficult thing that can happen here is how does one, who has been joking about things as well, intervene with a friend or coworker? You have been joking with them about the same things and now you want to tell them that their jokes have you concerned. This makes you look and feel very hypocritical.
What choices do you have? Ultimatums? Law enforcement? Work superiors? Are these really the best options? By joking along with your friends and peers you have immediately discredited your concerns. At least that is how it feels. Hindsight is always 20/20. You could have not joked with them, but it’s too late now. The truth here is that it does not matter. Yes, we shouldn’t joke about things like suicide and death like we do. We need to stop doing that, but that is not what we are trying to deal with. I have been on both sides of this equation, and I can say that being the one who feels that they need to intervene is much harder than being the one who needs someone to intervene.
First, get over yourself. Stop worrying about what you did or how you acted. This is not about you anymore. This is now about someone that you care about that clearly needs help. Now is the time to step up and be a better person. This becomes a big personal learning experience about your actions of the past, but like I said, deal with that later. So how do we intervene and help someone we care about?
How you are going to approach the situation and intervene is very dynamic. It will change, and it will change very quickly. There is no answer as to how to do this. Many feel that ultimatums are a bad thing. Sometimes they are and sometimes they get things done. Many feel that an ultimatum will push someone over the edge, and maybe it will at times, but other times they are needed. When I first began to show serious signs of PTSD, I ran into my boss on my day off at a hospital. When he asked when I was working next, I told him tomorrow. He looked me in the eye and said, “No you are not.” I told him that I needed to work to “get my mind off of things.” He knew how much my work meant to me and how dedicated I was to my job. He stood strong and told me that I was not coming into work. I disputed this with him and he gave me the option to not go to work, or show up and he would suspend me. I was unbelievable angry at this point, and he knew it.
The next morning, as I was at home and not at work, I was still angry. I stewed about it for most of the morning and then went about some errands. As I was driving I completely broke down. I was angry, sad, scared, nervous, anxious, depressed. My phone then rang. It was my boss. He asked one simple question, “How are you doing today?” He asked me in a normal tone of voice. He asked it as a person and not as my boss. One simple questions that allowed me to really accept how I was feeling. I replied very simply. I said, “I need help.” He then gave me all of the contact information for our employee assistance program and told me what time my appointment was. He had already taken care of contacting them and setting up an appointment for me. The amount support that this little bit of work and compassion gave was unbelievable. He then let me tell him everything that I was feeling. And he told me about a very traumatic event that he had been through recently that I had no idea he had even happened. At the end of our conversation he then said something else that impacted me greatly. He said, “You can’t come back to work until you can get psychologically cleared by a doctor.” I felt total desperation at this point. I was worried about bills and missing work. Before I could even ask, he told me that I will get a full paycheck and none of my sick time of vacation time would be used. I have no idea how he did this, but I was out of work for two weeks and received my full pay the whole time I was out.
This was a mastery of an ultimatum, but not just an ultimatum. This involved planned support, personal experience exchange, personal connection, planning, and compassion. He had no obligation to do any of this. He chose to help me and he saved my life by doing so. Do not look at ultimatums as bad things. When done correctly, they may be the only thing that can get someone the help that they need. I am forever grateful for being told that I was not allowed to do something.
Do not make excuses. For yourself or for others. Never feel like you do not have a right, or DUTY to step up and say something. You do. There is not right way to go about intervening and helping someone, so stop saying that you do not know what to do. Do what is right. Stop being selfish and actually worry about others. Do not worry that you will ruin a friendship. In time, what you did for someone will become apparent. Do not accept unusual behavior as being acceptable. Do not allow people to act in a way that concerns you and not say or do something. You are enabling them to accept how they are feeling as normal, when it is not. Support your friends, family and peers. Friendship and love is not always joy and happiness.
August is an interesting month for me. Most people, as they should, hold onto their sobriety anniversary and find some way of celebrating it. August for me is a month of remembrance; remembering that I have come so far from the depths of which I came and the ultimate reminder to me that my life and wellbeing are worth far more that I had ever realized. I was clouded, lost, and simply unsure of what lay ahead on the road for me. Thankfully with the help of the people who loved me I made it through to being able to experience happiness, joy, and all of their love once again. If it weren’t for my wonderful wife, I wouldn’t be here writing this.
As with most alcoholics, I grew up in an alcoholic household. There was never physical abuse, but the temperament in which I grew up left a mark which I have only recently been able to come to terms with. We drank - that’s what we did. It’s what we did when things were tough, when things were ok, and for no other reason than just to drink. That was my only coping skill. I was raised knowing that alcohol was the medicine of choice for just about everything. It’s a lot like normal people taking a Tylenol for aches and pains for me, except the pains were internal and became part of my soul. Where normal people were able to just have that one drink and put it down, I was the guy who finished the bottle or passed out. Later in life, social drinking just became a rouse for my closet drinking and pretty constant state of stupor when I was alone. I had become so conditioned to being drunk that I was functional; and because of that I was in denial for many years that I actually had a problem. Alcoholics can’t hold jobs, right?
I started my public service career at 15 as a cadet with my local volunteer fire department. While most guys my age were busy chasing after girls and planning things later in life like college, I was running calls and helping with fire department functions. It’s not that I didn’t have an interest in those things, but I became so enamored with other things that I eventually set myself up on a career path as a Paramedic. I didn’t fully understand how my experiences so young in life would affect me until much later on. I had an early interest in EMS and it wasn’t long before I would witness my first traumatic death. I remember tying to mentally prepare myself for the scene, but nothing prepared me for the sight and smells that accompany it. I still remember them very clearly and I think about it often. I was definitely too young to experience that and I wish that I had the knowledge I do today. I probably would have avoided it all together and chose a different career path.
I was always ahead of the curve as it relates to being in EMS. I had taken and passed my EMT test by the time I was 16 and had my first paid EMS job just before I turned 18. I worked for a great service - the people were great, the calls were “good” and I got experience that I don’t think I would have anywhere else in the area. I elected to go to Paramedic school at 18 and I was licensed and ready to go just before my 20th birthday. I got my first job as Paramedic and I remember being very proud of myself for the accomplishment. It didn’t come without my share of detractors however. I was young and relatively inexperienced compared to the rest of my coworkers, but I didn’t let that get in the way of what I was doing. Early on I received several awards for my work in the community. I wasn’t a big fan of awards and never have been, but I took it with what pride I could muster for the moment. As a few years moved on, I found myself in various positions of management at the company I worked for. I did well at it; people respected me and I could always get the job done. But at around five years into my career, something started to go wrong.
Social drinking, to say the least, is a favorite pass time of EMS. I very quickly found myself drinking to excess - blacking out, doing stupid things, and always having to pick up the pieces from the night before. I was young and making good money, so I didn’t think much of it at the time. It just seemed normal. Then about a year later, things started to really go downhill.
It started with not being able to sleep. I would often lay in bed for hours and not be able to close my eyes, and for no reason that I could think of. Alcohol was the answer for me. I got drunk, I was “happy”, and I was able to sleep. Then the nightmares began to set in. Nightmares so vivid and violent that I would often wake up and not be able to tell reality from what was going on in my head. I looked to alcohol again as my answer. The more I drank, the less likely I was to have the nightmares. The worst part about it was that it worked. It gave me exactly what I was looking for and I could keep doing it under the guise of just being a social drinker. It wasn’t long before my wife began to notice a change in me, especially my habits. I was hiding empty liquor bottles throughout the house and drinking just about anything I could get my hands on. And I’m not talking about one or two, I’m talking dozens. At the peak of my drinking career, I was drinking close to two gallons a week. But I sure as hell was no alcoholic; I have a steady job and I provided for the family.
Two years ago, my drinking finally reached a boiling point. My wife was working a late evening shift and I was home alone with my son. When I put him to bed, I began my ritual of drinking and then denying it when she got home. Only that night, I blacked out. Something had happened where there was a text exchange between herself and I. I still don’t know what it was about, but I envision she was - and correctly - upset that I had allowed myself to be so far gone while I was supposed to be watching our son. I woke up several hours later to my name being called over a PA system outside my house. In a drunken stupor, I walked out the front door and to my surprise, I was met by about a dozen state troopers and I was taken into protective custody. What I didn’t know at the time is that while I was in my blackout state, I had taken a picture of myself with a loaded gun in my mouth and sent it to my wife. I had put her in a position where she had to act, and I’m glad she did. I had unknowingly put everyone in dangerous position; especially the people I loved.
I took a very embarrassing ambulance ride to the local hospital in handcuffs. It got even worse because I knew all of the staff. I got to spend a majority of the night in the drunk tank and eventually made it upstairs into inpatient psych. I ended up staying for a little over a week. I had been stabilized both medically and psychiatrically and a discharge plan was set up for me. I’ll never forget how cold it was up there. I felt an overwhelming sense of embarrassment, shame, and felt like at total failure. I knew sobriety was my only choice if I wanted to keep my family and my job. I was set up with a local sobriety agency and began taking classes for several weeks. I began to feel better and regained my hope that better things were to come.
I maintained my sobriety for about six months, but I then found myself caught in a trap that many other people in my situation do. Everyone wanted to deal with the alcoholism - not the mental health aspect. I was told time and time again that if I just stayed sober, everything else would get better. That didn't happen. The nightmares began again, I was beginning to feel depressed and hopeless and I eventually made my way back to the old ways. It didn’t help the cause that I had a very passive Psychiatrist and therapist. I didn’t know any better at the time, because I felt I was doing the right thing. It wasn’t until several months later that I knew something was wrong with the situation I was in and even after all that I found out that they were fraudulently billing my insurance too. That had totally turned me off and I turned my back on what should have been the most important thing to me.
After about six months, I began to sneak alcohol. I had a radically different schedule from my wife, so I knew how far I could push the envelope and for the most part not get caught. I did get caught on several occasions, but after some creative wording and what would eventually be false promises, I managed to dig myself out of that hole. I continued this for several more months and before I knew it, I was again in the same position I was less than a year ago, only worse this time around. I was having daily flashbacks, sensitivity to smells, I was withdrawn and was feeling like there was no way out. Being sober had been helpful to a degree, but the people I was seeing were ignoring the fact that I had other issues going on. Alcoholism shows on the outside, but mental health problems are often only the burden of the people suffering with them.
Almost a year to the day, what would have been my final incident happened. It was a hot day and I was out doing yard work. I had an old tractor at the time which constantly caused me problems. One of the belts broke as was customary for me when trying to cut the grass. Two belts later, I finally had the bright idea that it was time to go get some beer. So I did. I ended up almost to the point of blackout. I remember screaming to the top of my lungs outside because I couldn’t get those belts on, kicking the tractor and throwing stuff around the yard. I had enough of that damn tractor and I refused to get the best of me. I didn’t know this until after what had happened, but I had stumbled down to the local tractor store with the intent to purchase a new one. I was completely drunk and they still let me open up a line of credit. I’m not entirely sure why I didn’t end up with a new tractor that day, but I’d like to believe that they thought I was too drunk to drive it home. As I was walking home, I remember a call from my wife. She knew that I was drunk and up to something stupid. The rest of what happened I’ve had to piece together because it’s a blur and even after a year I can only remember a few details.
I woke up four days later in the ICU. I had been on a ventilator and by all accounts, they were concerned that I was brain dead. Apparently my wife had come home after picking up our son and found me passed out on the couch. An exchange happened where she took our son and went to her parents house so I could hopefully get my act together. It was at that point, I decided I had done enough damage and I had enough of the person I had become. I was tired of the guilt and shame that came along with addiction. I was tired of suffering and not being able to find the light at the end of the tunnel. I took what should have been a fatal overdose of medication. I was still so drunk that I couldn’t even write a legible suicide note. That was enough for me. I was hopeless and in my mind at the time, my family and the world would be better off without me. The details are still quite fuzzy, but now knowing myself like I do, that’s the best reconstruction that I can come up with.
My wife had come home not too much later and immediately knew something was wrong. She could hear me gasping for breath in what could have been my very last few. She called 911 and my colleagues came to my rescue. Given the amount of medication I had taken and it was unknown how long I was down, it was doubtful that I was going to survive. Even the ER doctors had their doubts. My primary care Physician (who is awesome by the way) met my wife at the hospital. He basically explained that it would be a miracle if I woke up at all and without brain damage. Somehow I pulled through the next couple of days. I still cannot understand the stress and heartache I put her thought, but somehow she still managed to love me.
I remember waking up in the ICU and having my breathing tube removed. I was quite groggy but I remember several of my friends were there for the occasion. I spent the rest of the day in a haze from all the medication. When I finally came to, I was on a medical floor on 24 hour watch. I remember this being so strange - why was I here and what happened? It wasn’t until around the next day that I was told exactly what had happened. I was in total disbelief. This wasn’t me, I would never do something like that. It wasn’t until I was confronted with the hard evidence of what had transpired that day that I finally accepted the choice that I had made. I was in an alcoholic blackout and decided to end my life - something I never would have chosen to do sober.
I spent about a week on the medical floor trying to put the pieces of my life back together. It was there where I experienced one of the worst things in my life and definitely one of the more memorable. I had been without my medication for a little over a week at this point and I was caught completely by surprise by something I had never given thought to - serotonin withdrawal. The medications I was on work by increasing the amount of serotonin in the brain which helps alleviate some of the symptoms of depression, and now without this medication, my brain began to react badly to not having enough serotonin around to use. I became so disoriented that I couldn’t tell night from day, I couldn’t figure out where I was, I was having hallucinations to the point where I couldn’t sleep and had to be sedated. This lasted for about two days and was by far one of the worst experiences of my life.
Once I was able to get myself together, I elected to check myself back into the inpatient psych floor. Here I was again, in a place I dreaded and didn’t want to be. I knew that if I wanted any chance at being able to live a normal life again, I had to start somewhere. I got back on my medication and was feeling better. I also met some very good people there who I still stay in contact with. I was discharged with plans to start attending a hospital sponsored program the same day. I remember leaving the psych unit in a pair of sweatpants, hospital socks, and a t-shirt, and I hadn’t shaved in weeks. I arrived at the program looking just like that. Thankfully, some of the people there had encountered the same experiences so it was nice to not be alone.
My wife and I had decided that it was probably best that I not return home immediately until I was able to get myself together. I had already done a good job traumatizing my son and the distrust and uneasiness I left the house last time in was still looming in the air. I opted to stay with my brother for a period of time. I left the hospital that day looking like I had just crawled out of a cave and I didn’t even have shoes on. That for me sets the bar as the lowest point in my life. I was determined to never put anyone through that again, including myself.
I spent a few weeks in the hospital program. Thankfully the people were great and I was blessed with a good case worker. There did seem to be something missing. None of the people I was in the program with had any public service experience. They weren’t accustomed to the way we deal with things or even the humor. All were good people, but I couldn’t help but feel a bit lost still. How could I be open with people who have no clue what it is like to see tragedy and death on the scale we do? Most people only see this stuff when it makes the news or are watching one of several bad TV shows that portray emergency work. I was having trouble relating and engaging in the program. Thankfully my case worker was a very dedicated and intelligent person, so we began to look at alternatives.
After some research we stumbled upon a place called Brattleboro Retreat. They offered a program specifically for first responders and military veterans that focused around mental health and addiction called the Uniformed Services Program. After some calls and some more research, I decided to go. I was lucky enough to have the support of my friends and coworkers and two of them drove me up to Vermont to the campus. When we tend to think of Psychiatric Hospitals, we often think of these closed facilities where everyone is locked up and just force fed pills all day. The campus was beautiful, modern, and open. The people were caring, dedicated, and very well educated. It was the exact opposite of what I had expected.
I entered the program with my counselor and immediately began to feel at home. We entered our building and the walls were covered with patches of people who have been to the program. It was very reassuring that I wasn’t alone. All of the people there were either first responders or military, so we quickly got along. I was able to easily engage in therapy and medication management. After a few days, I felt so good and I hadn’t experienced that in quite some time. I missed my family very much, but I knew the only way to get them back was to get well. I spent two weeks there and when I left, I considered everyone there a part of my extended family. The friends who had dropped me off came to pick me up too. It was a great sight to see familiar faces and know that I was finally going home.
I knew that I still had a battle ahead of me, but this time I felt prepared. I was determined to regain my family, my dignity, and a sense of normalcy. I managed to get back to work just a few weeks later. I elected to resign my management position and go back to focusing on being a Paramedic. I think that was the best choice because now I was putting as little on my plate as possible. Learning to say no had always been a tough decision for me, but now I finally felt competent to do so. My employer was very understanding and quite helpful throughout the entire process. I am very grateful for that. When this first happened, I thought I had lost everything that I had worked so hard for.
A year has since passed since I made that drunken decision to commit suicide. Every day I am thankful that I survived despite the odds against me. Brattleboro Retreat gave me the tools to get my life back and my wife, friends, and my brother gave me the motivation to not only do so - but to be well in the process, something that had been missing from my life for many years. I can never express in words the gratitude I owe these people, but I just hope they know it.
I founded this organization to help plug a hole in the public service industry. I included veterans because so many of them end up in the public service sector at one point or another. I am committed that no one should have to suffer and go through the hell that I did just simply because good resources are hard to find and people may now know where to tun to. I know there are many out there who are suffering with mental health issues and addiction and I want my story to be a means shedding hope to those who need it. Life is precious - that includes yours. You don’ have to sacrifice your happiness or your livelihood to work in public service.
We as public servants see the worst humanity has to offer. We are expected to fix problems that sometimes cannot be. We see tragedy, death, and suffering on a daily basis and it affects who we are and how we see the world. Just bearing witness to these things can affect your soul. I am here to tell you it doesn’t have to kill you, it doesn’t mean you have to suffer - there is a sensible way out and it begins by speaking out, if not for yourself then someone else.
After working in EMS for over the last 11 years, I am used to suppressing my emotions, being happy yet grumpy, and being “tough.” This is the EMS way of life. This EMS way of life led me down a road of losing the ability to feel or understand emotions. All I knew how to do was compartmentalize my feelings, emotions and experiences. This worked well. It allowed me to continue working and become disconnected from traumatic experiences. It also led to my development of PTSD. I am publishing and excerpt of a prior blog that I published elsewhere.
I saw an article posted on an EMS site about PTSD, depression, and how EMS handles this within. This all made me think. What are we doing? Are we that naïve that we think this is not a problem? I know I am not alone in this fight. I see, almost daily, another story about an EMS provider committing suicide. I have hinted about it in past writings, but I will say it and not just hint. I have come really close to ending my own life. I had a gun to my head, and my finger on the trigger. You have no idea how hard that is to say, especially for someone who sees people put into police custody and dragged to the emergency room for mentioning thoughts of suicide. We see this daily and I believe that this is one of the many things that are discouraging EMS providers from getting the help that they not only need, but deserve. Just last week, I was about 95% committed that it was going to happen. I have not told this to anyone. Whatever it may be, it did not happen. Do I want to do it now? No. Will I have these thoughts again? Of course. They happen daily. Anyone who says they have “never” thought of suicide is lying. Thinking and intending are totally different things.
This all made me think more, why is this all happening? Why are we still a career field that disregards mental health? We treat our mental health emergencies as an inconvenience. We joke about suicides. I understand that this may be our way of coping, but it is the only method of coping that we allow. What if someone is genuinely upset? Oh yeah, that’s right, they are “weak” and should “get out” of EMS. Because that is logical. Lets be realistic. EMS is a field with a relatively young population. Sure there are plenty of older providers in EMS, and how do they act? What model do they set? Most that start in EMS are young and impressionable. The impression and “wisdom” that we bestow upon them is how to be “tough” and calloused. Come on. You wonder why trends are not broken… we are the ones that keep it going. I am guilty myself, but not anymore. We are a peer pressure driven field, so our peer pressure should be pushing them to get help when they need it.
Another thing that we do is complain and, to put it bluntly, bitch about how things are. We don’t get paid enough, we aren’t respected, we aren’t trusted. No way… you mean the miserable, grumpy, disgruntled, sloppily dressed, unkept EMT or paramedic that just walked in the suicidal patient, and gives the report of “it’s them again” as they walk by the charge nurse with the person they are training isn’t respected or trusted? Well that doesn’t make sense does it? They should be bowing to you as you walk in. This is what is being passed on to the next generation.
As far as what we make, get over it. Would I like to make more? Really? Is that a real question? But the fact that EMS has lower reimbursements will not change. We are not nurses or doctors, and I will not get started on that debate. We do a different job than them, and we chose this job. Yet we convince young people to do this job under the false pretense that they will be a hero and make such a difference. We do make a difference. A lot of people will tell you that it is only 1% of the calls that we can actually make a difference. But what if I said we make a difference on 100% of the calls. That lady who just fell may be lonely and you could be what gave her hope to keep going. That psychiatric evaluation that you made comfortable enough to tell you that they had a suicide plan… would they have told anyone else or just said it was a misunderstanding and leave the hospital and kill themselves? We seem to lose perspective to this. We say it’s a great job, act like it is an awful job, and teach people to do the exact same thing. Is this a great job? Sometimes. Honestly it is worse more than it is great. Get over it. Stop being like all the people that you once said that you would never be like. We all signed on and said we were going to be different. We wouldn’t get “burnt out.” We will change it. What have we done to accomplish any of that?
Enough is enough. We need to stand up and be human beings. We are not heroes. We are not superheroes. We are people. We are no different than that psych patient that you seem to be too good to pick up. We are made of the same things. We have the same feelings and emotions. We preach that we are here for our “fellow man.” We just are trained and conditioned to think we are different. We need to learn though. I know it is hard to undo years of this and suddenly be different. Will it get better? Hopefully. Will I get better??? Hopefully. I can only be hopeful and do my part to change it. We all need to do the same.
Many of us have families to look after. Our main goal is to be able to go home safe and take care of them. Scheduling and responses are, what I see, as the two biggest issues with the way we treat today’s EMS industry.
The modern EMS system as we know it has come a long way from it’s humble roots of simply being a transport service for the sick and injured to multi-tiered system capable of performing procedures that were once reserved for Physicians only. With all the change that has occurred over the years, we still have a lot of work to do. And I’m not talking about the care delivered in the system, I’m talking about taking care of our people.
It wasn’t too long ago where just about every single call we were dispatched on was an emergent (lights and sirens) response. At the small service where I worked at the time, I very distinctly remember the day the regional dispatch center finally started to triage calls into emergent and routine responses, my service being the first in the entire region to respond to that first call. At the time, this seemed to almost be an insult to the industry, but it strangely made sense. Although the systems has it’s flaws (mainly the person on the 911 line) it does, largely, work out. However with all the questions being asked by the dispatcher and science now behind the reasons why we respond the way we do, there are still some major flaws in the system; and these flaws are putting our lives at risk for no good reason other than some random statistics and risk factors that have absolutely no place in the response scheme. Does every single person you pick up with abdominal pain end up with an aneurysm? I didn’t think so.
A major determination in how we respond is how much information is available at the time of call. Unfortunately with a majority of calls detailed information is not available. This can be due to a variety of reasons such as a uncooperative or inebriated caller or the call coming for a second or third-hand source. So the typical rule of these responses is to make them emergent just simply based on the lack of information. But this also begs the question “how much information do you really need in certain circumstances?”. Are dispatchers competent enough to make an educated decision on how best to choose the response priority? I think they are, and they need to be allowed to do so without fear of being cut down by a bureaucracy supporting often vague, unrealistic statistics. So I’ll spell this out simply. If someone calls 911 stating they are drunk and wish to go to detox and hang up before all the questions can be asked, it is an emergent response. If the police request a transport for a mental health crisis and that is all the information available, it is an emergent response. This may seem like a fairly trivial, small amount of what we do in EMS, however anyone who has worked in the industry for any period of time can tell you otherwise. Despite advances in the 911 call taking system, there are still agencies out there that choose to disregard any type of prioritizing responses. Another example of inappropriate responses, particularly in the commercial sector is facilities exaggerating or overstating the complaint of a patient or their situation. We had serviced a facility for years that did exactly that. They would call two services with an “emergent” transport so naturally both services would respond as quick as possible. This often included crews getting out late or having to punch in early without properly checking their equipment. The only problem was, the service who showed up first got the transport. This facility willingly putting our lives at risk just so they could get the fastest time possible for the transport. And I speak from experience when I say that a majority of the time, there was actually nothing emergent about the patient’s condition. This was simply a measure of clearing beds for them. Fortunately for me, my administrators caught on to this game and quickly put an end to it - well at least for that facility. We still have facilities that refuse to take certain times for no justifiable reason - and I’m not talking about a four hour time either. Just like every EMS system, we have our abusers - and often the worst offenders are other medical facilities like nursing homes and dialysis centers. Shady Acres Nursing calls commercial company “A” looking for a time to transport a patient to the ED for something non-emergent like “abnormal lab values” or a blocked G-tube. They are unhappy with the time of an hour so they call 911 knowing they will get an immediate response from the very same company. This also taxes the systems who have separate 911 and commercial systems by causing backup but more importantly an unnecessary risk to the lives of the responders. We also have our share of “chronic inebriates” who use the system every day and in no way, shape, or form require an emergency response. Is it really worth the risk of losing people just to save a few minutes here and there? Is it worth having a vehicle involved in an accident for someone who is medically stable and just wants a ride or meal? I’m not asking you to evaluate the worth of another human asking for help, I am asking you assess the risk to yourself that is often unnecessary. Ask your boss the next time you see him/her if they think you are worth changing a protocol or allowing a dispatcher to make a common sense judgment.
Studies have been conducted nation-wide on the risks and benefits of responding emergently to calls for help and they overwhelmingly show that EMS providers are far more likely to die in a transportation related accident than in any other way. From the distractions inside the cab of the ambulance, to increasingly sound proof cars and distractions inside opposing vehicles, driving in emergency mode is increasingly more dangerous. Another killer of EMS professionals? Driving while tired and falling asleep at the wheel. EMS publication outlets feature one of these incidents about every month across the country. We know it happens, now why isn’t anything done about it?
Although various agencies have different schedules based on what the company or department deems out of need there is one thing in common: a majority of shifts are designed to kill or at least limit your ability to respond to stressors and lead a normal life outside of EMS. It is an inescapable reality that there is a need for us on a 24/7 basis, though this reality should not keep administrators from using common sense tactics to ensure coverage.
Though not as common as it once was, but incredibly deadly is the 24 hour shift. This is commonly used in agencies who seek to reduce staffing while still being able to cover the bare minimum needs. OSHA mandates that any shift over 16 hours requires sleeping accommodations. But how much sleep do you actually get? My personal experience with the 24 hour shift has been mixed at best. Typically it was a few broken hours in between calls. Mix in making sure your vehicle and equipment are ready for the next run and paperwork and the situation only gets more grim. Studies on this topic have shown that broken sleep is actually worse than no sleep; something that is often impossible for most people after the 16 hour mark. Researchers equate being awake for 16 hours to having a blood alcohol level of 0.08% which is legally drunk. So what is the solution to this problem? It’s quite simple, no more 24 hour shifts and no shifts longer than 12 hours. It is up to the administrators to ensure the safety of their people and this certainly includes making sure those who have to go out and do the work are fit for duty; not on the cusp of falling asleep at the wheel or making a treatment error that costs a patient their life.
Another fairly recent phenomena is the use of software to build schedules based on call volume or need. Unformed professionals all over the country who have taken a crash-course in software development have been creating programs that are intended to identify needs of the agency and fill them as the software sees fit and they are just as eager to sell it; damn the consequences. While this practice works in theory and in “the numbers” it can be just as detrimental as a 24 hour shift. Working odd hours that defy any sort of healthy sleep pattern, particularly the early morning hours, is detrimental in more than one way. These administrators have now become blind to the fact that the people working these shifts are actual people; they have lives and families outside of the EMS community but are finding it increasingly more difficult to function inside of a normal society and maintain a normal home life. What is the divorce rate of EMS providers? I’ll let you google that. The reality is the a majority of EMS spouses do not work in the industry or work typical hours so they are unfamiliar with the feeling of not being able to achieve restful sleep but still having to push on with life. You will often find that your administrators work typical hours or have some variety of set schedule that allows them to obtain the restful sleep that we all require. And it's with good reason: they should be sound of mind to make judgements that affect the organization and it's employees. The big question is: why can't that be at least partially extended throughout the organization?
I worked a rotating shift for many years and I can honestly say, beyond the shadow of a doubt, was the most detrimental shift work I have ever done. It has been almost a year since I worked that rotation and my sleep cycles are still completely erratic. Just as soon as you get used to working days, you switch to nights. Just as you get used to working nights, you get switched to days. There are a number of reasons why agencies opt for these shifts but largely it is because “we’ve always done it this way”. Rather than use this need-fulfilling software to justify at least semi-normal working hours, they use it to justify the needs of the agency weather that is in a decrease in staffing or payroll. But at what cost should the administration finally admit that putting arbitrary numbers over the needs of it’s employee base isn’t worth it anymore?
Should the turnover rate be the judge of it? Should those in the organization have a say in how they are scheduled? Should we just wait until we have enough fatal accidents or treatment errors that the liability falls solely on the employer? And don’t tell me it’s about proper customer service either. With the advent of electronic scheduling for the commercial groups and the simple idea of creating an overlapping shift there is absolutely no excuse for sacrificing the employee for getting the call done. Late or early calls will inevitably always happen; it’s just part of the industry. I don’t think anyone who works in EMS always expects to be out absolutely on time, but I think they do expect to be close to it unless there is a reasonable event that requires late work.
All of this builds on the stress of the industry. We take your wellness seriously. You should too. At the end of the day you have to be a person who is able to protect and provide for yourself and your family. Administrators should be actively assessing the stressors and risks involved in your schedule, how you respond to calls, and how it relates to your home life, your wellness and your safety. If they are not, then it is up to you to be asking why and advocating for yourself. It is important for your health, mental wellness, and just as important for the community we serve to see that we are also well served.
Check back for entries from some of our bloggers. We will also post some updates and keep you up to speed on what we are doing!