I feel proud to have been an Intensive Care Paramedic for the last 13 years. More often than not, I have the privilege managing medical emergencies and consequently meeting many people on the worst day of their life. I recognise that many of these experiences have had an ongoing effect in shaping the person I am today, leaving changed psychologies or physical habits. Whilst myself and Jake, who has also been an Intensive Care Paramedic for over 9 years are lucky enough to have an excellent support system to get us through even some of the most gut wrenching cases, I am acutely aware that what we face pales in comparison to what some of you guys may face; Having to treat your colleague, your friend in their moment of need. My wife, who has equally as much experience as a Paramedic can’t hide her own natural struggles when it comes to our kids. While she is cool as a cucumber at work, it is a different story at home. The smallest amount of blood from our son after a simple sporting accident and she can become quite emotional and upset (so do I!)
I would like to share with you some of my tips to help you deal with these situations, should you be thrust into them.
- BREATHE! It seems almost too simple yet it is infinitely effective. When encountering any stressful situation your amygdala is activated (the part of your brain controlling emotions) triggering the fight/flight reaction. It is, unfortunately, a part of the brain that we developed very early in the evolutionary process which subconsciously shapes our responses. Deep, abdominal breathing has shown to quell this part of the brain via engaging our pre-frontal cortex enabling a rational & controlled response. Your casualty needs for you to stay calm & make rational decisions under immense pressure, so if it becomes too much, simply take a pause point to control your own breathing before launching into a reactive action or decision.
- Remember the basics. Throughout Intensive Care Paramedic training we absorbed an immense amount of clinical knowledge & practiced significantly increases to our skills and medications. We practiced high fidelity simulations based on common & uncommon high stress, ‘big sick’ patients where critical decisions were required. One of the most important lessons I learnt there is that, even though I had all these extra skills and capabilities, what ACTUALLY saves lives is the basics. I still have my instructors’ words ringing in my ears: “You have to walk before you can run”. In high pressure, high acuity medical emergencies, I always resort back to the simple things. I still approach every situation with DRS ABC primary survey pneumonic in mind. Basics matter, because even if you get lost, panicked or feel out of control, you can always go back to basics.
- Non-technical aspects: In high pressure situations, it has been found that leadership, communication and team work are just as important as clinical excellence. Maintaining a calm and respectful scene ensures all individuals are working together (not against each other) creating a synchronous flow to the patient care. I am very often team lead through a cardiac arrest, often leading a team of 4 to 6 Paramedics while we attempt to resuscitate someone’s father, brother, even child. I have found that using a calm and polite voice is essential. I think my thoughts out loud, allowing for anyone who hears me to make suggestions. The concept of “No voice too small” is brilliant. If anyone has an idea, or suggestion, allow them to say it. It’s a team effort, and sharing the stress and the load with the team will help get a better result. Reducing conflict & stress on scene is vital not only for patient care but for the loved ones watching your efforts.
- Debriefing after any incident, especially significant ones, is a key component in improving response systems, future procedures and caring for the mental health of responders. After the dust has settled, sit down and take the time to talk about what happened. Talk about what went right, what didn’t go so well and what you could do differently next time. Normalise the emotions it made you feel. Everyone reacts differently to these situations and debriefing is a good opportunity to but to see where everyone is at mentally & physically. Debriefing is a positive and constructive learning experience for all, because it is important for your team to experience “Psychological safety”, that is, an environment where they can admit mistakes and not feel persecuted for it.
- Be kind to yourself. I don’t know what else to say. These are hard, sometimes gut-wrenching situations you may be faced with. You can do your best and still that may not be enough. You may have to watch your mate in pain or struggle to breathe for some time and naturally this may affect you for a while after. I deal with these situations every shift, but even though I try and detach myself, it still affects me because im human. I have always maintained the day I don’t feel a natural response then its time to take a step back. Recognise these responses, talk it over with your team or a confident & most of all be kind to yourself. You are not a robot.
At Risk Response + Rescue, we utilise high fidelity simulation & structured debrief to prepare you. Our aim is to have you confident, capable & adaptable to any situation where you can perform at your best.
Hari Krishnan in conjunction with Jake Broughton Rouse
Intensive Care Paramedics