Emergency Service Burnout Symptoms and Solutions

Burnout. When some hear that word, they might think of a tire squealing against concrete with smoke flying everywhere. In this case, the tire squealing is being replaced with tired, worn-out prehospital workers. The emergency world interprets the term “burnout” as a first responder who does not feel anymore. They do not get the excitement running their calls anymore. Many of them have night terrors throughout the night that will keep them up. A direct result of this is feeling exhausted for extended periods. Mainly paramedics and EMTs(emergency medical technicians) experience burnout. The amount and type of calls they run, add up over time. The once adrenaline-pumping calls, turn into a dull drive to the hospital and back. Eventually, it will slowly tear them down, one shift at a time. With so many countless calls and traumatic events, anyone could see why most of these emergency workers lose their touch. Then added with the long days, loss of sleep, and nightmares, burnout is inevitable.

One of the vast killers in the world is stress. On an ambulance, stress is not a foreign feeling. This career has many stress factors that can affect a person. Age is one that is overlooked in these careers. Practicing paramedics have a wide variety of ages. For instance, there are medics twenty-years-old or younger. Scientists have found that the human brain does not fully develop until the age of twenty-five(Backberg). With that being said, these under-developed twenty-year-olds are working traumatic, sometimes deadly, calls. The human brain is not meant to see that kind of gore, let alone an under-developed one. Along with being immature, a majority of the public does not trust an EMS worker who is under the age of twenty-five. Most believe they have not fully matured or intelligent enough to handle the responsibilities. Many times this leads to the young paramedic feeling despaired. Sometimes when they try to help, they get disbelief in their knowledge or skills. With that being said, the older paramedics also have their problems. On the other side of age, is where most of these burnout medics are found. Since they have run and seen many fatal outcomes over the course of their careers, they are more at risk.

Another significant form of stress comes from traumatic calls. Most of the gore-filled calls are the results of car crashes, falls, suicides, or fights. According to the U.S. Department of Transportation, “There were 37,133 people killed in motor vehicle traffic crashes on U.S. roadways during 2017…” (1). That is an average of 102 deaths by cars crashing per day. Most of the time these calls are not the worst though. Usually, the ones that hit close to home are the calls that have the most impact. “Close to Home”, meaning EMS providers linking patients to their own families. There might be days where the paramedic or EMT might have to run a call where the patient reminds them of their loved ones. Occasionally, these calls result in death for children or infants. As it can be assumed, nobody likes working calls on babies or young children. Especially when they have children of their own or the outcome is fatal.

One of the ugliest/worst feelings in the world is responding on scene to a dead on arrival(DOA). These calls can take a toll on mental health. These patients can die from decapitation, suicide, gunshot, or infections. These calls are pretty horrendous and the worst part is the emergency worker cannot help. All the classes, time spent doing clinicals, and calls ran in the past, do not affect the outcome of these situations. These calls are sometimes burned into their brains. Every time they close their eyes, they see that picture painted onto the back of their eyelids.

Ever looked on the schedule and found a little bit of overtime? The first feeling that comes to mind is anger at the manager for scheduling more work than usual. Well for EMS workers, this is not uncommon. On average, a regular workweek consists of seventy-two hours or more. Depending on the company, that is usually three twenty-four-hour shifts. Other businesses may have employees work forty-eight or even the whole seventy-two hours straight. That means the crew could run calls all day and throughout the night. No matter the time, if that ambulance is up for call, then they have to take it. This could leave no sleep for the crews on shift. Especially if they have to take a late-night transfer. Transfers are bringing a patient from one hospital to another medical facility. Sometimes these transfers can be two-to-four hours one- way, meaning four-to-six hours are taken away from valuable sleep. As everyone knows, sleep is sometimes more valuable than gold.

Along with working insane amounts of hours, these EMS providers have to work in all weather conditions. Whether it be blistering cold or smoldering heat, whenever a car is stuck in the ditch at three in the morning, the ambulance has to respond (Fleshner). Another consideration is when the roads get covered with ice. These ambulances are expected to respond in no more than ten minutes. If the EMT tries to hurry, he might cause an accident for himself.

There are many times where the local ambulance providers will stage at events. Many of these events may include races, special olympics, or county fairs. Throughout the whole event, the crew staging has to be ready at all times. Events like the Polar Plunge, occurring in the winter, require these EMTs or paramedics to be exposed to the cold. The crew has to stand outside and be ready for what might come their way.

One of the complaints of most paramedics and EMTs is their pay. Most of them believe they deserve to make a more adequate salary for what they do. On average, for example, paramedics in Chicago, make an annual salary of $40,788 (HOME). While nurses can go to school for the same amount of time and make way more. A lot of times this leads to friction between hospital and pre-hospital workers. Another common issue is that the highest degree most paramedics can achieve is an associate's degree. With a higher degree, the paramedics might be able to get an increase in pay. So the question persists, “Why would students study to be a paramedic when they could spend the same amount of time in school as a nurse and make less?”. All of this usually leads to EMS workers changing their majors to nursing.

A natural effect of running late-night calls and seeing outcomes of these patients are nightmares. Seeing flashes of mangled up cars in dreams, or patients passing away in the arms of a paramedic. These are images that can be seen by the prehospital workers. Most of the time the dreams they have about their job are not the pleasant ones. That is if they even get to sleep enough to dream. Jim Fleshner, an experienced paramedic, explains this a little more: “ So basically after running all of these horrible calls and running a lot of calls, it gets to you. You start having trouble sleeping because you sometimes see patients that have died. This can lead to worse problems if it is not handled correctly.”. The “worse problems” Jim is talking about is PTSD, or Post Traumatic Stress Disorder. PTSD is very common, not only in the medical field but in many careers. From experiencing terrible events over and over again, and if the stress is not handled well, this stress disorder will be knocking on the door. The worst part about this is that no matter what the provider tries, there is no way of completely relieving this stress. Inevitably, there will always be bad calls that will shake them up. As mentioned before, it is the calls that hit close to home that hit the hardest. These are the ones that ruin the job for people. The career expectancy for a paramedic is only five years (Elias). Why so short? These medics cannot handle the minimal sleep and traumatic calls being thrown at them every shift. Most of them go through therapy regularly. This might help relieve extra stress. Especially if these paramedics work in larger cities, where the likelihood of traumatic calls is increased.

As mentioned, all of this stress leads to nightmares. These nightmares lead to minimal sleep. The minimal sleep leads to fatigue. This is all a domino effect that finds the last piece falling into burnout. The scariest part of not having adequate sleep, aside from the health issues, is the level of care being provided. If the EMS provider is sleep-deprived and “off his game”, the services may not be adequate. Meaning the paramedic or EMT could cause more unintentional harm to the patient. Another point with this is that the medic might think the call is nonsense. From seeing many calls where the patient is faking their pain, or blowing it out of proportion, the medic gets a sense of disbelief from their patients. This could also lead to less empathy received from the paramedic. Which is not fair to the patient, no matter their case.

The loss of energy can lead to a decreased level of work. The long shifts start taking a toll on the body and the brain says “no more”. Eventually, the feeling of not wanting to go to work starts setting in. The thought of working a twenty-four or forty-eight-hour shift starts to drive the paramedic insane, making them want to stay home or work fewer shifts per week. The effect of not working their shifts results in lower pay; which leads to less happiness and more stress. When an average worker thinks of their job, the first point that comes to mind is money. Money is a part of any career, but happiness is what sustains the job. If these paramedics cannot enjoy their job or be happy with it, it is game over for them. They do not have a huge payroll to keep them at bay, so they need to have a good feeling for their work.

Throughout the whole paper, causes of burnout have been explained. The main question still finds itself unanswered, “ How is burnout prevented?’’. Well, there are many ways these young paramedics can prevent themselves from settling into this no man’s land. The best way to fight it is to accept it. There is no way to prepare for what is going to be seen. The paramedic has to recognize it and deal with it as soon as the problem arises. No matter how hard they try, they cannot prevent traumatic injuries, babies in pain, or patients taking their own lives. That is the bitter truth that all EMS workers have to deal with. Knowing this and going into a career with this mindset, can help prevent feelings of helplessness.

Another way to help prevent burnout is to decrease the amount of hours worked and increase their pay. With the reduced amount of hours, the paramedic would have more time to enjoy their days off and deal with their stress. They could spend more time with their loved ones and reflect on why they chose this career. That the reason they wake up and go to work is to potentially help someone else’s family. Along with working fewer hours, this would allocate more time for fun activities (Frediani 1). A recommended stress reliever is working out. Not only will it help keep the body in a satisfactory shape but also allow healthy physical exertion.

This has been proven, by scientists, to help clean-up the mind. As they say, a healthy body is a healthy mind.

Finally, the last way to help cope with stress is to let it out. Do not hold it in. The problem with this is the inability to talk to family about the details of calls. If the paramedic releases any identifying information, this leads to a HIPAA(Health Insurance Portability and Accountability Act). This is a law that keeps the patient’s information safe from the public ear. The medic can, however, talk to his partner who he ran the call with. It can be beneficial for both of them to let it all out.

The next time 911 is called, it might be a burnt-out medic responding to the call. That could mean this, sleep-deprived, medic has less sympathy for the patient or might not treat them appropriately. This patient could have a deadly end because of the poor treatment received. In turn, the paramedic keeps thinking about this patient and “how he should have done better?” or “What more could I have done?’’. This can lead to nightmares or even PTSD in an extreme case. That leads to even more sleep loss and fatigue. While all of this is going on, the medic has to work multiple long-hour shifts throughout the week. Just to look at his paycheck at the end of the week and have a feeling of despair. While he is thinking about this, another call comes out for a multiple-vehicle crash resulting in multiple, traumatic deaths. The site of all this blood and gore twists his stomach and haunts his dreams even more. The point is, all of this can add up quickly. Once those dominos start falling, it is hard to stop them unless there is early recognition. Exercising, working on projects, and doing fun activities are a few ways to relieve stress. Sometimes doing extra activities is not enough to help cope, so many of these medics will take on counseling or therapy. If they cannot get their stress at an adequate level, most of them leave the field. Whether it be a different medical career, or a completely different path. There have been paramedics who left and became welders. Choosing the EMS provider life is not necessarily the most fulfilling or easiest. If the stress can be handled, it can also be the best decision made.