One-the-job tragedies can have lasting effects for first responders
FARGO - For those in a medical crisis, a paramedic on the way can seem like an approaching angel.
So it's appropriate that "Angel," by Sarah McLachlan, is F-M Ambulance paramedic Lana Jackson's karaoke song of choice.
But when Jackson sings it, it isn't about her. It's about a little boy who was in a devastating car accident in Louisiana, a crash the paramedic, who has now been in the job for four years, responded to when still new to the field.
"This kid's heart stopped beating when I was with him, and then it didn't start again. There was a firefighter with me, helping - but it felt like it was just me and him," Jackson recalled last week.
Jackson got the boy to the nurses in the hospital and thought she was fine. She went outside, started to cry, and called her mom.
She couldn't stop crying.
A supervisor told her to go home for the day, but she didn't want to go be alone. It was the first time she lost a child. Soon after, her best friend noticed that Jackson was partying a lot. And her sleeping was out of whack - too much or not at all.
Jackson talked to another paramedic, a man who'd been on the job 20 years. He remembered every detail of the first time he lost a child, as well as the details of all 12 children who died in his care during his career.
A child dying is among the most emotionally devastating scenarios that first responders must handle. Yet the toll emotional such trauma takes on them isn't well-studied, something many local first responders say needs to change.
Nor are there formal "best practices" spelling out how first responders like emergency room personnel, ambulance companies and law enforcement agencies should care for their own in the wake of traumatic events on the job.
Recognizing the issues
"Children dying, that can be really bad. Sometimes it can be somebody we've taken care of for a long time who comes into the E.R., and staff has bonded with the family," said Susan Jarvis, head of Sanford Health in Fargo's ER and traumatic care department.
Jarvis said that after such an event, the hospital will hold a debriefing with the staff members who responded, to sit and talk it out. There's 24-hour counseling available via phone through a contract with Midwest Employee Assistance in St. Cloud, Minn., but sessions with counselors aren't mandatory.
Managers try to be in tune with how big events are affecting staff, but Jarvis acknowledges that workers are more likely to open up to each other than to supervisors.
Because employee assistance programs are confidential, she said she doesn't know if workers in the ER or trauma departments access the services more or whether people leave those jobs more often due to their emotional impact.
"It's hard to say. Some people have been there 25 years, some move on after 3 or 4. The high adrenaline can make them move on too," she said.
And the effects of traumatic on-the-job events don't always manifest themselves right away.
Lynette Tastad, the clinical mental health coordinator at the Cass County Jail, said a deputy there had a bad reaction to a "very realistic" video about deployed soldiers at war. The video was played as part of special training to teach deputies how to spot mental health issues in veterans.
Tastad said the video was coincidentally real footage of the military unit the deputy was a member of when she deployed overseas ten years ago. The deputy had to leave the training session. Compounding her reaction was the fact that a member of her unit had committed suicide.
"She wasn't real happy about it - she doesn't want to talk about it," even now, Tastad said.
Help from peers
Talking to others who face the same challenges in the course of their jobs can help.
Tastad is part of a Peer Assistance Crisis team set up for regional participation by Cpl. Tony Krogh of the Cass County Sheriff's Department.
Krogh, who calls post-traumatic stress disorder in first responders "one of my passions," established the PAC team five years ago, patterned after a similar team that was already in place with the Fargo Police Department.
The PAC team includes officers from West Fargo and Cass and Clay counties who go through specialized training to help them spot symptoms of PTSD in officers - substance abuse, jumpiness, nightmares, disturbed sleep and socialization patterns, feelings of numbness and avoiding family members.
The PAC team is available to respond to any regional agency that asks for it, said Krogh, such as after the shooting of Mahnomen County Deputy Chris Dewey as he responded to a routine call in February 2009. Dewey died in August 2010 of complications from his injuries.
The PAC team program is based on Red Cross practices developed for debriefing and assisting their volunteers after a disaster.
"I've taken it upon myself to read almost everything" published about the topic, said Krogh, who agrees that more studies need to be performed. "A lot of times you see numbers thrown around, suicides, substance abuse, that sort of thing" in first responders," said Krogh, "and they tend to be speculative."
Still, he said, PAC teams are shown to be effective when they are applied soon after a crisis.
"It shows you you're not alone, you're not going crazy," he said. "If you have someone within your own field, others from there are more willing to reach out to them."
But talking to the peer crisis team isn't required after traumatic events, and Krogh acknowledges that there can be real resistance in seeking help.
"They still have that mentality that 'I'm sucking it up on my own.' They don't want someone mucking around in their mind," he said.
That attitude is slowly changing, at least within Krogh's agency. The deputies who have talked with the PAC team are more willing to participate again, he said, and they're more willing to intervene and make referrals for other deputies whom they see struggling.
Jackson said she thinks the nature that draws many first responders to the job can be what prevents them from seeking help.
"You want to keep going - you don't want to be told to take time off," she said, "because they [the victims] are more important than you are."
She didn't go to the employee assistance program after losing the little boy, she said, "because what if I needed more than the six sessions it provided?"
Jackson ultimately said reaching out to her fellow paramedics helped most. She also recommends that other first responders tell family members to be aware of the signs of PTSD in their loved ones.
Above all, she said, it helps to find some joy outside of work. She taught herself to play guitar and started taking better care of herself.
And then there's the karaoke.
Sometimes she signs an angry song, sometimes it's a sad one. But often it is Sarah McLachlan's "Angel."
Sung in a bar, nobody knows that the angel in the song isn't her - no matter how many lives she's saved.
"It's sort of my mini-tribute," she said.