Paramedic – Resilient Responder

January 7, 2017

How’s Your Morale?

I was talking to some colleagues the other day and the subject of morale came up. There is a general consensus that morale in our agency is bad. But it’s not just our agency, I find that is true in other agencies too. Why is that? Any ideas?

In a recent survey of EMS employees, 60% of the participants said their personal morale was good. The interesting twist was the same respondents said that only 40% of the department’s morale was good. How is it possible that the majority of individuals in an agency have a good morale, but the agency as a whole does not?

Bad is Stronger than Good

Baumeister et al (2001) said that people are more likely to remember bad things than good things. It has a stronger psychological effect. We spend more brain power processing bad news than we do good news. Therefore, we remember negative experiences with more clarity.

Remembering bad things longer than the good is actually adaptive (Baumeister et al, 2001). In other words, we need to remember bad things so we can survive. It signals a need to change, a need to adjust our behavior or avoid situations that caused the bad emotion or outcome. That is why the mind takes more time to process bad experiences. It wants us to be safer the next time we encounter a similar situation. If we only remember the good, we are more likely to repeat the things that put us at risk.

So it is not unusual when we go around talking with each other that the conversation centers around the negative experiences we have. The problem is this becomes our perception of the whole rather than simply an interpretation of singular events. Have you ever tuned into the daily news expecting to hear only good things? It just doesn’t happen. There may be a few human interest stories, but overall the news is bad. And the job contributes to our overall negative perception because we see the bad things that happen to people up close and personal. Bad becomes normal.

Change the Focus

I encourage you to conduct a personal experiment. Deliberately look for the good things about the job. Focus on the ways you have helped your patients; how your coworkers work well together. Look for the positive supports from your supervisors and administration. (Yes, it is there!) Make a list so you can remember.

Then, when you talk about the bad experiences, counter it with something good you have noticed. When a coworker relates something bad, listen and then add a positive note. Not in a judgmental way, but just as a “by-the-way” statement.

If we take a positive focus instead of being led down the negative path, I wonder if the agency-wide morale will improve. At least the perception of it. Based on the statistics I have seen, it is probably pretty good already. We just cannot see it past the bad news that hides it.

What is your perception of morale? Add to the conversation by leaving a comment below.

Follow this blog and I will let you know when the next post comes out.

Thanks for reading!

Reference

Baumeister, R. F., Bratslavsky, E., Finkenauer, C., & Vohs, K. D. (2001). Bad is stronger than good. Review of General Psychology, 5(4), 323-370. doi:10.1037//1089-2680.5.4.323

December 31, 2016

Values

As I start a new year, I have been thinking a lot about values. This is the time of year when we set goals. New Year’s resolutions, if you will. Most of us will have good intentions, but never see through all of the plans we make.

So what determines whether or not you go through with your goals? How do you push through all of the challenges you will face? What motivates you to keep going?

Values.

Values are the things that set your path. They are the things that are the most important to you. Things you find useful, that have worth. Values keep you moving.

The first of the year is a time for new beginnings. It is a good time to look at your values. To look at the things that make you want to get up in the morning.

Values generally fall into one or more of several categories and sub-categories: circle-of-values

Personal goals (Emotional, Physical, Intellectual)
Financial goals (Budget, Savings)
Family (Marriage, Children, Parents, Other kin)
Relationships (Friends, Community)
Work (Career, Volunteer, Hobbies)
Spiritual (God, Church, Meditation/Prayer)

Some of these have higher priority than others. Sometimes priorities change as things happen to you or around you. You may not even be aware of all the values that shape you and direct your decisions.

But now is a good time to decide if what you do every day aligns with what you feel is important. Are there times when you feel uncomfortable or out of sync? That may be a sign that what you are doing is conflicting with your values.

The thing is, if you are having trouble getting motivated you are probably trying to do something that does not mesh with your values. You are going against the grain, so to speak. Even if it is something you used to enjoy. Remember, as you grow older, you change. That means values change too.

So think about your life right now. Are you happy? Are you doing what you want to do?

Or are you hanging onto something that no longer, or maybe never did, make you feel you are doing something important? Holding on to something just because you think you should is a sure-fire way to make yourself miserable. It might be a good idea to rethink this.

faith-integrity What are your values? How do you figure that out?

Start by making a list of each of the categories listed above. The sub-categories are suggestions. You can add your own.

For each category, write down at least one thing that is important to you. For example, under “Family”, you may write “Spending quality time with my wife/husband and children.” For “Finances” it could be regularly putting money in savings. It does not have to be complicated, but it does have to be what you find useful and worthy of your time.

Does your life reflect the things that are important to you? If not, what can you do this year to change?

Leave a comment below. Follow me and I will let you know when the next blog comes out.

Thanks for reading!

December 13, 2016

Introspection or Rumination? What Does the Cow Do?

You have a patient with respiratory distress, tripod position, BP 220/116, breath sounds diminished, chest pain, diaphoresis, SpO2 88% on room air…classic CHF. You immediately apply CPAP, NTG paste, start an IV, 12-lead, 15-lead. You are on the way to the ED! The patient seems to be improving. You keep monitoring him during transport. His SpO2 is 95% with CPAP. The BP is 200/98. No obvious STEMI on the ECG.

You run through the protocol. Have you missed anything? Is there anything else to look for? Can’t think of anything so you continue what you’re doing until you get to the hospital.

When you transfer the patient to the ED bed, you notice he does not move his left arm. In fact, it is flaccid. He has no history of stroke. You checked. On the scene, he moved all extremities equally because he initially tried to keep you from applying the CPAP. He used both hands at the time. He stood and pivoted from the chair to the stretcher without appearing to stumble.

It must have started during transport. How did you miss it? Great! Now the medical director will want to see you. Just what you need.

So begins the cycle of thinking. What did I do wrong? Did I do anything wrong? Should I have done something different? How did I miss that stroke!?!

Introspection versus Rumination

Two four-syllable words that have deep significance for resilience. One is helpful and the other not so much.

You ruminate when you think about something over and over and over…..

You focus on the bad things. You think about what went wrong. You worry about what someone will say. You worry that you’ll get in trouble. It is rarely productive. You ponder, mull over, cogitate; but never come to any helpful conclusions.

Cows ruminate. Yep. They have four stomachs. When they eat, they chew their food, swallow it, and it enters the first stomach where it begins to be processed. Then the cow regurgitates some of the contents and chews on it again. Yuck! I guess the cow doesn’t mind, though.

Rumination for us is similar. We have a problem. We “swallow” it for a time. Then we bring it back up and chew on it again. Unlike the cow, this is not always a one-time process for us. Our ruminating can get us into a vicious cycle that is hard to break. We end up thinking negative things about ourselves and our abilities and maybe even our worth.

Introspection, on the other hand, gives us the chance to examine the problem so we can find a solution. It sounds similar to rumination, but instead of focusing on the negative parts of the problem, introspection focuses on solutions.

Introspection is productive. Instead of thinking about our self-worth, we work on self-improvement. Rather than focusing on the one thing that went wrong, we remember all the rest that went right.

With introspection we learn. With rumination we make ourselves miserable.

Do you introspect or ruminate?

Leave a comment below. Follow me and I will let you know when the next blog comes out.

Thanks for reading!

December 6, 2016

Change on Your Terms

How do you like change?

If you’re like most people, you’re not crazy about it. Some change is good. Some not so much. It can even be painful if it means you have to lose someone or something you love. There are times when the status quo is preferable.

But, change happens whether we want it to or not. So how do you manage it without it overwhelming you?

So far, we have talked about two dimensions of resilience: determination and endurance (Taormina, 2015). Another part of resilience is adaptability.

Adaptability helps you cope with unexpected or unpleasant situations by keeping you flexible and resourceful. You are able to adjust to the changes you experience. You make purposeful efforts to change the way you think about your environment so that you feel more comfortable with the outcome.

You know what? You may be more adaptable than you realize. Have you ever been married? You had to adjust to having a new person in your life. Have children? That definitely requires adaptability!

The thing is, these are changes that you want…usually. You probably initiated them yourself. You might not even have thought of it as a change that would cause you stress because it was generally a positive experience.

So what do you do when change is forced on you?

Well, if it is change at work you could quit. That would certainly be the easy way out, but it is usually not the best response. After all, if you’re like most people, you need the job. (And you probably like the job, at least before the changes.)

What if it is a change in your family? Someone becomes seriously ill, or has a chronic illness, or has died leaving you extremely sad with an empty place in your heart. That one is especially hard because it is more personal!

Believe it or not, you can adapt to this change too. Really, you say? Keep reading.

Adapting to change requires changing the way you think about it. That is how resilient medics cope without losing their minds. Instead of looking at how the change has inconvenienced you, find the ways it will benefit you. If you cannot find a personal benefit, how will it help in a broader sense: your agency, your family, your finances, etc.

What can you contribute to the overall mission that will make the transition smoother? How can you be a part of the solution?

Use change for your personal growth. Use it to help you become the best medic, and person, you can be. You can be an example for other, less resilient, medics and maybe help them find a different way to look at change too. Your adaptability is another way to help someone else while you are helping yourself.

What changes have you experienced? How did you adapt?

Leave your comment below. We would love to learn from your experience!

Taormina, R. J. (2015). Adult Personal Resilience: A new theory, new measure, and practical implications. Psychological Thought, 8(1), 35-46. doi:10.5964/psyct.v8i1.126

December 1, 2016

Endurance: the Strength You Have Inside

In an earlier post, I talked about the dimensions of resilience: determination, endurance, adaptability, and recuperability (Taormina, 2015). Each of these are important aspects of understanding how you can live with and manage the stress this job causes.

I want to talk about endurance today. Endurance means getting through hard times, unpleasant situations, or difficult problems without giving up. You do this all the time.

What about that bad trauma? It may seem hopeless and it certainly is not pleasant, but you don’t quit in the middle and say “it’s not worth it”. Right? No, you endure. You get the job done and do everything you can do to get that patient to the definitive care he needs.

Then there’s the cardiac arrest. Maybe it is a child or a parent. It reminds you of something personal and you really don’t want to have to think about it. So, you push those thoughts aside and work that code to the best of your ability. You give that patient every opportunity possible. Maybe it works and maybe it doesn’t, but you did your best. That is what matters. That is endurance.

What gets to you is giving in to the negative thoughts that almost always arise. You wonder if there was something else you could have done. You tell yourself you are a black cloud, especially if you are having “one of those days.” Or, maybe, you blame someone else. They didn’t do what they were supposed to do. Usually, though, when you really look at it, you know everything went as well as it could under the circumstances.

You are not what you do. Does that make sense? You are not what happens around you. You are not the cause of all the bad calls you got today or any other day.

What you are is a person who, unfortunately, had a bad run. Nothing you could do about that. You just happened to be the available and closest truck to the call. If you could predict where the next call would be, you could go the other way. But it doesn’t work that way. (Oh, for the crystal ball!)

How can you turn those negative thoughts around? How can you give yourself the benefit of the doubt? It is okay to review the call. That’s how we learn. Just don’t dwell on it. If you did make a mistake, own it and learn from it.

Odds are you did just fine. Odds are you do just fine every day. You endure because you can. You endurance-athlete-runner DO have what it takes.

Give yourself some grace and remember who you are: a person who has dedicated your life to helping other people. That is a very noble and worthy person to be.

What have you needed to endure lately? Leave a comment below! I would love to hear from you.

Taormina, R. J. (2015). Adult Personal Resilience: A new theory, new measure, and practical implications. Psychological Thought, 8(1), 35-46. doi:10.5964/psyct.v8i1.126

November 24, 2016

Determination Wins!

I have been thinking a lot about determination since my last post. Willpower, purpose, intention…grit. So I am wondering…what am I determined about?

I am determined to not give in to the feelings I have about this job. I have truly enjoyed being a paramedic these 25+ years. Yes, there have been ups and downs. There are certainly some things, okay a lot of things, I prefer to not remember. Do you hate the question, “What’s the worst thing you’ve ever seen?” as much as I do? Nowadays, I just refuse to answer, politely but firmly. I do not need to relive those experiences. Once was enough.

Along with the stress of the job, I have had my share of personal issues as well. I still do not know how I managed to work my shift at night while taking care of my Mom during the day for over six years. All with only about three hours of sleep on my work days. (Thank God for slow nights!) How I managed to not kill my patients is beyond me. Not to mention, I was getting my bachelor and master degrees during this time too. Through it all, I was determined to do what I needed to do.

Today, I am determined to finish my Ph.D. I have an idea to do research on what motivates paramedics to do this job. Any ideas? For research purposes, I will have to look at things I can measure like personality traits, dimensions of resilience, coping skills, and such. It is an interesting project with a lot of potential to help medics stay on the job without suffering the debilitating effects of stress. It really doesn’t have to be that way. We just never learned how to handle it before we ran into it.

I am determined to do something to help my peers in EMS and first responders in other agencies. We started this at my agency with a peer support program. It still needs a little work, but it is a start. We need to know more about mental health and the effects of stress on our bodies and minds. We need to be able to recognize when problems start instead of waiting until we are overwhelmed by them.

There is a lot of great work already being done on this front. Code Green Campaign (https://codegreencampaign.org/) is a great effort to help all first responders by raising awareness and providing education. Safe Call Now (https://www.safecallnow.org/) is another excellent resource. They have a 24-hour hotline you can call when in distress: 206-459-3020.

While all of these focus on recognizing stress and providing support, I want to look primarily at not-the-stronger-the-one-who-never-gave-up prevention. I believe focusing on resilience and the things that help us to be strong and bounce back from adversity is a good way to start. I may not have as many supporters for this as I hope, but I am determined to keep trying.

What do you believe is important in keeping our medics and other first responders safe and sane?

Please share your thoughts in the “Leave a comment” below. Happy Thanksgiving!

November 21, 2016

The Ant is Determined

Have you ever thought about what it takes to be resilient? Turns out it’s not a mystery, though sometimes it feels like it is. Personal resilience is made up of four dimensions: determination, endurance, adaptability, and recuperability (Taormina, 2015). If you know how much you have of these, you can do things to improve your odds.

Let’s look at determination. Dictionary.com has 12 definitions for determination. Ready? Actually, you can focus on just a few words that stand out: resolute, setting a purpose, intention. Taormina (2015) said determination is willpower, perseverance, and the decision to succeed. Other synonyms are fortitude and grit.

Does this sound like you? I bet it does. As a matter of fact, you probably have a good degree of determination. Maybe you just haven’t thought of it as something that gives you resilience. Can you think of some things you do, or have done, when you were determined?

So what if you don’t think you are very determined? What can you do to change that? Keep reading.

Let’s look at one of the definitions: setting a purpose. To have the willpower to accomplish something, you have to have something to accomplish, right? So start with making a goal. What do you want to accomplish with your life? Or just with your day? You can start small if you need to.

So, now you have a goal. What do you need to reach that goal? This is where you figure out the steps you need to take. Your “To-Do” list, so to speak.

Look at each item on your list. Do you have the resources you need to check it off? If not, what do you need? How can you get it? Is there something you can substitute that would work?

If it seems simplistic, maybe it is a little. But, one of the things we do with problems is look at the big view of them. When we do that, it can get overwhelming. Do you have any challenges like that?

So look at your challenge. The challenge is the goal, right? Now break the challenge down. Look at the smaller pieces of it. Decide what parts of it are more important or have a higher priority. Make each part of it an item on your “To-Do” list.

Take one item at a time and figure out what you need to manage it or accomplish it. Then get to work! If you just focus on the smaller parts and get them done, you will eventually get everything finished and that challenge will be behind you.

Hey, if you want more information about how to do this, let me know! I’d love to help.

Oh, I almost forgot about the ant. You know, for such tiny critters they sure are determined. Take a look at this short video. Be warned! There’s a worm involved too. After you watch, come back and leave a comment at the bottom of the page. Let me know what you are determined about!

[youtube https://www.youtube.com/watch?v=vK71x7ZjjRQ&w=560&h=315]

Taormina, R. J. (2015). Adult Personal Resilience: A new theory, new measure, and practical implications. Psychological Thought, 8(1), 35-46. doi:10.5964/psyct.v8i1.126

Bad is Stronger than Good

Change the Focus

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Introspection versus Rumination

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