Triage and The Emotional Toll
In a field where members constantly ask themselves, “Could I have done more?”, the very idea of Triage is frightening and often overwhelming whether the individual is making the decision or merely acting on orders from another. It is a recipe for undeserved guilt and depression.
Triage is a method of allocating help to those who stand a reasonable chance of survival when patients outnumber the resources. Sometimes this means, in very cold terms, turning away from (trying) to save a life in order to save one you can. Every EMT and Paramedic is taught how to assess and make decisions on who can be helped and who is facing almost certain death even with heroic life saving attempts. It’s a situation that no one ever really wants to face and many often do.
When “Dave” took his first EMT class he sat there incredulous when after an intense question and answer period he was told, rather bluntly, by his instructor that he “tried to save a dead man (in cardiac arrest) and allowed a teen-age boy to die of hypovolemic shock (talking and lying in a pool of blood)”; in the scenario Dave was on his own and requested help was at least 20-minutes away. Even this fake scenario left Dave with a feeling of guilt for having made the wrong decision. It was also a lesson he learned and relied on the times he did face similar situations in his career.
Major disasters, many multi-vehicle car accidents, large fire scenes and even pandemics often produce a large number of victims. When there aren’t enough providers and resoources to treat everyone hard choices have to be made. Medical care given to people who will die anyway can be considered to be care withdrawn from others who might have survived had they been treated
In this current pandemic many healthcare systems (hospitals) and completely overwhelmed… not enough beds, not enough hands, and not enough respirators. Triage decisions and mandates have been made and handed down to the pre-hospital setting. In addition, protocols and pre-hospital patient care guidelines have changed nationwide. Whereas CPR was always initiated on patients without a pulse, now the recommendation is not to begin especially if there is any possibility that patient has Covid so that the virus will not be aerosolized. In some locations, hospitals are discouraging any transport of a patient who has coded because there aren’t enough beds.
Meanwhile media and grieving family members point fingers in frustration and grief at the EMS responders who, in their minds, did “nothing” to save their loved ones. For the EMT or Paramedic who always second-guesses themselves and is possibly angry at the system that STRONGLY recommended their decisions, this condemnation of their actions creates more guilt and depression.
Even though they SHOULD know better, most pre-hospital providers see themselves as cloaked heroes riding to the rescue… and knowing someone died on your call is a hard pill to swallow. EMS providers are, after all, just vulnerable human beings trying their best. Many resort to unhealthy stress relievers to combat the depression and guilt they feel, and sadly some have even taken their own lives. If you, or one of your colleagues are experiencing depression, emotional issues or are contemplating suicide, there is help. Your agency probably provides assistance, speak up, there is no shame.
If you would rather not speak to your superiors or you don’t feel comfortable with the support you receive, go to mhanational.org/frontline to be screened and find resources and support. If you are experiencing a mental health crisis, call 1-800-273-TALK (8255) to reach a 24-hour crisis center, or text MHA to 741741 to reach a trained Crisis Counselor 24/7.
Taking care of yourself is the best way to take care of your patients.
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