Picture this: The alarms go off and you hop in the passenger seat of the ambulance, your partner is in the driver seat, and you hear the side door of the truck open and you remember you have a new emergency medical technician (EMT) orientee with you today. They are bright eyed and bushy tailed contrasting your dark circles and Red Bull. You whisper to your partner “wow, the newbie looks like they are 12 years old.” You try to think back to your first day working on the ambulance, did you ever look that young? Surely not. After the call they say “wow, that was a real life-or-death situation, I had butterflies in my stomach the whole time. Are all your calls like that?”
That’s the reality many new EMTs face - equal parts excitement and anxiety. Whether they are fresh out of high school or changing careers mid life, new members of emergency medical services (EMS) often feel like they are navigating uncharted waters. But with the right support - from experienced mentors (like yourself) to a strong team culture - that excitement and anxiety can shift to confidence and resilience. Let’s explore how we can help these “baby EMTs” thrive in their new roles.
For many community-based 911 agencies it is not uncommon to have people volunteer before applying for a paid position. It is also not uncommon for many of these volunteers to be very young (think high school seniors) and they are often put with a senior Paramedic/EMT to show them the ropes. Many of these senior Paramedics/EMTs come with their own set of challenges, for example being burnt out or jaded. They have been in the field often longer than their new orientee has been alive and they “have seen it all.” The problem is that the new orientee has not seen it all and may be more severely affected by calls they receive than someone who has been in the field significantly longer.
If you have been a first responder for a while and are wondering how I can best support newer or “baby EMTs,” this tip is for you.
Be A Mentor
Being a mentor to a new EMT is more than just teaching them how to correctly check off the truck, write charts, and drive the truck without hitting anything. Being an effective mentor is about helping them feel confident in their skills, enabling them to autonomously provide effective care to patients, and helping them feel like they fit in at the organization.
Many new members feel like outsiders in the organization where their coworkers have been employed for years if not decades. They may not feel like they know how to relate to other senior members. A good preceptor is not always a good mentor, it is one thing to know how to teach new members the basics of the job, but it is another skill to help these new members feel like they belong, so take the time out of your day to take that new member under your wing.
A powerful mentor will provide regular check-ins with their mentees. Weekly check-ins with mentees can include discussing challenges from the previous week, current stressors, and personal goals. Going to breakfast after a night shift is a great way to have a regular check-in with your mentee. Use your reflexive listening skills (restate their concerns to show understanding) and open-ended questions to foster deeper conversations.
Share knowledge about common stress responses in EMS work for example, hypervigilance, difficulty sleeping, emotional numbing, and increased substance use. Discuss healthy coping skills, such as breathing exercises, journaling, physical activity, and progressive muscle relaxation. Encourage your mentee to turn to healthy coping mechanisms after stressful calls.
Try to remember what it was like when you were a new EMT… it felt kind of scary, right? Validate those feelings of uncertainty and anxiety that they are experiencing. Remind them that it is ok to feel anxious or overwhelmed in their new position. Use affirmations like “It’s ok to feel worried when we are going to a pediatric call,” or “this job can be tough, but I am here to support you,” to help them feel grounded and understood.
In addition to being a mentor to the new member, cultivate that relationship beyond the orientation phase. Really get to know them as a person. Celebrate their successes and recognize their accomplishments.
Debrief following tough calls
People who have been in EMS for an extended period of time are more resilient to the challenges that come with the job, including tough calls. For example, a seasoned paramedic has more experience dealing with the challenging feelings that arise following a traffic accident that results in a fatality. That is not to say they are not affected by it, they just know how it affects them and how that trauma shows up in their lives. They may know that following the call they may need a few moments alone in the bunk room to collect their thoughts, or they may know to put it at the top of their list for things to discuss in therapy this week. Many new members do not know how to deal with the mixed emotions following traumatic calls.
The nature of EMS does not always provide opportune times to debrief following difficult calls and the nature of people in general does not provide a clear blueprint for what a “difficult call” is. Many agencies have protocols in place for calling in the Critical Incident Debrief Team, unfortunately, that resource is often underutilized across EMS agencies. Many traumatic calls do not meet the criteria for calling in the team, but that does not mean you cannot ask your management team to bring them in for a debriefing on a call you deem appropriate. The team members may also be willing to provide individual support as well.
As a senior member of the crew conduct an immediate emotional check in following a difficult call. Encourage your crew to take a few moments to gauge how they are feeling. If you are feeling unsure how to do that, use open-ended questions like, “What’s on your mind right now?” or “How did that call affect you?” Using open-ended questions reduces the chance of them shutting you down as easily as they can if you ask “You ok?”
That being said, if you run a call and you think “wow, that was tough” or if you have a call that goes sideways, check in on your new member because chances are they are feeling some way about it and they might not feel comfortable saying anything to you about it. A good rule of thumb is if a call makes you feel uneasy, if it involves fatalities, abuse, children, or people close to the same age as your new member you should check in on them. It does not have to be at that moment, it can even be a day or so later, just let them know that you are someone they can talk to if they need to.
If the crisis team is unavailable, take some time where the team members can share what went well and what they found challenging. Keep the focus on practical (operational/procedural) improvements and emotional support, like how they were feeling during the call and following it.
In a field where time is of the essence it is good to know how to reground yourself quickly, you never know when your next call will come. A quick grounding exercise is the “5,4,3,2,1 Method.” Take a moment to identify five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. By focusing on your five senses you are able to quickly bring yourself back to the present moment. This is something that can even be done in the midst of a stressful call.
Another pointer, if you run multiple calls in a shift that you deem tough, check in on them. The unfortunate reality of the job is that crews are often going from one call to the next without proper time to debrief following difficult calls. So if you are unable to debrief that day, shoot them a text the next day, or check in with them on your next shift.
Build a culture of support in your workplace
If you are an EMS supervisor, this pointer is for you. Be present on tough calls, provide support and feedback to your crews, and be engaged. Everyone has heard the stories about supervisors who just sit in their offices and do not run calls with the crews. When you are in your office and not on the streets you do not know what your crews are experiencing, which can make it difficult to assess how to best help them after the call.
An additional way to build a culture of support is to reach out to your crews following tough calls. If you know your crew ran two back to back cardiac arrests you should reach out to them. It takes two minutes to send a text message that says, “Hey just checking in after your calls. Do you need anything?” Having a supervisor that cares enough to check in on their crews makes a world of difference to a new EMS provider. Promoting a positive culture of support helps with employee morale more so than fostering the attitude of “This is what EMS is! If you can’t tough it out, get out.” Gone are the days of “suck it up.”
Many new EMS members are unaware of the struggles of the job, they might know that the hours suck and that there may be bad calls, but being transparent about the struggles that EMS providers face can really help to set new members up for success. Be honest with new members about the resources you use to help manage your mental health as a first responder. Share the names of support groups for EMS members, share apps that are targeted at mental health, be honest with new members about the incidences of drug and alcohol abuse amongst EMS members, and be proactive in reducing the stigma of getting support for mental wellbeing.
As a senior provider or a supervisor these new EMTs look up to you. It can be beneficial to them to model self-care. Share your self-care routines with your coworkers. Self-care does not have to be an elaborate “treat yo’ self” kind of thing. It can be as simple as starting your day with gratitude and affirmations, or walking outside around the station between calls. Never underestimate the benefits of sunlight and movement. Encourage your newbie to find a self-care habit they enjoy and check in with them and see how it is going.
Everyone likes to feel appreciated and recognized. Maybe initiate a monthly recognition announcement. Include birthdays for the upcoming month, work anniversaries, successful completions of classes, clinical milestones (successful intubations, babies delivered, or sustained ROSC) and personal milestones as well.
Talk about resilience
Resilience training during onboarding is becoming more popular as the culture of EMS shifts . Resilience training includes discussing anxiety, PTSD, burnout, depression, suicidal ideation, and compassion fatigue. It also explores what could make those signs and symptoms worse, such as lack of sleep, substance abuse, and physical distress. Within resilience training new members can learn to recognize those signs in themselves and other crew members. Some examples of resilience training include: practicing mindfulness, learning stress management techniques, developing positive self-talk, utilizing support networks, and engaging in physical activity.
Make use of EMS Chaplains
For some EMS members there is great value in receiving support from someone outside the chain of command, but who still knows the ins and outs of EMS. Many organizations are utilizing chaplains to provide support to their members following difficult calls. The chaplains sole responsibility is to focus on the personal welfare of the clinicians, unlike shift supervisors who often wear many hats. Many chaplains are a good resource for connecting members to support groups or therapists as well.
Surely you remember what it was like being a “baby EMT,” so let’s work together as senior providers to help ease that transition. First responders are the primary line of defense in an emergency and are the first to step up to render aid, but often are the last ones to help themselves. By bringing awareness to the realities of the stressors of the job and the repercussions of years of systemic strain, first responders can get the help they deserve and feel like they are in a safe space. If you are a first responder and you feel like you need additional support in your mental wellness journey from a trained therapist please reach out to 215-922-5683 x 100 or schedule directly online. For your convenience, we have five in-person offices and can also provide counseling and therapy virtually.
