By: Wendy Lund, BScN, MSc in Mindfulness Studies
“Teaching how to manage a difficult airway saves patient lives, teaching first responders how to manage difficult emotions, saves theirs.”
COVID-19 is the largest health care crisis this world has seen in decades. A global crisis has a way of revealing the strengths and weaknesses of a system. One of the first things we do when training a first responder is place focus on ensuring their safety when arriving on scene. Scene survey and safety protocols are in place to protect, for the most part, our physical safety. PPE saves lives. We know that because we’ve studied, perfected and implemented it with great results.
Preventative education surrounding pandemics is rarely a point of focus in undergraduate programs for any health care professional, including first responders. Given what we’ve learned about pandemics and their capacity to kill millions of people, one has to wonder how we don’t better equip the very people charged with disengaging these types of threats.
The year that SARS arrived in Toronto, I was on sabbatical from my academic role. I had accepted a role as a RN on a busy maternity unit. Later that year, as SARS landed in Toronto, I also accepted a position with the Public Health Agency of Canada and became one of 28 Quarantine Officers across Canada in response to the threat that SARS presented to public health. SARS punctuated the importance of screening and PPE. Because SARS was an epidemic and not a pandemic, we did not experience a shortage of PPE, but it became clear that it was our only way to ensure physical safety in an outbreak. For cities that dealt directly with SARS, we also had a sneak preview into how much of an impact on the economics and day to day experiences an outbreak has. But experience and evidence do not necessarily equate to preparedness and meaningful policy changes, as we now know.
This experience changed not only how I worked as a nurse, but it opened my eyes to the gaps in the science curriculum that I was charged with for our 2 and 4 year paramedicine program. Once back from my sabbatical and after SARS ended, I added pandemics to the pathophysiology course and shared what we knew with students moving forward. Having had the experience and evidence of the impact of outbreaks on health care systems, it felt unethical to not prepare novice first responders with a basic understanding of the etiology and economics of an outbreak and use that as a platform to talk about working safely in an outbreak.
Did you know that, on average, pandemics occur about three times every hundred years? How do we not teach first responders about the mechanics of an outbreak given they are likely to have to work through at least one of them in their lifetime? The curriculum did not require a deep dive into microbiology, but rather an overview of how they manifest themselves.
The pandemic hour of training highlighted points such as:
- The history of pandemics over the past 500 years.
- The impact/loss of life with each.
- What the numbers and letters mean when you hear things like H1N1.
- How vaccines are developed, manufactured and distributed.
- How to recognize outbreaks in the community and how to report clusters.
- That pandemics almost always have several waves.
- That the second wave of a pandemic is typically worse than the first & why.
- The need for exquisite medical asepsis in calls.
- Why PPE is critical for all first responders and front line workers.
Mental wellness crisis and the other PPE shortage
Before COVID-19, we were dealing with another crisis in the first responder community. The crisis of psychological health and safety. Mental dis-ease; in all its forms, is threatening both the quantity and quality of life for thousands of first responders. We are no longer in the dark about the impact working with trauma can have on our psychological health. While death by suicide and PTSD garner the lion’s share of the spotlight (and rightfully so), there exists a plethora of other related disorders that acutely or cumulatively erode the quality/quantity of life in our first responder community. In addition death by suicide and PTSD, evidence proves that engaging trauma and tragedy as a first responder increases one’s risk of:
- Disordered sleep
- Disordered relationships
- Disordered sleeping
- Addiction/substance abuse (alcohol use disorder)
- Shift work disorder
As evidence related to the cost to services for lost hours due to musculoskeletal issues since the early 1980’s, training, procedures and policies have evolved that proactively speak to the risk that this job has on our physical health and safety. From day one, we educate first responders on proper body mechanics while ensuring our physical safety on scene.
But what of the mental safety of the first responder? Mental health IS health. Evidence exists now that shows us that the mind, like our body, is vulnerable to occupational stressors that come with witnessing and engaging with trauma and tragedy. Services were moved to provide better training about musculoskeletal injuries because of the operational costs. It’s time to push the pencil in a business case in the same way for psychological injuries.
And yet, despite the emerging evidence, little has been done to change how we train and sustain the mental health and safety of vulnerable sector workers. As with COVID-19, we have a serious deficit in providing PPE for the mental wellbeing of our first responders.
Stigma | The hidden Curriculum
My proximity and privileged seat as faculty to first responders for more than 22 years provided me with a unique perspective on what we were teaching. And, maybe more importantly, what we were not teaching. As I began to align with teaching the sciences to paramedics, I was impressed by the extensive curriculum and academic rigour this program was delivering! Yet over time, I became increasingly aware of the gaps in the curriculum. We were (like most programs) spending almost no time over the course of two years educating them on the emotional cost of pre-hospital work. An hour or two in semester one that amounted to ‘don’t forget to take care of yourself’ was the extent of our formal curriculum addressing the mental wellbeing of being a first responder.
When I would inquire about ‘when do we teach our students how to deal with picking up dead babies?’ What I often heard in response to that came down to something that looked and sounded like this; ‘they knew what they were signing up for’ or ‘if they can’t handle it, they shouldn’t be here’. For many years, I just accepted that, given I wasn’t a medic, just a nurse.
These weren’t just overt statements I heard from faculty and lab technicians that were in the academic trenches teaching medical pathways, but in behaviors how we treated students who were struggling. Our attrition rate was upwards of 40%. That’s a lot of students who come in just to fail in the process. It was not uncommon to hear faculty justify the high rate of failures in the program as a way of weeding out those who can’t handle the job. Handling the job is code for emotional fortitude. These limiting beliefs are not character flaws of the peers I worked with. These faculty, peers I respect, are also by-products of their own training and culture they’ve been taught. They too have been trained up in the hidden curriculum of stigma.
Culture is often what’s tucked away in the hidden curriculum. It’s in how we treat each other and how we evaluate you consciously or unconsciously about your worthiness to be ‘one of us’. It’s the passing of the torch of long held and often unchallenged beliefs each generation bestows on the next and it begins in base training. Unfortunately, the historical culture of the first responder community has upheld these cognitive biases and beliefs about how to ‘suck it up’ and ‘deal with it’ in a detrimental way for those who suffer mental disease or disorder along their career. Without doubt, it has been a huge barrier for getting first responders to seek the help they need when their mental health has been impacted.
Every program delivers this hidden curriculum. It’s how we teach our young about the culture of being a first responder. It’s not just what you teach someone, but how you teach it that delivers the hidden curriculum. Statements that carry the sentiment of ‘they should have realized what they were getting themselves into’ or ‘you knew what you were signing up for’ plant the seeds [weeds]of stigma related to mental health.
As my interest and concern for the wellbeing of our student population grew, I began to bring the art and science of mindfulness to the student body. Initially, a peer and I offered a three week ‘mini-mindfulness’ course as a way of coping with the practical exams paramedic students have to pass every term. It was so well received that it continued on for six months. Within two years, we had over 75% of the student population coming out weekly to talk about mindfulness, compassion and resiliency in the face of adversity and trauma. It became a formal student association that we called “Mindful Medics”.
A few years later, I would begin a MSc in Mindfulness Studies through the University of Aberdeen in Scotland. It took me four years to complete a full research study investigating the experience of trauma in first responders. After graduating from this program, I retired early after 32 years of teaching the sciences and launched Wellth Management Inc. Wellth Management is about redefining health and helping others to train and sustain a resilient mind. Every first responder should expect and demand base education and training with respect to managing and mitigating the psychological impact that this work creates.
You should be protecting your mental health with a protocol of PPE for the mind in the same way you do for this pandemic.
Reach for Resiliency
I created and trademarked a certificate program called ‘Reach for Resiliency’ or R4R. R4R is a 16 hour course and is based on the three main theories/models that I studied in writing my thesis. It’s an upstream approach to understanding how the mind operates and the evidence-based strategies known to cultivate wellbeing.
Over the coming year, I’ll be sharing here what I’ve learned along the way so that you can begin to understand what PPE for your own mind might look like. So, stay tuned and come to CRACKYL often to find out more of how to cause and create your wellbeing, not simply avoid depression and PTSD. R4R can be therapeutic and transformative, but it should never be used as a replacement for therapy and professional mental health care in crisis. You are welcome to visit our website: www.wellthmanagement.ca
In an effort to help public health and safety workers as COVID-19 appeared, we opened up a free ‘course’ (no homework or tests). You can find 25 hours of free content and conversations with all sorts of first responders, experts and family members where you can learn how they have cultivated their mental health while engaging in trauma and tragedy. There’s no upselling or annoying emails here. Just FREE information that comes from years of experience and study in the art and science of resilience.
Our ability to adequately equip our first responders with the awareness, knowledge and tools to address the fundamental question of ‘how do you work safely (emotionally) as a first responder is crucial. It’s no longer acceptable to simply cross one’s fingers and hope that this call or that this pandemic won’t create a psychological injury that threatens one’s life and livelihood.
Feel free to contact me if you have questions: [email protected] or you can follow her on Instagram: @wellth_management.inc
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